Mammography use among medicare beneficiaries after elimination of cost sharing
Sabatino SA , Thompson TD , Guy GP Jr , de Moor JS , Tangka FK . Med Care 2016 54 (4) 394-9 BACKGROUND: We examined mammography use before and after Medicare eliminated cost sharing for screening mammography in January 2011. METHODS: Using National Health Interview Survey data, we examined changes in mammography use between 2010 and 2013 among Medicare beneficiaries aged 65-74 years. Logistic regression and predictive margins were used to examine changes in use after adjusting for covariates. RESULTS: In 2013, 74.7% of women reported a mammogram within 2 years, a 3.5 percentage point increase (95% confidence interval, -0.3, 7.2) compared with 2010. Increases occurred among women aged 65-69 years, unmarried women, and women with usual sources of care and 2-5 physician visits in the prior year. After adjustment, mammography use increased in 2013 versus 2010 (74.8% vs. 71.3%, P=0.039). Interactions between year and income, insurance, race, or ethnicity were not significant. CONCLUSIONS: There was a modest increase in mammography use from 2010 to 2013 among Medicare beneficiaries aged 65-74 years, possibly consistent with an effect of eliminating Medicare cost sharing during this time. Findings suggest that eliminating cost sharing might increase use of recommended screening services. |
In their own words: A qualitative study of the psychosocial concerns of post-treatment and long-term lung cancer survivors
Rohan EA , Boehm J , Allen KG , Poehlman J . J Psychosoc Oncol 2016 34 (3) 0 While lung cancer is the deadliest type of cancer, survival rates are improving. To address the dearth of literature about the concerns of lung cancer survivors, we conducted 21 in-depth interviews with lung cancer survivors that focused on experiences during diagnosis, treatment, and long-term survivorship. Emergent themes included: feeling blamed for having caused their cancer, being stigmatized as "throwaways," and long-term survivors' experiencing surprise that they're still alive, given poor overall survival rates. Finally, survivors desired increased public support. It is imperative for healthcare and public health professionals to learn more about needs of this population. |
Barriers influencing linkage to hypertension care in Kenya: Qualitative analysis from the LARK Hypertension Study
Naanyu V , Vedanthan R , Kamano JH , Rotich JK , Lagat KK , Kiptoo P , Kofler C , Mutai KK , Bloomfield GS , Menya D , Kimaiyo S , Fuster V , Horowitz CR , Inui TS . J Gen Intern Med 2016 31 (3) 304-14 BACKGROUND: Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE: To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN: Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS: Mabaraza (traditional community assembly) participants (n = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n = 169). APPROACH: We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS: We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS: Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide. |
Changes in knowledge and beliefs about human papillomavirus and cervical cancer screening intervals in low-income women after an educational intervention
Roland KB , Benard VB , Greek A , Hawkins NA , Lin L . J Prim Care Community Health 2016 7 (2) 88-95 INTRODUCTION: Women have been reluctant to adopt longer than annual intervals for cervical cancer screening, despite guidelines recommending screening every 3 to 5 years. Our study assessed patient knowledge and beliefs about human papillomavirus (HPV) and cervical cancer screening after exposure to an educational intervention, and whether there was a change in time regarding knowledge and beliefs among all study participants in an underserved population. METHOD: The study was conducted in 15 clinics associated with 6 Federally Qualified Health Centers in Illinois, USA. Cervical cancer screening patients (n = 644) completed a baseline and postintervention follow-up survey. The intervention included an HPV test and an educational pamphlet. Significance testing of changes in knowledge and beliefs was conducted with multilevel, mixed-effects models adjusting for repeated measures of patients and clustering within clinics. RESULTS: No significant differences in study outcomes were found between the intervention and control groups. Among all women, knowledge of HPV significantly improved over time. At follow-up, fewer women reported that having a co-test is good, wise, will give you peace of mind, will tell you whether you need to worry if Pap is abnormal, is something your doctor thinks you should have, and will give you the best care available. More women said it would be bad, useless, or worrying to wait 3 years for a Pap test at follow-up. CONCLUSION: HPV knowledge improved over time, but the educational intervention utilized in this study was not successful in improving attitudes and beliefs about co-testing and longer screening intervals, and beliefs about HPV co-testing and 3-year screening intervals were less favorable. Having health care providers discuss the consequences of overscreening and the natural history of HPV and cervical cancer with their patients may help increase adherence to longer screening intervals. Further examination of the essential components for educational intervention in this population is warranted. |
The dose-response effect of insulin sensitivity on albuminuria in children according to diabetes type
Mottl AK , Divers J , Dabelea D , Maahs DM , Dolan L , Pettitt D , Marcovina S , Imperatore G , Pihoker C , Mauer M , Mayer-Davis EJ . Pediatr Nephrol 2016 31 (6) 933-40 BACKGROUND: Insulin resistance is associated with microalbuminuria among youth with diabetes mellitus. We sought to determine the dose-response effect of insulin sensitivity (IS) on the magnitude of albuminuria and whether there is a threshold below which urine albumin excretion increases. METHODS: These analyses included participants from the SEARCH for Diabetes in Youth Study with incident diabetes who completed a baseline study visit (n = 2988). We estimated IS using a validated equation incorporating waist circumference, HbA1C, and fasting serum triglycerides. Multivariate regression analyses were performed to assess the effect of IS on urine albumin creatinine ratio (UACR), stratified by diabetes type. The IS threshold was then determined using segmented regressions within each diabetes type and incorporated into the multivariate model. RESULTS: There was an association between IS and UACR in type 2 diabetes only (beta = -0.39; p < 0.001). There was strong statistical evidence for a threshold effect of IS score on UACR in the group of youth with type 2 (beta = 0.40; p < 0.001) but not type 1 diabetes (p = 0.3). CONCLUSIONS: In cross-sectional analyses, there is a negative association between IS and UACR in youth with type 2 but not type 1 diabetes, and this association likely includes a threshold effect of IS on UACR. |
Prevalence of metabolic syndrome in Central America: a cross-sectional population-based study
Wong-McClure RA , Gregg EW , Barcelo A , Lee K , Abarca-Gomez L , Sanabria-Lopez L , Tortos-Guzman J . Rev Panam Salud Publica 2015 38 (3) 202-8 OBJECTIVE: To report the prevalence of metabolic syndrome (MetS) as found by the Central American Diabetes Initiative (CAMDI) study for five major Central American populations: Belize (national); Costa Rica (San Jose); Guatemala (Guatemala City); Honduras (Tegucigalpa); and Nicaragua (Managua). METHODS: Study data on 6 185 adults aged 20 years or older with anthropometric and laboratory determination of MetS from population-based surveys were analyzed. Overall, the survey response rate was 82.0%. MetS prevalence was determined according to criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. The study's protocol was reviewed and approved by the bioethical committee of each country studied. RESULTS: The overall standardized prevalence of MetS in the Central American region was 30.3% (95% confidence interval (CI): 27.1-33.4). There was wide variability by gender and work conditions, with higher prevalence among females and unpaid workers. The standardized percentage of the population free of any component of MetS was lowest in Costa Rica (9.0%; CI: 6.5-11.4) and highest in Honduras (21.1%; CI: 16.4-25.9). CONCLUSIONS: Overall prevalence of MetS in Central America is high. Strengthening surveillance of chronic diseases and establishing effective programs for preventing cardiovascular diseases might reduce the risk of MetS in Central America. |
Verifying treatment of reported cases of gonorrhea
Bowen VB , Torrone EA , Peterman TA . Sex Transm Dis 2016 43 (2) 130-3 BACKGROUND: Verifying correct treatment of reported cases of gonorrhea may slow antibiotic resistance, but verification remains challenging for many sexually transmitted disease (STD) programs due to increased laboratory case reporting and decreased provider reporting. The objectives of this study were to document current reported levels of correct treatment of gonorrhea and to identify approaches and barriers to verifying treatment. METHODS: We reviewed funding opportunity reports for the Centers for Disease Control and Prevention's directly funded STD programs and conducted key-informant interviews to elicit further treatment verification details. RESULTS: Among STD programs containing at least one high-morbidity area, a median of 63.0% of gonorrhea cases were reported as treated correctly with a Centers for Disease Control and Prevention-recommended regimen, although the range reported was wide (11.2%-95.2%). Among cases with some type of documented treatment information, the proportion treated correctly was higher (median, 82.2%) but the use of correct treatment was quite variable among STD programs (range, 56.4%-98.5%). Approaches to verifying gonorrhea treatment included modifying outdated surveillance systems and educating providers about case reporting to enhance the passive capture of treatment information as well as active approaches that supported routine and immediate communication with providers regarding cases missing treatment information. Barriers to treatment verification included low levels of provider reporting, outdated surveillance systems, and human and financial resource constraints. CONCLUSIONS: Baseline assessments revealed that levels of correct gonorrhea treatment vary widely, even after accounting for those cases missing treatment information. Baseline data can help determine whether the active verification of treatment of all cases is warranted. |
Young sexual minority males in the United States: sociodemographic characteristics and sexual attraction, identity and behavior
Fasula AM , Oraka E , Jeffries WLth , Carry M , Banez Ocfemia MC , Balaji AB , Rose CE , Jayne PE . Perspect Sex Reprod Health 2016 48 (1) 3-8 CONTEXT: HIV incidence is increasing among 13-24-year-old U.S. men who have sex with men, yet limited research is available to guide HIV prevention efforts for this population. METHODS: National Survey of Family Growth data collected in 2002, in 2006-2010 and in 2011-2013 from 8,068 males aged 15-24 were analyzed to describe the population of U.S. young sexual minority males (i.e., males reporting same-sex attraction, identity or behavior). Correlates of sexual minority classification were assessed in logistic regression models. RESULTS: An estimated 10% of young males, representing a population of 2.1 million, were sexual minorities. Males had an elevated likelihood of being sexual minorities if they were aged 18-19 or 20-24, rather than 15-17 (prevalence ratio, 1.7 for each); belonged to nonblack, non-Hispanic racial or ethnic minority groups (1.6); had no religious affiliation, rather than considering religion very important (1.9); or lived below the federal poverty level (1.3). They had a reduced likelihood of being sexual minorities if they lived in metropolitan areas outside of central cities (0.7). Among young sexual minority males, 44% were 15-19 years old, 29% were poor and 59% resided outside central cities. Forty-seven percent had engaged in same-sex behavior. Of those with data on all measured dimensions of sexuality, 24% reported same-sex attraction, identity and behavior; 22% considered themselves heterosexual, yet had had a male sex partner. CONCLUSION: Future investigations can further explore subpopulations of young sexual minority males and assess sexual trajectories, resilience and HIV risk. |
The modern quest for the "Holy Grail" of pneumonia etiology
Jain S , Pavia AT . Clin Infect Dis 2016 62 (7) 826-8 Defining the etiology of pneumonia is a messy business. Blood cultures are considered the “gold standard” for bacterial pneumonia but have low sensitivity, yielding a causative organism in only 5%–14% of adults with pneumonia, and even fewer in children [1, 2]. Urine antigen assays for Streptococcus pneumoniae and Legionella pneumophila have good specificity and improved sensitivity compared with culture but sensitivity is still only 70%–80%, and these assays cannot distinguish between colonization and infection in children [1-3]. Molecular assays for viruses and atypical bacteria represent important diagnostic advances. However, molecular detection of viruses that cause pneumonia from upper respiratory tract specimens may be due to milder infection confined to the upper airway or may represent remnants of past infections [4]. Potentially pathogenic bacteria can be part of the normal microbiome, and thus organisms detected in the nasopharynx may not represent the true etiology of infection in the lower respiratory tract. Furthermore, specimens from the site of infection in the lower respiratory tract are usually not available. When deep specimens are obtained, they are often contaminated with bacteria from the upper respiratory tract [3, 5]. Thus, sputum specimens are more likely to yield potential pathogens but have low specificity, making it hard to correlate detection with causation [3, 5]. Moreover, even the clinical diagnosis of pneumonia is fraught with difficulty. Radiographs are not always obtained. When radiographs are taken, variability between clinicians’ readings is common in the determination of pneumonia [6]. For decades, the high proportion of pneumonia due to S. pneumoniae and Haemophilus influenzae, coupled with a false sense of security about the risks of antibiotic overuse, has led to recommendations for empiric antibiotic therapy for virtually all patients with presumed pneumonia [1]. However, the changing epidemiology due to the impact of pneumococcal and H. influenzae type B vaccines in the United States and globally, combined with the growing threat of antimicrobial resistance, make it critical to understand pneumonia etiology in individual patients and populations [7, 8]. |
Norovirus in 2016 - emesis aplenty but clear signs of progress
Head MG , Lopman BA . J Infect Dis 2016 213 Suppl 1 S1-2 The key theme emerging from the articles in this supplement is that burden of norovirus in the United Kingdom and elsewhere is substantial and that new tools for prevention, diagnosis, and treatment are required. Basic understanding of norovirus biology continues to accelerate, but parallel increases in capacity and research funding are going to be needed to translate this knowledge into clinical trials and translational research that can result in public health gains. |
Guiding and supporting adolescents living with HIV in sub-Saharan Africa: The development of a curriculum for family and community members
Winskell K , Miller KS , Allen KA , Obong'o CO . Child Youth Serv Rev 2016 61 253-260 Although HIV-related deaths declined globally by 30% between 2005 and 2012, those among adolescents living with HIV (ALHIV) rose by 50%. This discrepancy is primarily due to failure to address the specific needs of ALHIV and resulting poor clinical outcomes related to late diagnosis and poor adherence to antiretroviral therapy. The Families Matter! Program (FMP) is an evidence-based intervention for parents and caregivers of 9-12. year-olds that promotes positive parenting practices and effective parent-child communication about sexuality and sexual risk reduction. It is delivered to groups of participants at the community level through a series of six weekly three-hour sessions. Recognizing family and community members' need for guidance on issues specific to ALHIV, we developed a seventh FMP session to address their needs. Key themes treated in the curriculum for this session include: stigma and mental health, disclosure, ART adherence and self-care, and responsible sexual relationships. In developing the curriculum, we drew on narratives about growing up with HIV contributed by young Africans to a 2013 scriptwriting competition. We describe the data-driven process of developing this curriculum with a view to informing the development of much-needed interventions to serve this vulnerable population. |
Health department HIV prevention programs that support the national HIV/AIDS strategy: the enhanced comprehensive HIV prevention planning project, 2010–2013
Fisher HH , Hoyte T , Purcell DW , van Handel M , Williams W , Krueger A , Dietz P , Stratford D , Heitgerd J , Dunbar E , Wan C , Linley LA , Flores SA . Public Health Rep 2016 131 (1) 185-194 OBJECTIVE: The Enhanced Comprehensive HIV Prevention Planning project was the first initiative of the Centers for Disease Control and Prevention (CDC) to address the goals of the National HIV/AIDS Strategy (NHAS). Health departments in 12 U.S. cities with a high prevalence of AIDS conducted comprehensive program planning and implemented cost-effective, scalable HIV prevention interventions that targeted high-risk populations. We examined trends in health department HIV prevention programs in these cities during the project. METHODS: We analyzed the number of people who received partner services, condoms distributed, and people tested for HIV, as well as funding allocations for selected HIV prevention programs by year and by site from October 2010 through September 2013. We assessed trends in the proportional change in services and allocations during the project period using generalized estimating equations. We also conducted thematic coding of program activities that targeted people living with HIV infection (PLWH). RESULTS: We found significant increases in funding allocations for HIV testing and condom distribution. All HIV partner services indicators, condom distribution, and HIV testing of African American and Hispanic/Latino populations significantly increased. HIV tests associated with a new diagnosis increased significantly among those self-identifying as Hispanic/Latino but significantly decreased among African Americans. For programs targeting PLWH, health department activities included implementing new program models, improving local data use, and building local capacity to enhance linkage to HIV medical care, retention in care, and treatment adherence. CONCLUSIONS: Overall, these findings indicate that health departments in areas with a high burden of AIDS successfully shifted their HIV prevention resources to scale up important HIV programs and make progress toward NHAS goals. © 2016 Association of Schools and Programs of Public Health. |
Assessing efficacy of a retention in care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use
Gardner Lytt I , Marks Gary , Shahani L , Giordano TP , Wilson TE , Drainoni ML , Keruly JC , Batey DS , Metsch LR . AIDS 2016 30 (7) 1111-9 OBJECTIVE: We evaluated whether heavy alcohol use, illicit drug use or high levels of anxiety and depression symptoms were modifiers of the Retention through Enhanced Personal Contact ('REPC') intervention. The intervention had previously demonstrated overall efficacy in the parent study. DESIGN: Randomized trial. METHODS: A total of 1,838 patients from 6 U.S. HIV clinics were enrolled into a randomized trial in which intervention patients received an "enhanced contact" protocol for 12 months. All participants completed an ACASI interview that measured depression and anxiety symptoms from the Brief Symptom Inventory, alcohol use from the AUDIT-C instrument, and drug use from the WHO (ASSIST) questions. The 12-month binary outcome was completing an HIV primary care visit in three consecutive 4-month intervals. The outcome was compared between intervention and standard of care patients within subgroups on the effect modifier variables using log-binomial regression models. RESULTS: Persons with high levels of anxiety or depression symptoms and those reporting illicit drug use, or heavy alcohol consumption had no response to the intervention. Patients without these "higher-risk" characteristics responded significantly to the intervention. Further analysis revealed higher-risk patients were less likely to have successfully received the telephone contact component of the intervention. Among higher-risk patients who did successfully receive this component, the intervention effect was significant. CONCLUSIONS: Our findings suggest that clinic-based retention in care interventions are able to have significant effects on HIV patients with common behavioral health issues, but the design of those interventions should assure successful delivery of intervention components to increase effectiveness. |
Association between staff experience and effective tuberculosis contact tracing in North Carolina, 2008-2009
Bryant KE , Allen MG , Fortenberry ER , Luffman J , Zeringue E , Stout JE . N C Med J 2016 77 (1) 37-44 BACKGROUND: Effective investigation of tuberculosis (TB) contacts is essential for continued progress toward TB elimination. As the incidence of TB declines, staff experience will also decline. Little is known about the association between the experience level of public health TB staff and the quality of contact investigations. METHODS: Contact investigations involving fewer than 30 contacts during the period 2008-2009 were included in this analysis. Multivariable models were used to examine associations between staff TB experience (assessed by a standardized survey) and measures of contact investigation quality: time from case identification to contact identification and number of contacts identified per case investigated. RESULTS: A total of 501 cases and 3,230 contacts met the inclusion criteria. Data were stratified by the number of cases in the county and whether the case was smear-positive or smear-negative. For contacts of smear-positive cases, greater staff experience was associated with more rapid contact identification both in counties with high case counts (hazard ratio [HR] = 2.43; 95% CI, 1.79-3.31) and in counties with low case counts (HR = 1.142; 95% CI, 0.95-1.37). However, for smear-negative cases, staff in counties with low case counts identified contacts more slowly as years of experience increased (HR = 0.82; 95% CI, 0.62-1.07). For contacts of smear-negative cases, more contacts (relative risk [RR] = 1.20; 95% CI, 1.07-1.35) were identified per case in high case-count counties (more than 20 cases during 2008-2009). Conversely, in low case-count counties, fewer contacts were identified per case (RR = 0.94; 95% CI, 0.82-1.08); however, this finding was not significant. DISCUSSION: Speed of identification and number of contacts are imperfect surrogates for the most important outcome of contact investigations-that is, the rapid identification and treatment of infected contacts. CONCLUSION: More TB experience was associated with more rapid and thorough TB contact investigations. Retaining experienced staff and mentoring staff new to case management should be high priorities for TB control programs. |
Bloodstream infection caused by mucor velutinosus
Racsa LD , Willis B , Lockhart SR , Kraft CS . Infect Dis Clin Pract (Baltim Md) 2016 24 (1) e3-e4 A 74-year-old man with diffuse large B-cell lymphoma was admitted to our institution for chemotherapy treatment. He developed a neutropenic fever, and blood cultures were drawn. After 48 hours from the time of draw, 2 of 2 blood culture bottles flagged positive. Thin, septate hyphae were seen on Gram stain of both blood culture bottles. In 1 day, gray fluffy mold began growing on chocolate agar plates from both of the positive bottles. A tease prep revealed a Mucorales sporangiophore. The specimen was sent out for further identification, and sequencing identified the mold as Mucor velutinosus. |
Diagnosis and treatment of Clostridium difficile infection
Gerding DN , File TM Jr , McDonald LC . Infect Dis Clin Pract (Baltim Md) 2016 24 (1) 3-10 Early and accurate diagnosis is essential for optimal treatment of individuals with Clostridium difficile infection (CDI) and for implementation of effective infection control procedures. The decision about which diagnostic test to use is an important one that should be based on test sensitivity, specificity, and predictive value. The challenges of CDI go beyond rapid identification and management of symptomatic patients. Asymptomatic carriage has long been suspected in C. Difficile transmission, but it may play a larger role than previously thought. Emerging information also shows that patients treated for CDI remain colonized for many weeks after symptom resolution. In fact, stool culture positivity increases during the first weeks after treatment completion. Treatments that reduce the duration and degree of asymptomatic shedding could have added benefit for reduced transmission. © 2015 Wolters Kluwer Health, Inc. All rights reserved. |
Knowledge, attitudes, and experiences of HIV pre-exposure prophylaxis (PrEP) trial participants in Botswana
Toledo L , McLellan-Lemal E , Henderson FL , Kebaabetswe PM . World J AIDS 2015 5 (2) 10-20 Recent clinical trials have shown that a daily dose of oral TDF/FTC pre-exposure prophylaxis (PrEP) is effective in reducing human immunodeficiency (HIV) risk. Understanding trial participants' perspectives about retention and PrEP adherence is critical to inform future PrEP trials and the scale-up and implementation of PrEP programs. We analyzed 53 in-depth interviews conducted in April 2010 with participants in the TDF2 study, a Phase 3, randomized, double-blind, placebo-controlled clinical trial of daily oral TDF/FTC with heterosexual men and women in Francistown and Gaborone, Botswana. We examined participants' knowledge, attitudes, and experiences of the trial, identified facilitators and barriers to enrollment and retention, and compared participant responses by study site, sex, and study drug adherence. Our findings point to several factors to consider for participant retention and adherence in PrEP trials and programs, including conducting pre-enrollment education and myth reduction counseling, providing accurate estimates of participant obligations and side effect symptoms, ensuring participant understanding of the effects of non-adherence, gauging personal commitment and interest in study outcomes, and developing a strong external social support network for participants. |
NIH support of Centers for AIDS Research and Department of Health Collaborative Public Health Research: advancing CDC's Enhanced Comprehensive HIV Prevention Planning project
Greenberg AE , Purcell DW , Gordon CM , Flores S , Grossman C , Fisher HH , Barasky RJ . J Acquir Immune Defic Syndr 2013 64 Suppl 1 S1-6 The contributions reported in this supplemental issue highlight the relevance of NIH-funded CEWG research to health department-supported HIV prevention and care activities in the 9 US cities with the highest numbers of AIDS cases. The project findings have the potential to enhance ongoing HIV treatment and care services and to advance the wider scientific agenda. The HIV testing to care continuum, while providing a framework to help track progress on national goals, also can reflect the heterogeneities of local epidemics. The collaborative research that is highlighted in this issue not only reflects a locally driven research agenda but also demonstrates research methods, data collection tools, and collaborative processes that could be encouraged across jurisdictions. Projects such as these, capitalizing on the integrated efforts of NIH, CDC, DOH, and academic institutions, have the potential to contribute to improvements in the HIV care continuum in these communities, bringing us closer to realizing the HIV prevention and treatment goals of the NHAS. |
Panola Mountain Ehrlichia in Amblyomma maculatum from the United States and Amblyomma variegatum (Acari: Ixodidae) from the Caribbean and Africa
Loftis AD , Kelly PJ , Paddock CD , Blount K , Johnson JW , Gleim ER , Yabsley MJ , Levin ML , Beati L . J Med Entomol 2016 53 (3) 696-698 Panola Mountain Ehrlichia (PME) has been suggested as an emerging pathogen of humans and dogs. Domestic goats and white-tailed deer (Odocoileus virginianus) are also susceptible and likely serve as reservoirs. Experimentally, both the lone star tick (Amblyomma americanum (L.)) and the Gulf Coast tick (Amblyomma maculatum Koch) can transmit PME among deer and goats. In the current study, we detected PME in adult wild-caught A. maculatum from the United States and Amblyomma variegatum (F.) from the Caribbean and Africa. This significantly expands the range, potential tick vectors, and risk for exposure to PME. |
Accuracy of coverage survey recall following an integrated mass drug administration for Lymphatic Filariasis, Schistosomiasis, and soil-transmitted Helminthiasis
Budge PJ , Sognikin E , Akosa A , Mathieu EM , Deming M . PLoS Negl Trop Dis 2016 10 (1) e0004358 BACKGROUND: Achieving target coverage levels for mass drug administration (MDA) is essential to elimination and control efforts for several neglected tropical diseases (NTD). To ensure program goals are met, coverage reported by drug distributors may be validated through household coverage surveys that rely on respondent recall. This is the first study to assess accuracy in such surveys. METHODOLOGY/PRINCIPAL FINDINGS: Recall accuracy was tested in a series of coverage surveys conducted at 1, 6, and 12 months after an integrated MDA in Togo during which three drugs (albendazole, ivermectin, and praziquantel) were distributed. Drug distribution was observed during the MDA to ensure accurate recording of persons treated during the MDA. Information was obtained for 506, 1131, and 947 persons surveyed at 1, 6, and 12 months, respectively. Coverage (defined as the percentage of persons taking at least one of the MDA medications) within these groups was respectively 88.3%, 87.4%, and 80.0%, according to the treatment registers; it was 87.9%, 91.4% and 89.4%, according to survey responses. Concordance between respondents and registers on swallowing at least one pill was >95% at 1 month and >86% at 12 months; the lower concordance at 12 months was more likely due to difficulty matching survey respondents with the year-old treatment register rather than inaccurate responses. Respondents generally distinguished between pills similar in appearance; concordance for recall of which pills were taken was over 80% in each survey. SIGNIFICANCE: In this population, coverage surveys provided remarkably consistent coverage estimates for up to one year following an integrated MDA. It is not clear if similar consistency will be seen in other settings, however, these data suggest that in some settings coverage surveys might be conducted as much as one year following an MDA without compromising results. This might enable integration of post-MDA coverage measurement into large, multipurpose, periodic surveys, thereby conserving resources. |
Seasonal fluctuations of small mammal and flea communities in a Ugandan plague focus: evidence to implicate Arvicanthis niloticus and Crocidura spp. as key hosts in Yersinia pestis transmission
Moore SM , Monaghan A , Borchert JN , Mpanga JT , Atiku LA , Boegler KA , Montenieri J , MacMillan K , Gage KL , Eisen RJ . Parasit Vectors 2015 8 11 BACKGROUND: The distribution of human plague risk is strongly associated with rainfall in the tropical plague foci of East Africa, but little is known about how the plague bacterium is maintained during periods between outbreaks or whether environmental drivers trigger these outbreaks. We collected small mammals and fleas over a two year period in the West Nile region of Uganda to examine how the ecological community varies seasonally in a region with areas of both high and low risk of human plague cases. METHODS: Seasonal changes in the small mammal and flea communities were examined along an elevation gradient to determine whether small mammal and flea populations exhibit differences in their response to seasonal fluctuations in precipitation, temperature, and crop harvests in areas within (above 1300 m) and outside (below 1300 m) of a model-defined plague focus. RESULTS: The abundance of two potential enzootic host species (Arvicanthis niloticus and Crocidura spp.) increased during the plague season within the plague focus, but did not show the same increase at lower elevations outside this focus. In contrast, the abundance of the domestic rat population (Rattus rattus) did not show significant seasonal fluctuations regardless of locality. Arvicanthis niloticus abundance was negatively associated with monthly precipitation at a six month lag and positively associated with current monthly temperatures, and Crocidura spp. abundance was positively associated with precipitation at a three month lag and negatively associated with current monthly temperatures. The abundance of A. niloticus and Crocidura spp. were both positively correlated with the harvest of millet and maize. CONCLUSIONS: The association between the abundance of several small mammal species and rainfall is consistent with previous models of the timing of human plague cases in relation to precipitation in the West Nile region. The seasonal increase in the abundance of key potential host species within the plague focus, but not outside of this area, suggests that changes in small mammal abundance may create favorable conditions for epizootic transmission of Y. pestis which ultimately may increase risk of human cases in this region. |
Prenatal perfluoroalkyl substance exposure and child adiposity at 8 years of age: The HOME study
Braun JM , Chen A , Romano ME , Calafat AM , Webster GM , Yolton K , Lanphear BP . Obesity (Silver Spring) 2016 24 (1) 231-7 OBJECTIVE: To examine relationships between prenatal perfluoroalkyl substance (PFAS) exposure and adiposity in children born to women who lived downstream from a fluoropolymer manufacturing plant. METHODS: Data are from a prospective cohort in Cincinnati, Ohio (HOME Study). Perfluorooctanoic (PFOA), perfluorooctane sulfonic (PFOS), perfluorononanoic (PFNA), and perfluorohexane sulfonic (PFHxS) acids were measured in prenatal serum samples. Differences were measured in body mass index z-scores (BMI), waist circumference, and body fat at 8 years of age (n = 204) and BMI between 2-8 years of age (n = 285) according to PFAS concentrations. RESULTS: Children born to women in the top two PFOA terciles had greater adiposity at 8 years than children in the 1st tercile. For example, waist circumference (cm) was higher among children in the 2nd (4.3; 95% CI: 1.7, 6.9) and 3rd tercile (2.2; 95% CI: -0.5, 4.9) compared to children in the 1st tercile. Children in the top two PFOA terciles also had greater BMI gains from 2 to 8 years compared to children in the 1st tercile (P < 0.05). PFOS, PFNA, and PFHxS were not associated with adiposity. CONCLUSIONS: In this cohort, higher prenatal serum PFOA concentrations were associated with greater adiposity at 8 years and a more rapid increase in BMI between 2-8 years. |
Prenatal phthalate exposures and body mass index among 4 to 7 year old children: a pooled analysis
Buckley JP , Engel SM , Braun JM , Whyatt RM , Daniels JL , Mendez MA , Richardson DB , Xu Y , Calafat AM , Wolff MS , Lanphear BP , Herring AH , Rundle AG . Epidemiology 2016 27 (3) 449-58 BACKGROUND: Phthalates are hypothesized to cause obesity, but few studies have assessed whether prenatal phthalate exposures are related to childhood body mass index (BMI). METHODS: We included 707 children from three prospective cohort studies enrolled in the United States between 1998 and 2006 who had maternal urinary phthalate metabolite concentrations measured during pregnancy, and measures of weight and height at ages 4 to 7 years. We calculated age- and sex-standardized BMI z-scores and classified children with BMI percentiles ≥85 as overweight/obese. We used mixed effects regression models to estimate associations between a 1-standard deviation increase in natural log phthalate metabolite concentrations and BMI zscores and overweight/obesity. We estimated associations in multiple metabolite models adjusted for confounders, and evaluated heterogeneity of associations by child's sex, race/ethnicity, and cohort RESULTS: Mono-3-carboxypropyl phthalate (MCPP) concentrations were positively associated with overweight/obese status in children (odds ratio [95% credible interval] = 2.1 [1.2, 4.0]) but not with BMI z-scores (beta = -0.02 [-0.15, 0.11]). We did not observe evidence of obesogenic effects for other metabolites. However, monoethyl phthalate (MEP) and summed di-(2-ethylhexyl) phthalate metabolites ( summation operatorDEHP) concentrations were inversely associated with BMI z-scores among girls (MEP beta = -0.14 [-0.28, 0.00]; summation operatorDEHP beta = -0.12 [-0.27, 0.02]). CONCLUSIONS: Maternal urinary MCPP, a non-specific metabolite of several phthalates, was positively associated with childhood overweight/obesity. Metabolites of diethyl phthalate and DEHP were associated with lower BMI in girls but not boys, suggesting prenatal exposures may have sexually dimorphic effects on physical development. |
Giardiasis outbreaks in the United States, 1971-2011
Adam EA , Yoder JS , Gould LH , Hlavsa MC , Gargano JW . Epidemiol Infect 2016 144 (13) 1-12 Giardia intestinalis is the leading parasitic aetiology of human enteric infections in the United States, with an estimated 1.2 million cases occurring annually. To better understand transmission, we analysed data on all giardiasis outbreaks reported to the Centers for Disease Control and Prevention for 1971-2011. The 242 outbreaks, affecting ~41 000 persons, resulted from waterborne (74.8%), foodborne (15.7%), person-to-person (2.5%), and animal contact (1.2%) transmission. Most (74.6%) waterborne outbreaks were associated with drinking water, followed by recreational water (18.2%). Problems with water treatment, untreated groundwater, and distribution systems were identified most often during drinking water-associated outbreak investigations; problems with water treatment declined after the 1980s. Most recreational water-associated outbreaks were linked to treated swimming venues, with pools and wading pools implicated most often. Produce was implicated most often in foodborne outbreaks. Additionally, foods were most commonly prepared in a restaurant and contaminated by a food handler. Lessons learned from examining patterns in outbreaks over time can help prevent future disease. Groundwater and distribution system vulnerabilities, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene are promising targets for giardiasis prevention measures. |
Acute gastroenteritis on cruise ships - United States, 2008-2014
Freeland AL , Vaughan GH Jr , Banerjee SN . MMWR Morb Mortal Wkly Rep 2016 65 (1) 1-5 From 1990 to 2004, the reported rates of diarrheal disease (three or more loose stools or a greater than normal frequency in a 24-hour period) on cruise ships decreased 2.4%, from 29.2 cases per 100,000 travel days to 28.5 cases (1,2). Increased rates of acute gastroenteritis illness (diarrhea or vomiting that is associated with loose stools, bloody stools, abdominal cramps, headache, muscle aches, or fever) occurred in years that novel strains of norovirus, the most common etiologic agent in cruise ship outbreaks, emerged (3). To determine recent rates of acute gastroenteritis on cruise ships, CDC analyzed combined data for the period 2008-2014 that were submitted by cruise ships sailing in U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers and within 15 days of arriving in the United States) (4). CDC also reviewed laboratory data to ascertain the causes of acute gastroenteritis outbreaks and examined trends over time. During the study period, the rates of acute gastroenteritis per 100,000 travel days decreased among passengers from 27.2 cases in 2008 to 22.3 in 2014. Rates for crew members remained essentially unchanged (21.3 cases in 2008 and 21.6 in 2014). However, the rate of acute gastroenteritis was significantly higher in 2012 than in 2011 or 2013 for both passengers and crew members, likely related to the emergence of a novel strain of norovirus, GII.4 Sydney (5). During 2008-2014, a total of 133 cruise ship acute gastroenteritis outbreaks were reported, 95 (71%) of which had specimens available for testing. Among these, 92 (97%) were caused by norovirus, and among 80 norovirus specimens for which a genotype was identified, 59 (73.8%) were GII.4 strains. Cruise ship travelers experiencing diarrhea or vomiting should report to the ship medical center promptly so that symptoms can be assessed, proper treatment provided, and control measures implemented. |
Concentrations of phthalates and DINCH metabolites in pooled urine from Queensland, Australia
Gomez Ramos MJ , Heffernan AL , Toms LM , Calafat AM , Ye X , Hobson P , Broomhall S , Mueller JF . Environ Int 2016 88 179-186 Dialkyl phthalate esters (phthalates) are ubiquitous chemicals used extensively as plasticizers, solvents and adhesives in a range of industrial and consumer products. 1,2-Cyclohexane dicarboxylic acid, diisononyl ester (DINCH) is a phthalate alternative introduced due to a more favourable toxicological profile, but exposure is largely uncharacterised. The aim of this study was to provide the first assessment of exposure to phthalates and DINCH in the general Australian population. De-identified urine specimens stratified by age and sex were obtained from a community-based pathology laboratory and pooled (n=24 pools of 100). Concentrations of free and total species were measured using online solid phase extraction isotope dilution high performance liquid chromatography tandem mass spectrometry. Concentrations ranged from 2.4 to 71.9ng/mL for metabolites of di(2-ethylhexyl)phthalate, and from <0.5 to 775ng/mL for all other metabolites. Our data suggest that phthalate metabolites concentrations in Australia were at least two times higher than in the United States and Germany; and may be related to legislative differences among countries. DINCH metabolite concentrations were comparatively low and consistent with the limited data available. Ongoing biomonitoring among the general Australian population may help assess temporal trends in exposure and assess the effectiveness of actions aimed at reducing exposures. |
Hepatitis a infections among food handlers in the United States, 1993–2011
Sharapov UM , Kentenyants K , Groeger J , Roberts H , Holmberg SD , Collier MG . Public Health Rep 2016 131 (1) 26-29 We reviewed news reports of hepatitis A virus (HAV)-infected food handlers in the United States from 1993 to 2011 using the LexisNexis® search engine. Using U.S. news reports, we identified 192 HAV-infected food handlers who worked while infectious; of these HAV-infected individuals, 34 (18%) transmitted HAV to restaurant patrons. News reports of HAV-infected food handlers declined from 1993 to 2011. This analysis suggests that universal childhood vaccination contributed to the decrease in reports of HAV-infected food handlers, but mandatory vaccination of this group is unlikely to be cost-effective. |
Human Heat shock protein 40 (Hsp40/DnaJB1) promotes influenza A virus replication by assisting nuclear import of viral ribonucleoproteins.
Batra J , Tripathi S , Kumar A , Katz JM , Cox NJ , Lal RB , Sambhara S , Lal SK . Sci Rep 2016 6 19063 A unique feature of influenza A virus (IAV) life cycle is replication of the viral genome in the host cell nucleus. The nuclear import of IAV genome is an indispensable step in establishing virus infection. IAV nucleoprotein (NP) is known to mediate the nuclear import of viral genome via its nuclear localization signals. Here, we demonstrate that cellular heat shock protein 40 (Hsp40/DnaJB1) facilitates the nuclear import of incoming IAV viral ribonucleoproteins (vRNPs) and is important for efficient IAV replication. Hsp40 was found to interact with NP component of IAV RNPs during early stages of infection. This interaction is mediated by the J domain of Hsp40 and N-terminal region of NP. Drug or RNAi mediated inhibition of Hsp40 resulted in reduced nuclear import of IAV RNPs, diminished viral polymerase function and attenuates overall viral replication. Hsp40 was also found to be required for efficient association between NP and importin alpha, which is crucial for IAV RNP nuclear translocation. These studies demonstrate an important role for cellular chaperone Hsp40/DnaJB1 in influenza A virus life cycle by assisting nuclear trafficking of viral ribonucleoproteins. |
Phenotypic, genotypic, and antimicrobial characteristics of Streptococcus halichoeri isolated from humans and proposal to rename Streptococcus halichoeri as Streptococcus halichoeri subsp. halichoeri and description of Streptococcus halichoeri subsp. hominis subsp. nov., a bacterium associated with human clinical infections.
Shewmaker PL , Whitney AM , Humrighouse BW . J Clin Microbiol 2016 54 (3) 739-44 Phenotypic, genotypic and antimicrobial characteristics of six phenotypically distinct human clinical isolates that most closely resembled the type strain of Streptococcus halichoeri isolated from a seal are presented. Sequencing of the 16S rRNA, rpoB, sodA and recN genes, comparative whole genome analysis, conventional biochemical and rapid ID 32 STREP identification methods, and antimicrobial susceptibility testing were performed on the human isolates, the type strain of S. halichoeri, and type strains of closely related species. The six human clinical isolates were biochemically indistinguishable from each other and showed 100% 16S rRNA, rpoB, sodA and recN gene sequence similarity. Comparative 16S rRNA gene sequencing analysis revealed 98.6% similarity to S. halichoeri CCUG 48324T, 97.9% to S. canis ATCC 43496T and 97.8% to S. ictaluri ATCC BAA-1300T. A 3530 bp fragment of the rpoB gene was 98.8% similar to S. halichoeriT, 84.6% to S. canisT and 83.8% to S. ictaluriT. S. halichoeriT and the human clinical isolates were susceptible to the antimicrobials tested based on CLSI guidelines for Streptococcus species viridans group with the exception of tetracycline and erythromycin. The human isolates were phenotypically distinct from the type strain isolated from a seal; comparative whole genome sequence analysis confirmed that the human isolates were S. halichoeri. On the basis of these results, a novel subspecies, Streptococcus halichoeri subsp. hominis is proposed for the human isolates and S. halichoeri subsp. halichoeri for the grey seal isolates. The type strain of the novel subspecies is SS1844T = CCUG 67100T = LMG 28801T. |
Safe water, sanitation, hygiene, and a cholera vaccine
Azman AS , Ivers LC , Legros D , Luquero FJ , Mintz ED . Lancet 2016 387 (10013) 28 Firdausi Qadri and colleagues (July 8, p 1362)1 reported results from a trial of the oral cholera vaccine, which included an arm combining the oral cholera vaccine with an intervention promoting handwashing and drinking water treatment at home. The authors reported no significant protective effect of the behaviour change intervention over that of the vaccine alone. Despite the authors' cautions against drawing conclusions from a study that had no independent water and hygiene intervention arm, media sources misinterpreted the results2 as “…the oral vaccine worked way better than…getting people to wash their hands and drink clean water”.3 | Receipt of the intervention for behaviour change was contingent on the oral cholera vaccine, biasing any interpretation of its independent effectiveness, and was a poor proxy for access to potable water, soap, and sanitation, which eliminated cholera from much of the world more than a century ago. 2 months after vaccination, participants were offered a handwashing station, a sachet of soap, and a bottle of soapy water, and were trained in the use of these items. 4 months after vaccination, chlorine for water treatment was introduced and its use promoted. No measures of intervention uptake or compliance were described. |
Maintenance of increased childhood influenza vaccination rates 1 year after an intervention in primary care practices
Nowalk MP , Zimmerman RK , Lin CJ , Reis EC , Huang HH , Moehling KK , Hannibal KM , Matambanadzo A , Shenouda EM , Allred NJ . Acad Pediatr 2016 16 (1) 57-63 OBJECTIVE: Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently. METHODS: Twenty pediatric and family medicine practices were randomly assigned to receive the intervention in either year 1 or year 2. This study focuses on influenza vaccine uptake in the 10 year 1 intervention sites during intervention and the following maintenance year. The intervention included the 4 Pillars Immunization Toolkit-a practice improvement toolkit, early delivery of donated vaccine for disadvantaged children, staff education, and feedback on progress. During the maintenance year, practices were not assisted or contacted, except to complete follow-up surveys. Student's t tests assessed vaccine uptake of children aged 6 months to 18 years, and multilevel regression modeling in repeated measures determined variables related to the likelihood of vaccination. RESULTS: Influenza vaccine uptake increased 12.4 percentage points (PP; P < .01) during active intervention and uptake was sustained (+0.4 PP; P > .05) during maintenance, for an average change of 12.7 PP over all sites, increasing from 42.2% at baseline to 54.9% (P < .001) during maintenance. In regression modeling that controlled for age, race, and insurance, likelihood of vaccination was greater during intervention than baseline (odds ratio 1.47; 95% confidence interval 1.44-1.50; P < .001) and greater during maintenance than baseline (odds ratio 1.50; 95% confidence interval 1.47-1.54; P < .001). CONCLUSIONS: In primary care practices, a multistrategy intervention that included the 4 Pillars Immunization Toolkit, early delivery of vaccine, and feedback was associated with significant improvements in childhood influenza vaccination rates that were maintained 1 year after active intervention. |
Maternal Tdap vaccination: Coverage and acute safety outcomes in the Vaccine Safety Datalink, 2007-2013
Kharbanda EO , Vazquez-Benitez G , Lipkind HS , Klein NP , Cheetham TC , Naleway AL , Lee GM , Hambidge S , Jackson ML , Omer SB , McCarthy N , Nordin JD . Vaccine 2016 34 (7) 968-73 INTRODUCTION: Since October 2012, the combined tetanus toxoid, reduced diphtheria toxoid, acellular pertussis vaccine (Tdap) has been recommended in the United States during every pregnancy. METHODS: In this observational study from the Vaccine Safety Datalink, we describe receipt of Tdap during pregnancy among insured women with live births across seven health systems. Using a retrospective matched cohort, we evaluated risks for selected medically attended adverse events in pregnant women, occurring within 42 days of vaccination. Using a generalized estimating equation, we calculated adjusted incident rate ratios (AIRR). RESULTS: Our vaccine coverage cohort included 438,487 live births between January 1, 2007 and November 15, 2013. Across the coverage cohort, 14% received Tdap during pregnancy. By 2013, Tdap was administered during pregnancy in 41.7% of live births, primarily in the 3rd trimester. Our vaccine safety cohort included 53,885 vaccinated and 109,253 matched unvaccinated pregnant women. There was no increased risk for a composite outcome of medically attended acute adverse events within 3 days of vaccination. Similarly, across the safety cohort, over a 42 day window, incident neurologic events, thrombotic events, and new onset proteinuria did not differ by maternal receipt of Tdap. Among women receiving Tdap at 20 weeks gestation or later, as compared to their matched controls, there was no increased risk for gestational diabetes or cardiac events while venous thromboembolic events and thrombocytopenia were diagnosed within 42 days of vaccination at slightly decreased rates. CONCLUSION: Tdap coverage during pregnancy increased from 2007 through 2013, but was still below 50%. No acute maternal safety signals were detected in this large cohort. |
Overcoming barriers to low hpv vaccine uptake in the United States: Recommendations from the national vaccine advisory committee
Orenstein WA , Gellin BG , Beigi RH , Despres S , Lynfield R , Maldonado Y , Mouton C , Rawlins W , Rothholz MC , Smith N , Thompson K , Torres C , Viswanath K , Hosbach P , Despres S , Rawlins W , Orenstein WA , Beigi RH , Hosbach P , Rothholz MC , Viswanath K , Bobo N , Brewer NT , Eckert L , Etkind P , Kahn JA , Loehr J , Martin K , Morita J , Salisbury D , Saslow D , Tan L , Turner JC , Willoughby RE Jr , Borden V , Croyle R , Deal CD , Gold R , Hance MBE , Hess MA , Lee NC , Lowy D , Stokley S , Wharton M , Bergquist S , Bok K , Gellin BG , Seib K , Zettle M . Public Health Rep 2016 131 (1) 17-25 An average of 25,900 cases of human papillomavirus (HPV)-associated cancers are newly diagnosed in the United States each year.1,2 An estimated 14 million people are newly infected with HPV each year, and nearly half of these infections occur in people aged 14–25 years.3 Although most infections resolve over time, persistent infection with oncogenic HPV types is associated with a variety of cancers. Virtually all cervical cancers are caused by HPV, along with 90% of anal, 69% of vaginal, 60% of oropharyngeal, 51% of vulvar, and 40% of penile cancers.1 Furthermore, 87% of anal, 76% of cervical, 60% of oropharyngeal, 55% of vaginal, 44% of vulva, and 29% of penile cancers are caused by oncogenic HPV type 16 or 18.4 Of the 35,000 HPV cancers reported in 2009 in the United States, 39% occurred in males.1 | Three HPV vaccines are currently available in the United States. One is a bivalent vaccine (designated as HPV2) designed to protect against HPV types 16 and 18, which are responsible for the most HPV-associated cancers. One is a quadrivalent vaccine (HPV4), which protects against HPV types 16 and 18 and two additional types, 6 and 11, that are the most common causes of genital warts. One is a nonavalent vaccine (HPV9) that protects against HPV types 6, 11, 16, and 18, and offers additional protection against five oncogenic HPV types, 31, 33, 45, 52, and 58. To prevent cancers associated with HPV infections, the Advisory Committee on Immunization Practices (ACIP) recommends HPV immunization for all children aged 11 or 12 years with the licensed three-doses series. The ACIP has recommended routine HPV immunization for girls since 2006 and for boys since 2011.2 |
A highly immunogenic vaccine against A(H7N9) influenza virus
Cao W , Liepkalns J , Hassan AO , Kamal R , Hofstetter AR , Amoah S , Kim JH , Reber A , Stevens J , Katz JM , Gangappa S , York I , Mittal SK , Sambhara S . Vaccine 2016 34 (6) 744-9 Since the first case of human infection in March 2013, continued reports of H7N9 cases highlight a potential pandemic threat. Highly immunogenic vaccines to this virus are urgently needed to protect vulnerable populations who lack protective immunity. In this study, an egg- and adjuvant-independent adenoviral vector-based, hemagglutinin H7 subtype influenza vaccine (HAd-H7HA) demonstrated enhanced cell-mediated immunity as well as serum antibody responses in a mouse model. Most importantly, this vaccine provided complete protection against homologous A/(H7N9) viral challenge suggesting its potential utility as a pandemic vaccine. |
Influenza vaccine effectiveness against 2009 pandemic influenza A(H1N1) virus differed by vaccine type during 2013-2014 in the United States
Gaglani M , Pruszynski J , Murthy K , Clipper L , Robertson A , Reis M , Chung JR , Piedra PA , Avadhanula V , Nowalk MP , Zimmerman RK , Jackson ML , Jackson LA , Petrie JG , Ohmit SE , Monto AS , McLean HQ , Belongia EA , Fry AM , Flannery B . J Infect Dis 2016 213 (10) 1546-56 BACKGROUND: The predominant strain during the 2013-2014 influenza season was 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09). This vaccine-component has remained unchanged from 2009. METHODS: The US Flu Vaccine Effectiveness Network enrolled subjects aged ≥6 months with medically attended acute respiratory illness (MAARI), including cough, with illness onset ≤7 days before enrollment. Influenza was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). We determined the effectiveness of trivalent or quadrivalent inactivated influenza vaccine (IIV) among subjects ages ≥6 months and the effectiveness of quadrivalent live attenuated influenza vaccine (LAIV4) among children aged 2-17 years, using a test-negative design. The effect of prior receipt of any A(H1N1)pdm09-containing vaccine since 2009 on the effectiveness of current-season vaccine was assessed. RESULTS: We enrolled 5999 subjects; 5637 (94%) were analyzed; 18% had RT-PCR-confirmed A(H1N1)pdm09-related MAARI. Overall, the effectiveness of vaccine against A(H1N1)pdm09-related MAARI was 54% (95% confidence interval [CI], 46%-61%). Among fully vaccinated children aged 2-17 years, the effectiveness of LAIV4 was 17% (95% CI, -39% to 51%) and the effectiveness of IIV was 60% (95% CI, 36%-74%). Subjects aged ≥9 years showed significant residual protection of any prior A(H1N1)pdm09-containing vaccine dose(s) received since 2009, as did children <9 years old considered fully vaccinated by prior season. CONCLUSIONS: During 2013-2014, IIV was significantly effective against A(H1N1)pdm09. Lack of LAIV4 effectiveness in children highlights the importance of continued annual monitoring of effectiveness of influenza vaccines in the United States. |
Nasopharyngeal carriage of Streptococcus pneumoniae among children in an urban setting in Brazil prior to PCV10 introduction
Menezes AP , Azevedo J , Leite MC , Campos LC , Cunha M , Carvalho MD , Reis MG , Ko AI , Weinberger DM , Ribeiro G , Reis JN . Vaccine 2015 34 (6) 791-7 Information on pneumococcal carriage in the pre-vaccine period is essential to predict and assess the impact of PCV in settings where disease surveillance is particularly difficult. Therefore, we present data on pneumococcal carriage before the introduction of the 10-valent-pneumococcal conjugate vaccine (PCV10) in Brazil. We conducted a prospective study on a cohort of 203 children aged <5 years old, randomly selected in an urban community located in the periphery of the city of Salvador, Brazil and followed them from January/2008 to January/2009. Nasopharyngeal swabs were collected from each child at four times. In total, 721 swabs were collected, yielding a pneumococcal carriage prevalence of 55% (n=398). In multivariate analyses, the variables associated with carriage were having contact with three or more children <2 years old (OR, 2.00; 95% CI 1.33-2.89) and living in a house with an average of 3 residents per room (OR, 1.77; 95% CI 1.05-3.10). Also, white participants were more likely to be protected from colonization (OR, 0.52; 95% CI 0.29-0.93), and prevalence of carriage varied over time, with lower prevalence occurring from February to June (OR, 0.53; 95% CI 0.37-0.78) compared to July to January. Contact with children under 2 years of age and living in crowded housing also were associated with colonization by highly invasive serotypes, although this relationship was not significant. The most prevalent vaccine serotypes were 6A/B (25.4%), 19F (10.1%) and 14 (9.0%), while the most prevalent non-vaccine serotypes were 16F (4.8%), 15B/C (4.5%) and 6C/D (3.5%). Overall, 38.4% (153/398) of the isolates were non-susceptible to penicillin, and of those, 73.8% (113/153) were non-susceptible to trimethoprim/sulfamethoxazole. Colonization rate by PCV10 serotypes was 52.2%. Routine PCV10 vaccination can lead to significant changes in pneumococcal serotypes found in NP colonization, indicating a need for continued monitoring, especially in crowded settings, as occurs in Brazil's slums. |
Evaluation of manual and automated bloodstream infection surveillance in outpatient dialysis centers
Thompson ND , Wise M , Belflower R , Kanago M , Kainer MA , Lovell C , Patel PR . Infect Control Hosp Epidemiol 2016 37 (4) 1-3 Outpatient hemodialysis bloodstream infection rates, now used for performance measurement and were significantly higher for manual compared with automated surveillance (P<.001), largely owing to the absence of blood culture data in the dialysis electronic health record. Improvement in data sharing between hospitals and outpatient dialysis centers is necessary. |
Characteristics of residential care communities that use electronic health records
Park-Lee E , Rome V , Caffrey C . Am J Manag Care 2015 21 (12) e669-76 OBJECTIVES: Residential care communities' (RCCs) use of electronic health records (EHRs) has the potential to improve communication and facilitate care coordination. This study describes the use of, and examines characteristics associated with, any type of EHR system among RCCs in the United States, nationally and by Census division. STUDY DESIGN: This study examined organizational and geographic characteristics, as well as resident case-mix in association with the use of EHRs among RCCs. METHODS: Data from the 2012 National Study of Long-Term Care Providers were used for the analyses. Of 4694 sampled RCCs that completed the questionnaire, 3987 cases with complete data were included in the study. RESULTS: About 20.2% of RCCs used any type of EHR system and 3.1% used EHRs that had 6 selected computerized capabilities to meet this study's definition for a basic EHR system. Compared with the national rate of 20.2%, a higher percentage of RCCs in the following Census divisions used some type of an EHR system: New England (23.2%), East North Central (26.3%), and West North Central (32.9%). Larger size, being chain affiliated, owned by other organizations or part of a continuing care retirement community, and geographic location were independently associated with the use of any EHRs among RCCs. CONCLUSIONS: As RCCs serve increasingly less healthy and more disabled residents, improved communication and effective care coordination among RCC staff and across different care settings are critical. The estimates presented in this study can be used to establish a baseline for monitoring trends in EHR use among RCCs. |
Shared risk factors for the perpetration of physical dating violence, bullying, and sexual harassment among adolescents exposed to domestic violence
Foshee VA , McNaughton Reyes HL , Chen MS , Ennett ST , Basile KC , DeGue S , Vivolo-Kantor AM , Moracco KE , Bowling JM . J Youth Adolesc 2016 45 (4) 672-86 The high risk of perpetrating physical dating violence, bullying, and sexual harassment by adolescents exposed to domestic violence points to the need for programs to prevent these types of aggression among this group. This study of adolescents exposed to domestic violence examined whether these forms of aggression share risk factors that could be targeted for change in single programs designed to prevent all three types of aggression. Analyses were conducted on 399 mother victims of domestic violence and their adolescents, recruited through community advertising. The adolescents ranged in age from 12 to 16 years; 64 % were female. Generalized estimating equations was used to control for the covariation among the aggression types when testing for shared risk factors. Approximately 70 % of the adolescents reported perpetrating at least one of the three forms of aggression. In models examining one risk factor at a time, but controlling for demographics, adolescent acceptance of sexual violence, mother-adolescent discord, family conflict, low maternal monitoring, low mother-adolescent closeness, low family cohesion, depressed affect, feelings of anger, and anger reactivity were shared across all three aggression types. In multivariable models, which included all of the risk factors examined and the demographic variables, low maternal monitoring, depressed affect and anger reactivity remained significant shared risk factors. Our findings suggest that programs targeting these risk factors for change have the potential to prevent all three forms of aggression. In multivariable models, poor conflict management skills was a risk for bullying and sexual harassment, but not dating violence; acceptance of dating violence was a risk for dating violence and bullying, but not sexual harassment; and none of the examined risk factors were unique to aggression type. The study's implications for the development of interventions and future research are discussed. |
An investigation into suicides among Bhutanese refugees resettled in the United States between 2008 and 2011
Hagaman AK , Sivilli TI , Ao T , Blanton C , Ellis H , Lopes Cardozo B , Shetty S . J Immigr Minor Health 2016 18 (4) 819-827 An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations. |
Can you really swim? Validation of self and parental reports of swim skill with an inwater swim test among children attending community pools in Washington State
Mercado MC , Quan L , Bennett E , Gilchrist J , Levy BA , Robinson CL , Wendorf K , Gangan Fife MA , Stevens MR , Lee R . Inj Prev 2016 22 (4) 253-60 BACKGROUND: Drowning is the second leading cause of unintentional injury death among US children. Multiple studies describe decreased drowning risk among children possessing some swim skills. Current surveillance for this protective factor is self/proxy-reported swim skill rather than observed inwater performance; however, children's self-report or parents' proxy report of swim skill has not been validated. This is the first US study to evaluate whether children or parents can validly report a child's swim skill. It also explores which swim skill survey measure(s) correlate with children's inwater swim performance. METHODS: For this cross-sectional convenience-based sample, pilot study, child/parent dyads (N=482) were recruited at three outdoor public pools in Washington State. Agreement between measures of self-reports and parental-reports of children's swim skill was assessed via paired analyses, and validated by inwater swim test results. RESULTS: Participants were representative of pool's patrons (ie, non-Hispanic White, highly educated, high income). There was agreement in child/parent dyads' reports of the following child swim skill measures: 'ever taken swim lessons', perceived 'good swim skills' and 'comfort in water over head'. Correlation analyses suggest that reported 'good swim skills' was the best survey measure to assess a child's swim skill-best if the parent was the informant (r=0.25-0.47). History of swim lessons was not significantly correlated with passing the swim test. CONCLUSIONS: Reported 'good swim skills' was most correlated with observed swim skill. Reporting 'yes' to 'ever taken swim lessons' did not correlate with swim skill. While non-generalisable, findings can help inform future studies. |
Disability and exposure to high levels of adverse childhood experiences: effect on health and risk behavior
Austin A , Herrick H , Proescholdbell S , Simmons J . N C Med J 2016 77 (1) 30-6 BACKGROUND: Health disparities among persons with disabilities have been previously documented. However, there is little research specific to adverse childhood experiences (ACEs) in this population and how ACE exposure affects health outcomes in adulthood. METHODS: Data from the 2012 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed to compare the prevalence of ACEs between adults with and without disabilities and high ACE exposure (3-8 ACEs). Adjusted risk ratios of health risks and perceived poor health by disability status were calculated using predicted marginals. RESULTS: A higher percentage of persons with disabilities (36.5%) than those without disabilities (19.6%) reported high ACE exposure. Among those with high ACE exposure, persons with disabilities were more likely to report several ACE categories, particularly childhood sexual abuse. In adjusted analyses, persons with disabilities had an increased risk of smoking (relative risk [RR] = 1.29; 95% CI, 1.10-1.51), poor physical health (RR = 4.34; 95% CI, 3.08-6.11), poor mental health (RR = 4.69; 95% CI, 3.19-6.87), and doctor-diagnosed depression (RR = 2.16; 95% CI, 1.82-2.56) compared to persons without disabilities. LIMITATIONS: The definition of disability derived from the BRFSS survey does not allow for those with disabilities to be categorized according to physical disabilities versus mental or emotional disabilities. In addition, we were unable to determine the timing of ACE exposure in relation to disability onset. CONCLUSIONS: A better understanding of the life course associations between ACEs and disability and the impact of exposure to multiple types of childhood adversity on disability and health is needed to inform research and services specific to this vulnerable population. |
A recombinant positive control for serology diagnostic tests supporting elimination of Onchocerca volvulus
Golden A , Stevens EJ , Yokobe L , Faulx D , Kalnoky M , Peck R , Valdez M , Steel C , Karabou P , Banla M , Soboslay PT , Adade K , Tekle AH , Cama VA , Fischer PU , Nutman TB , Unnasch TR , de Los Santos T , Domingo GJ . PLoS Negl Trop Dis 2016 10 (1) e0004292 BACKGROUND: Serological assays for human IgG4 to the Onchocerca volvulus antigen Ov16 have been used to confirm elimination of onchocerciasis in much of the Americas and parts of Africa. A standardized source of positive control antibody (human anti-Ov16 IgG4) will ensure the quality of surveillance data using these tests. METHODOLOGY/PRINCIPAL FINDINGS: A recombinant human IgG4 antibody to Ov16 was identified by screening against a synthetic human Fab phage display library and converted into human IgG4. This antibody was developed into different positive control formulations for enzyme-linked immunosorbent assay (ELISA) and rapid diagnostic test (RDT) platforms. Variation in ELISA results and utility as a positive control of the antibody were assessed from multiple laboratories. Temperature and humidity conditions were collected across seven surveillance activities from 2011-2014 to inform stability requirements for RDTs and positive controls. The feasibility of the dried positive control for RDT was evaluated during onchocerciasis surveillance activity in Togo, in 2014. When the anti-Ov16 IgG4 antibody was used as a standard dilution in horseradish peroxidase (HRP) and alkaline phosphatase (AP) ELISAs, the detection limits were approximately 1ng/mL by HRP ELISA and 10ng/mL by AP ELISA. Positive control dilutions and spiked dried blood spots (DBS) produced similar ELISA results. Used as a simple plate normalization control, the positive control antibody may improve ELISA data comparison in the context of inter-laboratory variation. The aggregate temperature and humidity monitor data informed temperature parameters under which the dried positive control was tested and are applicable inputs for testing of diagnostics tools intended for sub-Saharan Africa. As a packaged positive control for Ov16 RDTs, stability of the antibody was demonstrated for over six months at relevant temperatures in the laboratory and for over 15 weeks under field conditions. CONCLUSIONS: The recombinant human anti-Ov16 IgG4 antibody-based positive control will benefit inter-laboratory validation of ELISA assays and serve as quality control (QC) reagents for Ov16 RDTs at different points of the supply chain from manufacturer to field use. |
What's in a name? The impact of accurate Staphylococcus pseudintermedius identification on appropriate antimicrobial susceptibility testing
Limbago BM . J Clin Microbiol 2016 54 (3) 516-7 Bacteria in the Staphylococcus intermedius, including Staphylococcus pseudintermedius, often encode mecA-mediated methicillin resistance. Reliable detection of this phenotype for proper treatment and infection control decisions requires that these coagulase-positive staphylococci are accurately identified, and specifically that they are not misidentified as S. aureus. As correct species-level bacterial identification becomes more commonplace in clinical laboratories, one can expect to see changes in guidance for antimicrobial susceptibility testing and interpretation. The study by Wu et al. (J Clin Microbiol, 54:XXXXXX, 2016, http://dx.doi.org/10.1128/JCM.02864-15) in this issue highlights the impact of robust identification of Staphylococcus intermedius group organisms on the selection of appropriate antimicrobial susceptibility testing methods and interpretation. |
Paired serum and urine concentrations of biomarkers of diethyl phthalate, methyl paraben, and triclosan in rats
Teitelbaum SL , Li Q , Lambertini L , Belpoggi F , Manservisi F , Falcioni L , Bua L , Silva MJ , Ye X , Calafat AM , Chen J . Environ Health Perspect 2016 124 (1) 39-45 BACKGROUND: Exposure to environmental chemicals, including phthalates and phenols such as parabens and triclosan, is ubiquitous within the U.S. general population. OBJECTIVE: This proof-of-concept rodent study examined the relationship between oral doses of three widely used personal care product ingredients [diethyl phthalate (DEP), methyl paraben (MPB), and triclosan] and urine and serum concentrations of their respective biomarkers. METHODS: Using female Sprague-Dawley rats, we carried out two rounds of experiments with oral gavage doses selected in accordance with no observed adverse effect levels (NOAELs) derived from previous studies: 1,735 (DEP), 1,050 (MPB), 50 (triclosan) mg/kg/day. Administered doses ranged from 0.005 to 173 mg/kg/day, 10-100,000 times below the NOAEL for each chemical. Controls for the MPB and triclosan experiments were animals treated with olive oil (vehicle) only; controls for the DEP serum experiments were animals treated with the lowest doses of MPB and triclosan. Doses were administered for 5 days with five rats in each treatment group. Urine and blood serum, collected on the last day of exposure, were analyzed for biomarkers. Relationships between oral dose and biomarker concentrations were assessed using linear regression. RESULTS: Biomarkers were detected in all control urine samples at parts-per-billion levels, suggesting a low endemic environmental exposure to the three chemicals that could not be controlled even with all of the precautionary measures undertaken. Among the exposed animals, urinary concentrations of all three biomarkers were orders of magnitude higher than those in serum. A consistently positive linear relationship between oral dose and urinary concentration was observed (R2 > 0.80); this relationship was inconsistent in serum. CONCLUSIONS: Our study highlights the importance of carefully considering the oral dose used in animal experiments and provides useful information in selecting doses for future studies. |
Field evaluation of 4 rapid tests for diagnosis of HIV infection in Panama
Juarez SI , Nunez AE , Aranda MM , Mojica D , Kim AA , Parekh B . J Clin Microbiol 2016 54 (4) 1127-9 Four HIV rapid tests were subjected to field validation in Panama comparing them to enzyme-linked immunosorbent assay/Multispot-based testing algorithm. Sensitivity of Determine, UniGold, SD Bioline and INSTI was 99.8%. Specificity of Determine, SD-Bioline, and UniGold was 100% and of INSTI was 99.8%. Based on these data, these rapid tests can be used in an appropriate algorithm to diagnose HIV infection and are suitable for use in testing and counseling settings in Panama. |
Combination emtricitabine and tenofovir disoproxil fumarate prevents vaginal SHIV infection in macaques harboring C. trachomatis and T. vaginalis
Radzio J , Henning T , Jenkins L , Ellis S , Farshy C , Phillips C , Holder A , Kuklenyik S , Dinh C , Hanson D , McNicholl J , Heneine W , Papp J , Kersh EN , Garcia-Lerma JG . J Infect Dis 2016 213 (10) 1541-5 Genital inflammation associated with STIs increases susceptibility to HIV but it is unclear if the increased risk can reduce the efficacy of pre-exposure prophylaxis (PrEP). We investigated if co-infection of macaques with Chlamydia trachomatis and Trichomonas vaginalis decreases the prophylactic efficacy of oral FTC/TDF. Macaques were exposed to SHIV vaginally each week for up to 16 weeks and received placebo or FTC/TDF peri-coitally. All placebos were infected with SHIV while 4/6 PrEP-treated animals remained uninfected (p=0.03). Oral FTC/TDF maintains efficacy in a macaque model of STI coinfection, although the infection of 2 macaques signals a modest loss of PrEP activity. |
Socialization of adult owl monkeys (Aotus sp.) in Captivity
Williams LE , Coke CS , Weed JL . Am J Primatol 2015 79 (1) 1-7 Social housing has often been recommended as one-way to address the psychological well-being of captive non-human primates. Published reports have examined methods to socialize compatible animals by forming pairs or groups. Successful socialization rates vary depending on the species, gender, and environment. This study presents a retrospective look at pairing attempts in two species of owl monkeys, Aotus nancymaae and A. azarae, which live in monogamous pairs in the wild. The results of 477 pairing attempt conducted with captive, laboratory housed owl monkeys and 61 hr of behavioral observations are reported here. The greatest success pairing these owl monkeys occurred with opposite sex pairs, with an 82% success rate. Opposite sex pairs were more successful when females were older than males. Female-female pairs were more successful than male-male (MM) pairs (62% vs 40%). Successful pairs stayed together between 3 and 7 years before the animals were separated due to social incompatibility. Vigilance, eating, and sleeping during introductions significantly predicted success, as did the performance of the same behavior in both animals. The results of this analysis show that it is possible to give captive owl monkeys a social alternative even if species appropriate social partners (i.e., opposite sex partners) are not available. The focus of this report is a description of one potential way to enhance the welfare of a specific new world primate, the owl monkey, under laboratory conditions. More important is how the species typical social structure of owl monkeys in nature affects the captive management of this genus. |
Label-free and continuous-flow ferrohydrodynamic separation of HeLa cells and blood cells in biocompatible ferrofluids
Zhao W , Zhu T , Cheng R , Liu Y , He J , Qiu H , Wang L , Nagy T , Querec TD , Unger ER , Mao L . Adv Funct Mater 2015 26 (22) 3990-3998 In this study, a label-free, low-cost, and fast ferrohydrodynamic cell separation scheme is demonstrated using HeLa cells (an epithelial cell line) and red blood cells. The separation is based on cell size difference, and conducted in a custom-made biocompatible ferrofluid that retains the viability of cells during and after the assay for downstream analysis. The scheme offers moderate-throughput (≈106 cells h-1 for a single channel device) and extremely high recovery rate (>99%) without the use of any label. It is envisioned that this separation scheme will have clinical applications in settings where rapid cell enrichment and removal of contaminating blood will improve efficiency of screening and diagnosis such as cervical cancer screening based on mixed populations in exfoliated samples. |
Public Health and Rare Diseases: Oxymoron No More.
Valdez R , Ouyang L , Bolen J . Prev Chronic Dis 2016 13 E05 The mission of public health has been succinctly stated as “the fulfillment of society’s interest in assuring conditions in which people can be healthy” (1). Public and private institutions charged with this mission monitor population health and respond when threats arise. These may be sudden health crises (eg, infectious outbreaks), persistent health problems (eg, chronic diseases), or buildups of environmental risk factors (eg, pollution). Public health practitioners use a combination of disciplines that include basic science, clinical research, epidemiology, statistics, behavioral research, health care services, economics, and policy to identify the primary or secondary causes of health threats and then systematically prevent, mitigate, or suppress these causes in entire populations. This approach has been tremendously successful against infectious diseases and has had notable successes against injuries, accidents, and major chronic diseases (2,3). The purpose of this essay is to highlight the case of a group of nearly 7,000 rare (low-prevalence) diseases, mostly of genetic or congenital origin, for which the applicability of the public health approach, primary prevention in particular, seems limited. We argue that a wider application of this approach could greatly benefit the patients affected by these diseases and their relatives. We start by presenting the challenges of implementing this approach for rare diseases, then we present the need for such an approach and a few notable examples of its successful application to these diseases. Finally, we provide a structured list of public health activities that are key to the management of rare diseases in populations. | A rare disease is a condition that affects fewer than 200,000 people in the United States or no more than 1 of every 2,000 people in Europe (4). Examples of rare diseases are life-threatening and physically or mentally disabling conditions such as Huntington disease, spina bifida, fragile X syndrome, Guillain-Barré syndrome, Crohn disease, cystic fibrosis, and Duchenne muscular dystrophy. Possibly the main reason for the limited applicability of the public health approach to rare diseases is that patients are few and scattered across populations. But another reason is that approaches based on identifying and removing risk factors are generally not well-suited for diseases whose primary risk factors are innate or congenital and therefore irremovable. |
Risk factors for pertussis among Hispanic infants - Metropolitan Portland, Oregon, 2010-2012
Levri KM , Reynolds L , Liko J , Dott M , Robinson BF , Cieslak PR . Pediatr Infect Dis J 2016 35 (5) 488-93 BACKGROUND: In 2012, Oregon observed its highest numbers of reported pertussis cases since 1953. The greatest morbidity occurred among infants <6 months of age, with higher rates among Hispanics than non-Hispanics. To explain this disparity, we analyzed pertussis surveillance data. METHODS: An analysis was conducted among infants <6 months of age in the Portland metropolitan area during 2010-2012. Characteristics examined were ethnicity (Hispanic or non-Hispanic), household size (>4 or ≤4 persons), pertussis vaccination status (up-to-date or not up-to-date for age), child care center attendance (yes or no), infant birth weight (<2,500 or ≥2,500 g), and maternal age (<20 or ≥20 years). RESULTS: Eighty-two infants <6 months of age with pertussis were identified. Twenty-eight case-infants (34%) were Hispanic, and 54 (66%) were non-Hispanic. By ethnicity, infants with pertussis were similar in illness confirmation method, sex, age, hospitalization status, vaccination status, child care center attendance, infant birth weight, and maternal age. Hispanic infants were more likely than non-Hispanic infants to live in households with >4 persons. Univariate analysis showed Hispanic infants had ~2.3 times the risk for pertussis, compared with non-Hispanic infants, and infants living in households >4 persons had ~2.4 times the risk for illness, compared with those in households with ≤4 persons; stratified risk ratios did not differ between Hispanic (2.4 [confidence interval {CI}: 1.0-5.7]) and non-Hispanic infants (2.0 [CI: 1.2-3.5]). CONCLUSIONS: A household size of >4 persons is a potential risk factor for pertussis; the magnitude of this risk is similar for Hispanic and non-Hispanic infants. |
Modelling subject-specific childhood growth using linear mixed-effect models with cubic regression splines
Grajeda LM , Ivanescu A , Saito M , Crainiceanu C , Jaganath D , Gilman RH , Crabtree JE , Kelleher D , Cabrera L , Cama V , Checkley W . Emerg Themes Epidemiol 2016 13 1 BACKGROUND: Childhood growth is a cornerstone of pediatric research. Statistical models need to consider individual trajectories to adequately describe growth outcomes. Specifically, well-defined longitudinal models are essential to characterize both population and subject-specific growth. Linear mixed-effect models with cubic regression splines can account for the nonlinearity of growth curves and provide reasonable estimators of population and subject-specific growth, velocity and acceleration. METHODS: We provide a stepwise approach that builds from simple to complex models, and account for the intrinsic complexity of the data. We start with standard cubic splines regression models and build up to a model that includes subject-specific random intercepts and slopes and residual autocorrelation. We then compared cubic regression splines vis-a-vis linear piecewise splines, and with varying number of knots and positions. Statistical code is provided to ensure reproducibility and improve dissemination of methods. Models are applied to longitudinal height measurements in a cohort of 215 Peruvian children followed from birth until their fourth year of life. RESULTS: Unexplained variability, as measured by the variance of the regression model, was reduced from 7.34 when using ordinary least squares to 0.81 (p < 0.001) when using a linear mixed-effect models with random slopes and a first order continuous autoregressive error term. There was substantial heterogeneity in both the intercept (p < 0.001) and slopes (p < 0.001) of the individual growth trajectories. We also identified important serial correlation within the structure of the data (rho = 0.66; 95 % CI 0.64 to 0.68; p < 0.001), which we modeled with a first order continuous autoregressive error term as evidenced by the variogram of the residuals and by a lack of association among residuals. The final model provides a parametric linear regression equation for both estimation and prediction of population- and individual-level growth in height. We show that cubic regression splines are superior to linear regression splines for the case of a small number of knots in both estimation and prediction with the full linear mixed effect model (AIC 19,352 vs. 19,598, respectively). While the regression parameters are more complex to interpret in the former, we argue that inference for any problem depends more on the estimated curve or differences in curves rather than the coefficients. Moreover, use of cubic regression splines provides biological meaningful growth velocity and acceleration curves despite increased complexity in coefficient interpretation. CONCLUSIONS: Through this stepwise approach, we provide a set of tools to model longitudinal childhood data for non-statisticians using linear mixed-effect models. |
Building capacity for birth defects surveillance in Africa: implementation of an intermediate birth defects surveillance workshop
Flores A , Valencia D , Sekkarie A , Hillard CL , Williams J , Groisman B , Botto LD , Pena-Rosas JP , Bauwens L , Mastroiacovo P . J Glob Health Perspect 2015 2015 Each year around the world, it is estimated that 300,000 neonates are born with a neural tube defect. Many countries, however, are still lacking comprehensive birth defects surveillance registries. Comprehensive birth defects surveillance systems can help countries understand the magnitude and distribution of the problem. These systems can also provide information about biological, contextual, social and environmental determinants of birth defects. This information in turn can be used to identify effective and implementable solutions, and to evaluate prevention and management strategies to improve quality performance. This paper summarizes the development and implementation of an online pre-course training and in-person surveillance workshop conducted between 2014 December and 2015 March for representatives from six African countries. Feedback given by participants provided valuable lessons learned that can be applied to subsequent trainings and workshops. |
Guest editorial - special issue on ground control in mining
Murphy MM , Finfinger GL , Peng SS . Int J Min Sci Technol 2015 26 (1) 1-2 Ground control is the science of studying and controlling the | behavior of rock strata in response to mining operations. Ground | control-related research has seen significant advancements over | the last 37 years, and these accomplishments are well documented | in the proceedings of the annual International Conference on | Ground Control in Mining (ICGCM) [1]. The ICGCM is a forum to | promote closer communication among researchers, consultants, | regulators, manufacturers, and mine operators to expedite solutions to ground control problems in mining [2–6]. Fundamental | research and advancements in ground control science define the | central core of the conference mission. Providing information to | mine operators is a priority, as the conference goal is to offer solutions-oriented information. In addition, the conference has | included innovative technologies and ideas in mining-related fields | such as exploration, geology, and surface and underground mining. | Many new ground control technologies and design standards | adopted by the mining industry were first discussed at ICGCM. | Therefore, this conference is recognized as the best international | forum for introducing new ground control-related research and | products. | Professor Syd Peng (West Virginia University), on his own initiative, organized the First Conference on Ground Control in Mining | in the summer of 1981. Dr. Peng keenly recognized that in order to | advance the state-of-the-art in ground control, a forum was | urgently needed whereby researchers, practitioners, equipment | manufacturers, and government regulators could meet regularly | and exchange information in a timely manner. Beginning in | 2016, the conference was taken over by the Society for Mining, | Metallurgy & Exploration (SME). Four researchers, Brijes Mishra | (West Virginia University), Kyle Perry (Missouri University of | Science and Technology), Heather Lawson (NIOSH), and Michael | Murphy (NIOSH), were chosen to serve as a secondary team from | the conference’s organizing committee to ensure that the ICGCM | continues to advance the science of evasive ground control problems and develop solutions through current mine design strategies, | operational practices, and engineering interventions. Ted Klemetti | (NIOSH) was added to the team in 2017 and will serve as the conference chair for the 38th and 39th conferences. |
Comparison of methods for auto-coding causation of injury narratives.
Bertke SJ , Meyers AR , Wurzelbacher SJ , Measure A , Lampl MP , Robins D . Accid Anal Prev 2015 88 117-123 Manually reading free-text narratives in large databases to identify the cause of an injury can be very time consuming and recently, there has been much work in automating this process. In particular, the variations of the naive Bayes model have been used to successfully auto-code free text narratives describing the event/exposure leading to the injury of a workers' compensation claim. This paper compares the naive Bayes model with an alternative logistic model and found that this new model outperformed the naive Bayesian model. Further modest improvements were found through the addition of sequences of keywords in the models as opposed to consideration of only single keywords. The programs and weights used in this paper are available upon request to researchers without a training set wishing to automatically assign event codes to large data-sets of text narratives. The utility of sharing this program was tested on an outside set of injury narratives provided by the Bureau of Labor Statistics with promising results. |
Sudden deaths among oil and gas extraction workers resulting from oxygen deficiency and inhalation of hydrocarbon gases and vapors - United States, January 2010-March 2015
Harrison RJ , Retzer K , Kosnett MJ , Hodgson M , Jordan T , Ridl S , Kiefer M . MMWR Morb Mortal Wkly Rep 2016 65 (1) 6-9 In 2013, an occupational medicine physician from the University of California, San Francisco, contacted CDC's National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA) about two oil and gas extraction worker deaths in the western United States. The suspected cause of these deaths was exposure to hydrocarbon gases and vapors (HGVs) and oxygen (O2)-deficient atmospheres after opening the hatches of hydrocarbon storage tanks. The physician and experts from NIOSH and OSHA reviewed available fatality reports from January 2010 to March 2015, and identified seven additional deaths with similar characteristics (nine total deaths). Recommendations were made to industry and regulators regarding the hazards associated with opening hatches of tanks, and controls to reduce or eliminate the potential for HGV exposure were proposed. Health care professionals who treat or evaluate oil and gas workers need to be aware that workers might report symptoms of exposure to high concentrations of HGVs and possible O2 deficiency; employers and workers need to be aware of this hazard and know how to limit exposure. Medical examiners investigating the death of oil and gas workers who open tank hatches should consider the contribution of O2 deficiency and HGV exposure. |
Survey of occupational hazards in Minnesota veterinary practices in 2012
Fowler HN , Holzbauer SM , Smith KE , Scheftel JM . J Am Vet Med Assoc 2016 248 (2) 207-18 OBJECTIVE: To identify the scope of occupational hazards encountered by veterinary personnel and compare hazard exposures between veterinarians and technicians working in small and large animal practices. DESIGN: Cross-sectional survey. POPULATION: Licensed veterinarians and veterinary staff in Minnesota. PROCEDURES: A survey of Minnesota veterinary personnel was conducted between February 1 and December 1, 2012. Adult veterinary personnel working in clinical practice for > 12 months were eligible to participate. Information was collected on various workplace hazards as well as on workplace safety culture. RESULTS: 831 eligible people responded, representing approximately 10% of Minnesota veterinary personnel. A greater proportion of veterinarians (93%; 368/394) reported having received preexposure rabies vaccinations than did veterinary technicians (54%; 198/365). During their career, 226 (27%) respondents had acquired at least 1 zoonotic infection and 636 (77%) had been injured by a needle or other sharps. Recapping of needles was reported by 87% of respondents; the most common reason reported by veterinarians (41%; 142/345) and veterinary technicians (71%; 238/333) was being trained to do so at school or work. Recent feelings of depression were reported by 204 (25%) respondents. A greater proportion of technicians (42%; 155/365) than veterinarians (21%; 81/394) indicated working in an environment in which employees experienced some form of workplace abuse. CONCLUSIONS AND CLINICAL RELEVANCE: Veterinary personnel in Minnesota were exposed to several work-related hazards. Practice staff should assess workplace hazards, implement controls, and incorporate instruction on occupational health into employee training. |
Effect of wearing an N95 filtering facepiece respirator on superomedial orbital infrared indirect brain temperature measurements
DiLeo T , Roberge RJ , Kim JH . J Clin Monit Comput 2016 31 (1) 67-73 To determine any effect of wearing a filtering facepiece respirator on brain temperature. Subjects (n = 18) wore a filtering facepiece respirator (FFR) for 1 h at rest while undergoing infrared thermography measurements of the superomedial periobital region of the eye, a non-invasive indirect method of brain temperature measurements we termed the superomedial orbital infrared indirect brain temperature (SOIIBT) measurement. Temperature of the facial skin covered by the FFR, infrared temperature measurements of the tympanic membrane and superficial temporal artery region were concurrently measured, and subjective impressions of thermal comfort obtained simultaneously. The temperature of the skin under the FFR and subjective impressions of thermal discomfort both increased significantly. The mean tympanic membrane temperature did not increase, and the superficial temporal artery region temperature decreased significantly. The SOIIBT values did not change significantly, but subjects who switched from nasal to oronasal breathing during the study (n = 5) experienced a slight increase in the SOIIBT measurements. Wearing a FFR for 1 h at rest does not have a significant effect on brain temperatures, as evaluated by the SOIIBT measurements, but a change in the route of breathing may impact these measurements. These findings suggest that subjective impressions of thermal discomfort from wearing a FFR under the study conditions are more likely the result of local dermal sensations rather than brain warming. |
Fatal traumatic brain injuries in the construction industry, 2003-2010
Konda S , Tiesman HM , Reichard AA . Am J Ind Med 2016 59 (3) 212-20 BACKGROUND: Research on fatal work-related traumatic brain injuries (TBIs) is limited. This study describes fatal TBIs in the US construction industry. METHODS: Fatal TBIs were extracted from the Bureau of Labor Statistics Census of Fatal Occupational Injuries. RESULTS: From 2003 to 2010, 2,210 fatal TBIs occurred in construction at a rate of 2.6 per 100,000 full-time equivalent (FTE) workers. Workers aged 65 years and older had the highest fatal TBI rates among all workers (7.9 per 100,000 FTE workers). Falls were the most frequent injury event (n = 1,269, 57%). Structural iron and steel workers and roofers had the highest fatal TBI rate per 100,000 FTE workers (13.7 and 11.2, respectively). Fall-related TBIs were the leading cause of death in these occupations. CONCLUSIONS: A large percentage of TBIs in the construction industry were due to falls. Emphasis on safety interventions is needed to reduce these fall-related TBIs, especially among vulnerable workers. |
Classification of neck/shoulder pain in epidemiological research: A comparison of personal and occupational characteristics, disability and prognosis among 12,195 workers from 18 countries
Sarquis LM , Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Vargas-Prada S , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Tiina , Freimann , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Salazar Vega EJ . Pain 2016 157 (5) 1028-1036 To inform case-definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9,150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The one-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs. 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs. 1.3) and poor mental health (PRR 1.3 vs. 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs. 61.7%). Our findings highlight important epidemiological distinctions between sub-categories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain which is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region. |
Determination of volumetric changes at an underground stone mine: A photogrammetry case study
Slaker B , Westman E , Ellenberger J , Murphy M . Int J Min Sci Technol 2015 26 (1) 149-154 Photogrammetry, as a tool for monitoring underground mine deformation, is an alternative to traditional point measurement devices, and may be capable of accurate measurements in situations where technologies such as laser scanning are unsuited, undesired, or cost-prohibitive. An underground limestone mine in Ohio is used as a test case for monitoring of structurally unstable pillars. Seven pillars were photographed over in a 63day period, punctuated by four visits. Using photogrammetry, point clouds of the mine geometry were obtained and triangulation surfaces were generated to determine volumes of change over time. Pillar spalling in the range of 0.29-4.03m3 of rock on individual rib faces was detected. Isolated incidents of rock expansion prior to failure, and the isolated failure of a weak shale band were also observed. Much of the pillars remained unchanged during the monitoring period, which is indicative of proper alignment in the triangulated surfaces. The photographs of some ribs were of either too poor quality or had insufficient overlap, and were not included. However, photogrammetry was successfully applied to multiple ribs in quantifying the pillar geometry change over time. |
Genetic diversity of Plasmodium falciparum parasite by microsatellite markers after scale-up of insecticide-treated bed nets in western Kenya.
Gatei W , Gimnig JE , Hawley W , Ter Kuile F , Odero C , Iriemenam NC , Shah MP , Howard PP , Omosun YO , Terlouw DJ , Nahlen B , Slutsker L , Hamel MJ , Kariuki S , Walker E , Shi YP . Malar J 2014 13 Suppl 1 495 BACKGROUND: An initial study of genetic diversity of Plasmodium falciparum in Asembo, western Kenya showed that the parasite maintained overall genetic stability 5 years after insecticide-treated bed net (ITN) introduction in 1997. This study investigates further the genetic diversity of P. falciparum 10 years after initial ITN introduction in the same study area and compares this with two other neighbouring areas, where ITNs were introduced in 1998 (Gem) and 2004 (Karemo). METHODS: From a cross-sectional survey conducted in 2007, 235 smear-positive blood samples collected from children ≤15-year-old in the original study area and two comparison areas were genotyped employing eight neutral microsatellites. Differences in multiple infections, allele frequency, parasite genetic diversity and parasite population structure between the three areas were assessed. Further, molecular data reported previously (1996 and 2001) were compared to the 2007 results in the original study area Asembo. RESULTS: Overall proportion of multiple infections (MA) declined with time in the original study area Asembo (from 95.9 %-2001 to 87.7 %-2007). In the neighbouring areas, MA was lower in the site where ITNs were introduced in 1998 (Gem 83.7 %) compared to where they were introduced in 2004 (Karemo 96.7 %) in 2007. Overall mean allele count (MAC ~ 2.65) and overall unbiased heterozygosity (H e ~ 0.77) remained unchanged in 1996, 2001 and 2007 in Asembo and was the same level across the two neighbouring areas in 2007. Overall parasite population differentiation remained low over time and in the three areas at FST < 0.04. Both pairwise and multilocus linkage disequilibrium showed limited to no significant association between alleles in Asembo (1996, 2001 and 2007) and between three areas. CONCLUSIONS: This study showed the P. falciparum high genetic diversity and parasite population resilience on samples collected 10 years apart and in different areas in western Kenya. The results highlight the need for long-term molecular monitoring after implementation and use of combined and intensive prevention and intervention measures in the region. |
Clonal population expansion in an outbreak of Plasmodium falciparum on the northwest coast of Ecuador.
Saenz FE , Morton LC , Okoth SA , Valenzuela G , Vera-Arias CA , Velez-Alvarez E , Lucchi NW , Castro LE , Udhayakumar V . Malar J 2014 13 Suppl 1 497 BACKGROUND: Determining the source of malaria outbreaks in Ecuador and identifying remaining transmission foci will help in malaria elimination efforts. In this study, the genetic signatures of Plasmodium falciparum isolates, obtained from an outbreak that occurred in northwest Ecuador from 2012 to 2013, were characterized. METHODS: Molecular investigation of the outbreak was performed using neutral microsatellites, drug resistance markers and pfhrp2 and pfhrp3 genotyping. RESULTS: A majority of parasite isolates (31/32) from this outbreak were of a single clonal type that matched a clonal lineage previously described on the northern coast of Peru and a historical isolate from Ecuador. All but one isolate carried a chloroquine-resistant pfcrt genotype and sulfadoxine- and pyrimethamine-sensitive pfdhps and pfdhfr genotypes. Pfmdr1 mutations were identified in codons 184 and 1042. In addition, most samples (97 %) showed presence of pfhrp2 gene. CONCLUSIONS: This study indicates that parasites from a single clonal lineage largely contributed to this outbreak and this lineage was found to be genetically related to a lineage previously reported in the Peruvian coast and historical Ecuadorian parasites. |
Anxious and depressive symptomatology among male youth: The joint and interactive contribution of temperament and executive functioning
Latzman RD , Shishido Y , Latzman NE , Clark LA . Child Psychiatry Hum Dev 2016 47 (6) 925-937 Few studies have investigated the combined effects of temperament and executive functioning (EF) on anxious and depressive symptomatology in youth. The current study is the first to investigate the joint and interactive contribution of mother- and youth self-reported affective dimensions of temperament and EF to the explanation of anxious and depressive symptomatology. Participants included 174 adolescent males (M age = 13.6 +/- 1.35). Results confirmed the joint and interactive contribution of temperament in the explanation of anxious and depressive symptomatology. Further, EF contributed to the explanation of anxious/depressive symptomatology via interaction with youth-, but not mother-reported, temperament; it was not a unique predictor. Results support the need to consider both affective dimensions of temperament and EF in etiological models of anxious and depressive symptomatology, which has implications for identifying at-risk youth and developing early intervention and targeted problem-specific prevention programs. |
North Carolina's Operation Medicine Drop: results from one of the nation's largest drug disposal programs
Fleming E , Proescholdbell S , Sachdeva N , Alexandridis AA , Margolis L , Ransdell K . N C Med J 2016 77 (1) 59-62 INTRODUCTION: In 2013, a total of 1,085 North Carolina residents died due to unintentional poisoning; 91% of these deaths were attributed to medications or drugs (over-the-counter, prescription, or illicit). Proper disposal of unused, unneeded, and/or expired medications is an essential part of preventing these unintentional deaths, as well as averting the other adverse consequences of these drugs on the environment and population health. METHODS: Operation Medicine Drop is a medication take-back program coordinated by Safe Kids North Carolina, a county-level, coalition-based injury prevention organization. The Operation Medicine Drop program and event registration system were used to review and validate the number of events, the counties where the events were held, and the number of unit doses (pills) collected from March 2010 to June 2014. SAS version 9.4 was used to generate basic counts and frequencies of events and doses, and ArcGIS version 10.0 was used to create the map. RESULTS: From March 2010 to June 2014, Operation Medicine Drop held 1,395 events with 245 different participating law enforcement agencies in 91 counties in North Carolina, and it collected 69.6 million unit doses of medication. More than 60 local Safe Kids North Carolina community coalitions had participated as of June 2014. Every year, Operation Medicine Drop has witnessed increases in events, participating agencies, participating counties, and the number of doses collected. CONCLUSION: Operation Medicine Drop is an excellent example of a successful and ongoing collaboration to improve public health. Medication take-back programs may play an important role in preventing future overdose deaths in North Carolina. |
The potential impact of a "no-buy" list on youth exposure to alcohol advertising on cable television
Ross CS , Brewer RD , Jernigan DH . J Stud Alcohol Drugs 2016 77 (1) 7-16 OBJECTIVE: The purpose of this study was to outline a method to improve alcohol industry compliance with its self-regulatory advertising placement guidelines on television with the goal of reducing youth exposure to noncompliant advertisements. METHOD: Data were sourced from Nielsen (The Nielsen Company, New York, NY) for all alcohol advertisements on television in the United States for 2005-2012. A "no-buy" list, that is a list of cable television programs and networks to be avoided when purchasing alcohol advertising, was devised using three criteria: avoid placements on programs that were noncompliant in the past (serially noncompliant), avoid placements on networks at times of day when youth make up a high proportion of the audience (high-risk network dayparts), and use a "guardbanded" (or more restrictive) composition guideline when placing ads on low-rated programs (low rated). RESULTS: Youth were exposed to 15.1 billion noncompliant advertising impressions from 2005 to 2012, mostly on cable television. Together, the three no-buy list criteria accounted for 99% of 12.9 billion noncompliant advertising exposures on cable television for youth ages 2-20 years. When we evaluated the no-buy list criteria sequentially and mutually exclusively, serially noncompliant ads accounted for 67% of noncompliant exposure, high-risk network-daypart ads accounted for 26%, and low-rated ads accounted for 7%. CONCLUSIONS: These findings suggest that the prospective use of the no-buy list criteria when purchasing alcohol advertising could eliminate most noncompliant advertising exposures and could be incorporated into standard post-audit procedures that are widely used by the alcohol industry in assessing exposure to television advertising. |
Prevalence and determinants of secondhand smoke exposure among middle and high school students
Agaku IT , Singh T , Rolle I , Olalekan AY , King BA . Pediatrics 2016 137 (2) e20151985 BACKGROUND: Secondhand smoke (SHS) causes disease and death among nonsmokers. Private settings are major sources of exposure for children. We assessed prevalence and determinants of self-reported SHS exposure in homes and vehicles, as well as school, work, and indoor/outdoor public areas, among US students in grades 6 through 12. METHODS: Data were from the 2013 National Youth Tobacco Survey (n = 18 406). Self-reported SHS exposure within the past 7 days was assessed overall and by extent of smoke-free home and vehicle rules among never users of 10 tobacco product types. Descriptive statistics were used to compare estimates, and adjusted prevalence ratios were calculated to assess determinants of SHS exposure. RESULTS: Among never tobacco users, 48.0% reported SHS exposure in 1 or more locations, including 15.5% in the home, 14.7% in a vehicle, 16.8% at school, 27.1% at work, and 35.2% in an indoor/outdoor public area. Home exposure was 8.5%, 55.3%, and 79.4% among never tobacco users with complete, partial, or no smoke-free home rules, respectively (P < .05). Vehicle exposure was 7.1%, 44.8%, and 70.2% among never tobacco users with complete, partial, or no smoke-free vehicle rules, respectively (P < .05). Factors associated with higher prevalence ratio of SHS exposure included current tobacco use, truant behavior, and having tobacco using household members/friends CONCLUSIONS: Approximately half of US students in grades 6 through 12 reported exposure to SHS in 2013. Smoke-free home and vehicle rules, coupled with intensified implementation and enforcement of comprehensive smoke-free laws, could help protect youth from this preventable health hazard. |
Effect of a "pill mill" law on opioid prescribing and utilization: The case of Texas
Lyapustina T , Rutkow L , Chang HY , Daubresse M , Ramji AF , Faul M , Stuart EA , Alexander GC . Drug Alcohol Depend 2015 159 190-7 BACKGROUND: States have attempted to reduce prescription opioid abuse through strengthening the regulation of pain management clinics; however, the effect of such measures remains unclear. We quantified the impact of Texas's September 2010 "pill mill" law on opioid prescribing and utilization. METHODS: We used the IMS Health LRx LifeLink database to examine anonymized, patient-level pharmacy claims for a closed cohort of individuals filling prescription opioids in Texas between September 2009 and August 2011. Our primary outcomes were derived at a monthly level and included: (1) average morphine equivalent dose (MED) per transaction; (2) aggregate opioid volume; (3) number of opioid prescriptions; and (4) quantity of opioid pills dispensed. We compared observed values with the counterfactual, which we estimated from pre-intervention levels and trends. RESULTS: Texas's pill mill law was associated with declines in average MED per transaction (-0.57. mg/month, 95% confidence interval [CI] -1.09, -0.057), monthly opioid volume (-9.99. kg/month, CI -12.86, -7.11), monthly number of opioid prescriptions (-12,200 prescriptions/month, CI -15,300, -9,150) and monthly quantity of opioid pills dispensed (-714,000 pills/month, CI -877,000, -550,000). These reductions reflected decreases of 8.1-24.3% across the outcomes at one year compared with the counterfactual, and they were concentrated among prescribers and patients with the highest opioid prescribing and utilization at baseline. CONCLUSIONS: Following the implementation of Texas's 2010 pill mill law, there were clinically significant reductions in opioid dose, volume, prescriptions and pills dispensed within the state, which were limited to individuals with higher levels of baseline opioid prescribing and utilization. |
Cigarette smoking and cigarette marketing exposure among students in selected African countries: Findings from the global youth tobacco survey
Zhao L , Palipudi KM , Ramanandraibe N , Asma S . Prev Med 2015 91S S35-S39 OBJECTIVE: To investigate cigarette smoking prevalence and exposure to various forms of cigarette marketing among students in 10 African countries. METHODS: We used data collected during 2009-2011 from the Global Youth Tobacco Survey (GYTS), a school based cross-sectional survey of students aged 13-15years, to measure the prevalence of cigarette smoking and exposure to cigarette marketing; comparisons to estimates from 2005 to 2006 were conducted for five countries where data were available. The correlations between country-level cigarette smoking prevalence and exposure to cigarette marketing were also studied. RESULTS: Current cigarette smoking ranged from 3.4% to 13.6% among students aged 13-15 in the 10 countries studied, although use of tobacco products other than cigarettes was more prevalent in all countries except in Cote D'Ivoire. Cigarette smoking was higher among boys than girls in seven out of the 10 countries. Among the five countries with two rounds of surveys, a significant decrease in cigarette smoking prevalence was observed in Mauritania and Niger; these two countries also experienced a decline in three measures of cigarette marketing exposure. It is also possible that smoking prevalence might have risen faster among girls than boys. CONCLUSION: Cigarette smoking among youth was noticeable in 10 African countries evaluated, with the prevalence over 10% in Cote D'Ivoire, Mauritania and South Africa. Cigarette marketing exposure varied by the types of marketing; traditional venues such as TV, outdoor billboards, newspapers and magazines, were still prominent. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Food Safety
- Genetics and Genomics
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- 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