Rickettsia felis infection in febrile patients, western Kenya, 2007-2010
Maina AN , Knobel DL , Jiang J , Halliday J , Feikin DR , Cleaveland S , Ng'ang'a Z , Junghae M , Breiman RF , Richards AL , Njenga MK . Emerg Infect Dis 2012 18 (2) 328-31 To determine previous exposure and incidence of rickettsial infections in western Kenya during 2007-2010, we conducted hospital-based surveillance. Antibodies against rickettsiae were detected in 57.4% of previously collected serum samples. In a 2008-2010 prospective study, Rickettsia felis DNA was 2.2x more likely to be detected in febrile than in afebrile persons. |
Oseltamivir-resistant pandemic (H1N1) 2009 virus infections, United States, 2010-11
Storms AD , Gubareva LV , Su S , Wheeling JT , Okomo-Adhiambo M , Pan CY , Reisdorf E , St George K , Myers R , Wotton JT , Robinson S , Leader B , Thompson M , Shannon M , Klimov A , Fry AM , USAntiviral Resistance Surveillance Working Group . Emerg Infect Dis 2012 18 (2) 308-311 During October 2010-July 2011, 1.0% of pandemic (H1N1) 2009 viruses in the United States were oseltamivir resistant, compared with 0.5% during the 2009-10 influenza season. Of resistant viruses from 2010-11 and 2009-10, 26% and 89%, respectively, were from persons exposed to oseltamivir before specimen collection. Findings suggest limited community transmission of oseltamivir-resistant virus. |
Pause on avian flu transmission research
Fouchier RA , Garcia-Sastre A , Kawaoka Y , Barclay WS , Bouvier NM , Brown IH , Capua I , Chen H , Compans RW , Couch RB , Cox NJ , Doherty PC , Donis RO , Feldmann H , Guan Y , Katz J , Klenk HD , Kobinger G , Liu J , Liu X , Lowen A , Mettenleiter TC , Osterhaus AD , Palese P , Peiris JS , Perez DR , Richt JA , Schultz-Cherry S , Steel J , Subbarao K , Swayne DE , Takimoto T , Tashiro M , Taubenberger JK , Thomas PG , Tripp RA , Tumpey TM , Webby RJ , Webster RG . Science 2012 335 (6067) 400-1 THE CONTINUOUS THREAT OF AN INFLUENZA PANDEMIC REPRESENTS ONE OF THE BIGGEST CHALlenges in public health. Influenza pandemics are known to be caused by viruses that evolve from animal reservoirs, such as in birds and pigs, and can acquire genetic changes that increase their ability to transmit in humans. Pandemic preparedness plans have been implemented worldwide to mitigate the impact of influenza pandemics. A major obstacle in preventing influenza pandemics is that little is known regarding what makes an influenza virus transmissible in humans. As a consequence, the potential pandemic risk associated with the many different influenza viruses of animals cannot be assessed with any certainty. | Recent research breakthroughs identified specific determinants of transmission of H5N1 influenza viruses in ferrets. Responsible research on influenza virus transmission using different animal models is conducted by multiple laboratories in the world using the highest international standards of biosafety and biosecurity practices that effectively prevent the release of transmissible viruses from the laboratory. These standards are regulated and monitored closely by the relevant authorities. This statement is being made by the principal investigators of these laboratories. |
Extended outbreak of cryptosporidiosis in a pediatric hospital, China
Feng Y , Wang L , Duan L , Gomez-Puerta LA , Zhang L , Zhao X , Hu J , Zhang N , Xiao L . Emerg Infect Dis 2012 18 (2) 312-4 Four Cryptosporidium spp. and 6 C. hominis subtypes were isolated from 102 of 6,284 patients in 3 pediatric hospitals in People's Republic of China. A cryptosporidiosis outbreak was identified retrospectively. The outbreak lasted >1 year and affected 51.4% of patients in 1 hospital ward, where 2 C. hominis subtypes with different virulence were found. |
Invasive pneumococcal disease and pandemic (H1N1) 2009, Denver, Colorado, USA
Nelson GE , Gershman KA , Swerdlow DL , Beall BW , Moore MR . Emerg Infect Dis 2012 18 (2) 208-16 Pneumococcal pneumonia was a complication during previous influenza pandemics but was not evident initially during pandemic (H1N1) 2009. During October 2009 in Denver, Colorado, USA, invasive pneumococcal disease (IPD) and pandemic (H1N1) 2009 peaked simultaneously, which suggests a link. We compared cases of IPD in October 2009 with cases in February 2009, the most recent peak month of seasonal influenza. During October 2009, we observed 58 IPD cases, which was 3x the average number of IPD cases that usually occur in October in Denver. Patients with IPD in October 2009 were younger and more likely to have chronic lung disease than patients who had IPD in February 2009; a total of 10/47 patients had influenza, and 33/53 patients had influenza-like illness. Thus, approximately 17%-62% cases of IPD may have been associated with pandemic (H1N1) 2009. Pneumococcal disease prevention strategies should be emphasized during future influenza pandemics. |
Commentary on Greig et al. Reduced mortality and loss to follow-up in integrated compared with vertical programmes providing antiretroviral treatment in sub-Saharan Africa, JAIDS
Spira TJ , Ellerbrock TV . J Acquir Immune Defic Syndr 2012 59 (5) e82-4 In the article by Greig et al1 from Médecins sans Frontières, the authors compared data from their supported HIV/AIDS care and treatment programs at 17 sites in 9 countries in sub-Saharan Africa. Initially, their support began as vertical programs, but later they changed to an integrated model that incorporated HIV treatment into general health care services. In this retrospective study (2003–2010), they compared a number of clinical indicators of antiretroviral treatment (ART) outcome, although controlling for a variety of potential confounders. However, a major potential confounder, CD4 count at initiation of ART, was not included due to 30% with missing data. The study included 14,124 patients at 7 vertical program sites and 1279 at 10 integrated sites. All of the integrated sites were rural, whereas 4 of 7 vertical sites were urban. Programs were standardized across both program types. Training and advisory staff were similar for both. A standardized electronic database containing routinely collected data facilitated this study. Follow-up data were censored at 30 months on ART to make the follow-up time equal between the 2 programs. | Although the authors used data collected from a large number of sites in multiple countries, they examined only retrospective data and were unable to address specific country contexts and the relative costs of the 2 approaches. However, the study results add useful information to the small body of studies that evaluate the utility of integrated programs compared with vertical programs. |
Diagnoses of HIV infection among Hispanics/Latinos in 40 states and Puerto Rico, 2006-2009
Espinoza L , Hall HI , Hu X . J Acquir Immune Defic Syndr 2012 60 (2) 205-13 BACKGROUND: In the United States, Hispanics are disproportionately affected by HIV infection. However, Hispanic subgroups of varied national origin differ culturally and HIV may impact them differently. METHODS: We used information on Hispanics/Latinos diagnosed with HIV during 2006-2009 in 40 states and Puerto Rico, and aged ≥ 13 years, reported to the Centers for Disease Control and Prevention through June 2010, to examine the distribution of disease by selected characteristics, including place of birth and place of residence at diagnosis. We used Poisson regression to calculate the estimated annual percent change (EAPC) in the rate of HIV diagnoses and estimated prevalence ratios of a short HIV-to-AIDS interval (AIDS diagnosis within 12 months of HIV diagnosis). Analyses were adjusted for reporting delays and missing risk factor information. RESULTS: During 2006-2009 HIV infection was diagnosed among 33,498 Hispanics/Latinos. From 2006-2009 the annual rate of diagnoses decreased among Hispanics/ Latinos (EAPC = -4.3%; 95% confidence interval [CI] = -6.5, - 2.0) including males (-2.8%; 95% CI = -5.2, -0.4) and females (-9.8%; 95% CI = -13.2, -6.3). The rate in HIV diagnosis remained stable by place of birth but decreased among Puerto Ricans (-13.1%; 95% CI = -17.0, -9.0). Among Hispanics/Latinos, a short HIV-to-AIDS interval was more common in non-urban areas than in urban areas. DISCUSSION: Diagnosis of HIV infection among Hispanics/Latinos decreased and HIV-to-AIDS intervals varied by place of birth and area of residence. To continue to decrease the incidence of HIV infection among Hispanics, prevention programs need to address cultural and regional differences. |
Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems and environmental change
Bunnell R , O'Neil D , Soler R , Payne R , Giles WH , Collins J , Bauer U , Communities Putting Prevention to Work Program Group . J Community Health 2012 37 (5) 1081-90 The burden of preventable chronic diseases is straining our nation's health and economy. Diseases caused by obesity and tobacco use account for the largest portions of this preventable burden. CDC funded 50 communities in 2010 to implement policy, systems, and environmental (PSE) interventions in a 2-year initiative. Funded communities developed PSE plans to reduce obesity, tobacco use, and second-hand smoke exposure for their combined 55 million residents. Community outcome objectives and milestones were categorized by PSE interventions as they related to media, access, promotion, pricing, and social support. Communities estimated population reach based on their jurisdiction's census data and target populations. The average proportion of each community's population that was reached was calculated for each intervention category. Outcome objectives that were achieved within 12 months of program initiation were identified from routine program records. The average proportion of a community's jurisdictional population reached by a specific intervention varied across interventions. Mean population reach for obesity-prevention interventions was estimated at 35%, with 14 (26%) interventions covering over 50% of the jurisdictional populations. For tobacco prevention, mean population reach was estimated at 67%, with 16 (84%) interventions covering more than 50% of the jurisdictional populations. Within 12 months, communities advanced over one-third of their obesity and tobacco-use prevention strategies. Tobacco interventions appeared to have higher potential population reach than obesity interventions within this initiative. Findings on the progress and potential reach of this major initiative may help inform future chronic disease prevention efforts. |
Typical noise exposure in daily life
Flamme GA , Stephenson MR , Deiters K , Tatro A , van Gessel D , Geda K , Wyllys K , McGregor K . Int J Audiol 2012 51 S3-S11 OBJECTIVE: Identify the distribution of typical noise levels present in daily life and identify factors associated with average sound levels. DESIGN: This was an observational study. STUDY SAMPLE: Participants (N = 286) were 20 to 68 year old men and women, drawn from the general population of Kalamazoo County, Michigan. A total of 73,000 person-hours of noise monitoring were conducted. RESULTS: Median overall daily average levels were 79 and 77 dBLeq(A,8,equiv) , with average levels exceeding EPA recommended levels for 70% of participants. Median levels were similar between the hours of 9 a.m. and 9 p.m., and varied little across days of the week. Gender, occupational classification, and history of occupational noise exposure were related to average noise levels, but age, educational attainment, and non-occupational noise exposures were not. CONCLUSIONS: A large portion of the general population is exposed to noise levels that could result in long-term adverse effects on hearing. Gender and occupation were most strongly related to exposure, though most participants in this study had occupations that are not conventionally considered noisy. |
Validity of expanded program on immunization contact method health behavior estimates in Mali
Wei SC , Vanden Eng JL , Patterson AE , Doumbia S , Kleinbaum DG , Ryman TK , Toure MB , McMorrow ML . J Infect Dis 2012 205 Suppl 1 S112-9 BACKGROUND: In the developing world, household surveys provide high-quality health behavior data integral to public health program management. The Expanded Program on Immunization Contact Method (EPI-CM) is a proposed, less resource-intensive method in which health center staff incorporate health behavior questions into routine vaccination activities. No systematic evaluation of EPI-CM validity has yet been conducted. METHODS: We used concurrent household survey and EPI-CM to collect data on 4 infant health behaviors in Mali at 2 time points (8 total comparisons). Studied health behaviors were bednet use, obtaining care for fever, obtaining care for a respiratory complaint, and using oral rehydration solution for diarrhea. Household survey and EPI-CM estimates were considered equivalent if a 95% confidence interval about the difference in estimated proportions fell within the interval (-.10, .10). RESULTS: EPI-CM estimates were higher than household survey estimates for 7 of 8 unadjusted paired estimates; estimates of bednet use in 2009 met a priori equivalence criteria in a setting of high bednet use (90.5%). When we restricted household survey data to infants up-to-date on vaccinations, estimates for behaviors other than bednet use remained substantially different. CONCLUSIONS: We were unable to demonstrate that EPI-CM, as implemented, consistently produces data comparable with household survey data. |
Active surveillance for influenza vaccine adverse events: the integrated vaccine surveillance system
Newes-Adeyi G , Greece J , Bozeman S , Walker DK , Lewis F , Gidudu J . Vaccine 2012 30 (6) 1050-5 OBJECTIVES: We conducted a pilot study of the Integrated Vaccine Surveillance System (IVSS), a novel active surveillance system for monitoring influenza vaccine adverse events that could be used in mass vaccination settings. METHODS: We recruited 605 adult vaccinees from a convenience sample of 12 influenza vaccine clinics conducted by public health departments of two U.S. metropolitan regions. Vaccinees provided daily reports on adverse reactions following immunization (AEFI) using an interactive voice response system (IVR) or the internet for 14 consecutive days following immunization. Followup with nonrespondents was conducted through computer-assisted telephone interviewing (CATI). Data on vaccinee reports were available real-time through a dedicated secure website. RESULTS: 90% (545) of vaccinees made at least one daily report and 49% (299) reported consecutively for the full 14-day period. 58% (315) used internet, 20% (110) IVR, 6% (31) CATI, and 16% (89) used a combination for daily reports. Of the 545 reporters, 339 (62%) reported one or more AEFI, for a total of 594 AEFIs reported. The majority (505 or 85%) of these AEFIs were mild symptoms. CONCLUSIONS: It is feasible to develop a system to obtain real-time data on vaccine adverse events. Vaccinees are willing to provide daily reports for a considerable time post vaccination. Offering multiple modes of reporting encourages high response rates. Study findings on AEFIs showed that the IVSS was able to exhibit the emerging safety profile of the 2008 seasonal influenza vaccine. |
Advances in surveillance of periodontitis: the Centers for Disease Control and Prevention Periodontal Disease Surveillance Project
Eke PI , Thornton-Evans G , Dye B , Genco R . J Periodontol 2012 83 (11) 1337-42 The Centers for Disease Control and Prevention (CDC) has as one of its strategic goals to support and improve surveillance of periodontal disease. In 2003, CDC initiated the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to address population-based surveillance of periodontal disease at the local, state, and national levels. This initiative has made significant advancements towards the goal of improved surveillance including developing valid self-reported measures that can be obtained from interview-based surveys to predict prevalence of periodontitis in populations. This will allow surveillance of periodontitis at the state and local levels and in countries where clinical resources for surveillance are scarce. This work has produced standard cases definitions for surveillance of periodontitis that are now widely recognized and applied in population studies and research. At the national level, this initiative has evaluated the validity of previous clinical examination protocols and tested new protocols on the National Health and Nutrition Examination Survey (NHANES), recommending and supporting funding for the gold standard full-mouth periodontal examination in NHANES 2009-2012. These examinations will generate accurate estimates of the prevalence of periodontitis in the U.S. adult population and provide a superior dataset for surveillance and research. Also this data will be used to generate the necessary coefficients for our self-report questions for use in subsets of the total U.S. population. The impact of these findings on population-based surveillance of periodontitis and future directions of the project are discussed along with plans for dissemination and translation efforts for broader public health use. |
Assessing the continuum of event-based biosurveillance through an operational lens
Corley CD , Lancaster MJ , Brigantic RT , Chung JS , Walters RA , Arthur RR , Bruckner-Lea CJ , Calapristi A , Dowling G , Hartley DM , Kennedy S , Kircher A , Klucking S , Lee EK , McKenzie T , Nelson NP , Olsen J , Pancerella C , Quitugua TN , Reed JT , Thomas CS . Biosecur Bioterror 2012 10 (1) 131-41 This research follows the Updated Guidelines for Evaluating Public Health Surveillance Systems, Recommendations from the Guidelines Working Group, published by the Centers for Disease Control and Prevention nearly a decade ago. Since then, models have been developed and complex systems have evolved with a breadth of disparate data to detect or forecast chemical, biological, and radiological events that have a significant impact on the One Health landscape. How the attributes identified in 2001 relate to the new range of event-based biosurveillance technologies is unclear. This article frames the continuum of event-based biosurveillance systems (that fuse media reports from the internet), models (ie, computational that forecast disease occurrence), and constructs (ie, descriptive analytical reports) through an operational lens (ie, aspects and attributes associated with operational considerations in the development, testing, and validation of the event-based biosurveillance methods and models and their use in an operational environment). A workshop was held in 2010 to scientifically identify, develop, and vet a set of attributes for event-based biosurveillance. Subject matter experts were invited from 7 federal government agencies and 6 different academic institutions pursuing research in biosurveillance event detection. We describe 8 attribute families for the characterization of event-based biosurveillance: event, readiness, operational aspects, geographic coverage, population coverage, input data, output, and cost. Ultimately, the analyses provide a framework from which the broad scope, complexity, and relevant issues germane to event-based biosurveillance useful in an operational environment can be characterized. |
Crowd and environmental management during mass gatherings
Johansson A , Batty M , Hayashi K , Al Bar O , Marcozzi D , Memish ZA . Lancet Infect Dis 2012 12 (2) 150-6 Crowds are a feature of large cities, occurring not only at mass gatherings but also at routine events such as the journey to work. To address extreme crowding, various computer models for crowd movement have been developed in the past decade, and we review these and show how they can be used to identify health and safety issues. State-of-the-art models that simulate the spread of epidemics operate on a population level, but the collection of fine-scale data might enable the development of models for epidemics that operate on a microscopic scale, similar to models for crowd movement. We provide an example of such simulations, showing how an individual-based crowd model can mirror aggregate susceptible-infected-recovered models that have been the main models for epidemics so far. |
Looking back at genomic medicine in 2011.
Auffray C , Caulfield T , Khoury MJ , Lupski JR , Schwab M , Veenstra T . Genome Med 2012 4 (1) 9 Genomic medicine, in its broadest sense of being medical developments informed by 'omic' advances, has continued to move towards the clinic in 2011. To mark the end of the year and the beginning of 2012, the editors of the six sections within Genome Medicine were invited to provide their highlights of the past year and to hint at the developments that we are likely to see in the near future. | Six different areas of progress are covered here, but the core of genomic medicine continues to be intrinsically linked to improvements in the underlying technology, and two obvious examples are sequencing and mass spectrometry. Technological advances have enabled larger studies and more complex analyses, allowing researchers and clinicians to track changes within a single cell and yet spot patterns across a whole population and within an entire physiological system. The foundations laid in 2011 should help the field to tackle the challenges of translating genomic medicine to the clinic in 2012. |
Estimating the contribution of genetic variants to difference in incidence of disease between population groups.
Moonesinghe R , Ioannidis JP , Flanders WD , Yang Q , Truman BI , Khoury MJ . Eur J Hum Genet 2012 20 (8) 831-6 Genome-wide association studies have identified multiple genetic susceptibility variants to several complex human diseases. However, risk-genotype frequency at loci showing robust associations might differ substantially among different populations. In this paper, we present methods to assess the contribution of genetic variants to the difference in the incidence of disease between different population groups for different scenarios. We derive expressions for the contribution of a single genetic variant, multiple genetic variants, and the contribution of the joint effect of a genetic variant and an environmental factor to the difference in the incidence of disease. The contribution of genetic variants to the difference in incidence increases with increasing difference in risk-genotype frequency, but declines with increasing difference in incidence between the two populations. The contribution of genetic variants also increases with increasing relative risk and the contribution of joint effect of genetic and environmental factors increases with increasing relative risk of the gene-environmental interaction. The contribution of genetic variants to the difference in incidence between two populations can be expressed as a function of the population attributable risks of the genetic variants in the two populations. The contribution of a group of genetic variants to the disparity in incidence of disease could change considerably by adding one more genetic variant to the group. Any estimate of genetic contribution to the disparity in incidence of disease between two populations at this stage seems to be an elusive goal. (European Journal of Human Genetics advance online publication, 15 February 2012; doi:10.1038/ejhg.2012.15.) |
A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men
Vosburgh HW , Mansergh G , Sullivan PS , Purcell DW . AIDS Behav 2012 16 (6) 1394-410 In the United States, there continues to be high incidence of HIV infection among men who have sex with men (MSM), who represent 57% of new infections in 2009. While many studies report associations between non-injection substance use and sexual risk behavior among MSM, overall results are mixed. Summarizing these studies is difficult because researchers have used a variety of assessment periods for substance use and sexual behavior. We review the scientific literature on event-level measures, which assess substance use and sexual risk behavior immediately before or during a sexual encounter and provide the most precise link between these two behaviors. From January 2009 through March 2010, we searched four databases: Ovid (MEDLINE and PsycINFO), Web of Knowledge, and Sociofile. Across studies, results varied by substance with little within substance consistency or a lack of research except for two notable exceptions: methamphetamine and binge alcohol use. The findings underscore the importance of providing HIV risk-reduction interventions for substance-using MSM. |
Sex education and adolescent sexual behavior: do community characteristics matter?
Kraft JM , Kulkarni A , Hsia J , Jamieson DJ , Warner L . Contraception 2012 86 (3) 276-80 BACKGROUND: Studies point to variation in the effects of formal sex education on sexual behavior and contraceptive use by individual and community characteristics. STUDY DESIGN: Using the 2002 National Survey of Family Growth, we explored associations between receipt of sex education and intercourse by age 15, intercourse by the time of the interview and use of effective contraception at first sex among 15-19-year-olds, stratified by quartiles of three community characteristics and adjusted for demographics. RESULTS: Across all quartiles of community characteristics, sex education reduced the odds of having sex by age 15. Sex education resulted in reduced odds of having sex by the date of the interview and increased odds of using contraception in the middle quartiles of community characteristics. CONCLUSION: Variation in the effects of sex education should be explored. Research might focus on programmatic differences by community type and programmatic needs in various types of communities. |
Trends in sunscreen use among U.S. high school students: 1999-2009
Jones SE , Saraiya M , Miyamoto J , Berkowitz Z . J Adolesc Health 2012 50 (3) 304-7 PURPOSE: To examine trends in sunscreen use during 1999-2009 among U.S. high school students. METHODS: Data from the 1999-2009 national Youth Risk Behavior Surveys were analyzed. The surveys used a three-stage cluster sample design to produce nationally representative samples of students in grades 9-12 attending public and private schools. Student participation in the survey was anonymous and voluntary. Participants completed a self-administered questionnaire during a regular class period. The overall response rates ranged from 63% to 72%. RESULTS: During 1999-2009, the percentage of white students who never or rarely wore sunscreen when outside on a sunny day for >1 hour increased (from 57.5% to 69.4%), as did the percentage among Hispanic students (from 71.6% to 77.9%). This increase was most pronounced among white female students. The percentage of white and Hispanic students who most of the time or always wore sunscreen decreased during this same period. Rates of sunscreen use did not change among black students. CONCLUSIONS: Because of declines in sunscreen use, professionals in clinical, school, and community settings should emphasize the important role sunscreen may play in preventing skin cancer. |
Effect of the expanded program on immunization contact method of data collection on health behaviors in Mali
Wei SC , Vanden Eng JL , Patterson AE , Doumbia S , Kleinbaum DG , Ryman TK , Toure MB , McMorrow ML . J Infect Dis 2012 205 Suppl 1 S103-11 BACKGROUND: The Expanded Program on Immunization Contact Method (EPI-CM) is a proposed monitoring and program management tool for developing countries. The method involves health workers tallying responses to questions about health behaviors during routine immunizations and providing targeted counseling. We evaluated whether asking caretakers about health behaviors during EPI visits led to changes in those behaviors. METHODS: We worked in 2 districts in Mali: an intervention district where during immunization visits workers asked about 4 health behaviors related to bed net use, fever, respiratory disease, and diarrhea, and a control district where workers conducted routine immunization activities without health behavior questions. To evaluate the effect of EPI-CM, we conducted a cross-sectional household survey at baseline and 1 year postintervention. We used multivariate logistic regression to compare between districts the change over 1 year in 4 health behaviors: use of insecticide-treated nets, appropriate fever treatment, care-seeking for respiratory complaints, and appropriate diarrhea treatment. RESULTS: There were no significant differences between the 2 districts in the change in the 4 health behaviors when controlling for age, sex, maternal education and occupation, immunization history, and wealth. CONCLUSIONS: We found no evidence that EPI-CM increases healthy behaviors. Further evaluation of other potential benefits and costs of EPI-CM is warranted. |
Indoor tanning device use among male high school students in the United States
Miyamoto J , Berkowitz Z , Jones SE , Saraiya M . J Adolesc Health 2012 50 (3) 308-10 PURPOSE: Indoor tanning is a risk factor for developing melanoma. Although in 2009, 6.7% of male high school students reported using an indoor tanning device, compared with 25.4% of female students (Eaton DK, Kann L, Kinchen S, et al, MMWR Surveill Summ 2010;59:1-142), it is also less well characterized in male than in female adolescents. METHODS: The associations between appearance-related and other health-related behaviors with indoor tanning device use were examined among male high school students in the United States, using the 2009 National Youth Risk Behavior Survey. RESULTS: Adjusted analysis of cross-sectional data showed that indoor tanning device use was positively associated with ever having taken steroids without a doctor's prescription, unhealthy weight control practices, binge drinking, eating fruits and vegetables five or more times per day, playing on at least one sports team, and attempted suicide. CONCLUSIONS: Understanding the relationship between indoor tanning device use and appearance-related and other health-related behaviors is useful in designing risk reduction interventions for skin cancer prevention. |
Medication-related barriers to entering HIV care
Beer L , Fagan JL , Garland P , Valverde EE , Bolden B , Brady KA , Courogen M , Hillman D , Neaigus A , Bertolli J , Never in Care Project . AIDS Patient Care STDS 2012 26 (4) 214-21 Early entry to HIV care and receipt of antiretroviral therapy improve the health of the individual and decrease the risk of transmission in the community. To increase the limited information on prospective decisions to enter care and how these decisions relate to beliefs about HIV medications, we analyzed interview data from the Never in Care Project, a multisite project conducted in Indiana, New Jersey, New York City, Philadelphia, and Washington State. From March 2008 through August 2010, we completed structured interviews with 134 persons with no evidence of HIV care entry, 48 of whom also completed qualitative interviews. Many respondents believed that HIV care entails the passive receipt of medications that may be harmful or unnecessary, resulting in reluctance to enter care. Respondents voiced concerns about prescription practices and preserving future treatment options, mistrust of medications and medical care providers, and ambivalence about the life-preserving properties of medications in light of an assumed negative impact on quality of life. Our results support the provision of information on other benefits of care (beyond medications), elicitation of concerns about medications, and assessment of psychosocial barriers to entering care. These tasks should begin at the time a positive test result is delivered and continue throughout the linkage-to-care process; for persons unwilling to enter care immediately, support should be provided in nonmedical settings. |
Feasibility of initiating and sustaining registry-based immunization recall in private practices
Dombkowski KJ , Cowan AE , Harrington LB , Allred NJ , Hudson E , Clark SJ . Acad Pediatr 2012 12 (2) 104-9 OBJECTIVE: To assess the feasibility of initiating and sustaining immunization recall by private practices, including the barriers and costs, using a statewide immunization information system (IIS). METHODS: Private practices in southeast Michigan were recruited in 2007 to perform IIS-based immunization recalls. Enrolled practices were provided with training and asked to conduct 4 recalls during the course of 12 months of children 19 to 35 months of age. Each practice recorded the time they spent performing recall-related activities; labor costs were estimated. Formative and summative evaluations with semistructured interviews were conducted to identify barriers. RESULTS: Of 97 eligible pediatric and family medicine practices, 44 declined to participate, 32 did not respond to repeated contacts, and 20 agreed to enroll in the study (21%). A total of 56 recalls were conducted during the study period, with 9 practices completing at least 4 recalls and 7 practices completing 1 to 3 recalls; 4 practices conducted no recalls. Common barriers reported included time constraints and executing all steps of the recalls. Practice costs per patient recalled ranged from $0.05 to more than $6 and were primarily driven by the type of personnel who performed recalls. The costs of creating a roster of current patients comprised nearly one-half of total labor costs. CONCLUSIONS: Few private provider practices that we contacted were willing to participate in this study of IIS-based recall, and less than one-half of enrolled practices completed the desired 4 recall cycles in 12 months. Time constraints and other real-world problems should not be underestimated in determining the feasibility of practice-based immunization recall. Efforts to increase the use of a statewide IIS for recall in private practice settings should emphasize ongoing training and technical support to practice staff. Improved interoperability with electronic health record systems may foster practice-based recall by reducing the labor intensity of roster building and other recall activities. |
Contribution of Immunization Weeks toward improving coverage, access to services, and completion of recommended childhood vaccinations in Assam, India
Ryman TK , Trakroo A , Ekka JB , Watkins M . Vaccine 2012 30 (15) 2551-5 Recommended childhood vaccines have typically been provided through routine immunization programs. Recently, implementation of strategies that use campaign-like features for providing all the recommended childhood immunizations have been utilized to increase vaccination coverage. Between January 2006 and January 2008, Assam, India, conducted Immunization Weeks (IWs), a periodic campaign-like approach for providing the recommended childhood vaccines generally administered through the routine Universal Immunization Program (UIP). Using data from a household vaccination coverage survey conducted in 5 districts of Assam in late-2007/early-2008 among children 12-28 months of age, a secondary analysis was conducted for a subset of children with vaccination cards to assess the impacts of implementing the IW-strategy. Sixty-five percent of the 3310 surveyed children received at least one vaccine dose through an IW. Without IWs, coverage would likely have been lower for all vaccines (e.g., 75% measles vaccine coverage including IWs doses and an estimated 61% without IWs). The proportion of children receiving at least one IW dose was significantly different depending on the child's residence; 72% in hard-to-reach char areas, 66% in rural areas and 53% in urban areas (p=0.01). Overall, 2085 (63%) of children were fully vaccinated; of these 60% received a combination of IW and UIP doses, 35% received doses only through the UIP, and 5% received doses only through IWs. A delay in administration later than the recommended ages was found for both UIP doses and for IW doses (e.g., for measles vaccine, UIP doses were 6.9 weeks delayed and IW doses 13.6 weeks delayed). Among this sample of vaccinated children, IWs appeared to increase vaccination coverage and improve access to services in hard-to-reach areas. However, the UIP appeared to be a better system for ensuring that children received all doses in the recommended vaccination series. |
Are the perpetrators of violence one and the same? Exploring the co-occurrence of perpetration of physical aggression in the United States
Klevens J , Simon TR , Chen J . J Interpers Violence 2012 27 (10) 1987-2002 Important gaps exist in our understanding of aggressive behavior and the extent to which aggression involves one or more types of victims. This information is critical for determining the utility of integrated approaches for violence prevention versus continuation of independent efforts for reducing community violence, partner violence, and child maltreatment. To better understand the overlap in aggressive behaviors within the general population, the authors examine the co-occurrence of self-reports of physically striking strangers, acquaintances, intimate partners, and children among a nationally representative sample of 3,024 U.S. adults. The findings from this cross-sectional random digit dial telephone survey show that more than a third of the population reports engaging in at least one form of aggression and that, of these, a third had perpetrated violence against more than one type of victim. The percent of respondents who reported perpetrating violence against more than one type of victim range from 13% (percent of those striking a friend or acquaintance who also struck a child) to 34% (percent of those striking a friend or acquaintance who also struck a stranger). Furthermore, engaging in one type of aggression substantially increases the odds of engaging in another from 1.5 to 4 times. The findings suggest potential value in pursuing both integrated and independent approaches in research and prevention. |
Characteristics of non-fatal abusive head trauma among children in the USA, 2003-2008: application of the CDC operational case definition to national hospital inpatient data
Parks S , Sugerman D , Xu L , Coronado V . Inj Prev 2012 18 (6) 392-8 OBJECTIVE: An International Classification of Diseases code-based case definition for non-fatal abusive head trauma (AHT) in children <5 years of age was developed in March 2008 by an expert panel convened at the Centers for Disease Control and Prevention (CDC). This study presents an application of the CDC recommended operational case definition of AHT to US hospital inpatient data to characterise the AHT hospitalisation rate for children <5 years of age. METHODS: Nationwide Inpatient Sample (NIS) data from the Healthcare Cost and Utilisation Project from 2003 to 2008 were examined. RESULTS: Inspection of the NIS data resulted in the identification of an estimated 10,555 non-fatal AHT hospitalisations with 9595 classified as definite/presumptive AHT and 960 classified as probable AHT. The non-fatal AHT rate was highest among children aged <1 year (32.2 per 100,000) with a peak in hospitalisations between 2 and 4 months of age. Non-fatal AHT hospitalisation rates for children <2 years of age were higher for boys (21.9 per 100,000) than girls (15.3 per 100,000). The non-fatal AHT hospitalisation rate showed little variation across seasons. CONCLUSIONS: To reduce the burden of AHT in the USA, a preventable public health problem, concerted prevention efforts targeting populations at risk should be implemented. This report demonstrates a model procedure for using the new CDC definition for public health surveillance and research purposes. Such findings can be used to inform parents and providers about AHT (eg, dangers of shaking, strategies for managing infant crying) as well as to monitor better the impact of prevention strategies over time. |
Trimethyltin-induced neurotoxicity: gene expression pathway analysis, q-RT-PCR and immunoblotting reveal early effects associated with hippocampal damage and gliosis.
Little AR , Miller DB , Li S , Kashon ML , O'Callaghan JP . Neurotoxicol Teratol 2012 34 (1) 72-82 Damage to the CNS results in a complex series of molecular and cellular changes involving the affected targets and the ensuing glial reaction. The initial gene expression events that underlie these cellular responses may serve as early biomarkers of neurotoxicity. Here, we examined gene expression profiles during the initial phase of hippocampal damage resulting from systemic exposure of rats to the organometallic neurotoxicant, trimethyltin (TMT, 8.0mg/kg, i.p.). Using TMT as a neurodegeneration tool confers several advantages for evaluating molecular events associated with neural damage: 1) regional and cellular targets and time course of damage are known, 2) the blood-brain barrier is not compromised, which limits the contribution of blood-borne factors, e.g. immune, to neural injury responses and 3) known protein and mRNA signatures of TMT-induced neurotoxicity can be used as positive controls to validate novel expression events associated with exposure to this neurotoxicant. Using Affymetrix Gene Chip(R) to assess gene expression after TMT, combined with Ingenuity Pathway Analysis(R), we observed changes consistent for genes known to be affected in hippocampus, while corresponding changes were not detected in cerebellum, a non-target region. In agreement with previous observations, limited changes in expression of inflammation-related genes were observed. Correlated expression profiles were found after exposure to TMT, including changes in gene ontologies associated with neurological disease, cellular assembly and maintenance, as well as signaling pathways associated with cellular stress, energy metabolism and glial activation. Selected gene changes were confirmed from each category by q-RT-PCR and immunoblot analysis. The canonical relationships identified implicate molecular pathways and processes relevant to detection of early stages of hippocampal damage in the TMT model. These observations provide new insight into early events associated with neuronal degeneration and associated glial activation that may serve as the basis for discovery and development of biomarkers of neurotoxicity. |
Use of denuder/filter apparatus to investigate terpene ozonolysis
Wells JR . J Environ Monit 2012 14 (3) 1044-54 A denuder/filter apparatus was used to collect the gaseous and particulate reaction products from ozonlysis of alpha-pinene, limonene and alpha-terpineol in an effort to develop sampling techniques for characterizing indoor environment chemistry. Carboxylic acids found in the particulate phase were derivatized to 2,2,2-trifuoroethylamides by reaction with 3-ethyl-1-[3-(dimethylamino)propyl]carbodiimide hydrochloride (EDC) and 2,2,2-trifluoroethylamine hydrochloride (TFEA). Carbonyl compounds collected in both gas phase and particulate phase were derivatized to their respective oximes by reaction with O-(2,3,4,5,6-pentafluoro-benzyl)hydroxylamine hydrochloride (PFBHA). The ozonolysis of alpha-pinene yielded the carboxylic acids: cis-pinonic acid and pinic acid and the proposed carboxylic acids methanetricarboxylic acid and terpenylic acid; the carbonyls: 4-oxopentanal, norpinonaldehyde, pinon aldehyde and the proposed carbonyl methylidenepropanedial. The ozonolysis of limonene yielded the carboxylic acids: limonic acid and pinic acid and the carbonyls: 1-(4-methylcyclohex-3-en-1-yl)ethanone (4AMCH), glyoxal, methyl glyoxal, 4-oxopentanal and 6-oxo-3-(prop-1-en-2-yl)heptanal (IPOH). The ozonolysis of alpha-terpineol yielded the proposed carboxylic acids: terpenylic acid and homoterpenylic acid and the carbonyls: (5E)-6-hydroxyhept-5-en-2-one, methyl glyoxal and 4-oxopentanal. |
Validation of evacuated canisters for sampling volatile organic compounds in healthcare settings
Lebouf RF , Stefaniak AB , Virji MA . J Environ Monit 2012 14 (3) 977-83 Healthcare settings present a challenging environment for assessing low-level concentrations of specific volatile organic compounds (VOCs) in the presence of high background concentrations of alcohol from the use of hand sanitizers and surface disinfectants. The purposes of this laboratory-based project were to develop and validate a sampling and analysis methodology for quantifying low-level VOC concentrations as well as high-level alcohol concentrations found together in healthcare settings. Sampling was conducted using evacuated canisters lined with fused silica. Gas chromatography/mass spectrometry analysis was performed using preconcentration (for ppb levels) and loop injection (for ppm levels). For a select list of 14 VOCs, bias, precision, and accuracy of both the preconcentration and loop injection methods were evaluated, as was analyte stability in evacuated canisters over 30 days. Using the preconcentration (ppb-level) method, all validation criteria were met for 13 of the 14 target analytes-ethanol, acetone, methylene chloride, hexane, chloroform, benzene, methyl methacrylate, toluene, ethylbenzene, m,p-xylene, o-xylene, alpha-pinene, and limonene. Using the loop injection (ppm-level) method, all validation criteria were met for each analyte. At ppm levels, alpha-pinene and limonene remained stable over 21 days, while the rest of the analytes were stable for 30 days. All analytes remained stable over 30 days at ppb levels. This sampling and analysis approach is a viable (i.e., accurate and stable) methodology that will enable development of VOC profiles for mixed exposures experienced by healthcare workers. |
Mechanical impedances distributed at the fingers and palm of the human hand in three orthogonal directions
Dong RG , Welcome DE , Xu XS , Warren C , McDowell TW , Wu JZ , Rakheja S . J Sound Vib 2012 331 (5) 1191-1206 The objective of this study is to investigate the basic characteristics of the three axis mechanical impedances distributed at the fingers and palm of the hand subjected to vibrations along three orthogonal directions (x(h), y(h), and z(h)). Seven subjects participated in the experiment on a novel three-dimensional (3-D) hand-arm vibration test system equipped with a 3-0 instrumented handle. The total impedance of the entire hand-arm system was obtained by performing a sum of the distributed impedances. Two major resonances were observed in the impedance data in each direction. For the hand forces (30 N grip and 50 N push) and body postures applied in this study, the first resonance was in the range of 20-40 Hz, and it was primarily observed in the impedance at the palm. The second resonance was generally observed in the impedance at the fingers, while the resonance frequency varied greatly with the subject and vibration direction, ranging from 100 to 200 Hz in the x(h) direction, 60 to 120 Hz in the y(h) direction, and 160 to 300 Hz in the z(h) direction. The impedance at the palm was greater than that at the fingers below a certain frequency in the range of 50100 Hz, depending on the vibration direction. At higher frequencies, however, the impedance magnitude at the fingers either approached or exceeded that at the palm. The impedance in the z(h) direction was generally higher than those in the other directions, but it became comparable with that in the x(h) direction at frequencies above 250 Hz, while the impedance in the y(h) direction was the lowest. The frequency dependencies of the vibration power absorptions for the entire hand-arm system in the three directions were different, but their basic trends were similar to that of the frequency weighting defined in the current ISO standard. The implications of the results are discussed. (Published by Elsevier Ltd.) |
Effect of chemokine receptor CX3CR1 deficiency in a murine model of respiratory syncytial virus infection
Johnson CH , Miao C , Blanchard EG , Caidi H , Radu GU , Harcourt JL , Haynes LM . Comp Med 2012 62 (1) 14-20 Respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory illness in infants and young children worldwide, making it a high priority for development of strategies for prevention and treatment. RSV can cause repeat infections throughout life, with serious complications in elderly and immunocompromised patients. Previous studies indicate that the RSV G protein binds through a CX3C chemokine motif to the host chemokine receptor, CX3CR1, and modulates the inflammatory immune response. In the current study, we examined the contribution of CX3CR1 to the immune response to RSV infection in mice. CX3CR1-deficient mice showed an impaired innate immune response to RSV infection, characterized by substantially decreased NK1.1(+) natural killer, CD11b(+), and RB6-8C5(+) polymorphonuclear cell trafficking to the lung and reduced IFNgamma production compared with those in wildtype control mice. Leukocytes from CX3CR1-deficient mice were poorly chemotactic toward RSV G protein and CX3CL1. These results substantiate the importance of the RSV G CX3C-CX3CR1 interaction in the innate immune response to RSV infection. |
Experimental flammability limits and associated theoretical flame temperatures as a tool for predicting the temperature dependence of these limits
Zlochower IA . J Loss Prev Process Ind 2012 25 (3) 555-560 The utility and limitations of adiabatic flame temperature calculations and minimum mixture energies in predicting the temperature dependence of flammability limits are explored. The limiting flame temperatures at constant pressure (1 bar) are calculated using a standard widely-used thermodynamic computer program. The computation is based on the calculated limiting flame temperature value at the reference initial temperature and the experimental limit concentration. The values recently determined in large chambers for the lower and upper flammability limits of a variety of simple organic and inorganic gases (methane, ethylene, dimethy lether, and carbon monoxide) are used as the basis for the predictions of the limiting flame temperature concept. Such thermodynamic calculations are compared with more traditional ones based on a limiting mixture energy and a constant average heat capacity of the reactant mixture. The advantages and limitations of the methods are discussed in this paper. |
Characterization of Nipah virus from outbreaks in Bangladesh, 2008-2010
Lo MK , Lowe L , Hummel KB , Sazzad HM , Gurley ES , Hossain MJ , Luby SP , Miller DM , Comer JA , Rollin PE , Bellini WJ , Rota PA . Emerg Infect Dis 2012 18 (2) 248-55 Nipah virus (NiV) is a highly pathogenic paramyxovirus that causes fatal encephalitis in humans. The initial outbreak of NiV infection occurred in Malaysia and Singapore in 1998-1999; relatively small, sporadic outbreaks among humans have occurred in Bangladesh since 2001. We characterized the complete genomic sequences of identical NiV isolates from 2 patients in 2008 and partial genomic sequences of throat swab samples from 3 patients in 2010, all from Bangladesh. All sequences from patients in Bangladesh comprised a distinct genetic group. However, the detection of 3 genetically distinct sequences from patients in the districts of Faridpur and Gopalganj indicated multiple co-circulating lineages in a localized region over a short time (January-March 2010). Sequence comparisons between the open reading frames of all available NiV genes led us to propose a standardized protocol for genotyping NiV; this protcol provides a simple and accurate way to classify current and future NiV sequences. |
The streptococcal collagen-like protein-1 (Scl1) is a significant determinant for biofilm formation by group A Streptococcus
Oliver-Kozup HA , Elliott M , Bachert BA , Martin KH , Reid SD , Schwegler-Berry DE , Green BJ , Lukomski S . BMC Microbiol 2011 11 262 BACKGROUND: Group A Streptococcus (GAS) is a human-specific pathogen responsible for a number of diseases characterized by a wide range of clinical manifestations. During host colonization GAS-cell aggregates or microcolonies are observed in tissues. GAS biofilm, which is an in vitro equivalent of tissue microcolony, has only recently been studied and little is known about the specific surface determinants that aid biofilm formation. In this study, we demonstrate that surface-associated streptococcal collagen-like protein-1 (Scl1) plays an important role in GAS biofilm formation. RESULTS: Biofilm formation by M1-, M3-, M28-, and M41-type GAS strains, representing an intraspecies breadth, were analyzed spectrophotometrically following crystal violet staining, and characterized using confocal and field emission scanning electron microscopy. The M41-type strain formed the most robust biofilm under static conditions, followed by M28- and M1-type strains, while the M3-type strains analyzed here did not form biofilm under the same experimental conditions. Differences in architecture and cell-surface morphology were observed in biofilms formed by the M1- and M41-wild-type strains, accompanied by varying amounts of deposited extracellular matrix and differences in cell-to-cell junctions within each biofilm. Importantly, all Scl1-negative mutants examined showed significantly decreased ability to form biofilm in vitro. Furthermore, the Scl1 protein expressed on the surface of a heterologous host, Lactococcus lactis, was sufficient to induce biofilm formation by this organism. CONCLUSIONS: Overall, this work (i) identifies variations in biofilm formation capacity among pathogenically different GAS strains, (ii) identifies GAS surface properties that may aid in biofilm stability and, (iii) establishes that the Scl1 surface protein is an important determinant of GAS biofilm, which is sufficient to enable biofilm formation in the heterologous host Lactococcus. In summary, the GAS surface adhesin Scl1 may have an important role in biofilm-associated pathogenicity. |
Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions
Bateman BT , Bansil P , Hernandez-Diaz S , Mhyre JM , Callaghan WM , Kuklina EV . Am J Obstet Gynecol 2012 206 (2) 134 e1-8 OBJECTIVE: We sought to define the prevalence, trends, and outcomes of primary and secondary chronic hypertension in a population-based sample of deliveries. STUDY DESIGN: An estimated 56,494,634 deliveries were identified from the 1995 through 2008 Nationwide Inpatient Sample. The association of primary and secondary chronic hypertension with adverse fetal and maternal outcomes was evaluated using regression modeling and adjusted population-attributable fractions were calculated. RESULTS: During the study period, the prevalence of primary and secondary hypertension increased from 0.90% in 1995 through 1996 to 1.52% in 2007 through 2008 (P for trend < .001) and from 0.07% to 0.24% (P for trend < .001), respectively. The population-attributable fraction for chronic hypertension was considerable for many maternal adverse outcomes, including acute renal failure (21%), pulmonary edema (14%), preeclampsia (11%), and in-hospital mortality (10%). CONCLUSION: Primary and secondary chronic hypertension were both strongly associated with adverse pregnancy outcomes and accounted for a substantial fraction of maternal morbidity. Prioritizing research efforts in this area is needed. |
Economic evaluation of a Child Health Days strategy to deliver multiple maternal and child health interventions in Somalia
Vijayaraghavan M , Wallace A , Mirza IR , Kamadjeu R , Nandy R , Durry E , Everard M . J Infect Dis 2012 205 Suppl 1 S134-40 INTRODUCTION: Child Health Days (CHDs) are increasingly used by countries to periodically deliver multiple maternal and child health interventions as time-limited events, particularly to populations not reached by routine health services. In countries with a weak health infrastructure, this strategy could be used to reach many underserved populations with an integrated package of services. In this study, we estimate the incremental costs, impact, cost-effectiveness, and return on investment of 2 rounds of CHDs that were conducted in Somalia in 2009 and 2010. METHODS: We use program costs and population estimates reported by the World Health Organization and United Nations Children's Fund to estimate the average cost per beneficiary for each of 9 interventions delivered during 2 rounds of CHDs implemented during the periods of December 2008 to May 2009 and August 2009 to April 2010. Because unstable areas were unreachable, we calculated costs for targeted and accessible beneficiaries. We model the impact of the CHDs on child mortality using the Lives Saved Tool, convert these estimates of mortality reduction to life years saved, and derive the cost-effectiveness ratio and the return on investment. RESULTS: The estimated average incremental cost per intervention for each targeted beneficiary was $0.63, with the cost increasing to $0.77 per accessible beneficiary. The CHDs were estimated to save the lives of at least 10,000 or 500,000 life years for both rounds combined. The CHDs were cost-effective at $34.00/life year saved. For every $1 million invested in the strategy, an estimated 615 children's lives, or 29,500 life years, were saved. If the pentavalent vaccine had been delivered during the CHDs instead of diphtheria-pertussis-tetanus vaccine, an additional 5000 children's lives could have been saved. CONCLUSIONS: Despite high operational costs, CHDs are a very cost-effective service delivery strategy for addressing the leading causes of child mortality in a conflict setting like Somalia and compare favorably with other interventions rated as health sector "best buys" in sub-Saharan Africa. |
Experiences integrating delivery of maternal and child health services with childhood immunization programs: systematic review update
Wallace AS , Ryman TK , Dietz V . J Infect Dis 2012 205 Suppl 1 S6-S19 BACKGROUND: The World Health Organization and the United Nations Children's Fund promote integration of maternal and child health (MCH) and immunization services as a strategy to strengthen immunization programs. We updated our previous review of integrated programs and reviewed reports of integration of MCH services with immunization programs at the service delivery level. METHODS: Published and unpublished reports of interventions integrating MCH and immunization service delivery were reviewed by searching journal databases and Web sites and by contacting organizations. RESULTS: Among 27 integrated activities, interventions included hearing screening, human immunodeficiency virus services, vitamin A supplementation, deworming tablet administration, malaria treatment, bednet distribution, family planning, growth monitoring, and health education. When reported, linked intervention coverage increased, though not to the level of the corresponding immunization coverage in all cases. Logistical difficulties, time-intensive interventions ill suited for campaign delivery, concern for harming existing services, inadequate overlap of target age groups, and low immunization coverage were identified as challenges. CONCLUSIONS: Results of this review reinforce our 2005 review findings, including importance of intervention compatibility and focus on immunization program strength. Ensuring proper planning and awareness of compatibility of service delivery requirements were found to be important. The review revealed gaps in information about costs, comparison to vertical delivery, and impact on all integrated interventions that future studies should aim to address. |
Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: the PEARL Study
Ekouevi DK , Stringer E , Coetzee D , Tih P , Creek T , Stinson K , Westfall AO , Welty T , Chintu N , Chi BH , Wilfert C , Shaffer N , Stringer J , Dabis F . PLoS One 2012 7 (1) e29823 BACKGROUND: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Cote d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant. CONCLUSIONS/RESULTS: We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage. |
Human teratogens update 2011: Can we ensure safety during pregnancy?
Rasmussen SA . Birth Defects Res A Clin Mol Teratol 2012 94 (3) 123-8 Anniversaries of the identification of three human teratogens (i.e., rubella virus in 1941, thalidomide in 1961, and diethylstilbestrol in 1971) occurred in 2011. These experiences highlight the critical role that scientists with an interest in teratology play in the identification of teratogenic exposures as the basis for developing strategies for prevention of those exposures and the adverse outcomes associated with them. However, an equally important responsibility for teratologists is to evaluate whether medications and vaccines are safe for use during pregnancy so informed decisions about disease treatment and prevention during pregnancy can be made. Several recent studies have examined the safety of medications during pregnancy, including antiviral medications used to treat herpes simplex and zoster, proton pump inhibitors used to treat gastroesophageal reflux, and newer-generation antiepileptic medications used to treat seizures and other conditions. Despite the large numbers of pregnant women included in these studies and the relatively reassuring results, the question of whether these medications are teratogens remains. In addition, certain vaccines are recommended during pregnancy to prevent infections in mothers and infants, but clinical trials to test these vaccines typically exclude pregnant women; thus, evaluation of their safety depends on observational studies. For pregnant women to receive optimal care, we need to define the data needed to determine whether a medication or vaccine is "safe" for use during pregnancy. In the absence of adequate, well-controlled data, it will often be necessary to weigh the benefits of medications or vaccines with potential risks to the embryo or fetus. (Birth Defects Research (Part A), 2012. (c) Published 2012 Wiley Periodicals, Inc.) |
Community and health worker perceptions and preferences regarding integration of other health services with routine vaccinations: four case studies
Ryman TK , Wallace A , Mihigo R , Richards P , Schlanger K , Cappelier K , Ndiaye S , Modjirom N , Tounkara B , Grant G , Anya B , Kiawi EC , Ochieng C , Kone S , Tesfaye H , Trayner N , Watkins M , Luman ET . J Infect Dis 2012 205 Suppl 1 S49-55 BACKGROUND: Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration. METHODS: Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon). RESULTS: Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times). CONCLUSIONS: Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services. |
Childhood obesity: are we all speaking the same language?
Flegal KM , Ogden CL . Adv Nutr 2011 2 (2) 159S-66S Terminology and measures used in studies of weight and adiposity in children can be complex and confusing. Differences arise in metrics, terminology, reference values, and reference levels. Most studies depend on body mass index (BMI) calculated from weight and height, rather than on more direct measures of body fatness. Definitions of overweight and obesity are generally statistical rather than risk-based and use a variety of different reference data sets for BMI. As a result, different definitions often do not give the same results. A basic problem is the lack of strong evidence for any one particular definition. Rather than formulate the question as being one of how to define obesity, it might be useful to consider what BMI cut-points best predict future health risks and how efficiently to screen for such risks. The answers may be different for different populations. In addition, rather than depending solely on BMI to make screening decisions, it is likely to be useful to also consider other factors, including not only race-ethnicity, sex and age, but also factors such as family history. Despite their limitations, BMI-based definitions of overweight and obesity provide working practical definitions that are valuable for general public health surveillance and screening. |
Pesticide concentrations in vacuum dust from farm homes: variation between planting and nonplanting seasons
Golla V , Curwin B , Sanderson W , Nishioka M . ISRN Public Health 2012 2012 1-10 The hazards of chronic low-level pesticide exposures inside homes have received little attention. Research to date does not provide answers regarding the long-term potential bioavailability of pesticides in homes and its risk factors. The purpose of this study was to investigate pesticide levels in Iowa homes during one year and assess the relationship between exposure levels and potential sources of pesticide contamination. The study involved sampling surveys of the target pesticide atrazine among 32 farm families in a three-county area of Iowa during the planting season (April–June) and nonplanting season (November-December). Dust samples were collected, and information gathered through questionnaires to evaluate pesticide migration inside homes. This study found that dust in every farm home surveyed was contaminated with atrazine during both seasons and these concentrations significantly decreased by the nonplanting season. Pesticide amounts, acreage, and spraying time determined the presence and persistence of this herbicide inside farm homes. |
Effects of handle size and shape on measured grip strength
McDowell TW , Wimer BM , Welcome DE , Warren C , Dong RG . Int J Ind Ergon 2012 42 (2) 199-205 The Jamar handle dynamometer is the most commonly used instrument for measuring grip strength. However, the grip strength applied on a cylindrical handle may not exhibit the same handle size relationship as that observed with the Jamar handle. Direct comparison studies are required to clearly identify the major differences between the two dynamometer styles. This study utilized a recent grip dynamometer design along with the Jamar dynamometer to further examine these relationships. The objective of this study was to compare how changes in grip size affects grip strength measured with each dynamometer style. Results confirm that handle size significantly affects the applied grip strength measured with both types of grip dynamometer. The handle size effect is more pronounced with the Jamar handle, especially at the small handle diameter/span. The highest grip force components observed with the cylindrical handles were found at the fingertips. The Jamar grip dynamometer may not adequately reflect the fingertip forces at the low and middle spans because the fingertips are not applied in the force measurement plane of the Jamar handle. Therefore, the Jamar dynamometer may not adequately capture changes in the fingertip forces under different grip spans. Relevance to Industry: It is important to properly characterize grip strength used in occupational settings in order to optimize tool and machine handle designs. The Jamar dynamometer may not be appropriate for assessing cylindrical or near-cylindrical handles that are found on the majority of tools and machines. The grip strength measured with the cylindrical dynamometer used in this study can be used to help optimize handle designs. |
Evaluating vehicle fire training inhalation hazards
Fent KW , Evans DE , Niemeier MT . Fire Eng 2012 165 (2) 63-68 The National Institute for Occupational Safety and Health (NIOSH) received a health hazard evaluation (HHE) request from an Ohio township fire and rescue department concerning potential inhalation exposures during vehicle fire suppression training. Although vehicle fires can be suppressed quickly, they can release hundreds of toxic chemicals into the air, which could cause short- and even long-term health effects over a firefighter's career. Even after a fire is extinguished, the off-gassing of potentially harmful chemicals and particles may continue because of thermal decomposition. Some of the chemicals released from vehicle fires are likely to be different from those released during structural fires because vehicles contain materials such as rubber (belts, tires), petrochemicals (oil, gasoline), and acids (batteries). |
A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization
Amick BC3rd , Menendez CC , Bazzani L , Robertson M , DeRango K , Rooney T , Moore A . Appl Ergon 2012 43 (3) 625-631 OBJECTIVE: Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions. METHODS: Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses. RESULTS: The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention. CONCLUSION: Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms. |
Absence of consequential changes in physiological, thermal and subjective responses from wearing a surgical mask
Roberge RJ , Kim JH , Benson SM . Respir Physiol Neurobiol 2012 181 (1) 29-35 Twenty subjects treadmill exercised at 5.6km/h for 1h with and without wearing a surgical mask while being monitored for heart rate, respiratory rate, oxygen saturation, transcutaneous CO(2), SpO(2), core and skin temperatures, mask deadspace heat and relative humidity, and skin temperature under the mask. Rating scales were utilized for exertion and heat perceptions. Surgical mask use resulted in increases in heart rate (9.5beats/min; p<0.001), respiratory rate (1.6breaths/min; p=0.02), and transcutaneous carbon dioxide (2.17mmHg; p=0.0006), and decreased temperature of uncovered facial skin (0.40 degrees C; p=0.03). The 1.76 degrees C increase in temperature of the skin covered by the mask was associated with a mask deadspace apparent heat index of 52.9 degrees C. Perceptions of heat were neutral to slightly hot, and for exertion ranged from very, very light to fairly light. Surgical mask use for 1h at a low-moderate work rate is not associated with clinically significant physiological impact or significant subjective perceptions of exertion or heat. |
Awarding and promoting excellence in hearing loss prevention
Meinke DK , Morata TC . Int J Audiol 2012 51 S63-70 OBJECTIVE: To describe the rationale and creation of a national award to recognize and promote hearing loss prevention. DESIGN: In 2007, the National Institute for Occupational Safety and Health partnered with the National Hearing Conservation Association to create the Safe-in-Sound Excellence in Hearing Loss Prevention Award ( www.safeinsound.us ). The objectives of this initiative were to recognize organizations that document measurable achievements and to share leading edge information to a broader community. RESULTS: An expert committee developed specific and explicit award evaluation criteria of excellence in hearing loss prevention for organizations in different industrial sectors. The general approach toward award criteria was to incorporate current 'best practices' and familiar benchmarks of hearing loss prevention programs. This approach was reviewed publicly. In addition, mechanisms were identified to measure the impact of the award itself. Interest in the award was recorded through the monitoring of the visitor traffic registered by the award web site and is increasing yearly. Specific values and strategies common across award winners are presented. CONCLUSION: The Safe-in-Sound Award has obtained high quality field data; identified practical solutions, disseminated successful strategies to minimize the risk of hearing loss, generated new partnerships, and shared practical solutions with others in the field. |
Occupational exposure assessment in carbon nanotube and nanofiber primary and secondary manufacturers
Dahm MM , Evans DE , Schubauer-Berigan MK , Birch ME , Fernback JE . Ann Occup Hyg 2011 56 (5) 542-56 RESEARCH SIGNIFICANCE: Toxicological evidence suggests the potential for a wide range of health effects, which could result from exposure to carbon nanotubes (CNTs) and carbon nanofibers (CNFs). The National Institute for Occupational Safety and Health (NIOSH) has proposed a recommended exposure limit (REL) for CNTs/CNFs at the respirable size fraction. The current literature is lacking exposure information, with few studies reporting results for personal breathing zone (PBZ) samples in occupational settings. To address this gap, exposure assessments were conducted at six representative sites identified as CNT/CNF primary or secondary manufacturers. METHODS: Personal and area filter-based samples were collected for both the inhalable mass concentration and the respirable mass concentration of elemental carbon (EC) as well as CNT structure count analysis by transmission electron microscopy to assess exposures. When possible, full-shift PBZ samples were collected; area samples were collected on a task-based approach. RESULTS: The vast majority of samples collected in this study were below the proposed REL (7 mcg m(-3)). Two of the three secondary manufacturers' surveyed found concentrations above the proposed REL. None of the samples collected at primary manufacturers were found to be above the REL. Visual and microscopy-based evidence of CNTs/CNFs were found at all sites, with the highest CNT/CNF structure counts being found in samples collected at secondary manufacturing sites. The statistical correlations between the filter-based samples for the mass concentration of EC and CNT structure counts were examined. A general trend was found with a P-value of 0.01 and a corresponding Pearson correlation coefficient of 0.44. CONCLUSIONS: CNT/CNF concentrations were above the proposed NIOSH REL for PBZ samples in two secondary manufacturing facilities that use these materials for commercial applications. These samples were collected during dry powder handling processes, such as mixing and weighing, using fairly large quantities of CNTs/CNFs. |
The effects of schistosomiasis on HIV/AIDS infection, progression and transmission
Secor WE . Curr Opin HIV AIDS 2012 7 (3) 254-9 PURPOSE OF REVIEW: The recent findings pertaining to the public health impact of schistosomiasis on the epidemiology of HIV/AIDS are summarized. RECENT FINDINGS: Both empiric data and mathematical models support the hypothesis that schistosome infections lead to increased susceptibility to infection with HIV-1, a more rapid progression to disease through more vigorous viral replication and immunosuppression, and a higher likelihood of transmitting the infection to others through both vertical and horizontal routes. Different species of schistosome infection vary in the magnitude of their effects on these mechanisms with Schistosoma haematobium playing a greater role for increased susceptibility and transmission because of its association with urogenital disease. SUMMARY: Schistosomiasis appears to be a cofactor in the spread and progression of HIV/AIDS in areas wherein both diseases are endemic; increased emphasis on treatment of schistosome infections in persons at risk of HIV/AIDS should be pursued. |
Strengthening evidence-based planning of integrated health service delivery through local measures of health intervention delivery times
Wallace A , Ryman T , Mihigo R , Ndoutabe M , Tounkara B , Grant G , Anya B , Kiawi EC , Kone S , Tesfaye H , Trayner N , Luman ET . J Infect Dis 2012 205 Suppl 1 S40-8 BACKGROUND: Immunization services in developing countries are increasingly used as platforms for delivery of other health interventions. A challenge for scaling up interventions on existing platforms is insufficient resources allocated to the integrated platform with the risk of overburdening a health worker. Determining the length of time to deliver priority interventions can be useful information in planning integrated services and mitigating this risk. We designed and tested a methodology for collecting the time needed to deliver selected interventions. METHODOLOGY: At 18 health facilities in Mali, Ethiopia, and Cameroon, we observed delivery of 11 maternal and child health interventions to determine delivery times. We interviewed health workers to estimate self-reported delivery times. RESULTS: Based on observations, vitamin A supplementation (median, 2:00 minutes per child) and vaccinations (median, 2:22 minutes) took the least amount of time to deliver, whereas human immunodeficiency virus counseling and testing and sick infant treatment interventions were among the longest to deliver. Health worker-reported times to deliver interventions were consistently higher than observed times. CONCLUSIONS: Using locally-obtained data can be useful to step for planners to determine how best to use existing platforms for delivering new interventions, particularly since these interventions may require substantially more time to deliver compared to immunizations. |
Association between depressed mood and perceived weight in middle and high school age students: Texas 2004-2005
Schiefelbein EL , Mirchandani GG , George GC , Becker EA , Castrucci BC , Hoelscher DM . Matern Child Health J 2012 16 (1) 169-76 Research exploring the relationship between weight perception and depressed mood among adolescents is limited in the United States. The purpose of this study is to examine the association of perceived versus actual body weight and depressed mood in a representative sample of 8th and 11th grade public school students in Texas. Using data from the 2004-2005 School Physical Activity and Nutrition (SPAN) study, logistic regression analyses were conducted to assess the association of weight perception with depressed mood. Healthy weight students who perceived themselves to be a healthy weight were the reference group for all analyses. A high prevalence of misperception of body weight was observed. Overweight and obese 8th grade girls and boys who perceived themselves to be overweight had increased odds of depressed mood [Girls: OR 1.70 (95% CI: 1.07-2.69), Boys: OR 2.05 (95% CI: 1.16-3.62)]. Healthy weight 8th grade girls who perceived themselves to be overweight had 2.5 times greater odds of depressed mood (OR 2.63, 95% CI: 1.54-4.50). Healthy weight boys who perceived themselves to be underweight had more than twice the odds (OR 2.18, 95% CI: 1.23-3.89) of depressed mood. No weight category was significantly associated with depressed mood in boys or girls in 11th grade. The present study suggests that weight misperceptions are associated with depressed mood in young adolescents. Education about healthy body size is necessary to correct the common weight misperceptions observed. The high prevalence rates of depressed mood suggest a greater need for research into understanding factors that may contribute to depressed mood in adolescents. |
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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