Prevalence and risk factors of cardiovascular disease (CVD) events among patients with haemophilia: experience of a single haemophilia treatment centre in the United States (US)
Sharathkumar AA , Soucie JM , Trawinski B , Greist A , Shapiro AD . Haemophilia 2011 17 (4) 597-604 SUMMARY: The primary objective of the study was to examine the prevalence of cardiovascular disease (CVD) events and their known risk factors among persons with haemophilia (PWH). This cross-sectional study, covering a 5-year period, included PWH aged ≥35 years who were cared for at a single haemophilia treatment centre in the United States. Medical records were extensively reviewed to collect the information about CVD events and their risk factors such as obesity, hypertension, diabetes, hypercholesterolemia and smoking. Prevalence rates were compared with national population estimates and associations between risk factors and CVD events were examined using logistic regression. The study cohort comprised 185 PWH (102 haemophilia A and 83 haemophilia B). Lifetime prevalence of a CVD event was 19.5% (36/185, 95% confidence interval [CI] 13.8-25.2%). CVD mortality was 5.4% (10/185, 95% CI 2.7-8.1). Compared with US non-Hispanic White males (NHWH), PWH had about twice the prevalence of coronary artery disease, stroke and myocardial infarction. The prevalence of CVD risk factors for PWH was similar to that for US NHWM with 39.5% of PWH exposed to two or more of these risk factors. Both hypertension and smoking were associated significantly with CVD events, with odds ratios of 4.9 and 6.3, respectively. In conclusion, this study revealed that both CVD events and its risk factors were at least equally prevalent among PWH and might have been even higher than among the US NHWM in the United States. Therefore, it is imperative to implement strategies for CVD prevention among PWH. |
High prevalence of echocardiographic abnormalities among HIV-infected persons in the era of highly active antiretroviral therapy
Mondy KE , Gottdiener J , Overton ET , Henry K , Bush T , Conley L , Hammer J , Carpenter CC , Kojic E , Patel P , Brooks JT . Clin Infect Dis 2011 52 (3) 378-86 BACKGROUND: In the era of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV)-infected persons have higher cardiovascular disease risk. Little is known about asymptomatic abnormalities in cardiac structure and function in this population. METHODS: The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study) is a prospective, observational, multi-site cohort of 656 HIV-infected participants who underwent baseline echocardiography during 2004-2006. We examined prevalence of and factors associated with left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary hypertension (PHTN), left ventricular hypertrophy (LVH), and left atrial enlargement (LAE). RESULTS: Participant characteristics were as follows: median age, 41 years; 24% women; 29% non-Hispanic black; 73% receiving HAART; and median CD4+ cell count, 462 cells/muL. Among evaluable participants, 18% had LVSD, 26% had DD, 57% had PHTN (right ventricular pressure >30 mm Hg), 6.5% had LVH, and 40% had LAE. In multivariate analyses, significant factors (P < .05) associated with LVSD were history of MI, elevated highly sensitive C-reactive protein (hsCRP) level, and current tobacco smoking; for DD, elevated hsCRP level and hypertension; for PHTN, current use of ritonavir; for LVH, hypertension, diabetes, non-white race, female sex with elevated body mass index, calculated as the weight in kilograms divided by the square of height in meters, of ≥ 25, elevated hsCRP level, and current use of abacavir; for LAE, hypertension and recent marijuana use. CONCLUSIONS: In this large contemporary HIV cohort, the prevalence of subclinical functional and structural cardiac abnormalities was greater than expected for age. Abnormalities were mostly associated with expected and often modifiable risks. Lifestyle modification should become a greater priority in the management of chronic HIV disease. |
Strong influence of human leukocyte antigen (HLA)-DP gene variants on development of persistent chronic hepatitis B virus carriers in the Han Chinese population.
Guo X , Zhang Y , Li J , Ma J , Wei Z , Tan W , O'Brien SJ . Hepatology 2011 53 (2) 422-8 Chronic hepatitis B virus (HBV) infection is a major health issue, especially in Asia. A recent genome-wide association study (GWAS) implicated genetic variants in the human leukocyte antigen (HLA)-DP locus associated with chronic hepatitis B in Japanese and Thai populations. To confirm whether the polymorphisms at the HLA-DP genes are associated with persistent chronic HBV infection in Han Chinese, we conducted an independent case-control study using 521 persistent chronic HBV carriers and 819 controls that included 571 persons with HBV natural clearance and 248 never HBV-infected (healthy) individuals. Eleven single nucleotide polymorphisms (SNPs) in a region including HLA-DPA and HLA-DPB and an adjacent SNP in strong linkage disequilibrium (LD) with a neighboring HLA-DR13 locus were genotyped using the TaqMan SNP genotyping assay. Eleven variants at HLA-DP showed a strong association with persistent chronic HBV carrier status (P = 1.82 x 10(-12) to 0.01). We also stratified the analysis by HBV clearance status to test the association between these polymorphisms and HBV natural clearance; similar results were obtained (P = 2.70 x 10(-11) to 0.003). Included SNPs define highly structured haplotypes that were also strongly associated with HBV chronic infection (block 1: odds ratio [OR] = 0.54, P = 8.73 x 10(-7) ; block 2: OR = 1.98, P = 1.37 x 10(-10) ). These results further confirm that genetic variants in the HLA-DP locus are strongly associated with persistent HBV infection in the Han Chinese population. (HEPATOLOGY 2011;53:422-428). |
Scale-up and continuation of antiretroviral therapy in South African treatment programs, 2005-2009
Klausner JD , Serenata C , O'Bra H , Mattson CL , Brown J , Wilson M , Mbengashe T , Goldman TM . J Acquir Immune Defic Syndr 2011 56 (3) 292-5 BACKGROUND: South Africa has the greatest burden of HIV-infection in the world with about 5.2 million HIV-infected adults. In 2003, the South African Government launched a comprehensive HIV and AIDS care treatment program supported by the United States in 2004 through the President's Emergency Plan for AIDS Relief (PEPFAR). METHODS: To describe the scale-up and continuation of antiretroviral therapy in South African Government and PEPFAR-supported sites in South Africa, we conducted a retrospective analysis of routinely collected program reporting data, 2005-2009. RESULTS: From 2005 through 2009, the average rate of persons initiated on antiretroviral therapy in PEPFAR-supported South African Government treatment programs increased nearly four-fold from 6,327 a month in 2005-2006 to 24,622 a month in 2008-2009 resulting in an increase from 33,543 patients on continued treatment in April-June 2005 to 631,985 patients in July-September 2009. Of those 631,985 patients receiving treatment, 65% were women. Men were more likely to be lost to follow-up (9.2% vs. 7.8%, PR 1.18, 95% CI 1.17-1.19) and more likely to die (5.6% vs. 4.1%, PR 1.36, 95% CI 1.35-1.37) than women. CONCLUSIONS: Scale-up and continuation of antiretroviral therapy in South Africa has been a remarkable medical accomplishment. Because more women receive and continue treatment, more efforts are needed to treat and retain men. |
Epidemiology of syphilis among Hispanic women and associations with congenital syphilis, Maricopa County, Arizona
Kirkcaldy RD , Su JR , Taylor MM , Koumans E , Mickey T , Winscott M , Kenney K , Weinstock HS . Sex Transm Dis 2011 38 (7) 598-602 OBJECTIVE: We investigated factors associated with high rates of congenital syphilis among Hispanic infants in Maricopa County, AZ. METHODS: Using 2004-2008 syphilis case report data from the state and county health departments, we examined characteristics of pregnant and nonpregnant women with syphilis and their male partners. RESULTS: During 2004-2008, 970 women were reported to have syphilis: 49% were Hispanic (of whom 49% were non-US citizens), 27% were white, 13% were black, and 8% were American Indian/Alaskan Native. Although 16% of Hispanic noncitizens reported drug use or high-risk sexual behaviors, 64% of these women had a male sex partner who reported drug use or anonymous sex. Hispanic women with syphilis were more likely to be pregnant (37%) than white (15%) or black women (13%) (P < 0.05), and were overrepresented among pregnant women with syphilis. Pregnant Hispanic noncitizens were treated later than pregnant Hispanic citizens (median 28 weeks gestation vs. 21 weeks, P = 0.01). CONCLUSIONS: Innovative congenital syphilis prevention strategies that are relevant to Hispanic women are warranted. Strategies should address the reproductive health and prenatal care needs of Hispanic women, and may include interventions for their male partners. |
Incidence and transmission patterns of acute hepatitis C in the United States, 1982-2006
Williams IT , Bell BP , Kuhnert W , Alter MJ . Arch Intern Med 2011 171 (3) 242-8 BACKGROUND: Monitoring disease incidence and transmission patterns is important to characterize groups at risk for hepatitis C virus (HCV) infection. Clinical cases generally represent about 20% to 30% of all newly acquired infections. METHODS: We used sentinel surveillance to determine incidence and transmission patterns for acute hepatitis C in the United States using data from 25 years of population-based surveillance in the general community. Acute cases of hepatitis C were identified from 1982 through 2006 by a stimulated passive surveillance system in 4 to 6 US counties. Cases were defined by a discrete onset of symptoms, alanine aminotransferase (ALT) levels greater than 2.5 times the upper limit of normal (xULN), negative findings for serologic markers for acute hepatitis A and B, and positive findings for antibody to HCV or HCV RNA. Incidence and frequency of reported risk factors were the main outcome measures. RESULTS: Of 2075 patients identified, the median age was 31 years, 91.5% had ALT values greater than 7 x ULN, 77.3% were jaundiced, 22.5% were hospitalized, and 1.2% died. Incidence averaged 7.4 per 100 000 individuals (95% confidence interval [CI], 6.4-8.5 per 100 000) during 1982 to 1989 then declined averaging 0.7 per 100 000 (95% CI, 0.5-1.0 per 100 000) during 1994 to 2006. Among 1748 patients interviewed (84.2%), injection drug use (IDU) was the most commonly reported risk factor. The average number of IDU-related cases declined paralleling the decline in incidence, but the proportion of IDU-related cases rose from 31.8% (402 of 1266) during 1982 to 1989 to 45.6% (103 of 226) during 1994 to 2006. Among IDU-related cases reported during 1994 to 2006, 56 of 61 individuals (91.8%) had been in a drug treatment program and/or incarcerated. CONCLUSIONS: The incidence of acute HCV declined substantially over the 25 years of population-based surveillance. Despite declines, IDU is the most common risk factor for new HCV infection. |
Influenza susceptibility, severity, and shedding in HIV-infected adults: a review of the literature
Sheth AN , Althoff KN , Brooks JT . Clin Infect Dis 2011 52 (2) 219-27 Influenza is a common cause of respiratory illness in adults infected with human immunodeficiency virus (HIV), but current knowledge about seasonal and 2009 H1N1 pandemic influenza A (H1N1pdm) virus infections in HIV-infected persons is limited. In this paper, we review the existing literature regarding influenza susceptibility, severity, and shedding in HIV-infected adults. Data show HIV infection does not significantly increase susceptibility to influenza. AIDS is associated with greater seasonal influenza-related morbidity and mortality, but the risk associated with HIV infection among those with less immune suppression is largely unknown. Immunologic compromise has been shown to increase the magnitude and duration of influenza virus shedding; however, these studies are limited within HIV-infected populations. With regards to H1N1pdm, data are even more limited. Reports raise concern of increased severity among HIV-infected persons, although this may be driven by other comorbid illnesses. Prospective studies are needed among HIV-infected persons to more definitively investigate influenza susceptibility, severity, and shedding. |
Postdiarrheal hemolytic uremic syndrome in persons aged 65 and older in FoodNet sites, 2000-2006
Gould LH , Jordan JG , Dunn J , Apostol M , Griffin PM . J Am Geriatr Soc 2011 59 (2) 366-368 Hemolytic uremic syndrome (HUS) is the leading cause of acute renal failure in children in the United States. Most postdiarrheal HUS follows infection with Shiga toxin–producing Escherichia coli O157 (STEC O157).1 HUS and STEC infection are also serious illnesses in older adults, but little is known about the clinical characteristics and course of HUS in this population. |
Gaps remain in China's ability to detect emerging infectious diseases despite advances since the onset of SARS and avian flu
Feng Z , Li W , Varma JK . Health Aff (Millwood) 2011 30 (1) 127-35 Early detection of emerging infections in China is critical to the health of the 1.3 billion Chinese people and to the world. China's surveillance system for endemic infectious diseases has improved greatly since 2003, but the country's ability to conduct surveillance for laboratory-confirmed infections remains underdeveloped. This is dangerous for China, the world's most populous country, which has been the focus of global attention since outbreaks of severe acute respiratory syndrome (SARS) and avian influenza. We describe China's public health advances since the 2003 SARS outbreak and conclude that China must now invest far more in pathogen-based surveillance. An enhanced disease-detection system in China will help prevent and contain outbreaks before they cause substantial illness and death in China and other countries. |
Clinical preventive services for patients at risk for cardiovascular disease, National Ambulatory Medical Care Survey, 2005-2006
Yoon PW , Tong X , Schmidt SM , Matson-Koffman D . Prev Chronic Dis 2011 8 (2) A43 INTRODUCTION: Clinical preventive services can detect diseases early, when they are most treatable, but these services may not be provided as recommended. Assessing the provision of services to patients at risk for cardiovascular disease (CVD) could help identify disparities and areas for improvement. METHODS: We used data on patient visits (n = 21,261) from the National Ambulatory Medical Care Survey, 2005-2006, and classified patients with hypertension, hyperlipidemia, obesity, or diabetes as being at risk for CVD. We assessed differences in the provision of preventive services offered to patients who were and who were not at risk for CVD. Further, for those at risk, we compared the demographic characteristics of those who had and who had not been offered services. RESULTS: Patients at risk for CVD received significantly more preventive services compared with those not at risk. For patients at risk for CVD, aspirin therapy was more likely to be recommended to those aged 65 years or older than those aged 45 to 64 years and to men than women. Cholesterol screening was more likely for men and was less likely for patients with Medicare/Medicaid or no insurance than for patients who were insured. Rates of counseling for diet and nutrition, weight reduction, and exercise were low overall, but younger patients received these services more than older patients did. CONCLUSION: Patients at risk for CVD are not all receiving the same level of preventive care, suggesting the need to clarify clinical practice guidelines and provide clinicians with education and support for more effective lifestyle counseling. |
Comments on 'Some methodological issues in biosurveillance'
Rolka HR . Stat Med 2011 30 (5) 416-9 I would first like to compliment Dr Fricker on the outreaching, cross-disciplinary nature of this work. Underlying his discussion of several important methodological issues in biosurveillance is an important theme: successful methods and approaches from other fields of endeavor have much to offer for the analysis and exploitation of public health data. Dr Fricker focuses on three topics from which applied public health surveillance and biosurveillance can certainly benefit: techniques for measuring change from the field of statistical process control, examples from perception and cognition theory (e.g. the ‘looking for everything’ analogy to sydromic surveillance), and the value of using simulation for substantiating new methodological applications. His development of concepts remains rooted in the goals of early disease event detection in a population and extends to the less rigorously defined but more intuitive goal of acquiring and maintaining situational awareness. Dr Fricker also clearly acknowledges various disciplines and problem areas of research necessary for more successfully addressing these goals. |
Concordance in the measurement of quality of life and health indicators between two methods of computer-assisted interviews: self-administered and by telephone
Klevens J , Trick WE , Kee R , Angulo F , Garcia D , Sadowski LS . Qual Life Res 2011 20 (8) 1179-86 PURPOSE: The aim of this study was to establish the concordance for quality of life (QOL), disability, and use of health service indicators between two modes of computer-assisted interviews: audio-computer-assisted self-interview (A-CASI) and computer-assisted telephone interview (CATI). High concordance between these modes of data collection would allow comparisons and interchangeable use in cross-sectional or longitudinal assessments. METHODS: Adult English-speaking women (n = 126) were enrolled from women's health clinics at a public hospital. QOL using the short form 12 version 2, disability (days missed from work, inability to do household activities), and utilization of health services (number of emergency room visits and hospitalizations) were assessed first with A-CASI at the time of enrollment and again (n = 102) with CATI 1 week later. Participants assessed with both modes were 38 years old on average, predominantly African-American, 41% had a high school education or less, and 61% were uninsured. Lin's concordance correlation coefficient or Cohen's kappa was calculated to establish concordance between paired A-CASI and CATI assessments. RESULTS: Concordance between the two interview methods ranged from fair to substantial for the QOL components, (concordance correlation coefficient [CCC] of .76 and .87, respectively), the QOL subscales, and disability indices (CCC range; .53-.91). For health services utilization, there was moderate concordance for emergency room visits (CCC = .70) but only slight concordance for the number of hospitalizations in the past year (CCC = .37). CONCLUSIONS: Administering surveys through a telephone or self-administered computer-assisted interview resulted in moderate to substantial agreement for the short form QOL components and fair to substantial for the QOL subscales and disability measures. These findings suggest A-CASI and CATI can be used interchangeably for some QOL scales. |
Public health genomics: the end of the beginning.
Khoury MJ . Genet Med 2011 13 (3) 206-9 In the 20-year journey of the American College of Medical Genetics, public health has had an important influence on the emergence and progress of genomic medicine. This influence can be readily discerned on the pages of Genetics in Medicine, the official journal of the College. As the journal's section editor in public health, I write this special anniversary commentary on the heels of the fourth national conference on genomics and public health, held in Bethesda, MD, in December 2010.1 The conference was attended by more than 500 people from multiple sectors including academia, industry, state and federal government, consumers, and the media, all interested in the translation of genome-based discoveries into health benefits now and in the future. The conference represented more than a decade-long progress in establishing the field of public health genomics as a scientific foundation for using genetic information to improve the health of populations. In a time of economic downturn and shrinkage of public health at the federal, state, and local levels, more resources will be shifted toward emergency programs and services with immediate health impact. Therefore, investments in public health genomics in 2011 are at an all-time low. This may be attributed, in part, to the fact that the promise of genomic medicine is still largely unfulfilled, and as such, genomics has not demanded the urgency of public health action today. Yet, if the promise of genomics is to be realized in the next decade, public health will have to play, as it has done in the past decade, an important leadership role. In this commentary, I revisit the basics of public health genomics and how the field has been represented in Genetics in Medicine. I use the three essential public health functions and priorities in genomics as discussed elsewhere2: (1) policy development function and public health's unique “honest broker” role, (2) assurance function and public health's role in implementation and evaluation of services, and (3) assessment function and the role of multidisciplinary population sciences in assessing impact and value of genomic information in health and health practice. Public health genomics in 2011 is more important than ever in realizing the health benefits of human genome discoveries in the 21st century. |
Genetic bases of the temperature-sensitive phenotype of a master donor virus used in live attenuated influenza vaccines: A/Leningrad/134/17/57 (H2N2).
Isakova-Sivak I , Chen LM , Matsuoka Y , Voeten JT , Kiseleva I , Heldens JG , den Bosch HV , Klimov A , Rudenko L , Cox NJ , Donis RO . Virology 2011 412 (2) 297-305 Trivalent live attenuated influenza vaccines whose type A components are based on cold-adapted A/Leningrad/134/17/57 (H2N2) (caLen17) master donor virus (MDV) have been successfully used in Russia for decades to control influenza. The vaccine virus comprises hemagglutinin and neuraminidase genes from the circulating viruses and the remaining six genes from the MDV. The latter confer temperature-sensitive (ts) and attenuated (att) phenotypes. The ts phenotype of the vaccine virus is a critical biological determinant of attenuation of virulence. We developed a plasmid-based reverse genetics system for MDV caLen17 to study the genetic basis of its ts phenotype. Mutations in the polymerase proteins PB1 and PB2 played a crucial role in the ts phenotype of MDV caLen17. In addition, we show that caLen17-specific ts mutations could impart the ts phenotype to the divergent PR8 virus, suggesting the feasibility of transferring the ts phenotype to new viruses of interest for vaccine development. |
Rapid pneumococcal evolution in response to clinical interventions
Croucher NJ , Harris SR , Fraser C , Quail MA , Burton J , van der Linden M , McGee L , von Gottberg A , Song JH , Ko KS , Pichon B , Baker S , Parry CM , Lambertsen LM , Shahinas D , Pillai DR , Mitchell TJ , Dougan G , Tomasz A , Klugman KP , Parkhill J , Hanage WP , Bentley SD . Science 2011 331 (6016) 430-4 Epidemiological studies of the naturally transformable bacterial pathogen Streptococcus pneumoniae have previously been confounded by high rates of recombination. Sequencing 240 isolates of the PMEN1 (Spain(23F)-1) multidrug-resistant lineage enabled base substitutions to be distinguished from polymorphisms arising through horizontal sequence transfer. More than 700 recombinations were detected, with genes encoding major antigens frequently affected. Among these were 10 capsule-switching events, one of which accompanied a population shift as vaccine-escape serotype 19A isolates emerged in the USA after the introduction of the conjugate polysaccharide vaccine. The evolution of resistance to fluoroquinolones, rifampicin, and macrolides was observed to occur on multiple occasions. This study details how genomic plasticity within lineages of recombinogenic bacteria can permit adaptation to clinical interventions over remarkably short time scales. |
Sequencing and phylogenetic analysis of the coding region of six common rotavirus strains: evidence for intragenogroup reassortment among co-circulating G1P[8] and G2P[4] strains from the United States
Banyai K , Mijatovic-Rustempasic S , Hull JJ , Esona MD , Freeman MM , Frace AM , Bowen MD , Gentsch JR . J Med Virol 2011 83 (3) 532-9 The segmented genome of rotaviruses provides an opportunity for rotavirus strains to generate a large genetic diversity through reassortment; however, this mechanism is considered to play little role in the generation of mosaic gene constellations between Wa-like and DS-1-like strains in genes other than the neutralization antigens. A pilot study was undertaken to analyze these two epidemiologically important strains at the genomic level in order to (i) identify intergenogroup reassortment and (ii) to make available additional reference genome sequences of G1P[8] and G2P[4] for future genomics analyses. The full or nearly complete coding region of all 11 genes for 3 G1P[8] (LB2719, LB2758, and LB2771) and 3 G2P[4] (LB2744, LB2764, and LB2772) strains isolated from children hospitalized with severe diarrhea in Long Beach, California, where these strains were circulating at comparable rates during 2005-2006 are described in this study. Based on the full-genome classification system, all G1P[8] strains had a conserved genomic constellation: G1-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-E1-H1 and were mostly identical to the few Wa-like strains whose genome sequences have already been determined. Similarly, the genome sequences of the 3 G2P[4] strains were highly conserved: G2-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-E2-H2 and displayed an overall lesser genetic divergence with reference DS-1-like strains. While intergenogroup reassortment was not seen between the G1P[8] and G2P[4] strains studied here, evidence for intragenogroup reassortment events was identified. Similar studies in the post-rotavirus genomic era will help uncover whether intergenogroup reassortment affecting the backbone genes could play a significant role in any potential vaccine breakthrough events by evading immunity of vaccinated children. |
Longitudinal examination of alcohol use: a predictor of risky sexual behavior and Trichomonas vaginalis among African-American female adolescents
Seth P , Sales JM , DiClemente RJ , Wingood GM , Rose E , Patel SN . Sex Transm Dis 2011 38 (2) 96-101 BACKGROUND: Alcohol use has been linked to risky sexual practices among adolescents. However, limited research on alcohol use and risky sexual behavior has been conducted on African-American female adolescents. This study examined high quantity of alcohol as a longitudinal predictor of risky sexual behavior and sexually transmitted diseases (STDs) among African-American female adolescents, a high-risk population for STDs. METHODS: Three hundred ninety-three adolescent females, 15 to 21 years, were assessed on sociodemographics, alcohol use, and risky sexual behaviors. Participants also provided 2 swab specimens that were assayed for STDs. High quantity of alcohol use was defined as ≥ 3 drinks in 1 sitting. RESULTS: Binary generalized estimating equation models were conducted assessing the impact of alcohol use at baseline on risky sexual behavior and STDs over a 12-month period. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high quantity of alcohol use predicted positive TV test results, inconsistent condom use, high sexual sensation seeking, multiple sexual partners, sex while high on alcohol or drugs, and having anal sex over a 12-month follow-up period. CONCLUSIONS: These findings suggest that HIV/STD-related behavioral interventions for African-American adolescents should discuss the link between alcohol and HIV/STD-risk behavior. A deeper understanding is paramount to the development of efficacious prevention programs at individual and community levels. |
Patient-provider communication and human papillomavirus vaccine acceptance
Rand CM , Schaffer SJ , Humiston SG , Albertin CS , Shone LP , Heintz EV , Blumkin AK , Stokley S , Szilagyi PG . Clin Pediatr (Phila) 2011 50 (2) 106-13 The authors performed telephone interviews of parents of adolescents (n = 430) and their older adolescents (n = 208) in Monroe County, New York to measure parent and adolescent acceptance of human papillomavirus (HPV) vaccine, its association with ratings of provider communication, and vaccine-related topics discussed with the adolescent's provider. More than half of adolescent girls had already received an HPV vaccination, with fewer than one quarter refusing. Parent and teen ratings of provider communication was high, and not related to HPV vaccine refusal. Parents were more likely to refuse if they were Hispanic (odds ratio [OR] = 5.88, P = .05) or did not consider vaccines "very safe" (OR = 2.76, P = .04). Most parents of boys (85%) believed males should be given HPV vaccine if recommended. Few parents and teens recalled discussing that vaccination does not preclude future Pap smear testing. Providers should address cultural and vaccine safety concerns in discussions about HPV vaccine. |
Carriage of Haemophilus influenzae among Brazilian children attending day care centers in the era of widespread Hib vaccination
de Carvalho CX , Kipnis A , Thorn L , de Andrade JG , Pimenta F , Brandileone MC , Zanella RC , Flannery B , Sgambatti S , Andrade AL . Vaccine 2011 29 (7) 1438-42 Haemophilus influenzae type b vaccine was introduced into the Immunization Program of Brazil in 1999 and no study has evaluated the impact of Hib vaccination in H. influenzae carriage so far. In June 2010, Brazil introduced the 10-valent pneumococcal nontypeable H. influenzae (NTHi) conjugate vaccine (PHiD-CV). We investigated the prevalence of encapsulated H. influenzae and NTHi isolates in nasopharyngeal samples of 1192 children attending day-care centers in Goiania, central Brazil. H. influenzae carriage rate was 32.1% and 38.4% of them carried beta-lactamase TEM-1 gene. Serotype f (4.6%) was the most frequent encapsulated isolate, type b was recovered in only 0.7% and carriage rate of NTHi was 23.3%. Recurrent acute otitis media and NTHi were independently associated with colonization by beta-lactamase producing H. influenzae. Changes in frequency of H. influenzae carriage isolates should be carefully monitored to assess the impact of the PHiD-CV on NTHi carriage in young children. |
A new methane control and prediction software suite for longwall mines
Dougherty HN , Karacan CO . Comput Geosci 2011 37 (9) 1490-1500 This paper presents technical and application aspects of a new software suite, MCP (Methane Control and Prediction), developed for addressing some of the methane and methane control issues in longwall coal mines. The software suite consists of dynamic link library (DLL) extensions to MS-AccessTM, written in C++. In order to create the DLLs, various statistical, mathematical approaches, prediction and classification artificial neural network (ANN) methods were used. The current version of MCP suite (version 1.3) discussed in this paper has four separate modules that (a) predict the dynamic elastic properties of coal-measure rocks, (b) predict ventilation emissions from longwall mines, (c) determine the type of degasification system that needs to be utilized for given situations and (d) assess the production performance of gob gas ventholes that are used to extract methane from longwall gobs. These modules can be used with the data from basic logs, mining, longwall panel, productivity, and coal bed characteristics. The applications of these modules separately or in combination for methane capture and control related problems will help improve the safety of mines. The software suite's version 1.3 is discussed in this paper. Currently, it's new version 2.0 is available and can be downloaded from http://www.cdc.gov/niosh/mining/products/product180.htm free of charge. The models discussed in this paper can be found under "ancillary models" and under "methane prediction models" for specific U.S. conditions in the new version. |
Human monoclonal antibodies to West Nile virus identify epitopes on the prM protein.
Calvert AE , Kalantarov GF , Chang GJ , Trakht I , Blair CD , Roehrig JT . Virology 2011 410 (1) 30-7 Hybridoma cell lines (2E8, 8G8 and 5G12) producing fully human monoclonal antibodies (hMAbs) specific for the pre-membrane (prM) protein of West Nile virus (WNV) were prepared using a human fusion partner cell line, MFP-2, and human peripheral blood lymphocytes from a blood donor diagnosed with WNV fever in 2004. Using site-directed mutagenesis of a WNV-like particle (VLP) we identified 4 amino acid residues in the prM protein unique to WNV and important in the binding of these hMAbs to the VLP. Residues V19 and L33 are important epitopes for the binding of all three hMAbs. Mutations at residue, T20 and T24 affected the binding of hMAbs, 8G8 and 5G12 only. These hMAbs did not significantly protect AG129 interferon-deficient mice or Swiss Webster outbred mice from WNV infection. |
Short-term inhalation of stainless steel welding fume causes sustained lung toxicity but no tumorigenesis in lung tumor susceptible A/J mice
Zeidler-Erdely PC , Battelli LA , Stone S , Chen BT , Frazer DG , Young SH , Erdely A , Kashon ML , Andrews R , Antonini JM . Inhal Toxicol 2011 23 (2) 112-20 Debate exists as to whether welding fume is carcinogenic, but epidemiological evidence suggests that welders are an at-risk population for development of lung cancer. Our objective was to expose, by inhalation, lung tumor susceptible (A/J) and resistant C57BL/6J (B6) mice to stainless steel (SS) welding fume containing carcinogenic metals and characterize the lung-inflammatory and tumorigenic response. Male mice were exposed to air or gas metal arc (GMA)-SS welding fume at 40 mg/m(3)x3 h/day for 6 and 10 days. At 1, 4, 7, 10, 14, and 28 days after 10 days of exposure, bronchoalveolar lavage (BAL) was done. Lung cytotoxicity, permeability, inflammatory cytokines, and cell differentials were analyzed. For the lung tumor study, gross tumor counts and histopathological changes were assessed in A/J mice at 78 weeks after 6 and 10 days of exposure. Inhalation of GMA-SS fume caused an early, sustained macrophage and lymphocyte response followed by a gradual neutrophil influx and the magnitudes of these differed between the mouse strains. Monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-2 (MIP-2), and tumor necrosis factor-a (TNF-a) were increased in both strains while the B6 also had increased interleukin-6 (IL-6) protein. BAL measures of cytotoxicity and damage were similar between the strains and significantly increased at all time points. Histopathology and tumorigenesis were unremarkable at 78 weeks. In conclusion, GMA-SS welding fume induced a significant and sustained inflammatory response in both mouse strains with no recovery by 28 days. Under our exposure conditions, GMA-SS exposure resulted in no significant tumor development in A/J mice. |
Laboratory diagnosis of sexually transmitted infections in Belarus
Pankratov O , Shimanskaya I , Pankratov V , Navrotsky A , Ballard RC , Unemo M , Domeika M . Acta Derm Venereol 2011 91 (1) 64-5 Following the collapse of the Soviet Union, the manage-ment of sexually transmitted infections (STIs) became fragmented, with a consequent increase in STI morbidity. In Belarus, reliable data are generally lacking as a result of poor access to effective diagnostic facilities, while the quality of laboratory testing for STIs in recognised centres is questionable. As part of the Belarusian-Swedish project “Optimization of the prevention and control of STI/HIV in Belarus” (1) we surveyed STI diagnostic facilities for the methods they used (including their range, availability and quality) and their adherence to international evidence-based guidelines |
New Delhi metallo-β-lactamase (NDM-1)-producing Klebsiella pneumoniae: case report and laboratory detection strategies
Mochon AB , Garner OB , Hindler JA , Krogstad P , Ward KW , Lewinski MA , Rasheed JK , Anderson KF , Limbago BM , Humphries RM . J Clin Microbiol 2011 49 (4) 1667-70 The spread of antimicrobial resistance among Enterobacteriaceae is a significant clinical threat. We report the first case in a pediatric patient of an Enterobacteriaceae harboring the NDM-1 metallo-beta-lactamase in the United States. We describe strategies for the detection of this novel resistance mechanism encountered in an isolate of Klebsiella pneumoniae. |
Proposed serum cholesterol reference measurement procedure by gas chromatography-isotope dilution mass spectrometry
Edwards SH , Kimberly MM , Pyatt SD , Stribling SL , Dobbin KD , Myers GL . Clin Chem 2011 57 (4) 614-22 BACKGROUND: Our purpose was to establish a mass spectrometry reference measurement procedure (RMP) for cholesterol to use in the CDC's standardization programs. We explored a gas chromatography-isotope dilution mass spectrometry (GC-IDMS) procedure using a multilevel standard calibration curve to quantify samples with varying cholesterol concentrations. METHODS: We calibrated the mass spectrometry instrument by isotope dilution with a pure primary standard reference material and an isotopically enriched cholesterol analog as the internal standard (IS). We diluted the serum samples with Tris-HCl buffer (pH 7.4, 0.05 mol/L, 0.25% Triton X-100) before analysis. We used 17 serum pools, 10 native samples, and 2 standard reference materials (SRMs). We compared the GC-IDMS measurements with the CDC's modified Abell-Levy-Brodie-Kendall (AK) RMP measurements and assessed method accuracy by analyzing 2 SRMs. We evaluated the procedure for lack of interference by analyzing serum spiked with a mixture of 7 sterols. RESULTS: The mean percent bias between the AK and the GC-IDMS RMP was 1.6% for all samples examined. The mean percent bias from NIST's RMP was 0.5% for the SRMs. The total %CVs for SRM 1951b levels I and II were 0.61 and 0.73%, respectively. We found that none of the sterols investigated interfered with the cholesterol measurement. CONCLUSIONS: The low imprecision, linear response, lack of interferences, and acceptable bias vs the NIST primary RMP qualifies this procedure as an RMP for determining serum cholesterol. The CDC will adopt and implement this GC-IDMS procedure for cholesterol standardization. |
Effect of CD4+ T-cell count and antiretroviral treatment on two serological HIV incidence assays
Hladik W , Olara D , Mermin J , Moore D , Were W , Alexander L , Downing R . AIDS Res Hum Retroviruses 2011 28 (1) 95-9 Serological assays are increasingly being used to measure HIV incidence in cross-sectional studies, but their specificity to determine incident infections remains problematic. We estimated the specificity of the BED assay in a cohort of long-term HIV-infected adults before and during antiretroviral treatment (ART) and evaluated an HIV avidity assay to detect BED-based false-recent results. We used the BED assay to test stored specimens from known long-term HIV-1-infected adult Ugandans before and at 3, 12, and 24 months after ART initiation. We evaluated the frequency of false-recent classifications by ART status and CD4+ T+ cell count. Specimens classified as BED false-recent were further tested with an avidity assay. 950 blood specimens from 253 adults were tested with the BED assay. 149 (15.7%) specimens tested false-recent and 64 (24.9%) individuals tested false-recent at least once. Among all specimens tested, the proportion of false-recent rose with increasing CD4+ cell count (<250 cells/mul: 11.3%, 250-499: 17.8%, ≥500: 21.4%; P for trend=0.002). Of 197 persons with all 4 BED results available, 75.6% were classified as long-term infected throughout and 8.1% as false-recent throughout; the remainder changed classification once (12.2%) or twice (4.1%). Of 105 false-recent specimens re-tested with the avidity assay, 101 (96.2%) were correctly classified as "long-term". The BED assay's specificity varied with CD4+ cell count and use of ART. Knowledge of these parameters for blood samples could improve incidence estimates using the BED assay. The additional use of an avidity assay may help to minimize the proportion of BED-false-recent specimens. |
Genotoxicity of carbon nanofibers: are they potentially more or less dangerous than carbon nanotubes or asbestos?
Kisin ER , Murray AR , Sargent L , Lowry D , Chirila M , Siegrist KJ , Schwegler-Berry D , Leonard S , Castranova V , Fadeel B , Kagan VE , Shvedova AA . Toxicol Appl Pharmacol 2011 252 (1) 1-10 The production of carbon nanofibers and nanotubes (CNF/CNT) and their composite products is increasing globally. CNF are generating great interest in industrial sectors such as energy production and electronics, where alternative materials may have limited performance or are produced at a much higher cost. However, despite the increasing industrial use of carbon nanofibers, information on their potential adverse health effects is limited. In the current study, we examine the cytotoxic and genotoxic potential of carbon-based nanofibers (Pyrograf ((R))-III) and compare this material with the effects of asbestos fibers (crocidolite) or single-walled carbon nanotubes (SWCNT). The genotoxic effects in the lung fibroblast (V79) cell line were examined using two complementary assays: the comet assay and micronucleus (MN) test. In addition, we utilized fluorescence in situ hybridization to detect the chromatin pan-centromeric signals within the MN indicating their origin by aneugenic (chromosomal malsegregation) or clastogenic (chromosome breakage) mechanisms. Cytotoxicity tests revealed a concentration- and time-dependent loss of V79 cell viability after exposure to all tested materials in the following sequence: asbestos>CNF>SWCNT. Additionally, cellular uptake and generation of oxygen radicals was seen in the murine RAW264.7 macrophages following exposure to CNF or asbestos but not after administration of SWCNT. DNA damage and MN induction were found after exposure to all tested materials with the strongest effect seen for CNF. Finally, we demonstrated that CNF induced predominately centromere-positive MN in primary human small airway epithelial cells (SAEC) indicating aneugenic events. Further investigations are warranted to elucidate the possible mechanisms involved in CNF-induced genotoxicity. |
Induction of immune memory by a multisubunit chlamydial vaccine
Eko FO , Ekong E , He Q , Black CM , Igietseme JU . Vaccine 2011 29 (7) 1472-80 We tested the hypothesis that intramuscular immunization with a multisubunit chlamydial vaccine candidate will induce long lasting immune responses in mice. Accordingly, groups of female C57BL/6 mice were immunized intramuscularly with Vibrio cholerae ghosts (VCG) expressing the Poring B and polymorphic membrane protein-D proteins of Chlamydia trachomatis or a control antigen. Humoral and cell-mediated immune responses were evaluated following immunization and after live chlamydial infection. Immunization induced an anamnestic response characterized by chlamydial-specific IgG2a and IgA antibodies in sera and vaginal lavage as well as specific genital and splenic T cell responses. The results also revealed that the local mucosal and systemic cellular and humoral immune effectors induced in mice following immunization with the vaccine candidate are long lasting. Vaccinated mice cleared intravaginal challenge with 10(5) chlamydial inclusion forming units within 12 days compared to control mice, which shed up to 2x10(3)IFUs at this time point. Moreover, rechallenge of mice 98 days after resolution of the primary infection resulted in the recall and retention of a relatively high frequency of chlamydial-specific Th1 cells and IgG2a in the genital mucosa. These results provide the first evidence that a VCG-based multisubunit chlamydial vaccine is capable of effectively stimulating anamnestic systemic and mucosal immune responses in mice. The data support further vaccine evaluation and testing for induction of long-term protective immunity. |
The changing spectrum of DNA-based specimen provenance testing in surgical pathology
Pfeifer JD , Zehnbauer B , Payton J . Am J Clin Pathol 2011 135 (1) 132-8 Short tandem repeat (STR) analysis has emerged as the method of choice for testing to resolve specimen source contamination and identity problems that arise in surgical pathology. We studied a series of consecutive cases referred for STR typing during a 5-year period to document the usefulness of the approach and to describe the broadening scope of testing. The series demonstrates that STR-based typing can be applied in virtually any setting in which specimen source confirmation is requested, that STR-based typing is informative in 92% of cases, but that exceptions occasionally arise that complicate test interpretation. The series also demonstrates that in addition to traditional uses of STR typing, testing is now performed in the absence of any direct indication that a specimen mix-up or contamination may have occurred, namely, when the pathologic findings are unexpected or the clinical setting is atypical. The case series underscores the ability of STR testing to detect errors that cannot be captured by current laboratory protocols, a finding that has important implications for patient safety. |
Characterization of CD8+ T-cell response in acute and resolved hepatitis A virus infection
Schulte I , Hitziger T , Giugliano S , Timm J , Gold H , Heinemann FM , Khudyakov Y , Strasser M , Konig C , Castermans E , Mok JY , van Esch WJ , Bertoletti A , Schumacher TN , Roggendorf M . J Hepatol 2011 54 (2) 201-8 BACKGROUND & AIMS: In contrast to the infection with other hepatotropic viruses, hepatitis A virus (HAV) always causes acute self-limited hepatitis, although the role for virus-specific CD8 T cells in viral containment is unclear. Herein, we analyzed the T cell response in patients with acute hepatitis by utilizing a set of overlapping peptides and predicted HLA-A2 binders from the polyprotein. METHODS: A set of 11 predicted peptides from the HAV polyprotein, identified as potential binders, were synthesized. Peripheral blood mononuclear cells (PBMCs) from patients were tested for IFNgamma secretion after stimulation with these peptides and ex vivo with HLA-A2 tetramers. Phenotyping was carried out by staining with the activation marker CD38 and the memory marker CD127. RESULTS: Eight out of 11 predicted HLA-A2 binders showed a high binding affinity and five of them were recognized by CD8+ T cells from patients with hepatitis A. There were significant differences in the magnitude of the responses to these five peptides. One was reproducibly immunodominant and the only one detectable ex vivo by tetramer staining of CD8+ T cells. These cells have an activated phenotype (CD38hi CD127lo) during acute infection. Three additional epitopes were identified in HLA-A2 negative patients, most likely representing epitopes restricted by other HLA-class I-alleles (HLA-A11, B35, B40). CONCLUSIONS: Patients with acute hepatitis A have a strong multi-specific T cell response detected by ICS. With the tetramer carrying the dominant HLA-A2 epitope, HAV-specific and activated CD8+ T cells could be detected ex vivo. This first description of the HAV specific CTL-epitopes will allow future studies on strength, breadth, and kinetics of the T-cell response in hepatitis A. |
Clinical and laboratory characteristics of invasive infections due to methicillin-resistant Staphylococcus aureus isolates demonstrating a vancomycin MIC of 2 micrograms per milliliter: lack of effect of heteroresistant vancomycin-intermediate S. aureus phenotype
Satola SW , Lessa FC , Ray SM , Bulens SN , Lynfield R , Schaffner W , Dumyati G , Nadle J , Patel JB . J Clin Microbiol 2011 49 (4) 1583-7 We describe clinical and laboratory characteristics of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections with vancomycin MICs of 2 mug/mL and compare hVISA to non-hVISA. Infections were most often healthcare-associated community-onset, demonstrated frequent complications and relapses. hVISA patients were more likely to have been hospitalized in the year prior to MRSA culture. |
Improving fruit and vegetable consumption: use of farm-to-consumer venues among US adults
Blanck HM , Thompson OM , Nebeling L , Yaroch AL . Prev Chronic Dis 2011 8 (2) A49 Improvements to the food environment including new store development and more farm-to-consumer approaches (ie, farmers' markets, roadside stands, pick-your-own produce farms, or community-supported agriculture programs) may aid Americans in making healthier dietary choices. We analyzed data from a subset of respondents (N = 1,994) in the National Cancer Institute's Food Attitudes and Behaviors Survey, a mail survey of US adults. We determined associations between primary grocery shoppers' region and sociodemographic characteristics and frequency of purchasing fruits and vegetables in the summer from farm-to-consumer venues. A little more than one-quarter (27%) of grocery shoppers reported a frequency of at least weekly use of farm-to-consumer approaches. Older adults and respondents who live in the Northeast were most likely to shop farm-to-consumer venues at least weekly, and no differences were found by sex, race/ethnicity, education, or annual household income. These findings suggest that farm-to-consumer venues are used by many Americans and could be expanded to increase access to fruits and vegetables. |
Iodine status of the U.S. population, National Health and Nutrition Examination Survey, 2005-2006 and 2007-2008
Caldwell KL , Makhmudov A , Ely E , Jones RL , Wang RY . Thyroid 2011 21 (4) 419-27 BACKGROUND: This report presents urinary iodine (UI) concentrations for the general U.S. population during 2005-2006 and 2007-2008. These findings are the fourth and fifth assessments of the population since National Health and Nutrition Examination Survey (NHANES) III (1988-1994), when the median UI concentration for the population decreased from NHANES I (1971-1974). METHODS: During 2005-2006 and 2007-2008, approximately 5000 participants per year were selected to participate in NHANES. The participants were interviewed and examined. UI concentration was measured on a random one third subsample of 2649 participants, aged 6 years and older in 2005-2006, and in all participants in 2007-2008. These urine iodine concentrations are representative of the general U.S. population by age, sex, and race/ethnicity. RESULTS: (i) The median UI concentrations for the general U.S. population in 2005-2006 and 2007-2008 were 164 mug/L (95% confidence interval [CI] 154-174) and 164 mug/L (95% CI 154-173), respectively. Also, the proportions of the population with a UI concentration of <50 mug/L during these survey periods were 9.8% +/- 1.3% and 8.8% +/- 0.4%, respectively. The median UI concentration and prevalence of ≥200 mug/L appeared to be higher in children and persons ≥70 years than in other age groups. (ii) In both surveys, children aged 6-11 years had median UI concentrations of ≥200 mug/L, and about 5% of them had a UI concentration of <50 mug/L. (iii) All pregnant women (sample size 184) surveyed during 2005-2008 had a median UI concentration of 125 mug/L (95% CI 86-198), and 56.9% +/- 7.9% of this group had a UI concentration of <150 mug/L. UI concentrations were lower among non-Hispanic black survey participants than non-Hispanic white and Mexican-American participants. CONCLUSIONS: These findings affirm the stabilization of UI concentration and adequate iodine nutrition in the general U.S. population since 2000. However, certain groups likely do not achieve a sufficient dietary iodine intake according to the World Health Organization. The needs of these vulnerable groups and the inadequacy of their dietary iodine intake should be addressed in future efforts. |
Dietary supplement use in the United States, 2003-2006
Bailey RL , Gahche JJ , Lentino CV , Dwyer JT , Engel JS , Thomas PR , Betz JM , Sempos CT , Picciano MF . J Nutr 2011 141 (2) 261-6 Dietary supplement use has steadily increased over time since the 1970s; however, no current data exist for the U.S. population. Therefore, the purpose of this analysis was to estimate dietary supplement use using the NHANES 2003-2006, a nationally representative, cross-sectional survey. Dietary supplement use was analyzed for the U.S. population (≥1 y of age) by the DRI age groupings. Supplement use was measured through a questionnaire and was reported by 49% of the U.S. population (44% of males, 53% of females). Multivitamin-multimineral use was the most frequently reported dietary supplement (33%). The majority of people reported taking only 1 dietary supplement and did so on a daily basis. Dietary supplement use was lowest in obese adults and highest among non-Hispanic whites, older adults, and those with more than a high-school education. Between 28 and 30% reported using dietary supplements containing vitamins B-6, B-12, C, A, and E; 18-19% reported using iron, selenium, and chromium; and 26-27% reported using zinc- and magnesium-containing supplements. Botanical supplement use was more common in older than in younger age groups and was lowest in those aged 1-13 y but was reported by ~20% of adults. About one-half of the U.S. population and 70% of adults ≥ 71 y use dietary supplements; one-third use multivitamin-multimineral dietary supplements. Given the widespread use of supplements, data should be included with nutrient intakes from foods to correctly determine total nutrient exposure. |
Underground mine refuge chamber expectations training: program development and evaluation
Margolis KA , Westerman CYK , Kowalski-Trakofler KM . Saf Sci 2011 49 (3) 522-530 Refuge chambers are new devices for underground coal mines that provide approximately 96 h of breathable air, water, food, and supplies in the event of an emergency where miners are unable to escape. Researchers at the National Institute for Occupational Safety and Health (NIOSH) developed a training program to prepare miners for what to expect psychologically and physiologically inside of a refuge chamber. The field tests of this training revealed that it was received very positively by miners and helped impart realistic views about the physical discomforts and psychological stresses of being inside a refuge chamber. |
Health-related quality of life and the physical activity levels of middle-aged women, California Health Interview Survey, 2005
Luncheon C , Zack M . Prev Chronic Dis 2011 8 (2) A36 INTRODUCTION: Several studies suggest that physical activity may improve health-related quality of life. Other studies have shown that participation in physical activity differs among women of different racial/ethnic groups. This study aimed to determine whether the association between physical activity and health-related quality of life differs among women aged 40 to 64 years from different racial/ethnic groups. METHODS: We explored the association between physical activity level and health-related quality of life with descriptive statistics and multiple regression analyses adjusting for potential confounders among 11,887 women aged 40 to 64 years who identified themselves as Latinas, Asians, African Americans, or whites in the 2005 California Health Interview Survey. RESULTS: Although white women reported more regular physical activity than women of other racial/ethnic groups, Asian women reported fewer mentally and overall unhealthy days than women of other groups. Nonetheless, as physical activity increased, health-related quality of life improved only among white women (fewer physically unhealthy, mentally unhealthy, recent activity limitation, and overall unhealthy days) and among Latinas (fewer overall unhealthy days). CONCLUSION: Future studies should try to confirm if and clarify why the association between physical activity level and health-related quality of life differs among these middle-aged women of different races/ethnicities. If confirmed, this association would imply that health care professionals and those who design public health interventions may need to vary their promotion methods and messages to encourage physical activity among women of different races/ethnicities. |
Program science: an initiative to improve the planning, implementation and evaluation of HIV/sexually transmitted infection prevention programmes
Blanchard JF , Aral SO . Sex Transm Infect 2011 87 (1) 2-3 Three decades into the emergence of the HIV epidemic, centuries into the appearance of other sexually transmitted infections (STI), and despite the development of many efficacious individual, group and structural level interventions, it is clear that advances made in the prevention of HIV and other STI have not been sufficient to get ahead of these epidemics.1–4 As in other spheres of public health and health service delivery, consensus emerged that central to this problem was insufficient use of scientific evidence in planning and delivering interventions.5 To address this gap, health programme planners and implementers were encouraged to adopt ‘evidence-based approaches’ by pulling in evidence from the scientific literature and experts to inform their decision making. Increasingly, scientists have been encouraged to engage in knowledge translation to ensure that the findings from their research is being made known to policy makers, planners and implementers to guide better decisions.6 | While reinforcing the need to close the gap between evidence and action, there is growing sentiment that current concepts and approaches for doing so are inadequate, and new paradigms are needed. In a recent article Parkhurst and colleagues7 pointed to a flaw in basic conceptual basis of knowledge translation. They argue that the usual paradigm of ‘getting research into practice’ by first developing ‘clear agreed-on evidence’ about interventions and then pushing that evidence into policy formulation and implementation has two important drawbacks. First, this approach does not address how policies and programmes are to be developed when there are evidence gaps, nor is this approach suited for dealing with complexity in causation or interventions and the importance of the social and epidemiological context. Second, this approach tends to separate researchers from those engaged in programme development and implementation. They therefore recommend emphasising a paradigm of ‘getting research out of practice’ that engages scientists and programme planners and implementers jointly to develop and refine hypotheses about the impact of an intervention strategy, and focuses on operational research, process evaluation and proper outcome evaluation to build the knowledge base further about what works in different contexts and why. |
Consent for future genetic research: the NHANES experience in 2007-2008
McQuillan GM , Porter KS . IRB 2011 33 (1) 9-14 The National Health and Nutrition Examination Survey (NHANES) is a program of studies conducted since the 1960s by the National Center for Health Statistics of the U.S. Centers for Disease Control and Prevention. Its purpose is to obtain information on the health and nutritional status of the U.S. population. The survey involves interviews and physical examinations of a nationally representative sample of civilian and noninstitutionalized adults and children. From 1999-2002, and again from 2007-2008, biospecimens (blood, urine, and DNA samples) were collected from NHANES participants. In 2006, we reported on the NHANES experience with obtaining consent for the storage and use of biospecimens for data years 1999-2002. (1) In this report, we provide an update on the NHANES experience regarding consent for collecting biospecimens for data years 2007-2008 (DNA samples were not collected from 2003-2006). |
Pursuing health equity: zoning codes and public health
Ransom MM , Greiner A , Kochtitzky C , Major KS . J Law Med Ethics 2011 39 Suppl 1 94-7 Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. |
An organizing framework for translation in public health: the knowledge to action framework
Wilson KM , Brady TJ , Lesesne C . Prev Chronic Dis 2011 8 (2) A46 A priority for the Centers for Disease Control and Prevention (CDC) is translating scientific knowledge into action to improve the public's health. No area has a more pressing need for translation than the prevention and control of chronic diseases. Staff from CDC's National Center for Chronic Disease Prevention and Health Promotion worked across disciplines and content areas to develop an organizing framework to describe and depict the high-level processes necessary to move from discovery into action through translation of evidence-based programs, practices, or policies. The Knowledge to Action (K2A) Framework identifies 3 phases (research, translation, and institutionalization) and the decision points, interactions, and supporting structures within the phases that are necessary to move knowledge to sustainable action. Evaluation undergirds the entire K2A process. Development of the K2A Framework highlighted the importance of planning for translation, attending to supporting structures, and evaluating the public health impact of our efforts. |
Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009
Gase LN , Kuo T , Dunet DO , Simon PA . Prev Chronic Dis 2011 8 (2) A33 INTRODUCTION: This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. METHODS: We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. RESULTS: Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. CONCLUSION: Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions. |
Addressing the needs of the whole child: what public health can do to answer the education sector's call for a stronger partnership
Allensworth D , Lewallen TC , Stevenson B , Katz S . Prev Chronic Dis 2011 8 (2) A44 Although the overall level of child health in the United States remains high, public health professionals know that racial and ethnic disparities in child and adolescent health persist and that lifestyle choices related to chronic disease in adults are often established in childhood and adolescence. And yet, those health needs are not the public health sector's alone to resolve. We have natural partners among educators. Improving graduation rates is one of the most cost-effective ways to reduce health disparities. This article provides strategies for how public health professionals can answer this call by educators to address the needs of the whole child. |
Use of contraception among US women with frequent mental distress
Farr SL , Curtis KM , Robbins CL , Zapata LB , Dietz PM . Contraception 2011 83 (2) 127-33 BACKGROUND: This study examines whether a woman's mental health is associated with use of contraception. STUDY DESIGN: We used national data from 2004 and 2006 to calculate the prevalence of contraceptive use among women with frequent mental distress. We examined associations among mental distress and permanent contraception and any highly or moderately effective, reversible contraceptive method. RESULTS: Women with (86%) and without (87%) frequent mental distress reported using contraception, but contraceptive type varied by mental distress and income. Among women who use contraception, those with frequent mental distress had 1.4 times higher odds (95% CI: 1.2-1.6) of using permanent contraception. Among lower income women who use reversible contraception, those with frequent mental distress had lower odds of using highly [adjusted odds ratio (aOR)=0.5, 95% CI: 0.4-0.8] and moderately (aOR=0.6, 95% CI: 0.4-0.9) effective methods than less effective methods. CONCLUSION: Contraceptive providers should consider mental health when providing counseling about contraception. |
Effect of treatment assignment on intravaginal cleansing in a randomized study of the diaphragm with candidate microbicide
Penman-Aguilar A , Legardy-Williams J , Turner AN , Rabozakandriana TO , Williams D , Razafindravoavy S , Behets F , Van Damme K , Jamieson DJ . J Womens Health (Larchmt) 2011 20 (2) 187-95 BACKGROUND: Intravaginal cleansing may predispose women to adverse health outcomes and may interfere with the effectiveness and safety of female-initiated methods for preventing sexually transmitted infections (STIs). In a 4-week randomized study of 192 Malagasy sex workers, we evaluated associations between self-reported intravaginal cleansing and randomization assignment: diaphragm with viscous candidate microbicide gel (Acidform, TOPCAD, Chicago, IL, licensed to Instead, Coppell, TX), diaphragm with placebo hydroxyethylcellulose gel (HEC, ReProtect LLC, Baltimore, MD), Acidform alone, or HEC alone. METHODS: Women were counseled to avoid intravaginal cleansing and were blinded to gel assignment. We evaluated changes in self-reported intravaginal cleansing across the study and assessed the effects of treatment assignment and covariates on frequent (more than once daily) intravaginal cleansing. Significant predictors in domain-specific models were evaluated in an all-domain multiple regression model. RESULTS: The proportion of women reporting intravaginal cleansing decreased from baseline (97%) to week 1 (82%) (p < 0.001). Self-reported frequent intravaginal cleansing decreased from baseline (87% to 56%) during the same time period (p < 0.001). In adjusted analyses, the Acidform-diaphragm group had 60% lower odds of frequent intravaginal cleansing during the study (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.8) compared to the control group (HEC only). HEC-diaphragm and Acidform only users did not differ from controls. Living on the coast of Madagascar, not cohabiting, frequent intravaginal cleansing at enrollment, and high coital frequency predicted frequent intravaginal cleansing during follow-up. CONCLUSIONS: Gel characteristics and the diaphragm's presence likely influenced women's cleansing. Viscous gel delivered by a cervical barrier (such as a diaphragm) may minimize the likelihood of frequent intravaginal cleansing. |
Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic influenza
Cauchemez S , Bhattarai A , Marchbanks TL , Fagan RP , Ostroff S , Ferguson NM , Swerdlow D . Proc Natl Acad Sci U S A 2011 108 (7) 2825-30 Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6-18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household. |
Ecological-type inference in matched-pair studies with fixed marginal totals.
Barker LK , Griffin SO , Jeon S , Gray SK , Vidakovic B . Stat Med 2011 30 (5) 541-8 This paper applies a Bayesian approach to ecological-type inference in matched-pair studies because traditional methods that assume parallel tables are not directly applicable. The proposed procedure is based on a hierarchical Bayes structure which models information about the within-pair association. The proposed algorithm relies on Markov chain Monte Carlo simulation, recovers the full table, and reports its accuracy in terms of credible sets for the cell counts. This methodology is motivated and illustrated with examples from split-mouth designs assessing the effectiveness of dental sealant materials and cross-over trials comparing two forms of insulin. Published in 2011 by John Wiley & Sons, Ltd. |
Important issues related to using pooled samples for environmental chemical biomonitoring
Caudill SP . Stat Med 2011 30 (5) 515-21 Pooling samples for analysis was first proposed in the 1940s to reduce analytical measurement costs associated with screening World War II recruits for syphilis. Later, it progressed to more complex screening strategies, to population prevalence estimation for discrete quantities, and to population mean estimation for continuous quantities. Recently, pooled samples have also been used to provide efficient alternatives for gene microarray analyses, epidemiologic studies of biomarkers of exposure, and characterization of populations regarding environmental chemical exposures. In this study, we address estimation and bias issues related to using pooled-sample variance information from an auxiliary source to augment pooled-sample variance estimates from the study of interest. The findings are illustrated by using pooled samples from the National Health and Nutrition Examination Survey 2001-2002 to assess exposures to perfluorooctanesulfonate and other polyfluoroalkyl compounds in the U.S. population. Published in 2011 by John Wiley & Sons, Ltd. |
Cryptosporidium andersoni is the predominant species in post-weaned and adult dairy cattle in China
Wang R , Ma G , Zhao J , Lu Q , Wang H , Zhang L , Jian F , Ning C , Xiao L . Parasitol Int 2011 60 (1) 1-4 Dairy industry plays an important role in the agricultural economy of China. To estimate the prevalence and public health significance of cryptosporidiosis in post-weaned and adult dairy cattle in China, during four consecutive years (from 2006 to 2009), a total of 1315 fecal samples from 22 dairy cattle farms in ten prefectures in Henan Province were examined for the presence of Cryptosporidium oocysts. The overall prevalence of Cryptosporidium was 7.9%, with the highest infection rate (11.3%) in 3 to 11-month-old calves and the lowest infection rate (1.0%) in >2-year-old cows (p<0.01). Cryptosporidium-positive samples (n=104) were analyzed by PCR-restriction fragment length polymorphism (RFLP) analysis of the small subunit (SSU) rRNA gene, and 25 representative samples were further analyzed by DNA sequencing of the PCR products. Cryptosporidium bovis and Cryptosporidium andersoni were identified. C. andersoni (84/104) was the predominant species and was found in all age groups, whereas C. bovis (20/104) was only detected in 3 to 11-month-old calves. Thus, C. andersoni appears to be the dominant species in weaned dairy calves and heifers in China, in contrast with its common occurrence in adult cattle in other parts of the world. |
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