Factors associated with control of hypertension, hypercholesterolemia, and diabetes among low-income women in West Virginia
Ahluwalia IB , Tessaro I , Greenlund KJ , Ford ES . J Womens Health (Larchmt) 2010 19 (3) 417-24 BACKGROUND: Adequate control of cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes, requires management. Low-income women living in rural areas with limited health services may experience special challenges in managing chronic conditions. METHODS: In 2008, we conducted an analysis of the baseline, cross-sectional survey of 733 uninsured, low-income, rural women aged 40-64 years participating in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to characterize prevalence, treatment, and control of hypertension, hypercholesterolemia, and diabetes. Data were collected from 2004 to 2007. RESULTS: About 56% of the women had hypertension (38% of which was untreated or uncontrolled), 45% had hypercholesterolemia (31% of which was untreated or uncontrolled), and 19% had diabetes (26% of which was untreated or uncontrolled). Multivariable analyses showed that those with a regular physician were less likely than those without a physician to have uncontrolled hypertension (adjusted odds ratio [AOR] 0.34, 95% CI 0.13-0.88) and hypercholesterolemia (AOR 0.14, 95% CI 0.04-0.47). Education level was also a significant predictor for uncontrolled hypertension, and physical activity level (measured by total metabolic equivalent [MET] hours) significantly predicted uncontrolled hypercholesterolemia (AOR 1.01, 95% CI 1.001-1.02). For diabetes, race/ethnicity was the main predictor; white women were less likely than other groups to have untreated or uncontrolled diabetes. CONCLUSIONS: High proportions of women in the WV-WISEWOMAN project had uncontrolled hypertension, hypercholesterolemia, and diabetes at baseline. These study results should be used to inform programs seeking to increase access to health services in order to reduce consequences of uncontrolled chronic conditions. |
Prevalence of chronic hepatitis B virus infection among patients in the HIV Outpatient Study, 1996-2007
Spradling PR , Richardson JT , Buchacz K , Moorman AC , Brooks JT . J Viral Hepat 2010 17 (12) 879-86 Coinfection with hepatitis B virus (HBV) is an important and preventable cause of chronic liver disease among HIV-infected patients. We calculated the prevalence of chronic HBV infection annually from 1996 to 2007 by age, gender, race/ethnicity, and HIV transmission risk in a multisite observational cohort study of HIV-infected patients. Prevalence of chronic HBV infection was calculated as the number of patients with a positive HBsAg or detectable HBV DNA divided by the number of patients tested using either one of these assays. Among 4467 (59%) patients tested for chronic HBV infection from a total of 7618 patients active during 1996-2007, median age was 38.5 years, 77% were men, 49% were white, 35% were black, 13% were Hispanic, and 53% were men who had sex with men (MSM). Overall, 8.4% tested positive for HBsAg or detectable HBV DNA. Annual chronic HBV prevalence during 1996-2007 ranged from 7.8% to 8.6% without a statistically significant trend. Overall, prevalence was greater among men compared with women; among whites, blacks, and persons of other race compared with Hispanics; among MSM compared with injection drug users and high-risk heterosexuals; and among patients aged 35-44 years compared with younger or older patients. MSM constituted the greatest fraction (63-72%) of all HBV-infected patients in the HIV Outpatient Study (HOPS) over the period. Of eligible patients, 5.8%, 23.4%, and 31.6% had received at least one dose of HBV vaccine by years 1996, 2002, and 2007, respectively. Despite the availability of an effective HBV vaccine for over two decades and long-standing recommendations for immunization of persons (with or without HIV infection) at risk for HBV, the prevalence of chronic HBV infection in this study has been largely unchanged over the past decade among patients in all groups, and overall was 20 times as high as the national population prevalence. |
Prevention with HIV-positive men who have sex with men: regaining lost ground
Fenton KA . Sex Transm Infect 2010 86 (1) 2-4 The data are clear: the sexual health of gay, bisexual and other men who have sex with men (MSM) continues to deteriorate in many western industrialised countries.1 2 The epidemiological trends appear consistent: a resurgence of bacterial and viral sexually transmitted infections (STI); rising or stable HIV incidence; recent outbreaks of lymphogranuloma venerum and hepatitis C, especially among HIV-positive MSM;3 4 accompanied by a stable or increasing prevalence of risky sexual behaviours including unprotected anal intercourse, serodiscordant unprotected anal intercourse and high rates of partner change.5 These individual level changes are occurring within a wider context of evolving social, cultural and risk environments and norms and at a time when MSM in many developed country settings are enjoying unparalleled social acceptance and freedoms.6 Concomitant changes in the availability, use and abuse of recreational drugs, including alcohol, continue to fuel risk behaviour and drive disease incidence.1 Similarly, the growing population of HIV-infected MSM, many of whom are unaware of their HIV infection, may be increasing the burden of infection at a time when more men are reporting homosexual sexual behaviours and partnerships.7 8 |
Factors associated with delayed entry into primary HIV medical care after HIV diagnosis
Bamford LP , Ehrenkranz PD , Eberhart MG , Shpaner M , Brady KA . AIDS 2010 24 (6) 928-30 The aim of the study was to assess the median time between HIV diagnosis and entry into primary HIV medical care in a large urban area and to assess the potential individual, diagnosing facility, and community level factors influencing entry into care. One thousand two hundred and sixty-six individuals diagnosed with HIV in Philadelphia between 1 July 2005 and 30 June 2006 were followed until entry into care through 15 June 2007. Time to entry into care was calculated as a survival time variable and was defined as the time in months between the date of HIV diagnosis and the date more than 3 weeks after diagnosis when a CD4 cell count or percentage and/or HIV viral load were obtained. The median time to entry into care for all individuals was 8 months, with a range of 1-26 months. Factors associated with delayed entry into care included age more than 40 years [hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.75-0.97] and diagnosis as an inpatient in the hospital (HR = 0.37; 95% CI = 0.37-0.57). Factors associated with earlier entry into care included Hispanic ethnicity (HR = 1.39; 95% CI = 1.05-1.84), male sex with men as HIV transmission risk factor (HR = 1.27; 95% CI = 1.03-1.56), and residence in a census tract with a high poverty rate (HR = 1.68; 95% CI = 1.22-2.30). Individuals newly diagnosed with HIV in Philadelphia demonstrated marked delays in accessing care highlighting the tremendous need for interventions to improve overall linkage. These interventions should especially be targeted at those aged more than 40 years and those diagnosed in the hospital. |
Access to HIV testing for sex workers in Bangkok, Thailand: a high prevalence of HIV among street-based sex workers
Nhurod P , Bollen LJM , Smutraprapoot P , Suksripanich O , Siangphoe U , Lolekha R , Manomaipiboon P , Nandavisai C , Anekvorapong R , Supawitkul S , Subhachaturas W , Akarasewi P , Fox KK . Southeast Asian J Trop Med Public Health 2010 41 (1) 153-162 We offered voluntary counseling and testing (VCT) for HIV and syphilis to women attending three public sexually transmitted infection (STI) clinics in Bangkok, Thailand from May 2004 to June 2006. The testing was performed at either one of three STI clinics in Bangkok or at mobile VCT in the same area as the outreach activity. Six-hundred eighty-four women were tested. The HIV prevalences among the street-based sex workers, brothel-based sex workers and other women in these areas not reporting sex work who tested in the clinics were 45.8% (38/83), 4.2% (10/236) and 9.9% (28/284), respectively. The prevalences of syphilis in these groups were 13.3%, 2.1%, and 2.6%, respectively. Street-based sex work and longer duration of sex work were independent risk factors for HIV infection (p<0.001 and p=0.02, respectively). HIV and syphilis prevalences were 21.0%, and 3.7% among 81 street-based sex workers accepting mobile VCT. The street-based sex workers in Bangkok had substantially higher HIV and syphilis prevalences than other sex workers. Street-based sex workers should be sampled during routine Surveillance to obtain systematic information on disease prevalence and risk behaviors in this group. |
Current challenges in the risk assessment of neuraminidase inhibitor-resistant influenza viruses
Gubareva LV , Fry AM . J Infect Dis 2010 201 (5) 656-8 In this issue of the Journal, Baz et al [1] present data on the replicative fitness and virulence of seasonal influenza A(H1N1) viruses and their oseltamivir-resistant variants. The sudden emergence and global spread of oseltamivir-resistant variants of seasonal influenza A(H1N1) viruses carrying the substitution His→Tyr at position 274 (275 by N1 numbering) in the drugtargeted neuraminidase (NA) were hallmarks of the 2007–2008 influenza season. The viruses continued to circulate during the next season and increased in prevalence to become the predominant circulating influenza virus strain in several countries. Moreover, there have been rare reports of the acquisition of the H275Y mutation by the pandemic novel influenza A(H1N1) virus (previously referred to as swine-origin influenza H1N1) that emerged in the spring of 2009. H275Y is the NA mutation that is most frequently associated with oseltamivir resistance in the N1 subtype. The emergence of drug-resistant viruses that retain replicative fitness is a significant obstacle in the effective management of influenza virus infections and poses a threat to pandemic strategies to reduce morbidity and mortality when vaccine is either not available or in limited supply. There is a need to better understand virological and clinical correlates of viral fitness and the methods used to assess viral fitness. The results of previous in vivo studies indicated that mutations conferring resistance to NA inhibitors (NAIs) often lead to a loss of viral fitness [2–5]. This is in contrast with the results of Baz and colleagues, which suggest that the viral fitness and virulence of oseltamivir-resistant influenza A(H1N1) viruses were unimpaired compared with those of oseltamivir-susceptible viruses. The conclusions drawn by Baz and colleagues are consistent with the available (although somewhat limited) epidemiological information [6–9]. Nevertheless, it is essential to analyze in more detail the experiments and experimental design that led to these conclusions. |
Low-frequency K103N strengthens the impact of transmitted drug resistance on virologic responses to first-line efavirenz or nevirapine-based highly active antiretroviral therapy
Geretti AM , Fox ZV , Booth CL , Smith CJ , Phillips AN , Johnson M , Li JF , Heneine W , Johnson JA . J Acquir Immune Defic Syndr 2009 52 (5) 569-73 BACKGROUND: There are conflicting data on the impact of low-frequency transmitted drug-resistant mutants on responses to first-line highly active antiretroviral therapy (HAART). METHODS: Patients started nevirapine or efavirenz with two or more nucleoside/nucleotide reverse transcriptase inhibitors in 1998-2007 without a prior resistance test at a median 1.0 (interquartile range, 0.0-3.4) year after diagnosis and with a median 218 (interquartile range, 131-296) CD4 cells/mm3, and had at least 24 weeks of follow up. Pre-HAART plasma samples were tested retrospectively by bulk genotyping and sensitive real-time polymerase chain reaction targeting reverse transcriptase K65R, K103N, Y181C, M184V, and G190A (interpretative cutoff 0.3%-0.9%). RESULTS: Among 93 patients, seven of 18 who experienced virologic failure and zero of 75 who maintained virologic suppression showed pre-HAART resistance, including three with high-frequency mutations detectable by bulk genotyping (two K103N, one G190A) and four with low-frequency K103N detectable only by polymerase chain reaction. Detection of either bulk (P = 0.006) or low-frequency (P = 0.001) resistance was significantly associated with the odds of virologic failure; combining the two markedly increased the strength of the association (P < 0.0001). At failure, the pre-HAART mutations were detected by bulk genotyping in five of seven patients alongside additional reverse transcriptase mutations. CONCLUSIONS: Low-frequency K103N mutants were as prevalent as bulk-detectable variants before starting HAART. Both high- and low-frequency mutants were significantly associated with virologic failure. |
Number of named partners and number of partners newly diagnosed with HIV infection identified by persons with acute versus established HIV infection
Moore ZS , McCoy S , Kuruc J , Hilton M , Leone P . J Acquir Immune Defic Syndr 2009 52 (4) 509-13 BACKGROUND: Acute infections with HIV account for a disproportionate share of forward transmission in certain populations. We hypothesized that persons with acute HIV infection (AHI) would identify more named partners than those with established HIV infection (EHI). METHODS: We reviewed North Carolina surveillance databases to identify all persons aged > or =18 years in whom HIV was diagnosed during November 1, 2002 to October 31, 2007. We compared the number of named partners identified by persons with AHI versus EHI (based on nucleic acid amplification plus serologic testing) using a multivariable model and also compared information regarding HIV testing among partners identified by these groups. RESULTS: EHI was diagnosed in 9044 persons and AHI in 120 persons during the study period. Persons with AHI named 2.5 times more partners per index patient [95% confidence interval: 2.1 to 3.0] and 1.9 times more partners newly diagnosed with HIV infection per index patient (95% confidence interval: 1.1 to 3.5) as did persons with EHI. DISCUSSION: In North Carolina, persons with AHI identified proportionately more named partners and more partners newly diagnosed with HIV infections than persons with EHI. Improved detection of AHI offers critical opportunities to intervene and potentially reduce transmission of HIV. |
Single- and multi-wall carbon nanotubes versus asbestos: are the carbon nanotubes a new health risk to humans?
Pacurari M , Castranova V , Vallyathan V . J Toxicol Environ Health A 2010 73 (5) 378-95 Carbon nanotubes (CNT), since their discovery, have become one of the most promising nanomaterials in many industrial and biomedical applications. Due to their unique physicochemical properties, interest is growing in the manufacture of CNT-based products and their subsequent marketing. Since their discovery, the prospect of possible undesirable human health effects has been a focus of many scientific studies. Although CNT possess unique physical properties that include (1) nanoscale diameter, (2) a wide length distribution ranging from tens of nanometers to several micrometers, and (3) high aspect ratio, the fibrous-like shape and durability suggest that their toxic properties may be analogous to those observed with other fibrous particles, such as asbestos. The present study provides a summary of published findings on CNT bioactivity, such as the potential of CNT, especially of multi-wall carbon nanotubes (MWCNT), to activate signaling pathways modulating transcription factor activity, induce apoptosis, induce DNA damage, and initiate biological responses. Assessment of risks to human health and adoption of appropriate exposure controls is critical for the safe and successful introduction of CNT -based products for future applications. |
Effect of production variables on microbiological removal in locally-produced ceramic filters for household water treatment
Lantagne D , Klarman M , Mayer A , Preston K , Napotnik J , Jellison K . Int J Environ Health Res 2010 20 (3) 1-17 Diarrhoeal diseases cause an estimated 1.87 million child deaths per year. Point-of-use filtration using locally made ceramic filters improves microbiological quality of stored drinking water and prevents diarrhoeal disease. Scaling-up ceramic filtration is inhibited by lack of universal quality control standards. We investigated filter production variables to determine their affect on microbiological removal during 5-6 weeks of simulated normal use. Decreases in the clay:sawdust ratio and changes in the burnable decreased effectiveness of the filter. Method of silver application and shape of filter did not impact filter effectiveness. A maximum flow rate of 1.7 l(-hr) was established as a potential quality control measure for one particular filter to ensure 99% (2- log(10)) removal of total coliforms. Further research is indicated to determine additional production variables associated with filter effectiveness and develop standardized filter production procedures prior to scaling-up. |
Comparative pharmacokinetics of chlorpyrifos versus its major metabolites following oral administration in the rat
Busby-Hjerpe AL , Campbell JA , Smith JN , Lee S , Poet TS , Barr DB , Timchalk C . Toxicology 2010 268 55-63 Chlorpyrifos (CPF) is a commonly used diethylphosphorothionate organophosphorus (OP) insecticide. Diethylphosphate (DEP), diethylthiophosphate (DETP) and 3,5,6-trichloro-2-pyridinol (TCPy) are products of both in vivo metabolism and environmental degradation of CPF and are routinely measured in urine as biomarkers of exposure. Hence, urinary biomonitoring of TCPy, DEP and DETP may be reflective of an individual's contact with both the parent pesticide and exposure to these metabolites in the environment. In the current study, simultaneous dosing of 13C- or 2H-isotopically labeled CPF (13C-labeled CPF, 5 13C on the TCPy ring; or 2H-labeled CPF, diethyl-D10 (deuterium labeled) on the side chain) were exploited to directly compare the pharmacokinetics and metabolism of CPF with TCPy, and DETP. The key objective in the current study was to quantitatively evaluate the pharmacokinetics of the individual metabolites relative to their formation following a dose of CPF. Individual metabolites were co-administered (oral gavage) with the parent compound at equal molar doses (14 micromol/kg; approximately 5 mg/kg CPF). Major differences in the pharmacokinetics between CPF and metabolite doses were observed within the first 3h of exposure, due to the required metabolism of CPF to initially form TCPy and DETP. Nonetheless, once a substantial amount of CPF has been metabolized (> or =3h post-dosing) pharmacokinetics for both treatment groups and metabolites were very comparable. Urinary excretion rates for orally administered TCPy and DETP relative to 13C-CPF or (2)H-CPF derived 13C-TCPy and 2H-DETP were consistent with blood pharmacokinetics, and the urinary clearance of metabolite dosed groups were comparable with the results for the 13C- and 2H-CPF groups. Since the pharmacokinetics of the individual metabolites were not modified by co-exposure to CPF; it suggests that environmental exposure to low dose mixtures of pesticides and metabolites will not impact their pharmacokinetics. |
Direct fibrogenic effects of dispersed single-walled carbon nanotubes on human lung fibroblasts
Wang L , Mercer RR , Rojanasakul Y , Qiu A , Lu Y , Scabilloni JF , Wu N , Castranova V . J Toxicol Environ Health A 2010 73 (5) 410-22 Nanomaterials, including single-walled carbon nanotubes (SWCNT), are being developed for a variety of commercial products. However, adverse health effects attributed to these new materials are not well understood. Recent reports showed that exposure of mice to dispersed SWCNT (DSWCNT) produced a rapid and progressive interstitial lung fibrosis without persistent inflammation. To understand the mechanism underlying this unusual fibrogenicity of DSWCNT, the present investigation focused on the direct bioactivity of DSWCNT using a cell culture of lung fibroblasts that represent a major cell type resident in the lung interstitium and responsible for the production of collagen matrix. At concentrations relevant to those used in vivo, in vitro exposure of lung fibroblasts to DSWCNT stimulated cell proliferation and induced collagen production without producing cell damage. One of the major matrix metalloproteinases (MMP), MMP-9, which is known to be involved in lung fibrosis, was also elevated by DSWCNT treatment both in vitro and in vivo. Taken together, these results suggest that direct stimulation of fibroblasts by DSWCNT translocated into the interstitium may play a significant role in DSWCNT-induced lung fibrosis. Our data also suggest that the dispersion status and/or size of the SWCNT structures is a critical factor in determining nanoparticle fibrogenicity and that MMP-9 may be involved in the fibrogenic process. The results obtained may aid in the development of in vitro models for rapid screening of the potential fibrogenicity of carbon nanotubes, which are lacking and urgently needed. |
A conditional expectation approach for associating ambient air pollutant exposures with health outcomes
Wannemuehler KA , Lyles RH , Waller LA , Hoekstra RM , Klein M , Tolbert P . Environmetrics 2009 20 (7) 877-894 Our research focuses on the association between exposure to an airborne pollutant and counts of emergency department visits attributed to a specific chronic illness. The motivating example for this analysis of measurement error in time series studies of air pollution and acute health outcomes was a study of emergency department visits from a 20-county Atlanta metropolitan statistical area from 1993-1999. The research presented illustrates the impact of using various surrogates for unobserved measurements of ambient concentrations at the zip code level. Simulation results indicate that the impact of measurement error on the association between pollutant exposure and a health outcome can be substantial. The proposed conditional expectation approach provided reliable estimates of the association and exhibited good confidence interval coverage for a variety of magnitudes of association. Use of a single-centrally located monitor, the arithmetic average, the nearest-neighbor monitor, and the inverse-distance weighted average surrogates resulted in biased estimates and poor coverage rates, especially for larger magnitudes of the association. A focus on obtaining reasonable exposure measurements within clearly defined subregions is important when the pollutant exposure of interest exhibits strong spatial variability. |
Medical history, body size, and cigarette smoking in relation to fatal prostate cancer
Weinmann S , Shapiro JA , Rybicki BA , Enger SM , Van Den Eeden SK , Richert-Boe KE , Weiss NS . Cancer Causes Control 2010 21 (1) 117-25 OBJECTIVES: Prostate cancer has few known risk factors. As part of a population-based case-control study conducted in four health maintenance organizations, the authors examined the associations between fatal prostate cancer and several medical and behavioral characteristics. METHODS: Cases were 768 health plan members who died of prostate adenocarcinoma during the period 1997-2001. We randomly selected controls (929) from the health plan membership and matched them to cases on health plan, age, race, and pattern of health plan membership. We examined medical records to obtain information on potential risk factors during the 10 years before the date on which prostate cancer was first suspected; the same reference date was used for the matched controls. RESULTS: Anthropometric characteristics, as well as personal histories of benign prostatic hypertrophy, transurethral prostatectomy, cancer, diabetes, prostatitis, hypertension, and vasectomy were largely similar for cases and controls. Men who died from prostate cancer were more likely than controls to have been cigarette smokers according to the most recent smoking notation before the reference date (odds ratio 1.5, 95% confidence interval 1.1-2.0). CONCLUSIONS: The observed increase in risk associated with recent cigarette smoking is consistent with the findings of several other studies. However, in contrast with some reports, we observed no connection between fatal prostate cancer and some prior health conditions or measures of body size. |
An early report from newly established laboratory-based influenza surveillance in Lao PDR
Vongphrachanh P , Simmerman JM , Phonekeo D , Pansayavong V , Sisouk T , Ongkhamme S , Bryce GT , Corwin A , Bryant JE . Influenza Other Respir Viruses 2010 4 (2) 47-52 Background Prior to 2007, little information was available about the burden of influenza in Laos. We report data from the first laboratory-based influenza surveillance system established in the Lao People's Democratic Republic. Methods Three hospitals in the capital city of Vientiane began surveillance for influenza-like illness (ILI) in outpatients in 2007 and expanded to include hospitalized pneumonia patients in 2008. Nasal/throat swab specimens were collected and tested for influenza and other respiratory viruses by multiplex ID-TagTM respiratory viral panel (RVP) assay on a Luminex (R) 100x MAP IS instrument (Qiagen, Singapore). Results During January 2007 to December 2008, 287 of 526 (54 center dot 6%) outpatients with ILI were positive for at least one respiratory virus. Influenza was most commonly identified, with 63 (12 center dot 0%) influenza A and 92 (17 center dot 5%) influenza B positive patients identified. In 2008, six of 79 (7 center dot 6%) hospitalized pneumonia patients were positive for influenza A and four (5 center dot 1%) were positive for influenza B. Children < 5 years represented 19% of viral infections in outpatients and 38% of pneumonia inpatients. Conclusion Our results provide the first documentation of influenza burden among patients with febrile respiratory illness and pneumonia requiring hospitalization in Laos. Implementing laboratory-based influenza surveillance requires substantial investments in infrastructure and training. However, continuing outbreaks of avian influenza A/H5N1 in poultry and emergence of the 2009 influenza A(H1N1) pandemic strain further underscore the importance of establishing and maintaining influenza surveillance in developing countries. |
The global burden of nontyphoidal salmonella gastroenteritis
Majowicz SE , Musto J , Scallan E , Angulo FJ , Kirk M , O'Brien SJ , Jones TF , Fazil A , Hoekstra RM . Clin Infect Dis 2010 50 (6) 882-9 To estimate the global burden of nontyphoidal Salmonella gastroenteritis, we synthesized existing data from laboratory-based surveillance and special studies, with a hierarchical preference to (1) prospective population-based studies, (2) "multiplier studies," (3) disease notifications, (4) returning traveler data, and (5) extrapolation. We applied incidence estimates to population projections for the 21 Global Burden of Disease regions to calculate regional numbers of cases, which were summed to provide a global number of cases. Uncertainty calculations were performed using Monte Carlo simulation. We estimated that 93.8 million cases (5th to 95th percentile, 61.8-131.6 million) of gastroenteritis due to Salmonella species occur globally each year, with 155,000 deaths (5th to 95th percentile, 39,000-303,000 deaths). Of these, we estimated 80.3 million cases were foodborne. Salmonella infection represents a considerable burden in both developing and developed countries. Efforts to reduce transmission of salmonellae by food and other routes must be implemented on a global scale. |
Personal genomics: information can be harmful.
Ransohoff DF , Khoury MJ . Eur J Clin Invest 2010 40 (1) 64-8 Information is generally considered a good thing. Information may of course lead to benefit through some action based on information. But, action can also lead to harm. We know about harm not only from everyday experience and common sense but also from the field of clinical medicine. Approaches to weigh harm vs. benefit have been developed in clinical medicine to aid doctors, patients and policy-makers in deciding whether to obtain and how to use certain kinds of information. | When personal genomics is used to improve health and prevent disease, the fundamental issues relating to benefit and harm of information are exactly the same as in the clinical medicine field of prevention. If information about risk or prognosis can be harmful in clinical medicine, is there a difference just because the health information is ‘genomic?’ | In this issue of the Journal, Gulcher and Stefansson argue that genetic risk information obtained from ongoing discoveries of genetic factors for common complex diseases can be useful for prevention and early detection now [1]. They make the case that risk assessment tests based on these discoveries represent tools for more cost-effective prioritization of scarce resources to address common and costly and deadly common diseases. They make the case that potential benefits of early detection are intuitive, biologically plausible and generally good for healthcare utilization and individual decision making; we contend that potential harms of such tests need to be explicitly considered and evaluated in appropriately designed studies before such tests are used on a population-wide basis in otherwise healthy people. |
Assessment of improved prediction beyond traditional risk factors: when does a difference make a difference?
Janssens AC , Khoury MJ . Circ Cardiovasc Genet 2010 3 (1) 3-5 The moderate predictive performance of cardiovascular disease risk models necessitates more studies that investigate the incremental value of novel biomarkers. In recent years, many new biomarkers have been evaluated for their ability to improve prediction of cardiovascular disease beyond traditional risk factors, including C-reactive protein, coronary artery calcium, and single-nucleotide polymorphisms in the 9p21 region.1 The interest in novel biomarkers is propelled, in part, by emerging discoveries from genomewide association studies of genetic variants associated with risk for many common diseases.2 Nonetheless, family history, an “old” tool in clinical practice—crucial for the diagnosis and management of genetic disorders—has not been adequately explored for its value in risk assessment and prevention of common diseases.3 Positive family history is a strong risk factor for cardiovascular diseases,4,5 reflecting the consequences of genetic and nongenetic risk factors that are shared among relatives. From a practical perspective, family history is a strong determinant of disease that is relatively easy to assess. For this reason, family history is advocated as a useful tool for identifying individuals at increased risk of disease and for tailoring preventive interventions.4,6,7 However, the challenge is to show that this knowledge has clinical utility for improving health.8 |
Recommendations for worksite-based interventions to improve workers' health
Task Force on Community Preventive Services , Pearson-Clarke T . Am J Prev Med 2010 38 S232-6 Over the past 25 years, the number of organizations and companies offering a health promotion program for their employees at the worksite has increased dramatically; by 1990, 81% of worksites and by 2000, nearly 90% of all workplaces with at least 50 employees offered their employees some type of health promotion program.1, 2 There are several reasons why health promotion in U.S. work settings has become increasingly common. The top five health conditions (heart disease, cancers, cerebrovascular disease, chronic lower respiratory disease, and unintentional injuries) are responsive to intervention; American adults spend increasing hours at work; and poor employee health results in substantial financial and productivity costs to employers. | In comparison to nonworksite environments, the worksite provides a number of advantages for health promotion: (1) the potential for intervention exposure because of a large and rather stable population; (2) the potential for adequate or enhanced promotion of, recruitment for, and participation in programs; and (3) the potential for social support networks and peer influences among coworkers as reinforcement of efforts.3 |
A systematic review of selected interventions for worksite health promotion: The assessment of health risks with feedback
Soler RE , Leeks KD , Razi S , Hopkins DP , Griffith M , Aten A , Chattopadhyay SK , Smith SC , Habarta N , Goetzel RZ , Pronk NP , Richling DE , Bauer DR , Buchanan LR , Florence CS , Koonin L , MacLean D , Rosenthal A , Matson Koffman D , Grizzell JV , Walker AM , Task Force on Community Preventive Services . Am J Prev Med 2010 38 S237-62 BACKGROUND: Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees. EVIDENCE ACQUISITION: The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity. EVIDENCE SYNTHESIS: The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone. CONCLUSIONS: The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. |
Worksite-based incentives and competitions to reduce tobacco use: a systematic review
Leeks KD , Hopkins DP , Soler RE , Aten A , Chattopadhyay SK . Am J Prev Med 2010 38 S263-74 The Guide to Community Preventive Service (Community Guide) methods for systematic reviews were used to evaluate the evidence of effectiveness of worksite-based incentives and competitions to reduce tobacco use among workers. These interventions offer a reward to individuals or to teams of individuals on the basis of participation or success in a specified smoking behavior change (such as abstaining from tobacco use for a period of time). The review team identified a total of 26 published studies, 14 of which met study design and quality of execution criteria for inclusion in the final assessment. Only one study, which did not qualify for review, evaluated the use of incentives when implemented alone. All of the 14 qualifying studies evaluated incentives and competitions when implemented in combination with a variety of additional interventions, such as client education, smoking cessation groups, and telephone cessation support. Of the qualifying studies, 13 evaluated differences in tobacco-use cessation among intervention participants, with a median follow-up period of 12 months. The median change in self-reported tobacco-use cessation was an increase of 4.4 percentage points (a median relative percentage improvement of 67%). The present evidence is insufficient to determine the effectiveness of incentives or competitions, when implemented alone, to reduce tobacco use. However, the qualifying studies provide strong evidence, according to Community Guide rules, that worksite-based incentives and competitions in combination with additional interventions are effective in increasing the number of workers who quit using tobacco. In addition, these multicomponent interventions have the potential to generate positive economic returns over investment when the averted costs of tobacco-associated illnesses are considered. A concurrent systematic review identified four studies with economic evidence. Two of these studies provided evidence of net cost savings to employers when program costs are adjusted for averted healthcare expenses and productivity losses, based on referenced secondary estimates. |
Guideline for prevention of catheter-associated urinary tract infections 2009
Gould CV , Umscheid CA , Agarwal RK , Kuntz G , Pegues DA . Infect Control Hosp Epidemiol 2010 31 (4) 319-26 This guideline updates and expands the original Centers | for Disease Control and Prevention (CDC) Guideline for | Prevention of Catheter-Associated Urinary Tract Infections | (CAUTI) published in 1981. Several developments necessitated revision of the 1981 guideline, including new research | and technological advancements for preventing CAUTI, increasing need to address patients in nonacute care settings | and patients requiring long-term urinary catheterization, and | greater emphasis on prevention initiatives as well as better | denned goals and metrics for outcomes and process measures. | In addition to updating the previous guideline, this revised | guideline reviews the available evidence on CAUTI prevention | for patients requiring chronic indwelling catheters and individuals who can be managed with alternative methods of | urinary drainage (eg, intermittent catheterization). The revised guideline also includes specific recommendations for | implementation, performance measurement, and surveillance. Although the general principles of CAUTI prevention | have not changed from the previous version, the revised | guideline provides clarification and more specific guidance | based oil a defined, systematic review of the literature through | July 2007. For areas where knowledge gaps exist, recommendations for further research are listed. Finally, the revised | guideline outlines high-priority recommendations for CAUTI | prevention in order to offer guidance for implementation. |
Improved anamnestic response among adolescents boosted with a higher dose of the hepatitis B vaccine
Chaves SS , Groeger J , Helgenberger L , Auerbach SB , Bialek S , Hu DJ , Drobeniuc J . Vaccine 2010 28 (16) 2860-4 Some hepatitis B vaccine booster studies have suggested waning of vaccine-induced immunity in adolescents vaccinated starting at birth. Those studies, however, used a pediatric formulation of the hepatitis B vaccine as a booster to detect anamnestic response. We compared adolescents boosted with an adult dose of hepatitis B vaccine with those boosted with a pediatric dose. Among adolescents who had lost protective antibody levels against hepatitis B, a higher proportion had an anamnestic response when boosted with the adult dose (60.0% vs. 43.8%). Thus, higher antigen concentrations may be required to elicit an adequate immune memory response. Despite improved anamnestic response, our study still raises concerns about whether children immunized in early infancy will remain protected from hepatitis B as they age into adulthood. |
Resistance to simian HIV infection is associated with high plasma interleukin-8, RANTES and Eotaxin in a macaque model of repeated virus challenges
Promadej-Lanier N , Hanson DL , Srinivasan P , Luo W , Adams DR , Guenthner PC , Butera S , Otten RA , Kersh EN . J Acquir Immune Defic Syndr 2010 53 (5) 574-81 Animal models for research on susceptibility to HIV are currently not available. Here we explore whether a macaque model of repeated low-dose rectal or vaginal virus challenges could be employed. We tested the hypothesis that susceptibility to Simian HIV is not merely stochastic in this model but rather is associated with identifiable host factors. Forty macaques required a median of 3.5 SHIVSF162P3 challenges for infection. We studied the association of their susceptibility with 13 predisposing plasma cytokines/chemokines (RANTES, Eotaxin, monocyte chemoattractant protein (MCP)-1, IL-7, MIP-1beta, TNF-alpha, MIP-1alpha, granulocyte colony-stimulating factor, IL-8, interferon-gamma, IL-17, IL-1beta, IL-6). Higher plasma RANTES, IL-8, and Eotaxin were associated with lower susceptibility, that is, higher resistance to infection. In a group of macaques with low IL-8 and RANTES, a median 3 exposures were required to infect; whereas, when either IL-8 or RANTES were high, a median 12 exposures were required. Thus, susceptibility was associated with identifiable discrete host factors and was not stochastic. In addition, the macaque model identified key human resistance factors (RANTES, Eotaxin), but also revealed a novel association with resistance (IL-8). Future direct evaluation of these or other factors in the animal model may be beneficial for developing new immunomodulation strategies for HIV prevention. |
Optimization of the design of a semivolatile aerosol dichotomous sampler
Kim SW , Raynor PC . Aerosol Sci Technol 2010 44 (2) 129-140 This article reports the results of an optimization procedure for a semivolatile aerosol dichotomous sampler (SADS) and experimental confirmation of the instrument's performance with an optimized sampler. Using numerical model results, the relationships between four major design and operating parameters significantly affecting the performance of the SADS and four performance parameters were expressed in log polynomial equations. Utilizing an optimization procedure, values for the major parameters giving the best performance were determined and used as the base model for optimizing minor parameters. Five minor parameters were then investigated for their possible contribution to better performance of the SADS. The optimal dimensions found were as follows: the diameter ratio between the nozzle and the collection probe was 1.30 and the length ratio of the distance between the nozzle and the collection probe divided by the nozzle diameter was 0.6. Among the minor parameters, only the entrance angle of the nozzle made noticeable improvement at 45 degrees. Experimental tests confirmed that the performance of the new sampler was improved although not as much as expected from the numerical simulation. |
Experimental evaluation of oil mists using a semivolatile aerosol dichotomous sampler
Kim SW , Raynor PC . J Occup Environ Hyg 2010 7 (4) 203-15 The sampling performance of the semivolatile aerosol dichotomous sampler (SADS) was tested and compared with existing vapor and particle sampling methods: filtration, electrostatic precipitation, and vapor adsorption. Seven different test fluids were used to generate test droplets, and their concentrations and composition in each phase were evaluated using gas chromatography. The amount of wall loss inside the SADS was also evaluated. Combined vapor and particle concentrations for each test aerosol were not statistically different from one another as a function of test method. However, the particle concentrations estimated using the SADS were statistically higher than those from the other methods. In experiments with hexadecane, the particle concentrations estimated using the SADS, an electrostatic precipitator, and a glass fiber filter were 2.50 mg/m3, 0.05 mg/m3, and 0.01 mg/m3, respectively. For commercial metalworking fluid (MWF) droplets, compounds having low molecular weight were more prevalent in the vapor phase than those compounds with high molecular weight. The compositions of the particle phase were similar to those of the original fluids. The wall losses of hexadecane and bis(2-ethylhexyl) sebacate (BEHS) were 0.25% and 26.5% of combined vapor and particle concentrations in the SADS sampling, respectively. Because it can avoid evaporative losses, SADS will sample semivolatile aerosols more accurately than common filtration methods and may often yield higher particle concentrations than can be measured using the other methods. |
CYP1A1 and CYP1B1 gene expression and DNA adduct formation in normal human mammary epithelial cells exposed to benzo[a]pyrene in the absence or presence of chlorophyllin
John K , Divi RL , Keshava C , Orozco CC , Schockley ME , Richardson DL , Poirier MC , Nath J , Weston A . Cancer Lett 2010 292 (2) 254-60 Benzo[a]pyrene (BP) is a potent pro-carcinogen and ubiquitous environmental pollutant. Here, we examined the induction and modulation of CYP1A1 and CYP1B1 and 10-(deoxyguanosin-N(2)-yl)-7,8,9-trihydroxy-7,8,9,10-tetrahydrobenzo[a]pyrene (BPdG) adduct formation in DNA from 20 primary normal human mammary epithelial cell (NHMEC) strains exposed to BP (4muM) in the absence or presence of chlorophyllin (5muM). Real-time polymerase chain reaction (RT-PCR) analysis revealed strong induction of both CYP1A1 and CYP1B1 by BP, with high levels of inter-individual variability. Variable BPdG formation was found in all strains by r7, t8-dihydroxy-t-9, 10 epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene (BPDE)-DNA chemiluminescence assay (CIA). Chlorophyllin mitigated BP-induced CYP1A1 and CYP1B1 gene expression in all 20 strains when administered with BP. Chlorophyllin, administered prior to BP-exposure, mitigated CYP1A1 expression in 18/20 NHMEC strains (p<0.005) and CYP1B1 expression in 17/20 NHMEC strains (p<0.005). Maximum percent reductions of CYP1A1 and CYP1B1 gene expression and BPdG adduct formation were observed when cells were pre-dosed with chlorophyllin followed by administration of the carcinogen with chlorophyllin (p<0.005 for CYP1A1 and CYP1B1 expression and p<0.0005 for BPdG adducts). Therefore, chlorophyllin is likely to be a good chemoprotective agent for a large proportion of the human population. |
Pregnancy-associated listeriosis
Jackson KA , Iwamoto M , Swerdlow D . Epidemiol Infect 2010 138 (10) 1-7 Infection by Listeria monocytogenes in pregnant women may result in fetal loss or invasive disease in the newborn. We examined listeriosis cases reported through the U.S. Listeria Initiative during 2004-2007. Cases were classified as pregnancy-associated if illness occurred in a pregnant woman or an infant aged <28 days. Of 758 reported Listeria cases, 128 (16.9%) were pregnancy-associated. Maternal infection resulted in four neonatal deaths and 26 (20.3%) fetal losses. Invasive illnesses in newborns (n=85) were meningitis (32.9%) and sepsis (36.5%). Pregnant women with Listeria were more likely to report Hispanic ethnicity (52.8% vs. 25.6%, respectively; OR 3.3 95% CI 2.2-4.8) than mothers giving live birth in the USA during 2005 and were more likely to report consumption of Mexican-style cheese (OR 2.6, 95% CI 1.6-4.2) than were non-pregnant patients with Listeria infection. Pregnant woman comprised a considerable proportion of reported listeriosis cases. Further declines in pregnancy-associated listeriosis will require education about avoiding high-risk foods, and continued regulatory and industry efforts to decrease Listeria in foods. |
The potential impact of new National Osteoporosis Foundation guidance on treatment patterns
Dawson-Hughes B , Looker AC , Tosteson AN , Johansson H , Kanis JA , Melton LJ 3rd . Osteoporos Int 2010 21 (1) 41-52 This analysis of National Health and Nutrition Examination Survey III data describes the prevalence of risk factors for osteoporosis and the proportions of men and postmenopausal women age 50 years and older who are candidates for treatment to lower fracture risk, according to the new FRAX-based National Osteoporosis Foundation Clinician's Guide. INTRODUCTION: Little information is available on prevalence of osteoporosis risk factors or proportions of US men and women who are potential candidates for treatment. METHODS: The prevalence of risk factors used in the new National Osteoporosis Foundation (NOF) FRAX-based Guide to the Prevention and Treatment of Osteoporosis was estimated using data from the third National Health and Nutrition Examination Survey (NHANES III). Risk factors not measured in NHANES III were simulated using World Health Organization cohorts. The proportion of US men and postmenopausal women age 50+ years who are treatment candidates by the new NOF Guide were calculated; for non-Hispanic white (NHW) women, the proportion eligible by the new NOF Guide was compared with that based on an earlier NOF Guide. RESULTS: Twenty percent of men and 37% of women were potential candidates for treatment to prevent fractures by the new NOF Guide. Among NHW women, 53% were potential candidates by the previous NOF Guide compared with 41% by the new guide. CONCLUSIONS: One fifth of men and 37% of postmenopausal women are eligible for osteoporosis treatment consideration by the new NOF Guide. However, fewer NHW women are eligible by the new guide than by the previous NOF Guide. |
Using surveillance data to promote occupational health and safety policies and practice at the state level: a case study
Calvert GM , Higgins SA . Am J Ind Med 2010 53 (2) 188-93 BACKGROUND: Following the investigation of a birth defects cluster involving migrant farmworkers employed in North Carolina and Florida, it became clear that greater efforts were needed to protect agricultural workers from pesticide exposure. METHODS: Documentation is drawn from peer-reviewed published articles, government reports and news accounts. RESULTS: The birth defects cluster was identified and investigated by state and federal pesticide poisoning surveillance system staff. Following the investigation, efforts were initiated to highlight pesticides as an important public health issue needing more attention. A series of subsequent events led to the creation and passage of important legislation recently enacted in North Carolina. The legislation resulted in funding to promote various activities to prevent harm from pesticides including strengthening surveillance, improving the quality of pesticide compliance inspections, and increasing and improving pesticide safety training. The legislation also broadened the coverage of anti-retaliation rules to include agricultural workers, and increased recordkeeping requirements pertaining to pesticide applications. CONCLUSION: The important and positive impacts that can occur through surveillance activities are highlighted. As such, it is important to continue to support and improve occupational illness and injury surveillance programs. |
Effects of fire fighter protective ensembles on mobility and performance
Coca A , Williams WJ , Roberge RJ , Powell JB . Appl Ergon 2010 41 (4) 636-41 Many studies have shown that fire fighter turnout gear and equipment may restrict mobility. The restriction of movement is usually due to a decrease in range of motion (ROM). It is important to know how much the decrease in ROM affects performance. The aim of this study was to determine the effects of fire fighter protective ensembles on mobility and performance by measuring static and dynamic range of motion (ROM) and job-related tasks. Eight healthy adults (5 males, 3 females), aged 20-40 years, participated in this study. The study consisted of measuring a battery of motions and fire fighter specific tasks while wearing a standard fire fighter ensemble (SE) or regular light clothing (baseline or BL). Several BL ROM tests were significantly (p < 0.05) different from the SE test, including a decrease in shoulder flexion, cervical rotation and flexion, trunk lateral flexion, and stand and reach. There was a significant decrease in time from SE to baseline performing the one-arm search task and object lift. These overall findings support the need for a comprehensive ergonomic evaluation of protective clothing systems to ascertain human factors issues. The development of a Standard Ergonomics Test Practice for further use in laboratories that conduct personal protective systems evaluations using human test subjects is recommended. |
Aerosols emitted in underground mine air by diesel engine fueled with biodiesel
Bugarski AD , Cauda EG , Janisko SJ , Hummer JA , Patts LD . J Air Waste Manag Assoc 2010 60 (2) 237-244 Using biodiesel in place of petroleum diesel is considered by several underground metal and nonmetal mine operators to be a viable strategy for reducing the exposure of miners to diesel particulate matter. This study was conducted in an underground experimental mine to evaluate the effects of soy methyl ester biodiesel on the concentrations and size distributions of diesel aerosols and nitric oxides in mine air. The objective was to compare the effects of neat and blended biodiesel fuels with those of ultralow sulfur petroleum diesel. The evaluation was performed using a mechanically controlled, naturally aspirated diesel engine equipped with a muffler and a diesel oxidation catalyst. The effects of biodiesel fuels on size distributions and number and total aerosol mass concentrations were found to be strongly dependent on engine operating conditions. When fueled with biodiesel fuels, the engine contributed less to elemental carbon concentrations for all engine operating modes and exhaust configurations. The substantial increases in number concentrations and fraction of organic carbon (OC) in total carbon over the baseline were observed when the engine was fueled with biodiesel fuels and operated at light-load operating conditions. Size distributions for all test conditions were found to be single modal and strongly affected by engine operating conditions, fuel type, and exhaust configuration. The peak and total number concentrations as well as median diameter decreased with an increase in the fraction of biodiesel in the fuels, particularly for high-load operating conditions. The effects of the diesel oxidation catalyst, commonly deployed to counteract the potential increase in OC emissions due to use of biodiesel, were found to vary depending upon fuel formulation and engine operating conditions. The catalyst was relatively effective in reducing aerosol number and mass concentrations, particularly at light-load conditions, but also showed the potential for an increase in nitrogen dioxide concentrations at high-load modes. |
Associations of occupational tasks with knee and hip osteoarthritis: the Johnston County Osteoarthritis Project
Allen KD , Chen JC , Callahan LF , Golightly YM , Helmick CG , Renner JB , Jordan JM . J Rheumatol 2010 37 (4) 842-50 OBJECTIVE: This cross-sectional study examined associations of occupational tasks with radiographic and symptomatic osteoarthritis (OA) in a community-based sample. METHODS: Participants from the Johnston County Osteoarthritis Project (n = 2729) self-reported the frequency of performing 10 specific occupational tasks at the longest job ever held (never/seldom/sometimes vs often/always) and lifetime exposure to jobs that required spending > 50% of their time doing 5 specific tasks or lifting 22, 44, or 110 pounds 10 times weekly. Multivariable logistic regression models examined associations of each occupational task separately with radiographic and symptomatic knee and hip OA, controlling for age, race, gender, body mass index, prior knee or hip injury, and smoking. RESULTS: Radiographic hip and knee OA were not significantly associated with any occupational tasks, but several occupational tasks were associated with increased odds of both symptomatic knee and hip OA: lifting > 10 pounds, crawling, and doing heavy work while standing (OR 1.4-2.1). More occupational walking and standing and less sitting were also associated with symptomatic knee OA, and more bending/twisting/reaching was associated with symptomatic hip OA. Exposure to a greater number of physically demanding occupational tasks at the longest job was associated with greater odds of both symptomatic knee and hip OA. CONCLUSION: Our results confirm an association of physically demanding occupational tasks with both symptomatic knee and hip OA, including several specific activities that increased the odds of OA in both joint groups. These tasks represent possibilities for identifying and targeting at-risk individuals with preventive interventions. |
Recommendation for use of point-of-decision prompts to increase stair use in communities
Task Force on Community Preventive Services , Soler RE . Am J Prev Med 2010 38 S290-1 Overweight and obesity remain major health concerns in the U.S. and elsewhere. Obesity increases the risk of many diseases and health conditions including coronary heart disease, type 2 diabetes, a range of cancers (e.g., endometrial, breast, and colon), hypertension, dyslipidemia (e.g., high total cholesterol or high levels of triglycerides), stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, and gynecologic problems (abnormal menses, infertility). While regular physical activity improves aerobic capacity, muscular strength, body agility and coordination, and metabolic functioning, and is associated with enhanced health and reduced risk for all-cause mortality, maintaining energy balance (defined as the balance between energy taken in and energy expended) is also important in achieving and maintaining a healthy weight and overall health.1, 2, 3, 4 | One way to increase energy expenditure, and improve energy balance, is to incorporate small bouts of physical activity into daily routines.3 According to the CDC, environmental and policy interventions to promote physical activity are important because they can benefit all people exposed to the environment rather than focusing on changing physical activity behavior one person at a time. The use of point-of-decision prompts (PODP) to increase the use of stairwells is one intervention of this type.5 |
Point-of-decision prompts to increase stair use: a systematic review update
Soler RE , Leeks KD , Buchanan LR , Brownson RC , Heath GW , Hopkins DH , Task Force on Community Preventive Services . Am J Prev Med 2010 38 S292-300 In 2000, the Guide to Community Preventive Services (Community Guide) completed a systematic review of the effectiveness of various approaches to increasing physical activity including informational, behavioral and social, and environmental and policy approaches. Among these approaches was the use of signs placed by elevators and escalators to encourage stair use. This approach was found to be effective based on sufficient evidence. Over the past 5 years the body of evidence of this intervention has increased substantially, warranting an updated review. This update was conducted on 16 peer-reviewed studies (including the six studies in the previous systematic review), which met specified quality criteria and included evaluation outcomes of interest. These studies evaluated two interventions: point-of-decision prompts to increase stair use and enhancements to stairs or stairwells (e.g., painting walls, laying carpet, adding artwork, playing music) when combined with point-of-decision prompts to increase stair use. This latter intervention was not included in the original systematic review. According to the Community Guide rules of evidence, there is strong evidence that point-of-decision prompts are effective in increasing the use of stairs. There is insufficient evidence, due to an inadequate number of studies, to determine whether or not enhancements to stairs or stairwells are an effective addition to point-of-decision prompts. This article describes the rationale for these systematic reviews, along with information about the review process and the resulting conclusions. Additional information about applicability, other effects, and barriers to implementation is also provided. |
Evaluation of program performance and expenditures in a report of performance measures (RPM) via a case study of two Florida county tuberculosis programs
Phillips VL , Teweldemedhin B , Ahmedov S , Cobb J , McNabb SJ . Eval Program Plann 2010 33 (4) 373-8 Health Department (HD) managers at both state and local levels are in desperate need of tools to assist in monitoring and evaluating programs. The purpose of this study is to assess the feasibility and utility of linking program performance scores and expenditures into a Report of Performance Measures (RPM). We analyzed secondary data on performance indicators, selected by HD staff, and expenditures, related to six surveillance activities, from two, similar, high-incidence, tuberculosis (TB) programs in Florida from 2002 to 2003. We compared the findings between the county HDs as an illustration of basic cost-effectiveness benchmarking, based on the cost-effectiveness grid. Data included here provide examples of: (1) two instances in which one county was operating relatively inefficiently compared to the other; (2) two instances in which performance and expenditures were similar for the counties; and (3) two instances in which one county spent more for higher performance scores than the other. These data illustrate how the RPM can be used to facilitate benchmarking, a basic evaluation tool. They also demonstrate ways to identify potential operational inefficiencies in a single time period and ultimately over time. It is thus likely to be a feasible and useful management tool. |
Reflections on the debate on disability and aid in dying
Krahn GL . Disabil Health J 2010 3 (1) 51-55 BACKGROUND: A policy resolution supporting physician aid in dying was proposed to the American Public Health Association (APHA) in 2007 that prompted a debate with the Disability Section on its meaning for people with disabilities. OBJECTIVE: The present paper reflects on the issues revealed and lessons learned. METHODS: The debate included subcommittee discussion; review of research, polls, administrative reports; discussion with disability rights organizations; and floor-debate and vote by the APHA Governing Council. RESULTS: Reflections on the process are summarized under the themes: we all have our own views; it's highly personal; confusion among key concepts; I might want it for myself; it's about control and not about pain; the slippery slope and other arguments; and undue burden on people with disabilities. CONCLUSIONS: The APHA resolution supporting aid in dying was passed in 2008 with some improvements in the language and a recommendation to measure pre-existing disability. Valuable lessons were learned through the debate process. |
Smokefree policies to reduce tobacco use: a systematic review
Hopkins DP , Razi S , Leeks KD , Priya Kalra G , Chattopadhyay SK , Soler RE . Am J Prev Med 2010 38 S275-89 In 2001, a systematic review for the Guide to Community Preventive Services identified strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modified for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. A total of 57 studies were identified in the period 1976 through June 2005 that met criteria to be candidates for review; of these, 37 met study design and quality of execution criteria to qualify for final assessment. Twenty-one studies measured absolute differences in tobacco-use prevalence with a median effect of -3.4 percentage points (interquartile interval: -6.3 to -1.4 percentage points). Eleven studies measured differences in tobacco-use cessation among tobacco users exposed to a smokefree policy compared with tobacco users not exposed to a smokefree policy. The median absolute change was an increase in cessation of 6.4 percentage points (interquartile interval: 1.3 to 7.9 percentage points). The qualifying studies provided sufficient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identified four studies that, overall, demonstrated economic benefits from a smokefree workplace policy. Additional research is needed to more fully evaluate the total economic effects of these policies. |
Leading and managing for improved health
Nicola RM . J Public Health Manag Pract 2010 16 (2) 91-92 One hundred one years ago, a group of health offi-cers, the leaders and managers of yesteryear’s fledglinghealth departments, founded the all-male physicianMunicipal Health Officers’ Section of the AmericanPublic Health Association (APHA). At the time thesehealth officials were facing waves of infectious diseasecaused by crowding, unsanitary conditions, and lim-ited prevention technology. When these APHA mem-bers presented scientific papers at the annual meeting,there were titles that reflected the major killers of theday: problems with quarantine in contagious diseasework; disinfection of rooms; and management of in-fectious disease in rural municipalities (V. Henry, un-published data, 2008). The section underwent threename changes in the first decade alone, resulting by1916 in the Public Health Administration Section. Thecurrent Health Administration Section reflects the sec-tion’s membership: the leaders, managers, and stu-dents of public health and health services organizationsand those interested in effectively organizing people toachieve an improvement in the health status of the com-munity by advancing the quality and practice of healthadministration |
Committee report: Method for evaluating conditions nominated for population-based screening of newborns and children
Calonge N , Green NS , Rinaldo P , Lloyd-Puryear M , Dougherty D , Boyle C , Watson M , Trotter T , Terry SF , Howell RR . Genet Med 2010 12 (3) 153-9 Secretary's Advisory Committee on Heritable Disorders in Newborns and Children is charged with evaluating conditions nominated for addition to the uniform screening panel and consequently making recommendations to the secretary of the US Department of Health and Human Services. This report describes the framework by which the committee approaches its task. Key decision nodes include initial review of every nomination to determine whether conditions are amenable for systematic evidence review, review of systematic evidence reviews conducted by the committee's external review group, and deliberation and formal recommendation for addition or exclusion to the uniform panel. Data analyzed include the accuracy and specificity of screening and diagnostic tests for nominated disorders, the extent of predicted health benefits, harms impact on disease course, and cost from early diagnosis and treatment. The committee process is guided by approaches used by similar entities, but more flexible criteria are sometimes needed to accommodate data limitations stemming from the rarity of many of these conditions. Possible outcomes of committee review range from recommendation to add a nominated condition to the uniform panel; provide feedback on specific gaps in evidence that must be addressed before making a decision; or rejection of a nomination (e.g., because of identified harms). The committee's structured evidence-based assessment of nominated conditions supports a consistently rigorous, iterative and transparent approach to its making recommendations regarding broad population-based screening programs for rare conditions in infants and children. |
Aggressive behavior and quality of friendships: linear and curvilinear associations
Fanti KA , Brookmeyer KA , Henrich CC , Kuperminc GP . J Early Adolesc 2009 29 (6) 826-838 The current study investigates linear and curvilinear associations between overt aggressive behavior and the adolescents' reports of the quality of their friendships over time. Moderation by gender was also investigated. The sample consisted of 246 boys and 253 girls from the sixth and seventh grades of a large public middle school. Findings suggested a curvilinear association between aggression and friendship quality for boys such that nonaggressive and highly aggressive boys tended to perceive their relationships with friends more positively than did boys who exhibited moderate levels of overt aggression. In contrast, a negative linear association was found between aggression and friendship quality for girls. These findings provide evidence that the association between friendship quality and overt aggression is a complex phenomenon and point to the importance of examining gender differences and the curvilinear association between aggression and friendship quality. |
The association of pipe and cigar use with cotinine levels, lung function, and airflow obstruction: a cross-sectional study
Rodriguez J , Jiang R , Johnson WC , Mackenzie BA , Smith LJ , Barr RG . Ann Intern Med 2010 152 (4) 201-10 BACKGROUND: Cigarette smoking is the major cause of chronic obstructive pulmonary disease, but studies on the contribution of other smoking techniques are sparse. OBJECTIVE: To determine whether pipe and cigar smoking was associated with elevated cotinine levels, decrements in lung function, and increased odds of airflow obstruction. DESIGN: Cross-sectional study. SETTING: Population-based sample from 6 U.S. communities. PARTICIPANTS: Men and women aged 48 to 90 years without clinical cardiovascular disease at enrollment who were part of MESA (Multi-Ethnic Study of Atherosclerosis). MEASUREMENTS: The MESA Lung Study measured spirometry according to American Thoracic Society guidelines and urine cotinine levels by immunoassay on a subsample of MESA. Pipe-years and cigar-years were calculated as years from self-reported age of starting to age of quitting (or to current age in current users) multiplied by pipe-bowls or cigars per day. RESULTS: Of 3528 participants, 9% reported pipe smoking (median, 15 pipe-years), 11% reported cigar smoking (median, 6 cigar-years), and 52% reported cigarette smoking (median, 18 pack-years). Self-reported current pipe and cigar smokers had elevated urine cotinine levels compared with never-smokers. Pipe-years were associated with decrements in FEV(1), and cigar-years were associated with decrements in the FEV(1)-FVC ratio. Participants who smoked pipes or cigars had increased odds of airflow obstruction whether they had also smoked cigarettes (odds ratio, 3.43 [95% CI, 1.75 to 6.71]; P < 0.001) or not (odds ratio, 2.31 [CI, 1.04 to 5.11]; P = 0.039) compared with participants with no smoking history. Limitation: Cross-sectional design. CONCLUSION: Pipe and cigar smoking increased urine cotinine levels and was associated with decreased lung function and increased odds of airflow obstruction, even in participants who had never smoked cigarettes. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute, National Institutes of Health. |
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