The longitudinal effect of body adiposity on joint mobility in young males with Haemophilia A
Soucie JM , Wang C , Siddiqi A , Kulkarni R , Recht M , Konkle BA . Haemophilia 2011 17 (2) 196-203 SUMMARY: Although body adiposity and disease severity in haemophilia have been found in cross-sectional studies to be negatively associated with joint mobility, it is not clear how these two factors affect the rate of joint mobility loss over time. Over a 10-year period, repeated measures of joint range of motion (ROM) were collected annually using universal goniometers on bilateral hip, knee, ankle, shoulder and elbow joints in 6131 young males with haemophilia A aged ≤20 years. Body mass index (BMI) was calculated using data on weight and height during follow up. The effect of body adiposity, adjusted for disease severity, on the rate of joint mobility loss over time was assessed using a longitudinal model. Compared with haemophilia males with normal BMI, those who were obese had lower ROM at initial visit and a faster rate of joint mobility loss in the lower limbs. Overweight subjects experienced similar loss in ROM, although to a lesser degree. A decline in ROM with age was also observed in upper limb joints but the rate was not significantly affected by body adiposity. Haemophilia severity, joint bleeding and the presence of an inhibitor were other significant contributors to joint mobility loss in both upper and lower limb joints. Excess body adiposity accelerates joint mobility loss in weight bearing joints particularly among those with severe haemophilia. Our findings suggest that body weight control and effective treatment of bleeds should be implemented together to achieve better joint ROM outcomes in males with haemophilia. |
Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States
Wolitski RJ , Fenton KA . AIDS Behav 2011 15 Suppl 1 S9-17 The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM's sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM. |
Highly pathogenic avian influenza (H5N1): pathways of exposure at the animal-human interface, a systematic review
Van Kerkhove MD , Mumford E , Mounts AW , Bresee J , Ly S , Bridges CB , Otte J . PLoS One 2011 6 (1) e14582 BACKGROUND: The threat posed by highly pathogenic avian influenza A H5N1 viruses to humans remains significant, given the continued occurrence of sporadic human cases (499 human cases in 15 countries) with a high case fatality rate (approximately 60%), the endemicity in poultry populations in several countries, and the potential for reassortment with the newly emerging 2009 H1N1 pandemic strain. Therefore, we review risk factors for H5N1 infection in humans. METHODS AND FINDINGS: Several epidemiologic studies have evaluated the risk factors associated with increased risk of H5N1 infection among humans who were exposed to H5N1 viruses. Our review shows that most H5N1 cases are attributed to exposure to sick poultry. Most cases are sporadic, while occasional limited human-to-human transmission occurs. The most commonly identified factors associated with H5N1 virus infection included exposure through contact with infected blood or bodily fluids of infected poultry via food preparation practices; touching and caring for infected poultry; consuming uncooked poultry products; exposure to H5N1 via swimming or bathing in potentially virus laden ponds; and exposure to H5N1 at live bird markets. CONCLUSIONS: Research has demonstrated that despite frequent and widespread contact with poultry, transmission of the H5N1 virus from poultry to humans is rare. Available research has identified several risk factors that may be associated with infection including close direct contact with poultry and transmission via the environment. However, several important data gaps remain that limit our understanding of the epidemiology of H5N1 in humans. Although infection in humans with H5N1 remains rare, human cases continue to be reported and H5N1 is now considered endemic among poultry in parts of Asia and in Egypt, providing opportunities for additional human infections and for the acquisition of virus mutations that may lead to more efficient spread among humans and other mammalian species. Collaboration between human and animal health sectors for surveillance, case investigation, virus sharing, and risk assessment is essential to monitor for potential changes in circulating H5N1 viruses and in the epidemiology of H5N1 in order to provide the best possible chance for effective mitigation of the impact of H5N1 in both poultry and humans. DISCLAIMER: The opinions expressed in this article are those of the authors and do not necessarily reflect those of the institutions or organizations with which they are affiliated. |
Incidence of influenza virus infection in early infancy: a prospective study in South Asia
Henkle E , Steinhoff MC , Omer SB , Roy E , Arifeen SE , Raqib R , McNeal M , Breiman RF , Moss WJ , Zaman K . Pediatr Infect Dis J 2011 30 (2) 170-3 We evaluated infant sera from an immunization trial in Bangladesh to assess influenza hemagglutination inhibition antibody titer increases in 131 unimmunized infants from birth to 6 months. We detected 31 serologically defined infections. Combined with 10 additional rapid test-proven influenza cases, the minimal estimated incidence was 31 of 100 infants (95% CI: 24-41). These data suggest a high burden of influenza in young infants in tropical South Asia. |
2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature
Mosby LG , Rasmussen SA , Jamieson DJ . Am J Obstet Gynecol 2011 205 (1) 10-8 To summarize the literature regarding 2009 H1N1 influenza A during pregnancy, we conducted a systematic literature review using a PubMed search and other strategies. Studies were included if they reported 2009 H1N1 influenza in pregnant women as original data. In all, 2153 abstracts were reviewed, and a total of 120 studies were included. Data were extracted regarding number of cases, additional risk factors for influenza-associated complications, treatment, and maternal and pregnancy outcomes. Authors were contacted to determine the extent of overlap when it was suspected. Pregnancy was associated with increased risk of hospital and intensive care unit admission and of death. Pregnant women who received delayed treatment with neuraminidase inhibitors or who had additional risk factors were more likely to develop severe disease. Preterm and emergency cesarean deliveries were frequently reported. These results reinforce the importance of early identification and treatment of suspected influenza in this high-risk population. |
2009 pandemic influenza A (H1N1) virus infection in postpartum women in California
Louie JK , Jamieson DJ , Rasmussen SA . Am J Obstet Gynecol 2011 204 (2) 144 e1-6 OBJECTIVE: The objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women. STUDY DESIGN: We reviewed case reports of infected hospitalized postpartum (≤6 months from delivery) women identified through statewide surveillance in California. From April 23 through August 11, 2009, all hospitalizations and/or deaths were reported. After August 11, reporting was limited to cases requiring intensive care or deaths. RESULTS: From April 23 to December 31, 2009, 15 cases were reported; 11 (73%) had symptom onset within 7 days postpartum. Of 10 hospitalized cases reported through August 11, 4 required intensive care, 3 required mechanical ventilation, and 2 died. Of 5 cases requiring intensive care reported after August 11, all required mechanical ventilation and 1 died. Overall, 6 (43%) received antivirals within 48 hours of symptom onset. CONCLUSION: The 2009 H1N1 can cause severe illness in postpartum women, especially in the first week following delivery. |
Spatial and temporal variation in the kdr allele L1014S in Anopheles gambiae s.s. and phenotypic variability in susceptibility to insecticides in Western Kenya
Mathias DK , Ochomo E , Atieli F , Ombok M , Bayoh MN , Olang G , Muhia D , Kamau L , Vulule JM , Hamel MJ , Hawley WA , Walker ED , Gimnig JE . Malar J 2011 10 (1) 10 BACKGROUND: Malaria vector control in Africa depends upon effective insecticides in bed nets and indoor residual sprays. This study investigated the extent of insecticide resistance in Anopheles gambiae s.l., Anopheles gambiae s.s. and Anopheles arabiensis in western Kenya where ownership of insecticide-treated bed nets has risen steadily from the late 1990s to 2010. Temporal and spatial variation in the frequency of a knock down resistance (kdr) allele in A. gambiae s.s. was quantified, as was variation in phenotypic resistance among geographic populations of A. gambiae s.l. METHODS: To investigate temporal variation in kdr frequency, individual specimens of A. gambiae s.s. from two sentinel sites were genotyped using RT-PCR from 1996-2010. Spatial variation in kdr frequency, species composition, and resistance status were investigated in additional populations of A. gambiae s.l. sampled in western Kenya in 2009 and 2010. Specimens were genotyped for kdr as above and identified to species via conventional PCR. Field-collected larvae were reared to adulthood and tested for insecticide resistance using WHO bioassays. RESULTS: Anopheles gambiae s.s. showed a dramatic increase in kdr frequency from 1996 - 2010, coincident with the scale up of insecticide-treated nets. By 2009-2010, the kdr L1014S allele was nearly fixed in the A. gambiae s.s. population, but was absent in A. arabiensis. Near Lake Victoria, A. arabiensis was dominant in samples, while at sites north of the lake A. gambiae s.s was more common but declined relative to A. arabiensis from 2009 to 2010. Bioassays demonstrated that A. gambiae s.s. had moderate phenotypic levels of resistance to DDT, permethrin and deltamethrin while A. arabiensis was susceptible to all insecticides tested. CONCLUSIONS: The kdr L1014S allele has approached fixation in A. gambiae s.s. populations of western Kenya, and these same populations exhibit varying degrees of phenotypic resistance to DDT and pyrethroid insecticides. The near absence of A. gambiae s.s. from populations along the lakeshore and the apparent decline in other populations suggest that insecticide-treated nets remain effective against this mosquito despite the increase in kdr allele frequency. The persistence of A. arabiensis, despite little or no detectable insecticide resistance, is likely due to behavioural traits such as outdoor feeding and/or feeding on non-human hosts by which this species avoids interaction with insecticide-treated nets. |
Effects of ivermectin on blood-feeding Phlebotomus papatasi, and the promastigote stage of Leishmania major
Hanafi HA , Szumlas DE , Fryauff DJ , El-Hossary SS , Singer GA , Osman SG , Watany N , Furman BD , Hoel DF . Vector Borne Zoonotic Dis 2011 11 (1) 43-52 Ivermectin (IVM) is a chemically modified macrocyclic lactone of Streptomyces avermitilis that acts as a potent neurotoxin against many nematodes and arthropods. Little is known of IVM's effect against either blood-feeding Phlebotomus sand flies, or the infective promastigote stage of Leishmania transmitted by these flies. We injected hamsters subcutaneously with two standard IVM treatments (200 and 400 mug/kg body weight) and allowed cohorts of Leishmania major-infected Phlebotomus papatasi to blood-feed on these animals at various posttreatment time points (4 h, 1, 2, 6, and 10 days). Infected and uninfected sand flies that bit treated and untreated hamsters served as controls. Serum levels of IVM in low- and high-dose-treated hamsters were determined at the five time points. Sand fly mortality following blood feeding was recorded at 24-h intervals and, in relation to IVM treatment, was time and dose dependent. Mortality was most rapid and greatest among infected flies that fed nearest to time of dosing. Mean survival of infected sand flies after feeding on untreated hamsters was 11.5 days, whereas that of infected sand flies that fed 4 h, 1 day, or 2 days posttreatment on high-dose-treated hamsters (400 mug/kg) was 1.6, 2.1, and 2.7 days, respectively. Infected and uninfected sand flies that blood fed 6 days following low-dose IVM treatment (200 mug/kg) still experienced significantly greater mortality (p < 0.02) than controls. Promastigotes dissected out of surviving flies that fed on IVM-treated hamsters showed typical motility and survival. Moreover, 21.7% of IVM-treated hamsters developed lesions after being fed upon by infected sand flies. L. major promastigotes appeared to be tolerant to ng/mL blood levels of IVM that caused significant mortality for up to 10 days posttreatment in blood-feeding P. papatasi. |
Prescription drug monitoring programs and death rates from drug overdose
Paulozzi LJ , Kilbourne EM , Desai HA . Pain Med 2011 12 (5) 747-54 OBJECTIVE: Drug overdoses resulting from the abuse of prescription opioid analgesics and other controlled substances have increased in number as the volume of such drugs prescribed in the United States has grown. State prescription drug monitoring programs (PDMPs) are designed to prevent the abuse of such drugs. This study quantifies the relation of PDMPs to rates of death from drug overdose and quantities of opioid drugs distributed at the state level. DESIGN: Observational study of the United States during 1999-2005. OUTCOME MEASURES: Rates of drug overdose mortality, opioid overdose mortality, and opioid consumption by state. RESULTS: PDMPs were not significantly associated with lower rates of drug overdose or opioid overdose mortality or lower rates of consumption of opioid drugs. PDMP states consumed significantly greater amounts of hydrocodone (Schedule III) and nonsignificantly lower amounts of Schedule II opioids. The increases in overdose mortality rates and use of prescription opioid drugs during 1999-2005 were significantly lower in three PDMP states (California, New York, and Texas) that required use of special prescription forms. CONCLUSIONS: While PDMPs are potentially an important tool to prevent the nonmedical use of prescribed controlled substances, their impact is not reflected in drug overdose mortality rates. Their effect on overall consumption of opioids appears to be minimal. PDMP managers need to develop and test ways to improve the use of their data to affect the problem of prescription drug overdoses. |
Low dose organochlorine pesticides and polychlorinated biphenyls predict obesity, dyslipidemia, and insulin resistance among people free of diabetes
Lee DH , Steffes MW , Sjodin A , Jones RS , Needham LL , Jacobs DR . PLoS One 2011 6 (1) e15977 BACKGROUND: There is emerging evidence that background exposure to persistent organic pollutants (POPs) are important in the development of conditions predisposing to diabetes as well as of type 2 diabetes itself. We recently reported that low dose POPs predicted incident type 2 diabetes in a nested case-control study. The current study examined if low dose POPs predicted future adiposity, dyslipidemia, and insulin resistance among controls without diabetes in that study. METHODOLOGY/PRINCIPAL FINDINGS: The 90 controls were diabetes-free during 20 years follow-up. They were a stratified random sample, enriched with overweight and obese persons. POPs measured in 1987-88 (year 2) sera included 8 organochlorine (OC) pesticides, 22 polychlorinated biphenyls (PCBs), and 1 polybrominated biphenyl (PBB). Body mass index (BMI), triglycerides, HDL-cholesterol, LDL-cholesterol, and homeostasis model assessment value for insulin resistance (HOMA-IR) were study outcomes at 2005-06 (year 20). The evolution of study outcomes during 18 years by categories of serum concentrations of POPs at year 2 was evaluated by adjusting for the baseline values of outcomes plus potential confounders. Parallel to prediction of type 2 diabetes, many statistically significant associations of POPs with dysmetabolic conditions appeared at low dose, forming inverted U-shaped dose-response relations. Among OC pesticides, p,p'-DDE most consistently predicted higher BMI, triglycerides, and HOMA-IR and lower HDL-cholesterol at year 20 after adjusting for baseline values. Oxychlordane, trans-nonachlor, and hexachlorobenzene also significantly predicted higher triglycerides. Persistent PCBs with ≥7 chlorides predicted higher BMI, triglycerides, and HOMA-IR and lower HDL-cholesterol at year 20 with similar dose-response curves. CONCLUSIONS/SIGNIFICANCE: Simultaneous exposure to various POPs in the general population may contribute to development of obesity, dyslipidemia, and insulin resistance, common precursors of type 2 diabetes and cardiovascular diseases. Although obesity is a primary cause of these metabolic abnormalities, POPs exposure may contribute to excess adiposity and other features of dysmetabolism. |
Communities near toluene diisocyanate sources: an investigation of exposure and health
Wilder LC , Langley RL , Middleton DC , Ernst K , Lummus ZL , Streicher RP , Campbell DS , Wattigney WA , Bernstein JA , Bernstein DI , Dearwent SM . J Expo Sci Environ Epidemiol 2011 21 (6) 587-94 Toluene diisocyanate (TDI) is a well-known cause of occupational asthma, but we know little about the potential for exposure and health effects among residents who live near facilities that release TDI. In the mid-1990's, the North Carolina Department of Health and Human Services and the Agency for Toxic Substances and Disease Registry investigated exposures to TDI and health outcomes in one community, which left some unanswered questions. This cross-sectional study evaluated the potential associations between living near a TDI source and the prevalence of three variables: asthma or asthma-like respiratory symptoms, antibodies specific to TDI, and verifiable levels of TDI in residential air. Results among North Carolina residents living near such facilities (five target communities) were compared with the results from residents living further away (five comparison communities). Overall, the prevalence of reporting either asthma or asthma-like respiratory symptoms was higher (odds ratio=1.60; 95% confidence interval=0.97-2.54) among residents in target communities than those in comparison communities. However, this difference was not statistically significant. Symptom prevalence varied greatly among the community populations. The prevalence of respiratory symptoms was higher near facilities with historically higher TDI emissions. Among the 351 participants who provided blood samples, only one had immunoglobulin G specific antibodies to TDI. This participant lived in a target area and may have had non-occupational exposure. TDI was detected at an extremely low level (1 ppt) in one of the 45 air samples from target communities. One ppt is one-tenth the EPA reference concentration. Overall, air sample and antibody test results are not consistent with recent or ongoing exposure to TDI. Journal of Exposure Science and Environmental Epidemiology advance online publication, 23 February 2011; doi:10.1038/jes.2011.5. |
Diarrhea prevention in people living with HIV: an evaluation of a point-of-use water quality intervention in Lagos, Nigeria
Barzilay EJ , Aghoghovbia TS , Blanton EM , Akinpelumi AA , Coldiron ME , Akinfolayan O , Adeleye OA , Latrielle A , Hoekstra RM , Gilpin U , Quick R . AIDS Care 2011 23 (3) 330-9 Diarrhea is a leading cause of morbidity and mortality in people living with HIV (PLHIV) in Africa. The impact of a point-of-use water chlorination and storage intervention on diarrheal-disease risk in a population of HIV-infected women in Lagos, Nigeria was evaluated. A baseline survey was performed, followed by six weeks of baseline diarrhea surveillance consisting of weekly home visits, distribution of free water chlorination products and safe storage containers to project participants, and continued weekly home-based diarrhea surveillance for 15 additional weeks. To confirm use of the water chlorination product, during each home visit, stored water was tested for residual chlorine. About 187 women were enrolled. At baseline, 80% of women had access to improved water supplies and 95% had access to sanitation facilities. Following distribution of the intervention, water stored in participants' households was observed to have residual chlorine during 50-80% of home visits, a sign of adherence to recommended water-treatment practices. Diarrhea rates in project participants were 36% lower in the post-intervention period than during the baseline period (p=0.04). Diarrhea rates were 46% lower in the post-intervention period than the baseline period among project participants who were confirmed to have residual chlorine in stored water during 85% or more of home visits (p=0.04); there was no significant difference in diarrhea rates between baseline and post-intervention periods in participants confirmed to have residual chlorine in stored water during less than 85% of home visits. The percent change in diarrhea rates between baseline and post-intervention surveillance periods was statistically significant among non-users of prophylactic antibiotics (-62%, p=0.02) and among persons who used neither prophylactic antibiotics nor antiretroviral treatment (-46%, p=0.04). Point-of-use water treatment was associated with a reduced risk of diarrhea in PLHIV. Regular water treatment was required to achieve health benefits. |
Use of hospital discharge data to evaluate notifiable disease reporting to Colorado's Electronic Disease Reporting System
Boehmer TK , Patnaik JL , Burnite SJ , Ghosh TS , Gershman K , Vogt RL . Public Health Rep 2011 126 (1) 100-6 OBJECTIVE: Notifiable disease surveillance systems are critical for communicable disease control, and accurate and timely reporting of hospitalized patients who represent the most severe cases is important. A local health department in metropolitan Denver used inpatient hospital discharge (IHD) data to evaluate the sensitivity, timeliness, and data quality of reporting eight notifiable diseases to the Colorado Electronic Disease Reporting System (CEDRS). METHODS: Using IHD data, we detected hospitalized patients admitted from 2003 through 2005 with a discharge diagnosis associated with one of eight notifiable diseases. Initially, we compared all cases identified through IHD diagnoses fields with cases reported to CEDRS. Second, we chose four diseases and conducted medical record review to confirm the IHD diagnoses before comparison with CEDRS cases. RESULTS: Relying on IHD diagnoses only, shigellosis, salmonellosis, and Neisseria meningitidis invasive disease had high sensitivity (> or = 90%) and timeliness (> or = 75%); legionellosis, pertussis, and West Nile virus infection were intermediate; and hepatitis A and Haemophilus influenzae (H. influenzae) invasive disease had low sensitivity (> or = 25%) and timeliness (< or = 33%). Medical record review improved the sensitivity to > or = 90% and timeliness to > or = 80% for H. influenza invasive disease, legionellosis, and pertussis; however, hepatitis A retained suboptimal sensitivity (67%) and timeliness (25%). CONCLUSIONS: Hospital discharge data are useful for evaluating notifiable disease surveillance systems. Limitations encountered by using discharge diagnoses alone can be overcome by conducting medical record review. Public health agencies should conduct periodic surveillance system evaluations among hospitalized patients and reinforce notifiable disease reporting among the people responsible for this activity. |
Monte Carlo analysis of impact of underascertainment of mesothelioma cases on underestimation of risk
Kopylev L , Sullivan PA , Vinikoor LC , Bateson TF . Open Epidemiol J 2011 4 (1) 45-53 The accuracy of cancer mortality data varies across different cancers. Mortality records and death certificates may not always reflect the true cause of death for various reasons (e.g., misdiagnosis, improper recording on the death certificate, miscoding of the cause of death recorded on the death certificate). Mesothelioma, a rare tumor which is caused by exposure to asbestos, is a special case. Until 1999 when the 10th revision of the International Classification of Diseases (ICD-10) introduced a specific mesothelioma code, mesothelioma deaths were coded to other causes (e.g., cancer of the pleura, cancer of other or ill-specified sites). Even after the introduction of this mesothelioma code, researchers have shown that estimates of mesothelioma mortality based on death certificates are still biased downward. This article reviews available literature with quantitative information on mesothelioma underascertainment, in particular on different rates of underestimation for pleural and peritoneal mesotheliomas, and suggests two approaches to estimating downward bias in absolute risk estimates due to mesothelioma underascertainment. The choice of approach used depends on whether the information on the proportion of peritoneal mesotheliomas is available. Both approaches are demonstrated and evaluated using a cohort of asbestos workers from Libby, MT. The methods developed in this article may be used in analyses of other asbestos cohorts and in methodologies to predict future mesothelioma burden in populations. Similar approaches can be used to assess the impact of underascertainment of other cancers on risk estimates of other chemicals. |
Epidemiologic research using administrative databases: garbage in, garbage out
Hoover KW , Tao G , Kent CK , Aral SO . Obstet Gynecol 2011 117 (3) 729 We agree with Dr. Grimes that epidemiologic research using administrative data can be problematic and is associated with possible pitfalls,1 and support his cautionary message about the careful use of these data in epidemiologic studies. However, we would like to point out that administrative claims data are ideal data for health services research and economic analyses. As is true of all data sources, administrative data are not a panacea for all research. The optimal data for a study should depend on the question being posed, and for some questions administrative data are the most appropriate choice. Many of the pitfalls that Dr. Grimes described can be avoided with careful analysis designs, transparency in the reporting of methods and results, and discussion of a study's limitations. | Administrative data are derived from insurers' billing systems and contain information about health plan enrollees' demographic characteristics, clinician profiles, healthcare services provided by providers who submit claims, and the cost of those services. These data are processed to create valid variables, are supported by a data clearinghouse, and made available for research. They are an invaluable resource for health services research studies monitoring access, utilization, quality of health services, and healthcare expenditures. Although Dr. Grimes discussed the use of Medicaid, Medicare, and HMO databases, he did not discuss the very large claims databases for services provided to other commercially-insured populations. These service provision data tend to be more complete, because services for most commercially-insured persons are typically provided on a fee-for-service basis which results in careful, complete filing of claims. This type of administrative data has steadily improved in completeness and accuracy in recent years by including more patient demographic information and laboratory testing data.2,3 Although medical records are thought to be the gold standard of healthcare service provision, analysis of administrative data along with medical record review can identify more sexual health services for adolescents than medical record review alone.4 In addition, administrative data have an important role in disease surveillance and outbreak detection in the United States.5 | The use of administrative data in health services and economic analyses can result in quality output that is essential for assessing the healthcare landscape, and the importance of these databases will grow in the upcoming years with the requirement to monitor both quality of services and spending for those services. |
Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda
Sserwanga A , Harris JC , Kigozi R , Menon M , Bukirwa H , Gasasira A , Kakeeto S , Kizito F , Quinto E , Rubahika D , Nasr S , Filler S , Kamya MR , Dorsey G . PLoS One 2011 6 (1) e16316 BACKGROUND: Heath facility-based sentinel site surveillance has been proposed as a means of monitoring trends in malaria morbidity but may also provide an opportunity to improve malaria case management. Here we described the impact of a sentinel site malaria surveillance system on promoting laboratory testing and rational antimalarial drug use. METHODOLOGY/PRINCIPAL FINDINGS: Sentinel site malaria surveillance was established at six health facilities in Uganda between September 2006 and January 2007. Data were collected from all patients presenting to the outpatient departments including demographics, laboratory results, diagnoses, and treatments prescribed. Between the start of surveillance and March 2010, a total 424,701 patients were seen of which 229,375 (54%) were suspected of having malaria. Comparing the first three months with the last three months of surveillance, the proportion of patients with suspected malaria who underwent diagnostic testing increased from 39% to 97% (p<0.001). The proportion of patients with an appropriate decision to prescribe antimalarial therapy (positive test result prescribed, negative test result not prescribed) increased from 64% to 95% (p<0.001). The proportion of patients appropriately prescribed antimalarial therapy who were prescribed the recommended first-line regimen artemether-lumefantrine increased from 48% to 69% (p<0.001). CONCLUSIONS/SIGNIFICANCE: The establishment of a sentinel site malaria surveillance system in Uganda achieved almost universal utilization of diagnostic testing in patients with suspected malaria and appropriate decisions to prescribed antimalarial based on test results. Less success was achieved in promoting prescribing practice for the recommended first-line therapy. This system could provide a model for improving malaria case management in other health facilities in Africa. |
2008 outbreak of Salmonella Saintpaul infections associated with raw produce
Barton Behravesh C , Mody RK , Jungk J , Gaul L , Redd JT , Chen S , Cosgrove S , Hedican E , Sweat D , Chavez-Hauser L , Snow SL , Hanson H , Nguyen TA , Sodha SV , Boore AL , Russo E , Mikoleit M , Theobald L , Gerner-Smidt P , Hoekstra RM , Angulo FJ , Swerdlow DL , Tauxe RV , Griffin PM , Williams IT . N Engl J Med 2011 364 (10) 918-27 BACKGROUND: Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008. METHODS: We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted. RESULTS: Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to infinity) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeno pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeno peppers were implicated in all three clusters with implicated ingredients, and jalapeno or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeno peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source. CONCLUSIONS: Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeno and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination. |
Telomere length and variation in telomere biology genes in individuals with osteosarcoma
Mirabello L , Richards EG , Duong LM , Yu K , Wang Z , Cawthon R , Berndt SI , Burdett L , Chowdhury S , Teshome K , Douglass C , Savage SA . Int J Mol Epidemiol Genet 2011 2 (1) 19-29 Osteosarcoma, the most common primary bone tumor, occurs most frequently in adolescents. Chromosomal aneuploidy is common in osteosarcoma cells, suggesting underlying chromosomal instability. Telomeres, located at chromosome ends, are essential for genomic stability; several studies have suggested that germline telomere length (TL) is associated with cancer risk. We hypothesized that TL and/or common genetic variation in telomere biology genes may be associated with risk of osteosarcoma. We investigated TL in peripheral blood DNA and 713 single nucleotide polymorphisms (SNPs) from 39 telomere biology genes in 98 osteosarcoma cases and 69 orthopedic controls. For the genotyping component, we added 1363 controls from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Short TL was not associated with osteosarcoma risk overall (OR 1.39, P=0.67), although there was a statistically significant association in females (OR 4.35, 95% CI 1.20-15.74, P=0.03). Genotype analyses identified seven SNPs in TERF1 significantly associated with osteosarcoma risk after Bonferroni correction by gene. These SNPs were highly linked and associated with a reduced risk of osteosarcoma (OR 0.48-0.53, P=0.0001-0.0006). We also investigated associations between TL and telomere gene SNPs in osteosarcoma cases and orthopedic controls. Several SNPs were associated with TL prior to Bonferroni correction; one SNP in NOLA2 and one in MEN1 were marginally non-significant after correction (P(adj)=0.057 and 0.066, respectively). This pilot-study suggests that females with short telomeres may be at increased risk of osteosarcoma, and that SNPs in TERF1 are inversely associated with osteosarcoma risk. |
Prevalence of health-risk behaviors among Asian American and Pacific Islander high school students in the U.S., 2001-2007
Lowry R , Eaton DK , Brener ND , Kann L . Public Health Rep 2011 126 (1) 39-49 OBJECTIVES: We provided national prevalence estimates for selected health-risk behaviors for Asian American and Pacific Islander high school students separately, and compared those prevalence estimates with those of white, black, and Hispanic students. METHODS: We analyzed data from the Youth Risk Behavior Surveillance System. To generate a sufficient sample of Asian American and Pacific Islander students, we combined data from four nationally representative surveys of U.S. high school students conducted in 2001, 2003, 2005, and 2007 (total n = 56,773). RESULTS: Asian American students were significantly less likely than Pacific Islander, white, black, or Hispanic students to have drunk alcohol or used marijuana. Asian American students also were the least likely to have carried a weapon, to have been in a physical fight, to have ever had sexual intercourse, or to be currently sexually active. Once sexually active, Asian American students were as likely as most other racial/ethnic groups to have used alcohol or drugs at last sexual intercourse or to have used a condom at last sexual intercourse. Pacific Islander students were significantly more likely than Asian American, white, black, or Hispanic students to have seriously considered or attempted suicide. CONCLUSIONS: The prevalence estimates of health-risk behaviors exhibited by Asian American students and Pacific Islander students are very different and should be reported separately whenever feasible. To address the different health-risk behaviors exhibited by Asian American and Pacific Islander students, prevention programs should use culturally sensitive strategies and materials. |
HIV/AIDS complacency and HIV infection among young men who have sex with men, and the race-specific influence of underlying HAART beliefs
Mackellar DA , Hou SI , Whalen CC , Samuelsen K , Valleroy LA , Secura GM , Behel S , Bingham T , Celentano DD , Koblin BA , Lalota M , Shehan D , Thiede H , Torian LV . Sex Transm Dis 2011 38 (8) 755-63 BACKGROUND: Among men who have sex with men (MSM) in the United States, the influence of HIV/AIDS complacency and beliefs about the efficacy of highly active antiretroviral therapy (HAART) on HIV-infection risk is unknown. METHODS: We analyzed data from a 1998-2000 cross-sectional 6-city survey of 1575 MSM aged 23 to 29 years who had never tested for HIV or had last tested HIV-negative to assess these plausible influences overall and by race/ethnicity. FINDINGS: Measured as strong endorsement for reduced HIV/AIDS concern due to HAART, HIV/AIDS complacency was associated with reporting ≥10 male sex partners (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.12-4.07), unprotected anal intercourse with an HIV-positive or HIV-unknown-status male partner (OR, 2.06; 95% CI, 1.51-2.81), and testing HIV-positive (adjusted OR [AOR], 2.35; 95% CI, 1.38-3.98). Strong endorsement of the belief that HAART mitigates HIV/AIDS severity was more prevalent among black (21.8%) and Hispanic (21.3%) than white (9.6%) MSM (P < 0.001), and was more strongly associated with testing HIV-positive among black (AOR, 4.65; 95% CI, 1.97-10.99) and Hispanic (AOR, 4.12; 95% CI, 1.58-10.70) than white (AOR, 1.62; 95% CI, 0.64-4.11) MSM. CONCLUSIONS: Young MSM who are complacent about HIV/AIDS because of HAART may be more likely to engage in risk behavior and acquire HIV. Programs that target HIV/AIDS complacency as a means to reduce HIV incidence among young MSM should consider that both the prevalence of strong HAART-efficacy beliefs and the effects of these beliefs on HIV-infection risk might differ considerably by race/ethnicity. |
Bridging populations - sexual risk behaviors and HIV prevalence in clients and partners of female sex workers, Bangkok, Thailand 2007
Shah NS , Shiraishi RW , Subhachaturas W , Anand A , Whitehead SJ , Tanpradech S , Manopaiboon C , Sabin KM , Fox KK , Kim AY . J Urban Health 2011 88 (3) 533-44 The aim of this study is to estimate HIV prevalence and assess sexual behaviors in a high-risk and difficult-to-reach population of clients of female sex workers (FSWs). A modified variation of respondent-driven sampling was conducted among FSWs in Bangkok, where FSWs recruited 3 FSW peers, 1 client, and 1 nonpaying partner. After informed consent was obtained, participants completed a questionnaire, were HIV-tested, and were asked to return for results. Analyses were weighted to control for the design of the survey. Among 540 FSWs, 188 (35%) recruited 1 client, and 88 (16%) recruited 1 nonpaying partner. Clients' median age was 38 years. HIV prevalence was 20% and was associated with younger age at first sexual experience [relative risk (RR) = 3.10, 95% confidence interval (CI) 1.16-8.24] and condom use during last sexual encounter with regular partner (RR = 3.97, 95% CI 1.09-14.61). Median age of nonpaying partners was 34 years, and HIV prevalence was 15.1%. There were 56 discordant FSW-client pairs and 14 discordant FSW-nonpaying partner pairs. Condom use was relatively high among discordant FSW-client pairs (90.1%) compared to discordant FSW-nonpaying partner pairs (18.7%). Results suggest that sexual partners of FSWs have a high HIV prevalence and can be a bridge for HIV transmission to other populations. Findings also highlight the importance of initiating surveillance and targeted programs for FSW partners, and demonstrate a recruitment method for hard-to-reach populations. |
Efficacy of seasonal live attenuated influenza vaccine against virus replication and transmission of a pandemic 2009 H1N1 virus in ferrets
Pearce MB , Belser JA , Houser KV , Katz JM , Tumpey TM . Vaccine 2011 29 (16) 2887-94 In March 2009, a swine origin influenza A (2009 H1N1) virus was introduced into the human population and quickly spread from North America to multiple continents. Human serologic studies suggest that seasonal influenza virus vaccination or infection would provide little cross-reactive serologic immunity to the pandemic 2009 H1N1 virus. However, the efficacy of seasonal influenza infection or vaccination against 2009 H1N1 virus replication and transmission has not been adequately evaluated in vivo. Here, ferrets received one or two doses of the US licensed 2008-2009 live attenuated influenza vaccine (LAIV) intranasally. An additional group of ferrets were inoculated with the A/Brisbane/59/07 (H1N1) virus to model immunity induced by seasonal influenza virus infection. All vaccinated and infected animals possessed high titer homologous hemagglutination-inhibition (HI) and neutralizing antibodies, with no demonstrable cross-reactive antibodies against 2009 H1N1 virus. However, in comparison to non-immune controls, immunized ferrets challenged with pandemic A/Mexico/4482/09 virus displayed a significant reduction in body temperature and virus shedding. The impact of single-dose LAIV inoculation on 2009 H1N1 disease and virus transmission was also measured in vaccinated ferrets that were challenged with pandemic A/Netherlands/1132/09 virus. Although a single dose of LAIV reduced virus shedding and the frequency of transmission following homologous seasonal virus challenge, it failed to reduce respiratory droplet transmission of 2009 H1N1 virus. The results demonstrate that prior immunization with seasonal LAIV or H1N1 virus infection provides some cross-protection against the 2009 H1N1 virus, but had no significant effect on the transmission efficiency of the 2009 H1N1 virus. |
Evaluation of an online partner notification program
Rietmeijer CA , Westergaard B , Mickiewicz TA , Richardson D , Ling S , Sapp T , Jordan R , Wilmoth R , Kachur R , McFarlane M . Sex Transm Dis 2011 38 (5) 359-64 BACKGROUND: Internet-based programs for sexually transmitted infections (STI)/HIV partner notification have generated considerable interest as public health interventions; yet data are lacking to support widespread dissemination. We report on a clinic-based and web-based evaluation of the Colorado inSPOT online partner notification program. METHODS: Clinic-based surveys were conducted at a large urban STI clinic before and after the implementation of feasible clinic interventions as well as nonclinic campaigns to promote the use of inSPOT Colorado. Questions assessed recognition and use of the site. Website statistics were provided by the inSPOT service, including the number of site hits, e-cards sent, and specific STI exposures identified on the card. RESULTS: Recognition and use of the service among STI clinic patients remained low (<6%) despite the interventions. Site statistics demonstrated an immediate but quickly diminishing response after placement of a banner ad on a popular gay website. Newspaper advertisements and radio public service announcements showed small increases in website use. Analysis of STIs specified on the e-cards, showed scabies and pediculosis as the most-identified STIs, accounting for nearly 30% of all e-cards sent. Clinic survey data indicated that when respondents were faced with the hypothetical situation of being diagnosed with an STI, more than 90% would notify partners in person; only 5% would use e-mail or the Internet. CONCLUSIONS: Our data did not support the effectiveness of the inSPOT intervention among a predominantly heterosexual population in a large urban STI clinic. |
Online aggression: a reflection of in-person victimization or a unique phenomenon?
Hertz MF , David-Ferdon C . J Adolesc Health 2011 48 (2) 119-20 Bullying is an age-old phenomenon. In 1904, Stanley G. Hall, the first president of the American Psychological Association, described bullying behaviors in his book chapter, “Juvenile faults, immoralities, and crimes [1].” In 1945, 50% of sixth-grade boys in Rose Zeligs' study cited bullying as “an annoying social factor [2].” Times have changed and, although bullying remains, its character has changed as well. Young people today live as much in the virtual world as in the “real world.” Aggression experienced remotely may be just as upsetting as aggression experienced in person, especially because the victimization may be “witnessed” by hundreds of peers. The analysis by Mitchell et al [3] in this issue of the Journal of Adolescent Health contributes to a growing body of research that seeks to understand the differences and similarities between in-person and virtual aggression. | The work by Mitchell et al highlights the overlap between in-person and online victimization, raising the following questions: Is online aggression a unique and discrete phenomenon that requires new prevention and intervention strategies? Or, is online aggression a manifestation of in-person aggression? The similarity in intent of the perpetrator (to embarrass, humiliate, or threaten), the co-occurrence of in-person and online victimization, and shared risk and protective factors suggest the latter. The online environment simply provides a more efficient way for young people to aggress. Thus, violence prevention strategies with evidence of effectiveness in reducing in-person aggression may also be effective when applied to online aggression. |
Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes: a community guide systematic review
Elder RW , Voas R , Beirness D , Shults RA , Sleet DA , Nichols JL , Compton R . Am J Prev Med 2011 40 (3) 362-76 A systematic review of the literature to assess the effectiveness of ignition interlocks for reducing alcohol-impaired driving and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). Because one of the primary research issues of interest-the degree to which the installation of interlocks in offenders' vehicles reduces alcohol-impaired driving in comparison to alternative sanctions (primarily license suspension)-was addressed by a 2004 systematic review conducted for the Cochrane Collaboration, the current review incorporates that previous work and extends it to include more recent literature and crash outcomes. The body of evidence evaluated includes the 11 studies from the prior review, plus four more recent studies published through December 2007. The installation of ignition interlocks was associated consistently with large reductions in re-arrest rates for alcohol-impaired driving within both the earlier and later bodies of evidence. Following removal of interlocks, re-arrest rates reverted to levels similar to those for comparison groups. The limited available evidence from three studies that evaluated crash rates suggests that alcohol-related crashes decrease while interlocks are installed in vehicles. According to Community Guide rules of evidence, these findings provide strong evidence that interlocks, while they are in use in offenders' vehicles, are effective in reducing re-arrest rates. However, the potential for interlock programs to reduce alcohol-related crashes is currently limited by the small proportion of offenders who participate in the programs and the lack of a persistent beneficial effect once the interlock is removed. Suggestions for facilitating more widespread and sustained use of ignition interlocks are provided. |
Receptor specificity of subtype H1 influenza A viruses isolated from swine and humans in the United States
Chen LM , Rivailler P , Hossain J , Carney P , Balish A , Perry I , Davis CT , Garten R , Shu B , Xu X , Klimov A , Paulson JC , Cox NJ , Swenson S , Stevens J , Vincent A , Gramer M , Donis RO . Virology 2011 412 (2) 401-10 The evolution of classical swine influenza viruses receptor specificity preceding the emergence of the 2009 H1N1 pandemic virus was analyzed in glycan microarrays. Classical swine influenza viruses from the alpha, beta, and gamma antigenic clusters isolated between 1945 and 2009 revealed a binding profile very similar to that of 2009 pandemic H1N1 viruses, with selectivity for alpha2-6-linked sialosides and very limited binding to alpha2-3 sialosides. Despite considerable genetic divergence, the 'human-like' H1N1 viruses circulating in swine retained strong binding preference for alpha2-6 sialylated glycans. Interspecies transmission of H1N1 influenza viruses from swine to humans or from humans to swine has not driven selection of viruses with distinct novel receptor binding specificities. Classical swine and human seasonal H1N1 influenza viruses have conserved specificity for similar alpha2-6-sialoside receptors in spite of long term circulation in separate hosts, suggesting that humans and swine impose analogous selection pressures on the evolution of receptor binding function. |
Structural and immunologic cross-reactivity among filarial and mite tropomyosin: implications for the hygiene hypothesis
Santiago HC , Bennuru S , Boyd A , Eberhard M , Nutman TB . J Allergy Clin Immunol 2011 127 (2) 479-86 BACKGROUND: The hygiene hypothesis suggests that parasitic infection modulates host immune responses and decreases atopy. Other data suggest parasitic infections may induce allergic responsiveness. OBJECTIVE: To assess the structural and immunologic relationships between the known Dermatophagoides pteronyssinus (Der p 10) tropomyosin allergen and filarial tropomyosin of Onchocerca volvulus (OvTrop). METHODS: The molecular, structural, and immunologic relationships between OvTrop and Der p 10 were compared. Levels of OvTrop-specific and Der p 10-specific IgE, IgG, and IgG(4) in sera of filaria-infected and filarial-uninfected D pteronyssinus-atopic individuals were compared, as were the responses in nonhuman primates infected with the filarial parasite Loa loa. Cross-reactivity was compared by antigen-mediated depletion assays and functionality by passive basophil sensitization. RESULTS: Filarial and mite tropomyosins were very similar, with 72% identity at the amino acid level, and overlapping predicted 3-dimensional structures. The prevalence of IgE and IgG to Der p 10 was increased in filaria-infected individuals compared with uninfected subjects. There was a strong correlation between serum levels of Ov- and Der p 10-tropomyosin-specific IgE, IgG, and IgG(4) (P < .0001; r > 0.79). Preincubation of sera from anti-Der p 10-positive subjects with OvTrop completely depleted IgE, IgG, and IgG(4) anti-Der p 10. Basophils sensitized with sera from individuals allergic to Der p 10 released histamine similarly when triggered with OvTrop or Der p 10. Primates experimentally infected with L loa developed IgE that cross-reacted with Der p 10. CONCLUSION: Filarial infection induces strong cross-reactive antitropomyosin antibody responses that may affect sensitization and regulation of allergic reactivity. |
Laboratory characteristics of suspected herpes zoster in vaccinated children
Chun C , Weinmann S , Riedlinger K , Mullooly JP , Houston H , Schmid DS , Seward JF . Pediatr Infect Dis J 2011 30 (8) 719-21 Varicella vaccination of children has decreased varicella disease incidence, but introduced the occurrence of herpes zoster (HZ) from vaccine-type virus. We identified 14 vaccinated children with suspected HZ and confirmed varicella virus by polymerase chain reaction in 6 cases. Two cases were due to vaccine-type virus. Serum varicella IgM and IgG were not useful for diagnosis of HZ among vaccinated children. |
Multi-locus sequence analysis reveals host specific association between Bartonella washoensis and squirrels
Inoue K , Kabeya H , Hagiya K , Kosoy MY , Une Y , Yoshikawa Y , Maruyama S . Vet Microbiol 2011 148 (1) 60-5 To clarify phylogenetic relationships and genetic diversity among Bartonella washoensis strains obtained from squirrels, multi-locus sequence analysis (MLSA) with the 16S rRNA, ftsZ, gltA, groEL, ribC, and rpoB genes was applied for 20 strains of B. washoensis isolated from five genera of squirrels (Tamias, Tamiasciurus, Glaucomys, Sciurus, and Spermophilus) within the family Sciuridae. Sequence similarities in the concatenated sequences of B. washoensis strains from squirrels of different genera ranged from 94.7% (Sciurus vs. Spermophilus) to 98.4% (Tamiasciurus vs. Glaucomys). Phylogenetic trees based on the concatenated sequences revealed that B. washoensis strains formed five distinct clades and each clade correlated with the genus of squirrel from which the strains were originally obtained. The discrimination was supported by 100% bootstrap values and posterior probabilities, respectively. These results suggest that B. washoensis strains may have co-speciated with their squirrel hosts and provide new insights into the application of the MLSA to identify sources of B. washoensis infection with accuracy. |
The evaluation of widely used diagnostic tests to detect West Nile virus infections in horses previously infected with St. Louis encephalitis or dengue virus
Ledermann JP , Lorono-Pino MA , Ellis C , Shaw KD , Blitvich BJ , Beaty BJ , Bowen RA , Powers AM . Clin Vaccine Immunol 2011 18 (4) 580-7 Primary West Nile virus (WNV) infections can be diagnosed using a number of tests that detect infectious particles, nucleic acid, specific IgM, and/or IgG antibodies. However, serological identification of the infecting agent in secondary or subsequent flavivirus infections is problematic due to extensive cross-reactivity of flavivirus antibodies. This is particularly difficult in the tropical Americas where multiple flaviviruses co-circulate. A sequential flavivirus infection study in horses was undertaken using three medically important flaviviruses and five widely utilized diagnostic assays to determine if WNV infection could be detected in horses that had a previous St. Louis encephalitis virus (SLEV) or Dengue 2 virus (DENV-2) infection. Following the primary inoculation, 25% (3/12) and 75% (3/4) mounted an antibody response against SLEV or DENV-2, respectively. Eighty eight percent of horses subsequently inoculated with WNV had a WNV-specific antibody response that could be diagnosed with one of these assays. The plaque reduction neutralization test (PRNT) was sensitive in detection, but lacked specificity especially following repeated flavivirus exposure. Only the WNV specific IgM-ELISA was able to detect an IgM antibody response and was not cross-reactive in a primary SLEV or DENV response. The WNV-specific blocking ELISA was specific, showing positives only following a WNV injection. Of great importance, we demonstrated that timing of sample collection and the need for multiple samples are important as the infecting etiology could be misdiagnosed if only a single sample is tested. |
HIV-1 enhancing effect of prostatic acid phosphatase peptides is reduced in human seminal plasma
Martellini JA , Cole AL , Svoboda P , Stuchlik O , Chen LM , Chai KX , Gangrade BK , Sorensen OE , Pohl J , Cole AM . PLoS One 2011 6 (1) e16285 We recently reported that HIV-1 infection can be inhibited by innate antimicrobial components of human seminal plasma (SP). Conversely, naturally occurring peptidic fragments from the SP-derived prostatic acid phosphatase (PAP) have been reported to form amyloid fibrils called "SEVI" and enhance HIV-1 infection in vitro. In order to understand the biological consequence of this proviral effect, we extended these studies in the presence of human SP. PAP-derived peptides were agitated to form SEVI and incubated in the presence or absence of SP. While PAP-derived peptides and SEVI alone were proviral, the presence of 1% SP ablated their proviral activity in several different anti-HIV-1 assays. The anti-HIV-1 activity of SP was concentration dependent and was reduced following filtration. Supraphysiological concentrations of PAP peptides and SEVI incubated with diluted SP were degraded within hours, with SP exhibiting proteolytic activity at dilutions as high as 1:200. Sub-physiological concentrations of two prominent proteases of SP, prostate-specific antigen (PSA) and matriptase, could degrade physiological and supraphysiological concentrations of PAP peptides and SEVI. While human SP is a complex biological fluid, containing both antiviral and proviral factors, our results suggest that PAP peptides and SEVI may be subject to naturally occurring proteolytic components capable of reducing their proviral activity. |
Attaching zanamivir to a polymer markedly enhances its activity against drug-resistant strains of influenza A virus
Weight AK , Haldar J , Alvarez de Cienfuegos L , Gubareva LV , Tumpey TM , Chen J , Klibanov AM . J Pharm Sci 2011 100 (3) 831-5 Effects of the commercial drug zanamivir (Relenza) covalently attached to poly-l-glutamine on the infectivity of influenza A viruses are examined using the plaque reduction assay and binding affinity to viral neuraminidase (NA). These multivalent drug conjugates exhibit (i) up to a 20,000-fold improvement in anti-influenza potency compared with the zanamivir parent against human and avian viral strains, including both wild-type and drug-resistant mutants, and (ii) superior neuraminidase (NA) inhibition constants, especially for the mutants. These findings provide a basis for exploring polymer-attached inhibitors as more efficacious therapeutics, particularly against drug-resistant influenza strains. (c) 2010 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 100:831-835, 2011. |
Comparison of air sampling methods for aerosolized spores of B. anthracis Sterne
Estill CF , Baron PA , Beard JK , Hein MJ , Larsen LD , Deye GJ , Rose L , Hodges L . J Occup Environ Hyg 2011 8 (3) 179-86 Bacillus anthracis Sterne spores were aerosolized within a chamber at concentrations ranging from 1x10(3) to 1.7x10(4) spores per cubic meter of air (particles (p)/m(3)) to compare three different sampling methods: Andersen samplers, gelatin filters, and polytetrafluoroethylene (PTFE) membrane filters. Three samples of each type were collected during each of 19 chamber runs. Chamber concentration was determined by an aerodynamic particle sizer (APS) for the size range of 1.114-1.596 mum. Runs were categorized (low, medium, and high) based on tertiles of the APS estimated air concentrations. Measured air concentrations and recovery efficiency [ratio of the measured (colony forming units (CFU)/m(3)) to the APS estimated (particles/m(3)) air concentrations] for the sampling methods were compared using mixed-effects regression models. Limits of detection for each method were estimated based on estimated recovery efficiencies. Mean APS estimated air concentrations were 1600 particles/m(3), 4100 particles/m(3), and 9100 particles/m(3) at the low, medium, and high tertiles, respectively; coefficient of variation (CV) ranged from 25 to 40%. Statistically significant differences were not observed among the three sampling methods. At the high and medium tertiles, estimated correlations of measured air concentration (CFU/m(3)) among samples collected from the same run of the same type were high (0.73 to 0.93). Among samples collected from the same run but of different types, correlations were moderate to high (0.45 to 0.85); however, correlations were somewhat lower at the low tertile (-0.31 to 0.75). Estimated mean recovery efficiencies ranged from 0.22 to 0.25 CFU/particle with total CVs of approximately 84 to 97%. Estimated detection limits ranged from 35 to 39 particles/m(3). These results will enable investigators to conduct environmental sampling, quantify contamination levels, and conduct risk assessments of B. anthracis. |
Detection of Staphylococcus aureus using (15)N-labeled bacteriophage amplification coupled with matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry
Pierce CL , Rees JC , Fernandez FM , Barr JR . Anal Chem 2011 83 (6) 2286-93 A novel approach to rapid bacterial detection using an isotopically labeled (15)N bacteriophage and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) is introduced. Current phage amplification detection (PAD) via mass spectrometric analysis is limited because host bacteria must be inoculated with low phage titers in such a way that initial infecting phage concentrations must be below the detection limit of the instrument, thus lengthening incubation times. Additionally, PAD techniques cannot distinguish inoculate input phage from output phage which can increase the possibility of false positive results. Here, we report a rapid and accurate PAD approach for identification of Staphylococcus aureus via detection of bacteriophage capsid proteins. This approach uses both a wild-type (14)N and a (15)N-isotopically labeled S. aureus-specific bacteriophage. High (15)N phage titers, above our instrument's detection limits, were used to inoculate S. aureus. MALDI-TOF MS detection of the (14)N progeny capsid proteins in the phage-amplified culture indicated the presence of the host bacteria. Successful phage amplification was observed after 90 min of incubation. The amplification was observed by both MALDI-TOF MS analysis and by standard plaque assay measurements. This method overcomes current limitations by improving analysis times while increasing selectivity when compared to previously reported PAD methodologies. |
Risk of venous thromboembolism during the postpartum period: a systematic review
Jackson E , Curtis KM , Gaffield ME . Obstet Gynecol 2011 117 (3) 691-703 OBJECTIVE: To determine, from the literature, the risk of venous thromboembolism during the postpartum period. DATA SOURCES: We searched PubMed and Cochrane Library databases for all articles (in all languages) published in peer-reviewed journals from database inception through May 2010 for evidence related to incidence of venous thromboembolism in postpartum women. METHODS OF STUDY SELECTION: We included studies reporting relative risk, incidence rate, or cumulative incidence of venous thromboembolism in postpartum women. TABULATION, INTEGRATION, AND RESULTS: We included 15 articles reporting findings from 13 studies. Two studies directly comparing venous thromboembolism during the first 6 weeks postpartum to nonpregnant, nonpostpartum women reported relative effect measures of 21.5 (rate ratio; 95% confidence interval [CI] unable to be calculated) and 84 (odds ratio; 95% CI 31.7-222.6), respectively. A third study reported relative effect measures for deep venous thrombosis (15.2, 95% CI 13.2-17.6; standardized incidence ratio) and pulmonary embolism (9.2, 95% CI 6.5-12.7) separately. Three studies reported incidence rates of venous thromboembolism during the postpartum period (range 25-99 per 10,000 woman-years). We compared these incidence rates to baseline rates among nonpregnant, nonpostpartum women reported in the literature to generate rate ratios; these rate ratios ranged from 2.5 to 21.5. Nine studies reported cumulative incidence proportions of postpartum venous thromboembolism, ranging from 0.14 to 3.24 per 1,000 deliveries at 6 weeks postpartum. Incidence of venous thromboembolism was highest immediately after delivery (standardized incidence ratio for deep venous thrombosis 115.1 [95% CI 96.4-137.0], and for pulmonary embolism 80.7 [95% CI 53.9-117.9]); between 4 and 6 weeks postpartum, risk declined but was still approximately five-times to seven-times that of nonpregnant, nonpostpartum women. CONCLUSION: During the first 6 weeks postpartum, women's risk of venous thromboembolism increased 21.5-fold to 84-fold from baseline in nonpregnant, nonpostpartum women in studies that included an internal reference group. Although incidence of venous thromboembolism declined quickly after delivery, when this risk returns to baseline is not clear from current data. |
Trends and characteristics of home births in the United States by race and ethnicity, 1990-2006
Macdorman MF , Declercq E , Menacker F . Birth 2011 38 (1) 17-23 BACKGROUND: After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. METHODS: U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. RESULTS: From 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. In 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non-Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non-Hispanic white women, two-thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or "other" attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. CONCLUSIONS: Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non-Hispanic white women, a larger proportion of non-Hispanic black and Hispanic home births represent unplanned, emergency situations. (BIRTH 38:1 March 2011). |
Variation in immunoreactive trypsinogen concentrations among Michigan newborns and implications for cystic fibrosis newborn screening
Korzeniewski SJ , Young WI , Hawkins HC , Cavanagh K , Nasr SZ , Langbo C , Teneyck KR , Grosse SD , Kleyn M , Grigorescu V . Pediatr Pulmonol 2011 46 (2) 125-30 OBJECTIVE: To investigate variation in immunoreactive trypsinogen (IRT) concentrations by race, sex, birth weight, and gestational age and their implications for the use of percentile-based cutoffs for cystic fibrosis (CF) newborn screening (NBS) programs. PATIENTS AND METHODS: This cross-sectional population-based study of resident infants screened in Michigan investigates associations between demographic and perinatal variables and IRT concentrations after controlling for covariates. This study also analyzed how 96th and 99.8th IRT concentration percentiles values calculated by Michigan NBS vary by demographic and perinatal factors. Characteristics of infants having high (≥99.8th percentile) IRT concentrations and negative DNA tests are also explored. RESULTS: IRT mean concentrations and percentiles vary significantly by race, birth weight, gestational age, and to a lesser degree by sex. The greatest variation in mean IRT concentrations was observed among racial categories; black infants had an adjusted mean concentration of 36 ng/ml and Asian/Pacific Islander infants had a mean concentration of 25 ng/ml compared to an average concentration of 28 ng/ml in white infants and infants of other races. CONCLUSIONS: Variation in IRT concentrations resulted in the over-representation of certain groups referred for secondary testing, particularly referrals for sweat testing based on very high (≥99.8th percentile) concentrations alone, which is no longer recommended in Michigan. Further research may be warranted to evaluate initial IRT cutoffs used for CF NBS. |
Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns
Rasmussen SA , Kissin DM , Yeung LF , Macfarlane K , Chu SY , Turcios-Ruiz RM , Mitchell EW , Williams J , Fry AM , Hageman J , Uyeki TM , Jamieson DJ . Am J Obstet Gynecol 2011 204 S13-20 Pregnant women and their newborn infants are at increased risk for influenza-associated complications, based on data from seasonal influenza and influenza pandemics. The Centers for Disease Control and Prevention (CDC) developed public health recommendations for these populations in response to the 2009 H1N1 pandemic. A review of these recommendations and information that was collected during the pandemic is needed to prepare for future influenza seasons and pandemics. The CDC convened a meeting entitled "Pandemic Influenza Revisited: Special Considerations for Pregnant Women and Newborns" on August 12-13, 2010, to gain input from experts and key partners on 4 main topics: antiviral prophylaxis and therapy, vaccine use, intrapartum/newborn (including infection control) issues, and nonpharmaceutical interventions and health care planning. Challenges to communicating recommendations regarding influenza to pregnant women and their health care providers were also discussed. After careful consideration of the available information and individual expert input, the CDC updated its recommendations for these populations for future influenza seasons and pandemics. |
Congenital heart defects and major structural noncardiac anomalies, Atlanta, Georgia, 1968 to 2005
Miller A , Riehle-Colarusso T , Alverson CJ , Frias JL , Correa A . J Pediatr 2011 159 (1) 70-78 e2 OBJECTIVE: To identify the proportion of major structural noncardiac anomalies identified with congenital heart defects (CHDs). STUDY DESIGN: Records of infants with CHDs in the Metropolitan Atlanta Congenital Defects Program who were born during the period 1968 through 2005 were classified as having isolated, syndromic, multiple CHD (ie, having an unrecognized pattern of multiple congenital anomalies or a recognized pattern of multiple congenital anomalies of unknown etiology), or laterality defects. Frequencies of associated noncardiac anomalies were obtained. RESULTS: We identified 7984 live-born and stillborn infants and fetuses with CHDs. Among them, 5695 (71.3%) had isolated, 1080 (13.5%) had multiple, 1048 (13.1%) had syndromic, and 161 (2.0%) had laterality defects. The percentage of multiple congenital anomalies was highest for case with atrial septal defects (18.5%), cardiac looping defects (17.2%), and conotruncal defects (16.0%), and cases with atrioventricular septal defects represented the highest percentages of those with syndromic CHDs (66.7%). CONCLUSIONS: Including those with syndromes and laterality defects, 28.7% of case infants with CHDs had associated major noncardiac malformations. Thus, infants with CHDs warrant careful examination for the presence of noncardiac anomalies. |
Descriptive study of nonsyndromic atrioventricular septal defects in the National Birth Defects Prevention Study, 1997-2005
Hartman RJ , Riehle-Colarusso T , Lin A , Frias JL , Patel SS , Duwe K , Correa A , Rasmussen SA . Am J Med Genet A 2011 155A (3) 555-64 Nonsyndromic atrioventricular septal defects (AVSDs) are serious congenital heart defects for which information on prevalence and descriptive characteristics based on large, geographically, and ethnically diverse populations has been limited. To describe the birth prevalence and phenotype of nonsyndromic AVSDs, we used data from the National Birth Defects Prevention Study (NBDPS), a multisite, population-based case-control study aimed at identifying genetic and environmental risk factors for birth defects. For this analysis, infants born during the period 1997-2005 and meeting the NBDPS case definition for AVSDs were included. Infants with an AVSD associated with recognized or strongly suspected chromosomal abnormalities or single-gene disorders (syndromic case infants) were excluded. We identified 302 infants with a nonsyndromic AVSD for a birth prevalence of 0.83/10,000 livebirths. Over 20% of infants with an AVSD had an additional major birth defect, with gastrointestinal, renal or urinary, and central nervous system defects being the most common. A lower prevalence of AVSDs was seen among infants born to Hispanic mothers compared with those born to non-Hispanic White mothers [prevalence ratio = 0.63 (95% confidence interval: 0.46-0.86)]. Understanding the prevalence of nonsyndromic AVSDs, demographic factors associated with their occurrence, and associated defects could help guide clinical care, as well as contribute to a better understanding of pathogenesis. (c) 2011 Wiley-Liss, Inc. |
Genetic susceptibility and the setting of occupational health standards.
Schulte P , Howard J . Annu Rev Public Health 2011 32 5.1-5.11 As more is learned about genetic susceptibility to occupational and environmental hazards, there will be increasing pressure to use genetic susceptibility information in setting occupational health standards. Historically, this has not been done, but a growing body of research assesses inherited genetic factors as modifiers of the effects of hazardous exposures. Additionally, acquired genetic and epigenetic characteristics could also be used in standard setting. However, for both inherited and acquired genetic characteristics, many scientific ethical, legal, and social issues could arise. Investigators need to examine the potential role and implications of using genetic information in standard setting. In this review, we focus primarily on inherited genetic factors and their role in occupational health standard setting. |
Perfluoroalkyl acids including perfluorooctane sulfonate and perfluorohexane sulfonate in firefighters
Jin C , Sun Y , Islam A , Qian Y , Ducatman A . J Occup Environ Med 2011 53 (3) 324-8 OBJECTIVE: Firefighters were likely exposed to perfluorooctane sulfonate since it was a component of extinguishing foams and perfluorohexane sulfonate (PFHxS), a surfactant coating carpet and other building materials, during firefighting. The objective of the study is to evaluate serum concentrations of perfluoroalkyl acids (PFAAs) in firefighters. METHODS: A total of 8826 male adults, including 37 firefighters, were analyzed. Multivariate analysis was conducted by using a general linear model. The least square mean of serum PFAAs was obtained after adjustment for demographic and socioeconomic variables. RESULTS: Serum concentration of PFHxS was statistically higher in firefighters both before and after adjustment. Perfluorooctane sulfonate and perfluorononanoic acid were also found higher in firefighters, though not statistically significant. CONCLUSIONS: The study suggests that fighting fire can be a risk of exposure to PFAAs, specifically PFHxS. |
Characteristics of HIV care and treatment in PEPFAR-supported sites
Filler S , Berruti AA , Menzies N , Berzon R , Ellerbrock TV , Ferris R , Blandford JM . J Acquir Immune Defic Syndr 2011 57 (1) e1-6 BACKGROUND: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has supported the extension of HIV care and treatment to 2.4 million individuals as of September 2009. With increasing resources targeted toward rapid scale-up, it is important to understand the characteristics of current PEPFAR-supported HIV care and treatment sites. METHODS: Forty-five sites in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam were sampled. Data were collected retrospectively from successive 6-month periods through reviews of facility records and interviews with site personnel between April 2006 and March 2007. Facility size and scale-up rate, patient characteristics, staffing models, clinical and laboratory monitoring, and intervention mix were compared. RESULTS: Sites added a median of 293 patients per quarter. By the evaluation's end, sites supported a median of 1,649 HIV patients, 922 of them receiving antiretroviral therapy (ART). Patients were predominantly adult (97.4%) and the majority (96.5%) were receiving regimens based on nonnucleoside reverse transcriptase inhibitors (NNRTIs). The ratios of physicians to patients dropped substantially as sites matured. ART patients were commonly seen monthly or quarterly for clinical and laboratory monitoring, with CD4 counts being taken at 6-month intervals. One-third of sites provided viral load testing. Cotrimoxazole prophylaxis was the most prevalent supportive service. CONCLUSIONS: HIV treatment sites scaled up rapidly with the influx of resources and technical support through PEPFAR, providing complex health services to progressively expanding patient cohorts. Human resources are stretched thin, and delivery models and intervention mix differ widely between sites. Ongoing research is needed to identify best-practice service delivery models. |
Patterns of antidepressant medication use among pregnant women in a United States population
Alwan S , Reefhuis J , Rasmussen SA , Friedman JM . J Clin Pharmacol 2011 51 (2) 264-70 This article describes the pattern of reported antidepressant use around the time of pregnancy in a population-based sample of women who delivered live-born babies without birth defects. Data were used from the National Birth Defects Prevention Study, an ongoing case-control study of risk factors for birth defects covering 10 US states. Mothers of live-born infants without birth defects (controls) born between 1998 and 2005 were randomly selected from each site. Information on the mother's characteristics and exposure to antidepressants was collected via a standardized telephone interview. Among 6582 mothers included in the study, 298 (4.5%) reported use of an antidepressant in the period of 3 months before through the end of pregnancy. Use of selective serotonin-reuptake inhibitors was reported most often (3.8%), followed by bupropion (0.7%). A statistically significant decline was observed, from 3.1% to 2.3% (P < .001), in reported use of antidepressants between the first and second month after conception. The frequency of reported antidepressant use at any time during pregnancy increased from 2.5% in 1998 to 8.1% in 2005 (P < .001) in 4 states. The findings show an increase in reported antidepressant use over a 9-year period and a substantial decrease in use around the usual time of pregnancy recognition. |
Accelerating science-driven solutions to challenges in global reproductive health: a new framework for moving forward
Peterson HB , D'Arcangues C , Haidar J , Curtis KM , Merialdi M , Gulmezoglu AM , Say L , Mbizvo M . Obstet Gynecol 2011 117 (3) 720-726 Recommendations shaping policies, programs, and practices in global health should be based on the best available science, but how best to achieve this objective is less clear. We describe a new approach developed by the United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development and Research Training in Human Reproduction within the World Health Organization Department of Reproductive Health and Research for addressing key challenges in global reproductive health. This approach leads to new recommendations for accelerating solutions to priority needs in the field and continued improvements in the science base-including the implementation science base-for meeting these needs. The key components of this new cycle for science-driven solutions include: 1) identifying priority needs of the field; 2) creating guidance that meets the needs of the field; 3) identifying research gaps and establishing and funding research priorities; 4) research synthesis and updating of the guidance in a timely fashion; and 5) supporting utilization in countries through systematic introduction of science-driven solutions. There is a synergistic effect when the contributions of the individual components of this cycle are linked. Strong institutional support is required for this collective effort, as is the creation of a team of researchers, practitioners, donors, and implementing agencies with shared responsibilities for its success. This new approach has already made important contributions toward addressing key challenges in family planning and maternal and perinatal health. We believe that it will help bridge the gap between knowledge and action for reproductive health and for global health more broadly. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Program Evaluation
- Reproductive Health
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure