Chronic fatigue syndrome is associated with metabolic syndrome: results from a case-control study in Georgia
Maloney EM , Boneva RS , Lin JM , Reeves WC . Metabolism 2010 59 (9) 1351-7 We hypothesized that persons with chronic fatigue syndrome (CFS) would have a higher prevalence of metabolic syndrome compared with well controls, and that unwell persons with insufficient symptoms or fatigue for CFS (termed ISF) would have a prevalence of metabolic syndrome intermediate between those with CFS and the controls. We also sought to examine the relationship between metabolic syndrome and measures of functional impairment, fatigue, and other symptoms. Our analysis was based on a population-based case-control study conducted in metropolitan, urban, and rural areas of Georgia, United States, between September 2004 and July 2005. There were 111 persons with CFS, 259 with ISF, and 123 controls. Metabolic syndrome was determined based on having at least 3 of 5 standard risk components (abdominal obesity, high triglycerides, high blood pressure, elevated fasting glucose, and decreased high-density lipids) according to the National Cholesterol Education Program Adult Treatment Panel III definition. Persons with CFS were 2-fold as likely to have metabolic syndrome (odds ratio = 2.12, confidence interval = 1.06, 4.23) compared with the controls. There was a significant graded relationship between the number of metabolic syndrome factors and CFS; each additional factor was associated with a 37% increase in likelihood of having CFS. The association of ISF with metabolic syndrome was weaker (odds ratio = 1.72, confidence interval = 0.94-3.16). Among persons with CFS, the number of metabolic syndrome factors was significantly correlated with worse fatigue on a standardized summary measure of fatigue (r = 0.20, P = .04). In conclusion, CFS was associated with metabolic syndrome, which further exacerbated fatigue. |
A simulating analysis of the effects of increased joint stiffness on muscle loading in a thumb
Wu JZ , Li ZM , Cutlip RG , An KN . Biomed Eng Online 2009 8 41 BACKGROUND: The development of osteoarthritis (OA) in the hand results in increased joint stiffness, which in turn affects the grip strength. The goal of the present study is to theoretically analyze the muscle forces in a thumb in response to the increased joint stiffness. METHODS: The thumb was modeled as a linkage system consisting of a trapezium, a metacarpal bone, a proximal and a distal phalanx. Nine muscles were included in the model: flexor pollicis longus (FPL), extensor pollicis longus (EPL), extensor pollicis brevis (EPB), abductor pollicis longus (APL), flexor pollicis brevis (FPB), abductor pollicis brevis (APB), the transverse head of the adductor pollicis (ADPt), the oblique head of the adductor pollicis (ADPo), and opponens pollicis (OPP). Numerical tests were performed using an inverse dynamic approach. The joints were prescribed to an angular motion at one degree-of-freedom (DOF) each time with all other DOFs of the joints being mechanically constrained, while the muscle forces in response to the joint motions were predicted. The normal joint stiffness was assumed to be 0.05, 0.10, and 0.15 N m/rad for interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint, respectively. The joint stiffness was assumed to increase by 50% and 100%, simulating the biomechanical consequences of OA. RESULTS: Our simulations indicated that the increase in joint stiffness induced substantial increases in muscle forces, especially in the EPL and FPL muscles in response to IP, MCP, or CMC extension/flexion motions. CONCLUSIONS: Because the strength of the muscles in the fingers is limited, the muscles will not be able to overcome joint resistance if joint stiffness is increased to its limit due to OA. This may contribute to the reduced range of motion typically seen in OA. |
When do minority drug-resistant HIV-1 variants have a major clinical impact?
Heneine W . J Infect Dis 2010 201 (5) 647-9 As our understanding of the virologic and clinical significance of drug-resistant human immunodeficiency virus type 1 (HIV-1) continues to expand, attention is now turning to detecting and assessing the clinical impact of minority (low frequency/abundance) drug-resistant HIV-1, the variants in the viral population present below the ∼20% detection threshold of conventional bulk sequencing. The interest in studying minority resistance has been fueled by improved diagnostic technologies that allow detection of drug-resistant variants below the 1% threshold, and by the recognition that drug-resistant viral populations often exist as a complex mixture of genetic populations in which only the dominant viral sequence is detected by standard sequencing. Three common approaches are used to detect minority resistance: point mutations assays, clonal sequencing, and ultra deep sequencing. Point mutations assays selectively amplify resistance or wild-type alleles at a drug resistance position and can have detection limits as low as 0.0001% on cloned mutant templates, although such detection thresholds are not always achieved in clinical samples [1–4]. These assays are so sensitive that they are able to detect naturally occurring mutations in the viral quasispecies of samples from the pre-antiretroviral drug era but can be adjusted to cutoffs above which the detection of any mutation would reflect the presence of drug-selected viruses [1]. Clonal sequencing uses the standard sequencing method on a large number of variants cloned from polymerase chain reaction (PCR)-amplified viral RNA from a plasma sample or generated by limiting-dilution PCR such as in single-genome sequencing methods [5]. Ultra-deep sequencing refers to more recently developed high-throughput sequencing technologies like pyrosequencing that allow sequencing large numbers of individual DNA molecules in a sample [6]. Two articles in the current issue of the Journal by Halvas et al [7] and Paredes et al [8] use the first 2 approaches to examine the clinical impact of minority nonnucleoside reverse-transcriptase inhibitor (NNRTI) mutations in treatmentnaive and treatment-experienced patients. NNRTIs are essential components of antiretroviral therapy. Treatment guidelines recommend NNRTIs with a combination of nucleoside or nucleotide reverse-transcriptase inhibitors for initial therapy [9]. NNRTIs have a low genetic barrier to resistance often requiring only 1 mutation to cause resistance to the commonly used first-generation NNRTIs efavirenz and nevirapine. The K103N mutation in reverse transcriptase is the most frequently seen NNRTI mutation in patients who experience failure of NNRTI-based regimens, although other mutations such as Y181C are also prevalent [10]. |
Glucocorticoid and pyrazolone treatment of acute fever is a risk factor for critical and life-threatening human enterovirus 71 infection during an outbreak in China, 2008
Ma H , He F , Wan J , Jin D , Zhu L , Liu X , Liu Q , Zhang G , Ding Z , Fontaine RE , Zhu BP , Jian H , Zhang L , Xu W , Zeng G . Pediatr Infect Dis J 2010 29 (6) 524-9 BACKGROUND: Human enterovirus 71 (HEV71) causes outbreaks of life-threatening diseases throughout the world. The genesis of these severe diseases is unknown. METHODS: During an outbreak of HEV71 infection, we investigated risk factors for critical illness. We developed a modified pediatric index of mortality (mPIM) incorporating heart rate, temperature, white blood cell count, respiratory rate, chest infiltrates, skin color, reflexes, responsiveness, and mobility. We calculated the mPIM for 103 patients (22 deaths) using complete scoring criteria in the medical record. In a case-control study, we compared cases (mPIM ≥10 or death) with controls (mPIM = 0-9) by drugs received within 96 hours after onset of fever, initial temperature, age, and nutritional anthropometry. RESULTS: About 66% (68/103) of the patients with an mPIM score (28 cases and 40 controls) had data on initial exposures. About 50% of the 28 cases and 18% of the 40 controls received an injection to treat fever during the first 96 hours after onset (Odds ratio [OR] = 7.0, 95% confidence interval [CI]: 1.8-28). Injections containing exclusively glucocorticoids (OR = 4.8, 95% CI: 1.2-21) or pyrazolones (OR = 4.1, 95% CI: 0.91-19, P = 0.047) were risk factors for severe HEV71 infection. About 25% of cases and 5% of controls received both drugs parenterally while 7% of cases and 30% of controls received neither (OR = 21, 95% CI: 1.8-305). Conversely, cases and controls had identical average initial temperature, and did not differ significantly by age, sex, nutritional measurements, use of other drugs, or timeliness of medical care received. CONCLUSION: Fever treatment with glucocorticoids and/or pyrazolones is a risk factor for life-threatening HEV71 infection. |
HIV genital shedding and safety of Carraguard use by HIV-infected women: a crossover trial in Thailand
McLean CA , van de Wijgert JH , Jones HE , Karon JM , McNicoll JM , Whitehead SJ , Braunstein S , Achalapong J , Chaikummao S , Tappero JW , Markowitz LE , Kilmarx PH . AIDS 2010 24 (5) 717-22 OBJECTIVE: To evaluate the safety, including impact on genital HIV RNA shedding, of Carraguard vaginal gel in HIV-infected women. DESIGN: This is a randomized, controlled, crossover study of Carraguard in HIV-infected women in Thailand. METHODS: Each woman (CD4 cell count 51-500 cells/mul and not on antiretroviral therapy) used each treatment (Carraguard, methylcellulose placebo, and no-product) once daily for 7 days during each 1-month period (3-week wash-out). Women were randomized to one of the six possible treatment sequences. Safety assessments were conducted at baseline (pregel), 15 min postgel, day 7, and day 14, and included HIV RNA measurements in cervicovaginal lavage (CVL) specimens. RESULTS: Sixty women were enrolled, and 99% of scheduled study visits were completed. At baseline, median age (34 years), CD4 lymphocyte count (296 cells/mul), plasma HIV viral load (4.6 log10 copies/ml), CVL HIV viral load (3.1 log10 total copies per CVL), and sexual behaviors were similar among randomization groups. HIV viral load, leukocyte and hemoglobin levels, and epithelial cell counts in CVLs were lower 15 min after application of Carraguard or placebo compared with no product; CVL HIV viral load was still lower at day 7 but returned to baseline by day 14. Carraguard use was not associated with prevalent or incident genital findings or abnormal vaginal flora. CONCLUSION: Carraguard appears to be well tolerated for once-daily vaginal use by HIV-infected women. The observed reduction in CVL HIV viral load in the gel months may be clinically relevant but could have resulted from interference with sample collection by study gels. |
Hospitalizations for invasive pneumococcal disease among human immunodeficiency virus-1 infected childern, adolescents and young adults in the United States in the era of highly active antiretroviral therapy and the conjugate pneumococcal vaccine
Kourtis AP , Ellington S , Bansil P , Jamieson DJ , Posner SF . Pediatr Infect Dis J 2010 29 (6) 561-3 We describe hospitalization trends of invasive pneumococcal disease (IPD) among human immunodeficiency virus-infected individuals <25 years of age since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the Nationwide Inpatient Sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994 to 1995 (pre-HAART and pre-PCV7 era); 1998 to 1999 (HAART and pre-PCV7 era); and 2004 to 2005 (HAART and early PCV7 era). The number of IPD hospitalizations among human immunodeficiency virusinfected children and youth <25 years in the United States declined by 78.7% between 1994/1995 and 2004/2005 (P = 0.03). This decrease was more pronounced among younger children. |
Antiviral treatment of patients with oseltamivir-resistant and oseltamivir-susceptible seasonal influenza A (H1N1) infection during the 2007-2008 influenza season in the United States
Dharan NJ , Gubareva LV , Klimov AI , Fiore AE , Bresee JS , Fry AM . Clin Infect Dis 2010 50 (4) 621-2 During the 2007–2008 influenza season, we collected epidemiologic and clinical information from patients infected with seasonal influenza A (H1N1) viruses to describe the characteristics of oseltamivir-resistant infection and compare them with the characteristics of oseltamivir-susceptible infection [1]. Here we use the data collected to compare the clinical symptoms and outcomes of patients with oseltamivir-resistant and oseltamivir-susceptible A (H1N1) virus infections that were treated and not treated with antiviral agents. Specimens for laboratory testing were collected before antivirals were started. Few reports that correlate antiviral resistance, determined by in vitro assays [2], with clinical response have been published [3]. | We used generalized estimating equations controlling for state as a clustered variable and age group, and we used Wilcoxon rank-sum tests for continuous var-iables. Among 99 patients with oselta-mivir-resistant A (H1N1) infection, 47 (47%) were treated; 44 (94%) received oseltamivir alone and 3 (6%) received oseltamivir and rimantadine. Among 182 patients with oseltamivir-susceptible A (H1N1) infections, 64 (35%) were treated; 60 (94%) received oseltamivir, 2 (3%) received amantadine, 1 (2%) received rimantadine, and 1 (2%) received zanamivir. We excluded 37 case patients: 14 who were <1 year old, 2 who died before a decision on antiviral treatment could have been made, 3 who were treated with oseltamivir and an adamantane, and 19 for whom antiviral treatment could not be confirmed. |
Distribution of airborne influenza virus and respiratory syncytial virus in an urgent care medical clinic
Lindsley WG , Blachere FM , Davis KA , Pearce TA , Fisher MA , Khakoo R , Davis SM , Rogers ME , Thewlis RE , Posada JA , Redrow JB , Celik IB , Chen BT , Beezhold DH . Clin Infect Dis 2010 50 (5) 693-8 BACKGROUND: Considerable controversy exists with regard to whether influenza virus and respiratory syncytial virus (RSV) are spread by the inhalation of infectious airborne particles and about the importance of this route, compared with droplet or contact transmission. METHODS: Airborne particles were collected in an urgent care clinic with use of stationary and personal aerosol samplers. The amounts of airborne influenza A, influenza B, and RSV RNA were determined using real-time quantitative polymerase chain reaction. Health care workers and patients participating in the study were tested for influenza. RESULTS: Seventeen percent of the stationary samplers contained influenza A RNA, 1% contained influenza B RNA, and 32% contained RSV RNA. Nineteen percent of the personal samplers contained influenza A RNA, none contained influenza B RNA, and 38% contained RSV RNA. The number of samplers containing influenza RNA correlated well with the number and location of patients with influenza ([Formula: see text]). Forty-two percent of the influenza A RNA was in particles 4.1 mum in aerodynamic diameter, and 9% of the RSV RNA was in particles 4.1 mum. CONCLUSIONS: Airborne particles containing influenza and RSV RNA were detected throughout a health care facility. The particles were small enough to remain airborne for an extended time and to be inhaled deeply into the respiratory tract. These results support the possibility that influenza and RSV can be transmitted by the airborne route and suggest that further investigation of the potential of these particles to transmit infection is warranted. |
Molecular evolution of measles viruses circulated in Taiwan 1992-2008
Cheng WY , Lee L , Rota PA , Yang DC . Virol J 2009 6 219 Genetic analyses of viral samples from 74 laboratory confirmed measles cases occurring in Taiwan during 1992-2008 identified six viral genotypes D3, D5, D9, G2, H1 and H2. The most frequently detected genotype, H1, was associated with outbreaks in 1994 and 2002, and was the likely indigenous genotype in 1992. In response to the outbreaks, two catch-up campaigns were launched and a routine second dose of measles, mumps, and rubella vaccine at entry to elementary school was introduced. The vaccination campaigns successfully reduced the number of measles cases in Taiwan, and many of the more recent cases can be traced to importations, primarily from other Asian countries. A number of measles genotypes which were associated with outbreaks in other Asian countries were detected among the more recent cases. The more recent genotype H1 viruses had sequences that were identical to those currently circulating in China or associated with international importation of virus. |
Short communication: HIV type 1 genetic diversity among tea plantation workers in Kericho, Kenya
Arroyo MA , Sateren WB , Foglia G , Kibaya R , Langat L , Wasunna M , Bautista CT , Scott PT , Shaffer DN , Robb ML , Michael NL , Birx DL , McCutchan FE . AIDS Res Hum Retroviruses 2009 25 (11) 1061-4 In preparation for HIV-1 vaccine trials in Kenya, 2801 study volunteers, from a tea plantation in Kericho, were recruited as part of a prospective vaccine cohort development study. Cryopreserved plasma was available from 401 HIV-positive volunteers, and was the source of viral RNA for genotyping by the multiregion hybridization assay (MHA). Logistic regression was performed to determine association of risk factors and HIV-1 recombinant and dual infections. At baseline, HIV-1 subtype A was the dominant circulating pure subtype (56%), followed by subtype D (10%) and C (5%). Recombinant HIV-1 strains accounted for almost one-third of all infections (29%), with 7% infected with a dual strain of the HIV-1 variants described. A higher number of HIV-1 recombinant and dual infections was observed among volunteers who were 18-24 and 25-29 years of age, affiliated with the Luo tribe, had been married two or more times, reported not being circumcised, and had STI symptoms in the past 6 months. Adjusted odds ratios (AOR) significantly associated with HIV-1 recombinant and dual infection were age difference from current spouse (5-9 years; AOR = 2.5, 95% CI = 1.2-5.3 and > or = 10 years; AOR = 3.1, 95% CI = 1.5-6.4) and reported STI symptoms in the past 6 months (AOR = 4.8, 95% CI = 2.0-11.6), respectively. In conclusion, our results suggest that there is considerable heterogeneity with respect to HIV-1 subtype diversity in this population that should be considered in the planning for future vaccine trials in the region. |
Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective
Tomblyn M , Chiller T , Einsele H , Gress R , Sepkowitz K , Storek J , Wingard JR , Young J-AH , Boeckh MJ . Bone Marrow Transplant 2009 44 (8) 453-558 This report, cosponsored by Center for International Blood & Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), European Group for Blood and Marrow Transplantation (EBMT), American Society for Blood and Marrow Transplantation (ASBMT), Canadian Blood and Marrow Transplant Group (CBMTG), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Association of Medical Microbiology and Infectious Disease (AMMI), Centers for Disease Control (CDC) and the Health Resources and Services Administration, represents an update of the guidelines published in 2000 for preventing infections among hematopoietic cell transplant (HCT) recipients.1 An international group of experts in infectious diseases, hematopoietic cell transplantation and public health worked together to compile this document with four goals in mind: (1) to summarize the current available data in the field; (2) to provide evidence-based recommendations regarding the prevention of infectious complications among HCT patients; (3) to serve as a reference for health-care providers worldwide who care for HCT recipients; and (4) to serve as a reference for HCT recipients and their nonmedical caregivers. In updating these guidelines, the committee sought to summarize the currently available data and present them as concisely as possible in an evidence-based manner. |
Discovery of Culex pipiens pipiens form molestus in Chicago
Mutebi JP , Savage HM . J Am Mosq Control Assoc 2009 25 (4) 500-3 A population of Culex pipiens pipiens form molestus was detected in a drainage sump in Calumet Water Reclamation Plant on the South Side of Chicago, IL. This is the first documented collection of a molestus population within the city of Chicago and the second collection of a molestus population in the Chicago metropolitan area in >60 years. Field-collected specimens were used to initiate a colony without bloodfeeding, and the colony is autogenous and stenogamous. |
Serological surveys for 2009 pandemic influenza A H1N1
Reed C , Katz JM . Lancet 2010 375 (9720) 1062-3 Since 2009 pandemic influenza A H1N1 was first identified in April, 2009,1 the virus has caused widespread illness worldwide. In The Lancet today, Elizabeth Miller and colleagues2 from the UK Health Protection Agency report a pair of cross-sectional serological surveys in which they address the level of pre-existing immunity to 2009 pandemic H1N1 in the population and, more importantly, estimate the proportion of the population infected during the first pandemic wave in the UK. | Most people have some pre-existing immunity to influenza viruses, which circulate globally every year. Although the 2009 pandemic H1N1 haemagglutinin is antigenically and genetically distinct from haemagglutinins of contemporary human seasonal influenza H1N1 viruses, some degree of cross-reactivity with H1N1 influenza viruses exists.3 Miller and colleagues established a baseline prevalence of cross-reactive antibody to 2009 pandemic H1N1 in the UK by using a collection of prepandemic serum samples from late 2008. Around 3% of children younger than 15 years of age and 23% of adults aged 65 years or older had pre-existing haemagglutination inhibition antibody titres of 1:32 or more against 2009 pandemic H1N1, a titre generally associated with reduced risk of influenza infection. |
Sources of differences in estimates of obesity-associated deaths from first National Health and Nutrition Examination Survey (NHANES I) hazard ratios
Flegal KM , Graubard BI , Williamson DF , Gail MH . Am J Clin Nutr 2010 91 (3) 519-27 BACKGROUND: Estimates of obesity-associated deaths in the United States for 1991 were published by Allison et al and subsequently for 2000 by Mokdad et al. Flegal et al then published lower estimates of obesity-associated deaths for 2000. All 3 studies incorporated data from the first National Health and Nutrition Examination Survey (NHANES I). OBJECTIVE: The objective was to clarify the effects of methodologic differences between the 3 studies in estimates of obesity-associated deaths in the US population by using NHANES I hazard ratios. DESIGN: The earlier reports used imputed smoking data for much of the NHANES I sample rather than the available reported data and applied a method of calculating attributable fractions that did not adjust for the effects of age, sex, and smoking on mortality in the target US population and did not account for effect modification by age. The effects of these and other methodologic factors were examined. RESULTS: The NHANES I hazard ratios in the earlier reports were too low, probably because of the imputed smoking data. The low hazard ratios obscured the magnitude and direction of the bias arising from the incompletely adjusted attributable fraction method. When corrected hazard ratios were used, the incompletely adjusted attributable fraction method overestimated obesity-associated mortality in the target population by >100,000 deaths. CONCLUSION: Methodologic sources of bias in the reports by Allison et al and Mokdad et al include the assessment of smoking status in NHANES I and the method of calculating attributable fractions. |
U.S. maternally linked birth records may be biased for Hispanics and other population groups
Leiss JK , Giles D , Sullivan KM , Mathews R , Sentelle G , Tomashek KM . Ann Epidemiol 2010 20 (1) 23-31 PURPOSE: We sought to advance understanding of linkage error in U.S. maternally linked datasets and how the error might affect results of studies based on the linked data. METHODS: North Carolina birth and fetal death records for 1988-1997 were maternally linked (n=1,030,029). The maternal set probability, defined as the probability that all records assigned to the same maternal set do in fact represent events to the same woman, was used to assess differential maternal linkage error across race/ethnic groups. RESULTS: Maternal set probabilities were lower for records specifying Asian or Hispanic race/ethnicity, suggesting greater maternal linkage error for these sets. The lower probabilities for Hispanics were concentrated in women of Mexican origin who were not born in the United States. CONCLUSIONS: Differential linkage error may be a source of bias in studies that use U.S. maternally linked datasets to make comparisons between Hispanics and other groups or among Hispanic subgroups. Methods to quantify and adjust for this potential bias are needed. |
Urban-rural residence and the occurrence of cleft lip and cleft palate in Texas, 1999-2003
Messer LC , Luben TJ , Mendola P , Carozza SE , Horel SA , Langlois PH . Ann Epidemiol 2010 20 (1) 32-9 PURPOSE: The etiology of orofacial clefts is complex and relatively unknown. Variation in cleft lip with or without palate (CLP) and cleft palate alone (CP) was examined in Texas across urban-rural residence (1999 to 2003). METHODS: Cases came from the Texas Birth Defects Registry (1,949 CLP and 1,054 CP) and denominator data came from vital records (254 counties; 1,827,317 live births). Variation in maternal residence was measured using four classification schemes: Rural Urban Continuum Codes, Urban Influence Codes, percentage of county in cropland, and Rural Urban Commuting Areas. Poisson regression was used to calculate rate ratios, adjusted for infant sex, plurality, gestational age, maternal parity, age, race/ethnicity, and education. RESULTS: Compared to the most urban referent category, living in more rural areas was associated with an increased adjusted risk of CLP. For example, the Rural-Urban Continuum Codes demonstrated elevated risks for CLP in "thinly populated areas" compared to "metropolitan-urban areas" (adjusted prevalence ratio = 1.9; 95% confidence intervals (CI) 1.2-2.8); CP was not similarly associated. Percentage of county cropland was not consistently associated with any outcome. CONCLUSION: The association patterns between non-urban residence and risk of CLP, except for percentage of cropland, suggests a constellation of exposures that may differ across urban-rural residence. |
Characterizing populations of individuals using pooled samples
Caudill SP . J Expo Sci Environ Epidemiol 2010 20 (1) 29-37 Biomonitoring involves the assessment of human or animal populations by measuring organic or biological compounds or their metabolites in the body fluids or tissues of individuals in those populations. Pooling samples before making analytical measurements can reduce the costs of biomonitoring by reducing the number of analyses. By proper choice of pooled-sample design, population means can be estimated without measuring individual samples. I present a statistical method for characterizing an entire population distribution of such compounds by exploiting the theoretic relationship between interindividual-sample variance and the variation between pooled samples. I use simulation experiments to determine an optimum pooled-sample design as a function of the number of subpopulations and the number of available samples. Using pooled samples to characterize populations is not only more cost-efficient, but also in some cases it can lead to more precise and less biased parameter estimation than that occurs with individual samples. |
Research using emergency department-related data sets: current status and future directions
Hirshon JM , Warner M , Irvin CB , Niska RW , Andersen DA , Smith GS , McCaig LF . Acad Emerg Med 2009 16 (11) 1103-9 The 2009 Academic Emergency Medicine consensus conference focused on "Public Health in the ED: Surveillance, Screening and Intervention." One conference breakout session discussed the significant research value of health-related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)-related data sets and includes examples of the use of a data set based on ED visits for research purposes. It discusses types of ED-related data sets available, highlights barriers to research use of ED-related data sets, and notes limitations of these data sets. The paper highlights future directions and challenges to using these important sources of data for research, including identification of five main needs related to enhancing the use of ED-related data sets. These are 1) electronic linkage of initial and follow-up ED visits and linkage of information about ED visits to other outcomes, including costs of care, while maintaining de-identification of the data; 2) timely data access with minimal barriers; 3) complete data collection for clinically relevant and/or historical data elements, such as the external cause-of-injury code; 4) easy access to data that can be parsed into smaller jurisdictions (such as states) for policy and/or research purposes, while maintaining confidentiality; and 5) linkages between health survey data and health claims data. ED-related data sets contain much data collected directly from health care facilities, individual patient records, and multiple other sources that have significant potential impact for studying and improving the health of individuals and the population. |
Evolution of the Global Tobacco Surveillance System (GTSS) 1998-2008
Warren CW , Lee J , Lea V , Goding A , O'Hara B , Carlberg M , Asma S , McKenna M . Glob Health Promot 2009 16 4-37 Tobacco use is one of the leading preventable causes of morbidity and mortality worldwide. Given that country-specific international data on tobacco use were limited or nonexistent, in 1998, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association (CPHA) initiated the Global Tobacco Surveillance System (GTSS) to assist countries in establishing tobacco control surveillance and monitoring programs. GTSS includes collection of data through three school-based surveys: the Global Youth Tobacco Survey (GYTS) for youth; the Global School Personnel Survey (GSPS), and the Global Health Professions Student Survey (GHPSS) for adults; and one household survey: the Global Adult Tobacco Survey (GATS) for adults. The GTSS provides a globally implemented and consistent framework for conducting surveillance including standard sampling procedures, core questionnaire items, training in field procedures and analysis of data consistent across all GTSS countries. The GTSS also enhances the role of the nongovernmental sector by supporting participation of civil society agencies in surveillance, monitoring, and policy and program development. The synergy between countries passing tobacco control laws, regulations or decrees, ratifying and complying with the WHO Framework Convention on Tobacco Control, and conducting GTSS surveys offers a unique opportunity to develop, implement, and evaluate comprehensive tobacco control policy that can be helpful to each country document the development, growth, and collaboration in sustaining the GTSS. The report highlights countries' involvement in tobacco control measures and the establishment of comprehensive tobacco control programs worldwide. This report can assist countries in prioritizing and developing tobacco control programs, including surveillance, evaluation, and policy development. |
The Global Tobacco Surveillance System (GTSS) for continuous tobacco control surveillance and monitoring. Foreword
Warren CW . Glob Health Promot 2009 16 3 The World Health Organization (WHO), the USCenters for Disease Control and Prevention, and theCanadian Public Health association developed theGlobal Tobacco Surveillance System (GTSS) toassist WHO member states in establishing continu-ous tobacco control surveillance and monitoring.The GTSS provides a flexible system that includescommon data items but allows countries to includeimportant and unique information at their discre-tion. It also uses a common survey methodology,similar field procedures for data collection, andsimilar data management and processing tech-niques. The GTSS includes collection of datathrough four surveys: three school-based and onehousehold survey. The three school-based surveysinclude the Global Youth Tobacco Survey (GYTS)for youth, the Global School Personnel Survey(GSPS), and the Global Health Professions StudentSurvey (GHPSS) for adults. The household survey,added to the surveillance system in 2006 is theGlobal Adult Tobacco Survey (GATS). |
Phylogeographic reconstruction of a bacterial species with high levels of lateral gene transfer
Pearson T , Giffard P , Beckstrom-Sternberg S , Auerbach R , Hornstra H , Tuanyok A , Price EP , Glass MB , Leadem B , Beckstrom-Sternberg JS , Allan GJ , Foster JT , Wagner DM , Okinaka RT , Sim SH , Pearson O , Wu Z , Chang J , Kaul R , Hoffmaster AR , Brettin TS , Robison RA , Mayo M , Gee JE , Tan P , Currie BJ , Keim P . BMC Biol 2009 7 78 BACKGROUND: Phylogeographic reconstruction of some bacterial populations is hindered by low diversity coupled with high levels of lateral gene transfer. A comparison of recombination levels and diversity at seven housekeeping genes for eleven bacterial species, most of which are commonly cited as having high levels of lateral gene transfer shows that the relative contributions of homologous recombination versus mutation for Burkholderia pseudomallei is over two times higher than for Streptococcus pneumoniae and is thus the highest value yet reported in bacteria. Despite the potential for homologous recombination to increase diversity, B. pseudomallei exhibits a relative lack of diversity at these loci. In these situations, whole genome genotyping of orthologous shared single nucleotide polymorphism loci, discovered using next generation sequencing technologies, can provide very large data sets capable of estimating core phylogenetic relationships. We compared and searched 43 whole genome sequences of B. pseudomallei and its closest relatives for single nucleotide polymorphisms in orthologous shared regions to use in phylogenetic reconstruction. RESULTS: Bayesian phylogenetic analyses of >14,000 single nucleotide polymorphisms yielded completely resolved trees for these 43 strains with high levels of statistical support. These results enable a better understanding of a separate analysis of population differentiation among >1,700 B. pseudomallei isolates as defined by sequence data from seven housekeeping genes. We analyzed this larger data set for population structure and allele sharing that can be attributed to lateral gene transfer. Our results suggest that despite an almost panmictic population, we can detect two distinct populations of B. pseudomallei that conform to biogeographic patterns found in many plant and animal species. That is, separation along Wallace's Line, a biogeographic boundary between Southeast Asia and Australia. CONCLUSION: We describe an Australian origin for B. pseudomallei, characterized by a single introduction event into Southeast Asia during a recent glacial period, and variable levels of lateral gene transfer within populations. These patterns provide insights into mechanisms of genetic diversification in B. pseudomallei and its closest relatives, and provide a framework for integrating the traditionally separate fields of population genetics and phylogenetics for other bacterial species with high levels of lateral gene transfer. |
Development of a barbershop-based cancer communication intervention
Holt CL , Wynn TA , Lewis I , Litaker MS , Jeames S , Huckaby F , Stroud L , Southward PL , Simons V , Lee C , Ross L , Mitchell T . Health Educ 2009 109 (3) 213-225 PURPOSE: Prostate and colorectal cancer (CRC) rates are disproportionately high among African-American men. The purpose of this paper is to describe the development of an intervention in which barbers were trained to educate clients about early detection for prostate and CRC. DESIGN/METHODOLOGY/APPROACH: Working with an advisory panel of local barbers, cancer survivors and clients, educational materials are developed and pilot tested through use of focus groups and cognitive response interviews. FINDINGS:The advisory panel, focus groups, and interviews provide key recommendations for core content, intervention structure, and evaluation strategies. The men suggest a variety of things they want to know about prostate cancer, however the perceived need for CRC information is much broader, suggesting a knowledge gap. The men prefer print materials that are brief, use graphics of real African-American men, and provide a telephone number they can call for additional information. RESEARCH LIMITATIONS/IMPLICATIONS: Community involvement is key in developing a well-accepted and culturally-relevant intervention. ORIGINALITY/VALUE: The paper usefully describes the process of developing and pilot testing educational materials for use in an intervention in which barbers would be trained as community health advisors, to educate their clients about CRC screening and informed decision making for prostate cancer screening. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract). |
Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes
Dubberke ER , Butler AM , Yokoe DS , Mayer J , Hota B , Mangino JE , Khan YM , Popovich KJ , Stevenson KB , McDonald LC , Olsen MA , Fraser VJ . Infect Control Hosp Epidemiol 2010 31 (3) 262-8 OBJECTIVE: To compare incidence of hospital-onset Clostridium difficile infection (CDI) measured by the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis codes with rates measured by the use of electronically available C. difficile toxin assay results. METHODS: Cases of hospital-onset CDI were identified at 5 US hospitals during the period from July 2000 through June 2006 with the use of 2 surveillance definitions: positive toxin assay results (gold standard) and secondary ICD-9-CM discharge diagnosis codes for CDI. The chi(2) test was used to compare incidence, linear regression models were used to analyze trends, and the test of equality was used to compare slopes. RESULTS: Of 8,670 cases of hospital-onset CDI, 38% were identified by the use of both toxin assay results and the ICD-9-CM code, 16% by the use of toxin assay results alone, and 45% by the use of the ICD-9-CM code alone. Nearly half (47%) of cases of CDI identified by the use of a secondary diagnosis code alone were community-onset CDI according to the results of the toxin assay. The rate of hospital-onset CDI found by use of ICD-9-CM codes was significantly higher than the rate found by use of toxin assay results overall ([Formula: see text]), as well as individually at 3 of the 5 hospitals ([Formula: see text] for all). The agreement between toxin assay results and the presence of a secondary ICD-9-CM diagnosis code for CDI was moderate, with an overall kappa value of 0.509 and hospital-specific kappa values of 0.489-0.570. Overall, the annual increase in CDI incidence was significantly greater for rates determined by the use of ICD-9-CM codes than for rates determined by the use of toxin assay results ([Formula: see text]). CONCLUSIONS: Although the ICD-9-CM code for CDI seems to be adequate for measuring the overall CDI burden, use of the ICD-9-CM discharge diagnosis code for CDI, without present-on-admission code assignment, is not an acceptable surrogate for surveillance for hospital-onset CDI. |
Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: demand, supply and seasonality
Lorick SA , Fishbein D , Weintraub E , Wortley PM , Lee GM , Zhou F , Davis R . BMC Infect Dis 2009 9 175 BACKGROUND: In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4) for routine use among 11- to 12-year-olds (at the preadolescent health-care visit), 14- to 15-year-olds (before high-school entry), and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds) and non-target (13- plus 16-year-olds) age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4) and tetanus diphtheria (Td) vaccines. METHODS: We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD). For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. RESULTS: Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. CONCLUSION: A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005. |
A comparison of high school sports injury surveillance data reporting by certified athletic trainers and coaches
Yard EE , Collins CL , Comstock RD . J Athl Train 2009 44 (6) 645-52 CONTEXT: High school athletes sustain more than 1.4 million injuries annually. National high school sports injury surveillance forms the foundation for developing and evaluating preventive interventions to reduce injury rates. For national surveillance, individuals must report consistently and accurately with little one-on-one interaction with study staff. OBJECTIVE: To examine the feasibility of relying on high school coaches as data reporters in a national, Internet-based sports injury surveillance study, using the same methods that have already proven successful in the National High School Sports-Related Injury Surveillance Study, which calls on certified athletic trainers (ATs) as reporters. DESIGN: Prospective injury surveillance study. SETTING: Eighteen United States high schools PARTICIPANTS: Athletic trainers and varsity coaches for football, boys' and girls' soccer, and boys' and girls' basketball. MAIN OUTCOME MEASURE(S): Quantity and quality of exposure and injury reports. RESULTS: All enrolled ATs participated, compared with only 43.0% of enrolled coaches. Participating ATs submitted 96.7% of expected exposure reports, whereas participating coaches submitted only 36.5%. All ATs reported athlete exposures correctly, compared with only 2 in 3 coaches. Participating ATs submitted 338 injury reports; participating coaches submitted only 55 (16.3% of the 338 submitted by ATs). Injury patterns differed between AT-submitted and coach-submitted injury reports, with ATs reporting a higher proportion of ankle injuries and coaches reporting a higher proportion of knee injuries. The reports submitted by ATs and coaches for the same injury had low agreement for diagnosis and time loss, with only 63.2% and 55.3% of pairs, respectively, providing the same response. The ATs lacked more responses for demographic questions, whereas coaches lacked more responses regarding the need for surgery. CONCLUSIONS: Whenever possible, ATs should be the primary data reporters in large, national studies. In high schools without access to an AT, researchers must be willing to devote significant time and resources to achieving high participation and compliance from other reporters. |
Measurement of ethyl methanesulfonate in human plasma and breast milk samples using high-performance liquid chromatography-atmospheric pressure chemical ionization-tandem mass spectrometry
Montesano MA , Whitehead RD Jr , Jayatilaka NK , Kuklenyik P , Davis MD , Needham LL , Barr DB . J Pharm Biomed Anal 2010 52 (2) 260-4 Ethyl methanesulfonate (EMS) is a mesylate ester, which is known to be a potent mutagen, teratogen, and possibly carcinogen. Mesylate esters have been found in pharmaceuticals as contaminants formed during the manufacturing process and may potentially pose an exposure hazard to humans. We have developed and validated a method for detection of trace amounts (ng/ml levels) of EMS in human plasma and breast milk. The samples were extracted by matrix solid-phase dispersion with ethyl acetate using Hydromatrix and the ASE 200 Accelerated Solvent Extractor. The extracts were separated by high-performance liquid chromatography (HPLC) using a HILIC column. The detection was performed with a triple quadrupole mass spectrometer (TSQ Quantum Ultra, Thermo Electron Corporation) using atmospheric pressure chemical ionization in negative-ion mode and multiple reaction monitoring. The use of a surrogate internal standard in combination with HPLC-MS/MS provided a high degree of accuracy and precision. The extraction efficiency was greater than 70%. Repeated analyses of plasma and breast milk samples spiked with high (100ng/ml), medium (50ng/ml) and low (5ng/ml) concentrations of the analytes gave relative standard deviations of less than 12%. The limits of detection were in the range of 0.5-0.9ng/ml for both matrices. |
Microbiologic and clinical features of Salmonella species isolated from bacteremic children in Eastern Democratic Republic of Congo
Vandenberg O , Nyarukweba DZ , Ndeba PM , Hendriksen RS , Barzilay EJ , Schirvel C , Bisimwa BB , Collard JM , Aidara Kane A , Aarestrup FM . Pediatr Infect Dis J 2010 29 (6) 504-10 BACKGROUND: The morbidity of Salmonella bloodstream infections is unacceptably high in Africa. In 2000, the WHO Global Salmonella-Surveillance (GSS) program was founded to reduce the health burden of foodborne diseases. The incorporation, in 2002, of the Democratic Republic of Congo (DRC) in this program allowed the improvement of laboratory capacities. In this retrospective study, we describe the first signs of impact the GSS program has had in DRC in the management of bacteremia. METHODS: Between 2002 and 2006, we evaluated, in one pediatric hospital, the microbiologic and clinical features of Salmonella isolated from children suspected of having bacteremia. A random selection of isolates was typed by pulsed field gel electrophoresis (PFGE). RESULTS: Among the 1528 children included in the study, 26.8% were bacteremic. Salmonella accounted for 59% of all bloodstream infections. Salmonella typhimurium (60.5%) and Salmonella enteritidis (22.3%) were the most common Salmonella serotypes. In total, 92.4% were resistant to at least 3 antimicrobials with the following proportion of strains resistant to: ampicillin (86%), chloramphenicol (92%), trimethoprim/sulfamethoxazole (95%), and tetracycline (34%). In 2002, 32.1% of children received an appropriate empiric antimicrobial treatment. In 2006, with the restoration of the confidence in the results provided by the laboratory, we observed an increase of the proportion of patients appropriately (82.9%) treated with antimicrobials (P < 0.01) without any decrease in the overall mortality rates associated with salmonellae bacteremia. CONCLUSIONS: Our findings indicate the benefit to strengthen laboratory capacities in Africa, allowing the development of management guidelines of bloodstream infection. |
Numerical study of pleated fabric cartridges during pulse-jet cleaning
Lo LM , Hu- SC , Chen DR , Pui DYH . Powder Technol 2010 198 (1) 75-81 We established a numerical model and used computational fluid dynamics (CFD) analysis to observe transient flow behavior across pleated filter cartridges in a dust collector during pulse-jet cleaning. The numerical results were in good agreement with the filter-testing data during important periods including during pressure ramp-up and valve opening. Larger errors for predicting overpressure occurred during the pressure ramp-down period likely due to the uniformity of the filters' permeability. This confirmed that the numerical model demonstrated the cleaning efficiency and the local cleaning quality of three different filter cartridges with different filter dimensions and pleat ratios. Data calculated from the average static pressure on the filters' surfaces were more closely correlated to cleaning efficiency than overpressure. The surface static pressure distribution along all filter cartridges showed that the top area of the filter cartridge is difficult to clean because of the lower surface pressure generated by the pulse jet. Filter cartridges with higher pleat ratios were found to have greater instances of incomplete cleaning due to the large variation of static pressure distribution along the filter cartridges. Our results showed that although information such as average pressure and pressure distribution on the filter surface is difficult to obtain by physical measurement, this data is tractable using CFD analysis and is useful for filter design and system optimization. |
Influence of artificial gastric juice composition on bioaccessibility of cobalt- and tungsten-containing powders
Stefaniak AB , Abbas Virji M , Harvey CJ , Sbarra DC , Day GA , Hoover MD . Int J Hyg Environ Health 2010 213 (2) 107-15 The dissolution of metal-containing particles in the gastric compartment is poorly understood. The purpose of this study was to elucidate the influence of artificial gastric juice chemical composition on bioaccessibility of metals associated with ingestion-based health concerns. Dissolution rates were evaluated for well-characterized feedstock cobalt, tungsten metal, and tungsten carbide powders, chemically bonded pre-sintered (spray dryer material) and post-sintered (chamfer grinder) cemented tungsten carbide materials, and an admixture of pure cobalt and pure tungsten carbide, prepared by mechanically blending the two feedstock powders. Dissolution of each study material was evaluated in three different formulations of artificial gastric juice (from simplest to most chemically complex): American Society of Testing Materials (ASTM), U.S. Pharmacopoeia (USP), and National Institute for Occupational Safety and Health (NIOSH). Approximately 20% of cobalt dissolved in the first dissolution phase (t(1/2) = 0.02 days) and the remaining 80% was released in the second long-term dissolution phase (t(1/2) = 0.5 to 1 days). Artificial gastric juice chemical composition did not influence dissolution rate constant values (k, g/cm(2)day) of cobalt powder, either alone or as an admixture. Approximately 100% of the tungsten and tungsten carbide that dissolved was released in a single dissolution phase; k-values of each material differed significantly in the solvents: NIOSH > ASTM > USP (p<0.05). The k-values of cobalt and tungsten carbide in pre- and post-sintered cemented tungsten carbide powders were significantly different from values for the pure feedstock powders. Solvent composition had little influence on oral bioaccessibility of highly soluble cobalt and our data support consideration of the oral exposure route as a contributing pathway to total-body exposure. Solvent composition appeared to influence bioaccessibility of the low soluble tungsten compounds, though differences may be due to variability in the data associated with the small masses of materials that dissolved. Nonetheless, ingestion exposure may not contribute appreciably to total body burden given the short residence time of material in the stomach and relatively long dissolution half-times of these materials (t(1/2) = 60 to 380 days). |
Analysis of free-radical scavenging of Yerba Mate (Ilex paraguriensis) using electron spin resonance and radical-induced DNA damage
Leonard SS , Hogans VJ , Coppes Petricorena Z , Peer CJ , Vining TA , Fleming DW , Harris GK . J Food Sci 2010 75 (1) C14-C20 Mate (MT) is a popular South American beverage that has been used as a traditional medicine for centuries, spurring recent interest in its nutraceutical properties. MT is prepared as an infusion of leaves fromthe Yerba Mate (llex paraguriensis) tree. MT has been reported to have antioxidant properties in vitro and in vivo, but these have not been fully characterized in terms of effects against specific radicals. Accordingly, we examined the antioxidant effects of an MT infusion against hydroxyl and superoxide radicals in both chemical and cell culture assays. MT infusions were prepared at 3.10 g/L in boiling water and diluted to experimental dilutions from this stock. Electron spin resonance (ESR) experiments indicated that MT scavenged hydroxyl radicals (produced via the Fenton reaction) and superoxide radicals (produced via the xanthine/xanthine oxidase enzymatic reaction) at all concentrations tested (P <0.05). Further controls indicated that superoxide radical scavenging was not due to xanthine oxidase inhibition. MT scavenged hydroxyl radicals and decreased cellular oxygen consumption in a dose-dependent manner in Cr(VI)-stimulated RAW 264.7 cells, based on ESR and oxygraph measurements (P < 0.05). Similarly, MT also inhibited hydroxyl-radical-induced lipid peroxidation and DNA damage in a dose-dependent manner in RAW 264.7 cells, based on malondialdehyde and Comet assay data (P < 0.05). This study indicates that MT possesses potent antioxidant effects against hydroxyl and superoxide radicals in both chemical and cell culture systems, as well as DNA-protective properties. These data further clarify the reported antioxidant effects of Yerba Mate infusions. |
Particle length-dependent titanium dioxide nanomaterials' toxicity and bioactivity
Hamilton RF Jr , Wu N , Porter D , Buford M , Wolfarth M , Holian A . Part Fibre Toxicol 2009 6 (1) 35 BACKGROUND: Titanium dioxide (TiO2) nanomaterials have considerable beneficial applications varying from additives in paint, paper, plastics and cosmetics to uses in photocatalysts, solar cells and medical materials and devices. It has been established for many years that pigment-grade TiO2 (200 nm sphere) is relatively inert when internalized into a biological model system (in vivo or in vitro). For this reason, TiO2 nanomaterials are an attractive alternative in applications where biological exposures will occur. Unfortunately, metal oxides on the nanoscale (one dimension < 100 nm) may or may not exhibit the same toxic potential as the original material. A further complicating issue is the effect of modifying or engineering of the nanomaterial to be structurally and geometrically different from the original material. RESULTS: TiO2 nanospheres, short (< 5 um) and long (> 15 um) nanobelts were synthesized, characterized and tested for biological activity using primary murine alveolar macrophages and in vivo in mice. This study demonstrates that alteration of anatase TiO2 nanomaterial into a fibre structure of greater than 15 um creates a highly toxic particle and initiates an inflammatory response by alveolar macrophages. These fibre-shaped nanomaterials induced inflammasome activation and release of inflammatory cytokines through a cathepsin B-mediated mechanism. Consequently, long TiO2 nanobelts interact with lung macrophages in a manner very similar to asbestos or silica. CONCLUSIONS: These observations suggest that any modification of a nanomaterial, resulting in a wire, fibre, belt or tube, be tested for pathogenic potential. As this study demonstrates, toxicity and pathogenic potential change dramatically as the shape of the material is altered into one that a phagocytic cell has difficulty processing resulting in lysosomal dysruptiion. |
Identification of candidate genes using the murine model of female genital tract infection with Chlamydia trachomatis
Lyons JM , Igietseme JU , Black CM , Morre SA . Drugs Today (Barc) 2009 45 Suppl B 51-9 The integrated approach to the study of female genital tract infection (GTI) with Chlamydia trachomatis is a conceptual framework through which a consistent and comprehensive evidence-based understanding of C. trachomatis GTI could evolve. One application of this approach has been to identify candidate genes that may play a role in the course and severity of C. trachomatis GTI in women, using human clinical and genetic data together with results obtained in the female mouse model to guide the selection process This model has been proven robust enough: i) to identify stable phenotypic differences in the course and outcome of GTI among commonly used immunocompetent inbred mouse stains that are used in the construction of gene knockout (KO) and transgenic mice; as well as ii) to serve as a platform in which to assess the influence of genetic differences among human genital tract isolates of C. trachomatis as well as between this biovar and the mouse biovar, Chlamydia muridarum. This review presents a summary of published and unpublished results from 25 years of studies in immunodeficient and gene-deficient KO mice that both inform our present understanding of the immunogenetics of C. trachomatis GTI and serve to guide candidate gene selection. |
Hospitalizations for Kawasaki syndrome among children in the United States, 1997-2007
Holman RC , Belay ED , Christensen KY , Folkema AM , Steiner CA , Schonberger LB . Pediatr Infect Dis J 2010 29 (6) 483-8 BACKGROUND: The present study describes the rate and trends of childhood hospitalizations with Kawasaki syndrome (KS) in the United States. METHODS: Retrospective analysis of hospitalizations with KS among children <18 years of age in the United States using the Kids' Inpatient Database (1997, 2000, 2003, and 2006) and the Nationwide Inpatient Sample (1998-2007). RESULTS: The KS-associated hospitalization rate for children <5 years of age was 20.8 (95% CI: 18.5-23.1) per 100,000 children in 2006. Annual rates remained constant during the study period, except for a peak in 2005. In 2006, 76.8% (SE = 0.9%) of an estimated 5523 (SE = 289) KS-associated hospitalizations among children <18 years of age were <5 years of age. The mean age for all children at hospitalization was 1.6 years (SE <0.1); 25.7 months (SE = 0.3) for children <5 years of age, and 24.8 months (SE = 0.4) and 27.1 months (SE = 0.5) for boys and girls, respectively. The rate for boys was higher than that for girls (24.2 [95% CI: 21.3-27.1] and 16.8 [95% CI: 14.7-18.9], respectively). The rate for Asian/Pacific Islander children (30.3 [95% CI: 20.2-40.4]) was the highest among the racial groups. CONCLUSIONS: The national KS-associated annual hospitalization rate for children <5 years of age from 1997 to 2007 was relatively stable and was similar to previously published rates, except for an increase in 2005. Most hospitalizations were in children <3 years of age with few hospitalizations during the first 2 months of age. Children of Asian/Pacific Islander descent had the highest hospitalization rate. |
Surveillance of occupational health disparities: challenges and opportunities
Souza K , Steege AL , Baron SL . Am J Ind Med 2010 53 (2) 84-94 Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA). |
Introduction to a special issue: occupational health disparities
Baron S , Cone J , Markowitz SB , Souza K . Am J Ind Med 2010 53 (2) 82-3 Research into disparities in occupational health by socialand economic factors has a long history [Ramazzini, 1913;Hamilton, 1943]. Driven in part by changes in the workforceand economy, recent years have seen a renewed attention todisparities in work-related health outcomes and the experi-ence of worker groups who are at increased risk in theworkplace [Murray, 2003; Lipscomb et al., 2006].In 1996, the National Institute for Occupational Safetyand Health (NIOSH) established the National OccupationalResearch Agenda (NORA) to stimulate innovative researchand improve workplace practices. The NORA agendaincluded an explicit emphasis on worker populations thathave been overlooked and underserved by past effortsincluding immigrant workers, low-wage, contingent andtemporary workers, racial and ethnic minority workers,workers with disabilities, and younger and older workers.Later, through a joint effort with the National Institute ofEnvironmental Health Sciences (NIEHS) to develop andrelease a request for proposals involving environmentalandoccupationaljustice, NIOSH provided unprecedented sup-port to community-based coalitions of community andacademic groups addressing the needs of underserved workergroups. This funding further spurred the development ofresearch and intervention activities aimed at understandingand eliminating occupational health disparities [Birnbaumet al., 2009] |
Analytical methodology and assessment of potential second-hand exposure to fentanyl in the hospital surgical setting
Law BF , Hettick JM , Hornsby Myers J , Siegel PD . J Addict Dis 2010 29 (1) 51-58 Second-hand exposure to aerosols containing fentanyl and other opiates during surgical procedures has been implicated as possibly contributing to maintenance of addiction among medical professionals, specifically anesthesiologists. This article outlines a pilot study that was conducted to verify a reported finding fentanyl in the air of operating suites. Environmental fentanyl air sampling and analysis methods were developed and evaluated for this study. Multiple sampling media and extraction solvents were evaluated for trace fentanyl air sampling. Non-specific binding losses were reduced by using silanized binder-free glass fiber sampling media with subsequent methanol extraction. Filtration air samples were then collected in surgical suites during the entire operation time from two cardiovascular surgical procedures. Both surgical procedures were conducted at the same hospital but on different days. Samples were extracted and analyzed by high-performance liquid chromatography/tandem mass spectrometry using a capillary high-performance liquid chromatography coupled to a quadrupole time-of-flight mass spectrometer. The total air volume collected per surgery was 290 to 300 L at a rate of 1 LPM giving an limit of quantification for fentanyl of 57 pg/m3 air (17 pg/filter). No fentanyl was detected in the air during cardiovascular surgical operations from either surgical suite. |
Bloodborne pathogen risk reduction activities in the body piercing and tattooing industry
Lehman EJ , Huy J , Levy E , Viet SM , Mobley A , McCleery TZ . Am J Infect Control 2009 38 (2) 130-8 BACKGROUND: This study examines how well regulations for bloodborne pathogens (BBPs), established primarily to reduce exposure risk for health care workers, are being followed by workers and employers in the tattooing and body piercing industry. METHOD: Twelve shops performing tattooing and/or body piercing (body art) in Pennsylvania and Texas were assessed for compliance with 5 administrative and 10 infection control standards for reducing exposure to BBPs. RESULTS: All shops demonstrated compliance with infection control standards, but not with administrative standards, such as maintaining an exposure control plan, offering hepatitis B vaccine, and training staff. Shops staffed with members of professional body art organizations demonstrated higher compliance with the administrative standards. Shops in locations where the body art industry was regulated and shops in nonregulated locations demonstrated similar compliance, as did contractor- and employee-staffed shops. CONCLUSIONS: Regulations to control occupational exposure to BBPs have been in place since 1991. This study corroborates noncompliance with some standards within the body art industry reported by previous studies. Without notable enforcement, regulation at national, state, or local levels does not affect compliance. In this study, the factor most closely associated with compliance with administrative regulations was the artist's membership in a professional body art association. |
The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms
Elder RW , Lawrence B , Ferguson A , Naimi TS , Brewer RD , Chattopadhyay SK , Toomey TL , Fielding JE . Am J Prev Med 2010 38 (2) 217-229 A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups. |
Public health in the emergency department: surveillance, screening, and intervention--funding and sustainability
Woolard R , Degutis LC , Mello M , Rothman R , Cherpitel CJ , Post LA , Hirshon JM , Haukoos JS , Hungerford DW . Acad Emerg Med 2009 16 (11) 1138-42 This article summarizes the work and discussions of the funding and sustainability work group at the 2009 Academic Emergency Medicine consensus conference "Public Health in the ED: Surveillance, Screening, and Intervention." The funding and sustainability session participants were asked to address the following overarching question: "What are the opportunities and what is needed to encourage academic emergency medicine (EM) to take advantage of the opportunities for funding available for public health research initiatives and build stronger academic programs focusing on public health within EM?" Prior to the session, members of the group reviewed research funding for EM in public health, as well as the priorities of federal agencies and foundations. Recommendations for actions by EM summarize the findings of workshop. |
Emergency medicine public health research funded by federal agencies: progress and priorities
D'Onofrio G , Goldstein AB , Denisco RA , Hingson R , Heffelfinger JD , Post LA . Acad Emerg Med 2009 16 (11) 1065-71 The emergency department (ED) visit provides an opportunity to impact the health of the public throughout the entire spectrum of care, from prevention to treatment. As the federal government has a vested interest in funding research and providing programmatic opportunities that promote the health of the public, emergency medicine (EM) is prime to develop a research agenda to advance the field. EM researchers need to be aware of federal funding opportunities, which entails an understanding of the organizational structure of the federal agencies that fund medical research, and the rules and regulations governing applications for grants. Additionally, there are numerous funding streams outside of the National Institutes of Health (NIH; the primary federal health research agency). EM researchers should seek funding from agencies according to each agency's mission and aims. Finally, while funds from the Department of Health and Human Services (HHS) are an important source of support for EM research, we need to look beyond traditional sources and appeal to other agencies with a vested interest in promoting public health in EDs. EM requires a broad skill set from a multitude of medical disciplines, and conducting research in the field will require looking for funding opportunities in a variety of traditional and not so traditional places within and without the federal government. The following is the discussion of a moderated session at the 2009 Academic Emergency Medicine consensus conference that included panel discussants from the National Institutes of Mental Health, Drug Abuse, and Alcoholism and Alcohol Abuse and the Centers for Disease Control and Prevention (CDC). Further information is also provided to discuss those agencies and centers not represented. |
You, too, can have a great career in the U.S. Public Health Service
Shepherd CA . J Environ Health 2010 72 (6) 59-61 Many attendees at NEHA’s Annual Educational Conference (AEC) & Exhibition might wonder about the uniformed offi cers who also attend the conference. A few | of these people in uniform are U.S. Navy and | U.S. Army offi cers, but most are U.S. Public | Health Service (USPHS) Commissioned Corps | offi cers. Most of those USPHS offi cers are environmental health offi cers (EHOs). | As a recently retired USPHS EHO, I would | like to share some details about my more than | 30 years in the U.S. Public Health Service and | about how you can become a USPHS EHO. |
Prevalence and correlates of depressive symptoms among United States adults with disabilities using assistive technology
Okoro CA , Strine TW , Balluz LS , Crews JE , Mokdad AH . Prev Med 2010 50 (4) 204-9 OMB DISCLAIMER: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. ABSTRACT OBJECTIVES: To estimate the prevalence of current depressive symptoms (CDS) among adults that reported disabilities requiring the use of assistive technology (AT) and those that did not, and to examine the sociodemographic, comorbidity, health behavior, and social support correlates of this condition in adults who use AT. METHODS: Data from the 2006 Behavioral Risk Factor Surveillance System, a standardized telephone survey among U.S. adults, were analyzed (n=195,033). The Patient Health Questionnaire diagnostic algorithm was used to identify CDS. RESULTS: AT users were significantly more likely than AT non-users to have CDS (age-standardized: 30.4% vs. 7.4%). Among AT users, there was a dose-response relationship between depression severity and increased prevalence of health conditions, obesity, smoking, and physical inactivity. In the full covariate logistic regression model, the strongest sociodemographic variables associated with CDS among AT users were age and employment status. Other variables strongly associated with CDS were lack of social support and anxiety. CONCLUSIONS: An integrated approach to health care should be taken with adults who use AT. AT service providers, primary health care providers, and other care givers should be alert to the possibility of depression in AT users; and opportunities to prevent, detect, and treat depression among this population should not be missed. |
The intensity of binge alcohol consumption among U.S. adults
Naimi TS , Nelson DE , Brewer RD . Am J Prev Med 2010 38 (2) 201-207 BACKGROUND: Binge drinking (consuming five or more drinks during a drinking occasion) is responsible for more than half of the 79,000 annual deaths due to excessive drinking in the U.S. Although studies show a strong dose-response relationship between the intensity of binge drinking (i.e., the number of drinks consumed per binge episode) and adverse outcomes, there are no population-based studies assessing this measure. PURPOSE: This study aims to analyze population-based data from a module of questions on binge drinking among U.S. adults to assess the number of drinks consumed by binge drinkers and the associated independent risk factors for consuming more drinks. METHODS: Data were analyzed from 14,143 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge drinking module in 2003 and 2004. Total drinks were calculated by summing the total number of beer, wine, and liquor-containing drinks consumed during a respondents' most recent binge drinking episode. RESULTS: Binge drinkers consumed an average of 8.0 drinks (median 6) during their most recent binge drinking episode; 70.0% of binge drinkers consumed six or more drinks, and 38.4% consumed eight or more drinks. Men consumed more drinks during their last binge episode than women (M=8.3 vs 7.0, median=7 vs 6), and those aged 18-34 years consumed more drinks than those aged >34 years for both men and women. Independent risk factors for consuming eight or more drinks included being male; being aged <35 years; being other than white race/ethnicity; having less education; not being married; binge drinking three or more times in the past 30 days; and drinking mostly beer. CONCLUSIONS: Most adult binge drinkers drink in excess of the five-drink threshold defining this risky behavior. The intensity of binge drinking should be monitored regularly by health agencies to improve surveillance and to better assess the impact of interventions designed to reduce binge drinking and its consequences. |
Change in tobacco use among 13-15 year olds between 1999 and 2008: findings from the Global Youth Tobacco Survey
Warren CW , Lea V , Lee J , Jones NR , Asma S , McKenna M . Glob Health Promot 2009 16 38-90 Tobacco use is the leading preventable cause of death and disease in the world; yet little is known about the levels or patterns of youth tobacco use on a global basis. The purpose of this paper is to focus on change in youth tobacco use using data from 100 sites that have conducted repeat Global Youth Tobacco Surveys (GYTS). The GYTS is a school-based survey that collects data from students aged 13-15 years using a standardized methodology for constructing the sample frame, selecting schools and classes, and processing data. GYTS is conducted in school classes using self-administered anonymous data collection. The GYTS sample produces representative, independent, cross-sectional estimates for each sampling frame. Of the 100 sites surveyed, 61 reported no change over time in prevalence of cigarette smoking, likewise in 50 of the 97 sites with data on use of other tobacco products there was no change. However, 34 sites reported an increase in other tobacco use. This appears to be attributed to waterpipe, an emerging trend in tobacco use. Evidence was found supporting the idea that tobacco use among adolescent girls is likely increasing. The global tobacco control effort continues to face many challenges in reversing the tobacco epidemic. Few countries have implemented comprehensive tobacco control legislation laid out by the World Health Organization. The few countries that have adopted some of these proven policies can serve as examples in achieving positive results in curbing the tobacco epidemic. |
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