Knowledge integration in cancer: current landscape and future prospects.
Ioannidis JP , Schully SD , Lam TK , Khoury MJ . Cancer Epidemiol Biomarkers Prev 2013 22 (1) 3-10 Knowledge integration includes knowledge management, synthesis, and translation processes. It aims to maximize the use of collected scientific information and accelerate translation of discoveries into individual and population health benefits. Accumulated evidence in cancer epidemiology constitutes a large share of the 2.7 million articles on cancer in PubMed. We examine the landscape of knowledge integration in cancer epidemiology. Past approaches have mostly used retrospective efforts of knowledge management and traditional systematic reviews and meta-analyses. Systematic searches identify 2,332 meta-analyses, about half of which are on genetics and epigenetics. Meta-analyses represent 1:89-1:1162 of published articles in various cancer subfields. Recently, there are more collaborative meta-analyses with individual-level data, including those with prospective collection of measurements [e.g., genotypes in genome-wide association studies (GWAS)]; this may help increase the reliability of inferences in the field. However, most meta-analyses are still done retrospectively with published information. There is also a flurry of candidate gene meta-analyses with spuriously prevalent "positive" results. Prospective design of large research agendas, registration of datasets, and public availability of data and analyses may improve our ability to identify knowledge gaps, maximize and accelerate translational progress or-at a minimum-recognize dead ends in a more timely fashion. (Cancer Epidemiol Biomarkers Prev; 22(1); 3-10. (c)2012 AACR.) |
Prevalence and risk factors for metabolic syndrome in Medellin and surrounding municipalities, Colombia, 2008-2010
Davila EP , Quintero MA , Orrego ML , Ford ES , Walke H , Arenas MM , Pratt M . Prev Med 2013 56 (1) 30-4 OBJECTIVE: We assessed the prevalence of and risk factors for metabolic syndrome (MetS) among adults 25-64years of age from Medellin and surrounding municipalities, Colombia. METHOD: We used 2008-2010 data from the Antioquia STEPwise approach to Surveillance (STEPS), a multi-stage complex cross-sectional survey designed according to World Health Organization guidelines. The revised 2005 International Diabetes Federation definition of MetS was used. RESULTS: There were a total of 3000 participants. Of these, 21.4% had high blood pressure (HBP) and 64% had abdominal obesity (AO). In the subsample with serum data (n=943), 19.8% had high fasting serum glucose, 43.9% had high triglycerides (HTG), and 56.6% had low HDL cholesterol (L-HDL). Among those with data to define MetS (n=901), 41% had MetS. Older age was associated with MetS and all components except L-HDL. Female sex [odds ratio (OR)=2.85, 95% confidence interval (CI): 2.20-3.70], being married (OR=1.40, CI: 1.09-1.82), and high physical activity (OR=0.59, CI: 0.39-0.91) were associated with AO, smoking with HTG (OR=1.76, CI: 1.16-2.67) and L-HDL (OR=1.67, CI: 1.10-2.51) and rural residence with HBP (OR=3.42, CI: 1.83-6.37) and L-HDL (OR=1.18, CI: 1.10-2.51). CONCLUSION: The prevalence of MetS and AO was high in this Colombian region. Targeted strategies for promoting healthy behaviors are needed. |
HIV status determination among tuberculosis patients from California during 2008
Kong DG , Watt JP , Marks S , Flood J . J Public Health Manag Pract 2013 19 (2) 169-77 CONTEXT: Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV. OBJECTIVE: We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence. DESIGN: We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. SETTING: California TB programs. PARTICIPANTS: All TB patients reported from California in 2008. MAIN OUTCOME MEASURES: Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types. RESULTS: Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider. CONCLUSIONS: The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination. |
Incidence and determinants of tuberculosis among adults initiating antiretroviral therapy - Mozambique, 2004-2008
Auld AF , Mbofana F , Shiraishi RW , Alfredo C , Sanchez M , Ellerbrock TV , Nelson LJ . PLoS One 2013 8 (1) e54665 BACKGROUND: In Mozambique, tuberculosis (TB) is thought to be the most common cause of death among antiretroviral therapy (ART) enrollees. Monitoring proportions of enrollees screened for TB, and incidence and determinants of TB during ART can help clinicians and program managers identify program improvement opportunities. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective cohort study among a nationally representative sample of the 79,500 adults (>14 years old) initiating ART during 2004-2007 to estimate clinician compliance with TB screening guidelines, factors associated with active TB at ART initiation, and incidence and predictors of documented TB during ART follow-up. Of 94 sites enrolling >50 adults on ART, 30 were selected using probability-proportional-to-size sampling; 2,596 medical records at these sites were randomly selected for abstraction and analysis. At ART initiation, median age of patients was 34, 62% were female, median baseline CD4(+) T-cell count was 153/microL, and 11% were taking TB treatment. Proportions of records with TB screening documentation before ART initiation improved from 31% to 66% during 2004-2007 (p<0.001). TB screening compliance varied widely by ART clinic [n = 30, 2%-98% (p<0.001)] and supporting non-Governmental Organization (NGO) [n = 7, 27%-83% (p<0.001)]. Receiving TB treatment at ART enrollment was associated with male sex (p<0.001), weight <45 kg (p<0.001) and CD4<50/microL (p = 0.001). Isoniazid preventive therapy (IPT) was prescribed to <1% of ART enrollees not taking TB treatment. TB incidence during ART was 2.32 cases per 100 person-years. Factors associated with TB incidence included adherence to ART <95% (AHR 2.06; 95% CI, 1.32-3.21). CONCLUSION: Variations in TB screening by clinic and NGO may reflect differing investments in TB screening activities. Future scale-up should target under-performing clinics. Scale-up of TB screening at ART initiation, IPT, and ART adherence interventions could significantly reduce incident TB during ART. |
Indications for worldwide increased norovirus activity associated with emergence of a new variant of genotype II.4, late 2012
van Beek J , Ambert-Balay K , Botteldoorn N , Eden J , Fonager J , Hewitt J , Iritani N , Kroneman A , Vennema H , Vinje J , White P , Koopmans M . Euro Surveill 2013 18 (1) 8-9 Globally, surveillance systems showed an increasein norovirus activity in late 2012. Molecular datashared through the NoroNet network suggest thatthis increase is related to the emergence of a newnorovirus genotype II.4 variant, termed Sydney 2012.Healthcare institutions are advised to be prepared fora severe norovirus season. |
Cephalosporin-resistant gonorrhea in North America
Kirkcaldy RD , Bolan GA , Wasserheit JN . JAMA 2013 309 (2) 185-7 Gonorrhea has affected humans for centuries and remains common. Worldwide, an estimated 106.1 million cases occur annually.1 In 2011, gonorrhea again was the second most commonly reported notifiable infection in the United States with 321 849 cases reported.2 Because gonorrhea often can be asymptomatic, the true disease burden may be closer to 700 000.3 Gonorrhea disproportionately affects racial, ethnic, and sexual minorities. Untreated gonococcal infection can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women and can facilitate transmission of human immunodeficiency virus.4 Childhood blindness still affects infants born to mothers infected with gonorrhea, particularly in resource-limited countries. | For years, gonorrhea has been easily treated with a single oral dose of antibiotics. However, Neisseria gonorrhoeae has progressively acquired resistance to each new agent: sulfonamides in the 1940s, penicillins and tetracyclines in the 1970s and 1980s, and fluoroquinolones by 2007 in the United States. Since then, cephalosporins have been the only antibiotics recommended for gonorrhea treatment.5 However, gonococcal susceptibility to oral cephalosporins is declining, and the effectiveness of these drugs is threatened. | Increasing cephalosporin minimum inhibitory concentrations (MICs), an early warning of impending resistance, and treatment failures with cephalosporins have been reported from east Asia since the early 2000s and recently have been reported from Europe.6,7 In the United States, the Gonococcal Isolate Surveillance Project (GISP), a national surveillance system that monitors trends in antibiotic susceptibility, has documented increasing cefixime MICs since 2009.8 The steepest cefixime MIC increases have been reported in the western United States and among individuals who have had male-to-male sexual contact, the region and population in which fluoroquinolone resistance initially emerged. However, data are lacking on the cefixime MICs at which clinical effectiveness wanes. |
Influenza viruses in Nigeria, 2009-2010: results from the first 17 months of a national influenza sentinel surveillance system
Dalhatu IT , Medina-Marino A , Olsen SJ , Hwang I , Gubio AB , Ekanem EE , Coker EB , Akpan H , Adedeji AA . J Infect Dis 2012 206 Suppl 1 S121-8 BACKGROUND: Influenza surveillance data from tropical, sub-Saharan African countries are limited. To better understand the epidemiology of influenza, Nigeria initiated influenza surveillance in 2008. METHODS: Outpatients with influenza-like illness (ILI) and inpatients with severe acute respiratory illness (SARI) were enrolled at 4 sentinel facilities. Epidemiologic data were obtained, and respiratory specimens were tested for influenza viruses, using real-time reverse-transcription polymerase chain reaction assays. RESULTS: During April 2009-August 2010, 2841 patients were enrolled. Of 2803 specimens tested, 217 (7.7%) were positive for influenza viruses (167 [8%] were from subjects with ILI, 17 [5%] were from subjects with SARI, and 33 were from subjects with an unclassified condition). During the prepandemic period, subtype H3N2 (A[H3N2]) was the dominant circulating influenza A virus subtype; 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09) replaced A(H3N2) as the dominant circulating virus during November 2009. Among persons with ILI, A(H1N1)pdm09 was most frequently found in children aged 5-17 years, whereas among subjects with SARI, it was most frequently found in persons aged ≥ 65 years. The percentage of specimens that tested positive for influenza viruses peaked at 18.9% in February 2010, and the majority were A(H1N1)pdm09. CONCLUSIONS: Influenza viruses cause ILI and SARI in Nigeria. Data from additional years are needed to better understand the epidemiology and seasonality of influenza viruses in Nigeria. |
Transmission and maintenance cycle of Bartonella quintana among rhesus macaques, China
Li H , Liu W , Zhang GZ , Sun ZZ , Bai JY , Jiang BG , Zhang YY , Zhao XG , Yang H , Tian G , Li YC , Zeng L , Kosoy M , Cao WC . Emerg Infect Dis 2013 19 (2) 297-300 We detected Bartonella quintana in 48.6% of captive rhesus macaques from an animal facility in Beijing, China. Prevalence of infection increased over the period of observation. Our findings suggest that macaques may serve as reservoir hosts for B. quintana and that Pedicinus obtusus lice might act as efficient vectors. |
O'nyong nyong virus molecular determinants of unique vector specificity reside in non-structural protein 3
Saxton-Shaw KD , Ledermann JP , Borland EM , Stovall JL , Mossel EC , Singh AJ , Wilusz J , Powers AM . PLoS Negl Trop Dis 2013 7 (1) e1931 O'nyong nyong virus (ONNV) and Chikungunya virus (CHIKV) are two closely related alphaviruses with very different infection patterns in the mosquito, Anopheles gambiae. ONNV is the only alphavirus transmitted by anopheline mosquitoes, but specific molecular determinants of infection of this unique vector specificity remain unidentified. Fifteen distinct chimeric viruses were constructed to evaluate both structural and non-structural regions of the genome and infection patterns were determined through artificial infectious feeds in An. gambiae with each of these chimeras. Only one region, non-structural protein 3 (nsP3), was sufficient to up-regulate infection to rates similar to those seen with parental ONNV. When ONNV non-structural protein 3 (nsP3) replaced nsP3 from CHIKV virus in one of the chimeric viruses, infection rates in An. gambiae went from 0% to 63.5%. No other single gene or viral region addition was able to restore infection rates. Thus, we have shown that a non-structural genome element involved in viral replication is a major element involved in ONNV's unique vector specificity. |
Isolation and molecular characterization of Leptospira interrogans and Leptospira borgpetersenii isolates from the urban rat populations of Kuala Lumpur, Malaysia
Benacer D , Zain SN , Amran F , Galloway RL , Thong KL . Am J Trop Med Hyg 2013 88 (4) 704-9 Rats are considered the principle maintenance hosts of Leptospira. The objectives of this study were isolation and identification of Leptospira serovars circulating among urban rat populations in Kuala Lumpur. Three hundred urban rats (73% Rattus rattus and 27% R. norvegicus) from three different sites were trapped. Twenty cultures were positive for Leptospira using dark-field microscopy. R. rattus was the dominant carrier (70%). Polymerase chain reaction (PCR) confirmed that all isolates were pathogenic Leptospira species. Two Leptospira serogroups, Javanica and Bataviae, were identified using microscopic agglutination test (MAT). Pulsed-field gel electrophoresis (PFGE) identified two serovars in the urban rat populations: L. borgpetersenii serovar Javanica (85%) and L. interrogans serovar Bataviae (15%). We conclude that these two serovars are the major serovars circulating among the urban rat populations in Kuala Lumpur. Despite the low infection rate reported, the high pathogenicity of these serovars raises concern of public health risks caused by rodent transmission of leptospirosis. |
Geographic correlation between tapeworm carriers and heavily infected cysticercotic pigs
O'Neal SE , Moyano LM , Ayvar V , Gonzalvez G , Diaz A , Rodriguez S , Wilkins PP , Tsang VC , Gilman RH , Garcia HH , Gonzalez AE . PLoS Negl Trop Dis 2012 6 (12) e1953 BACKGROUND: Neurocysticercosis is a leading cause of preventable epilepsy in the developing world. Sustainable community-based interventions are urgently needed to control transmission of the causative parasite, Taenia solium. We examined the geospatial relationship between live pigs with visible cysticercotic cysts on their tongues and humans with adult intestinal tapeworm infection (taeniasis) in a rural village in northern Peru. The objective was to determine whether tongue-positive pigs could indicate high-risk geographic foci for taeniasis to guide targeted screening efforts. This approach could offer significant benefit compared to mass intervention. METHODS: We recorded geographic coordinates of all village houses, collected stool samples from all consenting villagers, and collected blood and examined tongues of all village pigs. Stool samples were processed by enzyme-linked immunosorbent assay (ELISA) for presence of Taenia sp. coproantigens indicative of active taeniasis; serum was processed by enzyme-linked immunoelectrotransfer blot for antibodies against T. solium cysticercosis (EITB LLGP) and T. solium taeniasis (EITB rES33). FINDINGS: Of 548 pigs, 256 (46.7%) were positive for antibodies against cysticercosis on EITB LLGP. Of 402 fecal samples, 6 (1.5%) were positive for the presence of Taenia sp. coproantigens. The proportion of coproantigen-positive individuals differed significantly between residents living within 100-meters of a tongue-positive pig (4/79, 5.1%) and residents living >100 meters from a tongue-positive pig (2/323, 0.6%) (p = 0.02). The prevalence of taeniasis was >8 times higher among residents living within 100 meters of a tongue-positive pig compared to residents living outside this range (adjusted PR 8.1, 95% CI 1.4-47.0). CONCLUSIONS: Tongue-positive pigs in endemic communities can indicate geospatial foci in which the risk for taeniasis is increased. Targeted screening or presumptive treatment for taeniasis within these high-risk foci may be an effective and practical control intervention for rural endemic areas. |
Safe lists for medications in pregnancy: inadequate evidence base and inconsistent guidance from Web-based information, 2011
Peters SL , Lind JN , Humphrey JR , Friedman JM , Honein MA , Tassinari MS , Moore CA , Mathis LL , Broussard CS . Pharmacoepidemiol Drug Saf 2013 22 (3) 324-8 PURPOSE: Medication use during pregnancy is common and increasing. Women are also increasingly getting healthcare information from sources other than their physicians. METHODS: This report summarizes an environmental scan that identified 25 active Internet sites that list medications reported to be safe for use in pregnancy and highlights the inadequate evidence base and inconsistent guidance provided by these sites. RESULTS: These lists included 245 different products, of which 103 unique components had been previously evaluated in terms of fetal risk by the Teratogen Information System (TERIS), a resource that assesses risk of birth defects after exposure under usual conditions by consensus of clinical teratology experts. For 43 (42%) of the 103 components that were listed as 'safe' on one or more of the Internet sites surveyed, the TERIS experts were unable to determine the fetal risk based on published scientific literature. For 40 (93%) of these 43, either no data were available to assess human fetal risk or the available data were limited. CONCLUSIONS: Women who see a medication on one of these 'safe' lists would be led to believe that there is no increased risk of birth defects resulting from exposure. Thus, women are being reassured that fetal exposure to these medications is safe even though a sufficient evidence base to determine the relative safety or risk does not exist. (Copyright (c) 2013 John Wiley & Sons, Ltd.) |
Fish consumption patterns and mercury exposure levels among women of childbearing age in Duval County, Florida
Traynor S , Kearney G , Olson D , Hilliard A , Palcic J , Pawlowicz M . J Environ Health 2013 75 (6) 8-15 Consumption of fish containing methylmercury can pose serious health concerns including neurotoxic effects in adults and toxicity to the fetuses of mothers exposed during pregnancy. In the study described in this article, the authors examined fish consumption patterns and measured hair mercury levels of women of childbearing age in a coastal county in Florida. Women from the community participated in a risk factor assessment survey (N = 703). Hair samples (n = 698) were collected and analyzed for mercury. The authors identified 74.8% below detection limit; 25.2% had detectable limits of mercury, while 7% exceeded 1 mcg/g. Hair mercury levels increased with fish consumption and age. Race, income, and education levels were also associated with increased hair mercury levels. Women of Asian/Pacific Islander origin had the highest levels. Although reported fish consumption exceeded the recommendations for women of childbearing age, the study population had lower mercury levels than other comparative studies in Florida and at national levels. |
Laboratory-based surveillance for hepatitis E virus infection, United States, 2005-2012
Drobeniuc J , Greene-Montfort T , Le NT , Mixson-Hayden TR , Ganova-Raeva L , Dong C , Novak RT , Sharapov UM , Tohme RA , Teshale E , Kamili S , Teo CG . Emerg Infect Dis 2013 19 (2) 218-22 To investigate characteristics of hepatitis E cases in the United States, we tested samples from persons seronegative for acute hepatitis A and B whose clinical specimens were referred to the Centers for Disease Control and Prevention during June 2005-March 2012 for hepatitis E virus (HEV) testing. We found that 26 (17%) of 154 persons tested had hepatitis E. Of these, 15 had not recently traveled abroad (nontravelers), and 11 had (travelers). Compared with travelers, nontravelers were older (median 61 vs. 32 years of age) and more likely to be anicteric (53% vs. 8%); the nontraveler group also had fewer persons of South Asian ethnicity (7% vs. 73%) and more solid-organ transplant recipients (47% vs. 0). HEV genotype 3 was characterized from 8 nontravelers and genotypes 1 or 4 from 4 travelers. Clinicians should consider HEV infection in the differential diagnosis of hepatitis, regardless of patient travel history. |
The impact of National Death Index linkages on population-based cancer survival rates in the United States
Johnson CJ , Weir HK , Fink AK , German RR , Finch JL , Rycroft RK , Yin D . Cancer Epidemiol 2013 37 (1) 20-28 BACKGROUND: In order to ensure accurate survival estimates, population-based cancer registries must ascertain all, or nearly all, patients diagnosed with cancer in their catchment area, and obtain complete follow-up information on all deaths that occurred among registered cancer patients. In the US, linkage with state death records may not be sufficient to ascertain all deaths. Since 1979, all state vital statistics offices have reported their death certificate information to the National Death Index (NDI). OBJECTIVE: This study was designed to measure the impact of linkage with the NDI on population-based relative and cancer cause-specific survival rates in the US. METHODS: Central cancer registry records for patients diagnosed 1993-1995 from California, Colorado, and Idaho were linked with death certificate information (deaths 1993-2004) from their individual state vital statistics offices and with the NDI. Two databases were created: one contained incident records with deceased patients linked only to state death records and the second database contained incident records with deceased patients linked to both state death records and the NDI. Survival estimates and 95% confidence intervals from each database were compared by state and primary site category. RESULTS: At 60 months follow-up, 42.1-48.1% of incident records linked with state death records and an additional 0.7-3.4% of records linked with the NDI. Survival point estimates from the analysis without NDI were not contained within the corresponding 95% CIs from the NDI augmented analysis for all sites combined and colorectal, pancreas, lung and bronchus, breast, prostate, non-Hodgkin lymphoma, and Kaposi sarcoma cases in all 3 states using relative survival methods. Additional combinations of state and primary site had significant survival estimate differences, which differed by method (relative versus cause-specific survival). CONCLUSION: To ensure accurate population-based cancer survival rates, linkage with the National Death Index to ascertain out of state and late registered deaths is a necessary process for US central cancer registries. |
Cervical cancer screening among young adult women in the United States
Roland KB , Benard V , Soman A , Breen N , Kepka D , Saraiya M . Cancer Epidemiol Biomarkers Prev 2013 22 (4) 580-8 BACKGROUND: Cervical cancer screening guidelines have evolved significantly in the last decade for young adult women, with current recommendations promoting later initiation and longer intervals. METHODS: Using self-reported cross-sectional National Health Interview Survey (NHIS) 2000-2010 data, trends in Papanicolaou (Pap) testing among women aged 18-29 years were examined. NHIS 2010 data were used to investigate age at first Pap test (N=2,198), time since most recent Pap test (n=1,622), and predictors of Pap testing within the last 12 months (n=1,622). RESULTS: The percentage of 18-year-olds who reported ever having a Pap test significantly decreased from 49.9% in 2000 to 37.9% in 2010. Mean age at first Pap test in 2010 was significantly younger for non-Hispanic black women (16.9 years), women <high school education (16.9 years), women who received the HPV vaccine (17.1 years), and women who have ever given birth (17.3 years). The majority reported their last Pap test within the previous 12 months (73.1%). Usual source of healthcare (OR 2.31) and current birth control use (OR 1.64) significantly increased chances of having a Pap test within the previous 12 months. CONCLUSIONS: From 2000 to 2010 there was a gradual decline in Pap test initiation among 18-year-olds, however, in 2010 many women reported ≤12 months since last screening. Evidence-based guidelines should be promoted, as screening young adult women for cervical cancer more frequently than recommended can cause considerable harms. IMPACT: A baseline of cervical cancer screening among young adult women in the United States to assess adherence to evidence-based screening guidelines. |
Challenges to evaluating respiratory syncytial virus mortality in Bangladesh, 2004-2008
Stockman LJ , Brooks WA , Streatfield PK , Rahman M , Goswami D , Nahar K , Rahman MZ , Luby SP , Anderson LJ . PLoS One 2013 8 (1) e53857 BACKGROUND: Acute lower respiratory illness is the most common cause of death among children, globally. Data are not available to make accurate estimates on the global mortality from respiratory syncytial virus (RSV), specifically. METHODS: Respiratory samples collected from children under 5 years of age during 2004 to 2008 as part of population-based respiratory disease surveillance in an urban community in Dhaka, Bangladesh were tested for RSV, human metapneumovirus (HMPV), human parainfluenza virus (PIV) types 1, 2, and 3, influenza and adenovirus by RT-PCR. Verbal autopsy data were used to identify children who died from respiratory illness in a nearby rural community. Significance of the correlation between detections and community respiratory deaths was determined using Spearman's coefficient. RESULTS: RSV activity occurred during defined periods lasting approximately three months but with no clear seasonal pattern. There was no significant correlation between respiratory deaths and detection of any of the respiratory viruses studied. CONCLUSION: Outbreaks of respiratory viruses may not be associated with deaths in children in the study site; however, the few respiratory deaths observed and community-to-community variation in the timing of outbreaks may have obscured an association. An accurate assessment of respiratory virus-associated deaths will require detections and death data to come from the same location and a larger study population. |
Changes to cervical cancer prevention guidelines: effects on screening among U.S. women ages 15-29
Henderson JT , Saraiya M , Martinez G , Harper CC , Sawaya GF . Prev Med 2013 56 (1) 25-9 OBJECTIVE: A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15-29 before and after the first evidence-based recommendations for reduced cervical cancer screening. METHOD: We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006-2008, stratified by age (15-17, 18-20, 21-29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables. RESULTS: Among females ages 15-17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18-20, 24% were screened too early in 2006-2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women. CONCLUSION: Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening. |
Comparison of 3 school-based influenza surveillance indicators: lessons learned from 2009 pandemic influenza A (H1N1)-Denver metropolitan region, Colorado
Williams NJ , Ghosh TS , Bisgard KM , Vogt RL . J Public Health Manag Pract 2013 19 (2) 119-25 CONTEXT: Early in the 2009 pandemic influenza A (H1N1) experience, children aged 5 to 17 years were determined to be disproportionately affected compared with recent influenza seasons. OBJECTIVE: To characterize the pandemic among school-aged children, to enable timely influenza outbreak identification, and to determine which school-based influenza surveillance indicator correlated most closely with a laboratory-based standard influenza indicator (standard) and, therefore, might be most useful for future school-based influenza surveillance. DESIGN: During the 2009-2010 school year, we monitored students using 3 different surveillance indicators: (1) all-cause absenteeism, (2) influenza-like illness (ILI)-related absenteeism, (3) and ILI-related school health office visits. Thresholds were set for each indicator to identify individual school outbreaks. Each surveillance indicator was compared with the standard, confirmed influenza cases among hospitalized patients. SETTING: Tri-County (Denver metropolitan area), Colorado. PARTICIPANTS: Prekindergarten through 12th-grade students in public schools. MAIN OUTCOME MEASURES: Correlation coefficients comparing each influenza surveillance indicator with the standard and graphs comparing weekly rates for each influenza surveillance indicator or weekly outbreak counts with the standard. RESULTS: Correlation between the surveillance indicators and the standard varied greatly. All-cause absenteeism correlated most poorly with the standard (Pearson's r = 0.33) and ILI-related health office visits correlated moderately well (r = 0.63). Influenza-like illness-related absenteeism correlated best (r = 0.92) and could be improved (r = 0.97) by shifting ILI-absenteeism data later by 1 week. Graphs of weekly rates or weekly outbreak counts also illustrated that ILI-related absenteeism correlated best with the standard. CONCLUSIONS: For influenza surveillance among school-aged children, when feasible, we recommend using ILI-related absenteeism, which correlated best and its rate peaked more than 1 week sooner than the standard. The other 2 surveillance indicators might be useful in certain situations, such as when resources are limited. |
Increasing scientific and analytic capacity in states: extending epidemiology collaborations beyond traditional workforce development
Rosenberg D , Barfield WD , Rankin KM , Kroelinger CD . Matern Child Health J 2012 16 S193-S195 This editorial discusses the articles which were featured in this issue of Maternal and Child Health Journal. Many article in this issue showcase examples of the high level applied research currently being conducted by Maternal and Child Health (MCH) epidemiologists working in state health agencies. The articles in this issue focuses on collective leadership of federal/state/local/tribal health agencies, non-governmental organizations, and university partners. A design initiatives is needed which work on multiple fronts: to increase the skill level of the public health workforce, to encourage use of new analytic methods, to promote timely and relevant data systems, to facilitate innovative dissemination strategies, to support advocacy, and to shape new institutional structures and processes. The goal of collaboration aimed at increasing scientific capacity in state public health agencies must be to galvanize the support and resources necessary to create and sustain a culture and context that facilitates rigorous science and promotes its use to improve the health of women, children, and families. (PsycINFO Database Record (c) 2013 APA, all rights reserved). |
Building analytic capacity, facilitating partnerships, and promoting data use in state health agencies: a distance-based workforce development initiative applied to maternal and child health epidemiology
Rankin KM , Kroelinger CD , Rosenberg D , Barfield WD . Matern Child Health J 2012 16 S196-S202 The purpose of this article is to summarize the methodology, partnerships, and products developed as a result of a distance-based workforce development initiative to improve analytic capacity among maternal and child health (MCH) epidemiologists in state health agencies. This effort was initiated by the Centers for Disease Control's MCH Epidemiology Program and faculty at the University of Illinois at Chicago to encourage and support the use of surveillance data by MCH epidemiologists and program staff in state agencies. Beginning in 2005, distance-based training in advanced analytic skills was provided to MCH epidemiologists. To support participants, this model of workforce development included: lectures about the practical application of innovative epidemiologic methods, development of multidisciplinary teams within and across agencies, and systematic, tailored technical assistance The goal of this initiative evolved to emphasize the direct application of advanced methods to the development of state data products using complex sample surveys, resulting in the articles published in this supplement to MCHJ. Innovative methods were applied by participating MCH epidemiologists, including regional analyses across geographies and datasets, multilevel analyses of state policies, and new indicator development. Support was provided for developing cross-state and regional partnerships and for developing and publishing the results of analytic projects. This collaboration was successful in building analytic capacity, facilitating partnerships and promoting surveillance data use to address state MCH priorities, and may have broader application beyond MCH epidemiology. In an era of decreasing resources, such partnership efforts between state and federal agencies and academia are essential for promoting effective data use. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract). |
Developing a standard approach to examine infant mortality: findings from the State Infant Mortality Collaborative (SIMC)
Stampfel C , Kroelinger CD , Dudgeon M , Goodman DA , Ramos LR , Barfield WD . Matern Child Health J 2012 16 S360-S369 States can improve pregnancy outcomes by using a standard approach to assess infant mortality. The State Infant Mortality Collaborative (SIMC) developed a series of analyses to describe infant mortality in states, identify contributing factors to infant death, and develop the evidence base for implementing new or modifying existing programs and policies addressing infant mortality. The SIMC was conducted between 2004 and 2006 among five states: Delaware, Hawaii, Louisiana, Missouri, and North Carolina. States used analytic strategies in an iterative process to investigate contributors to infant mortality. Analyses were conducted within three domains: data reporting (quality, reporting, definitional criteria, and timeliness), cause and timing of infant death (classification of cause and fetal, neonatal, and postneonatal timing), and maturity and weight at birth/maturity and birth weight-specific mortality. All states identified the SIMC analyses as useful for examining infant mortality trends. In each of the three domains, SIMC results were used to identify important direct contributors to infant mortality including disparities, design or implement interventions to reduce infant death, and identify foci for additional analyses. While each state has unique structural, political, and programmatic circumstances, the SIMC model provides a systematic approach to investigating increasing or static infant mortality rates that can be easily replicated in all other states and allows for cross-state comparison of results. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract). |
KPC-4 Is encoded within a truncated Tn4401 in an IncL/M plasmid, pNE1280, isolated from Enterobacter cloacae and Serratia marcescens.
Bryant KA , Van Schooneveld TC , Thapa I , Bastola D , Williams LO , Safranek TJ , Hinrichs SH , Rupp ME , Fey PD . Antimicrob Agents Chemother 2013 57 (1) 37-41 We describe the transfer of bla(KPC-4) from Enterobacter cloacae to Serratia marcescens in a single patient. DNA sequencing revealed that KPC-4 was encoded on an IncL/M plasmid, pNE1280, closely related to pCTX-M360. Further analysis found that KPC-4 was encoded within a novel Tn4401 element (Tn4401f) containing a truncated tnpA and lacking tnpR, ISKpn7 left, and Tn4401 IRL-1, which are conserved in other Tn4401 transposons. This study highlights the continued evolution of Tn4401 transposons and movement to multiple plasmid backbones that results in acquisition by multiple species of Gram-negative bacilli. |
Improving the efficiency and relevance of evidence-based recommendations in the era of whole-genome sequencing: an EGAPP methods update.
Veenstra DL , Piper M , Haddow JE , Pauker SG , Klein R , Richards CS , Tunis SR , Djulbegovic B , Marrone M , Lin JS , Berg AO , Calonge N . Genet Med 2013 15 (1) 14-24 To provide an update on recent revisions to Evaluation of Genomic Applications in Practice and Prevention (EGAPP) methods designed to improve efficiency, and an assessment of the implications of whole genome sequencing for evidence-based recommendation development. Improvements to the EGAPP approach include automated searches for horizon scanning, a quantitative ranking process for topic prioritization, and the development of a staged evidence review and evaluation process. The staged process entails (i) triaging tests with minimal evidence of clinical validity, (ii) using and updating existing reviews, (iii) evaluating clinical validity prior to analytic validity or clinical utility, (iv) using decision modeling to assess potential clinical utility when direct evidence is not available. EGAPP experience to date suggests the following approaches will be critical for the development of evidence based recommendations in the whole genome sequencing era: (i) use of triage approaches and frameworks to improve efficiency, (ii) development of evidence thresholds that consider the value of further research, (iii) incorporation of patient preferences, and (iv) engagement of diverse stakeholders. The rapid advances in genomics present a significant challenge to traditional evidence based medicine, but also an opportunity for innovative approaches to recommendation development. (Genet Med 2013:15(1):14-24.) |
Pneumococcal capsular switching: a historical perspective.
Wyres KL , Lambertsen LM , Croucher NJ , McGee L , von Gottberg A , Linares J , Jacobs MR , Kristinsson KG , Beall BW , Klugman KP , Parkhill J , Hakenbeck R , Bentley SD , Brueggemann AB . J Infect Dis 2013 207 (3) 439-49 BACKGROUND: Changes in serotype prevalence among pneumococcal populations result from both serotype replacement and serotype (capsular) switching. Temporal changes in serotype distributions are well documented, but the contribution of capsular switching to such changes is unknown. Furthermore, it is unclear to what extent vaccine-induced selective pressures drive capsular switching. METHODS: Serotype and multilocus sequence typing data for 426 pneumococci dated from 1937 through 2007 were analyzed. Whole-genome sequence data for a subset of isolates were used to investigate capsular switching events. RESULTS: We identified 36 independent capsular switch events, 18 of which were explored in detail with whole-genome sequence data. Recombination fragment lengths were estimated for 11 events and ranged from approximately 19.0 kb to ≥58.2 kb. Two events took place no later than 1960, and the imported DNA included the capsular locus and the nearby penicillin-binding protein genes pbp2x and pbp1a. CONCLUSIONS: Capsular switching has been a regular occurrence among pneumococcal populations throughout the past 7 decades. Recombination of large DNA fragments (>30 kb), sometimes including the capsular locus and penicillin-binding protein genes, predated both vaccine introduction and widespread antibiotic use. This type of recombination has likely been an intrinsic feature throughout the history of pneumococcal evolution. |
Survival among people with Down syndrome: a nationwide population-based study in Denmark.
Zhu JL , Hasle H , Correa A , Schendel D , Friedman JM , Olsen J , Rasmussen SA . Genet Med 2013 15 (1) 64-9 PURPOSE: Several studies have shown substantially longer survival among persons with Down syndrome in recent decades. We examined survival patterns among Danish persons with Down syndrome by karyotype. METHODS: A national cohort of 3,530 persons with Down syndrome identified from the Danish Cytogenetic Register and a reference cohort of persons without Down syndrome randomly selected from the general population were followed from 1 April 1968 to 15 January 2009 by linkages to the Register of Causes of Death and the Civil Registration System. RESULTS: Overall, persons with Down syndrome had higher mortality than the reference cohort but to a lesser degree for persons with mosaic trisomy 21 than for persons with standard trisomy 21 or with Robertsonian translocations (hazard ratio 4.98 (95% confidence interval 3.51-7.08), 8.94 (8.32-9.60), and 10.23 (7.50-13.97), respectively). Among persons with Down syndrome born after April 1968, more recent birth cohorts had lower mortality rates than older birth cohorts, which was largely due to declining mortality among persons with Down syndrome who also had congenital heart defects. CONCLUSION: Recent birth cohorts of persons with Down syndrome experienced declining mortality, likely due to treatment for congenital heart defects, and persons with mosaic trisomy 21 had better survival than persons with other Down syndrome karyotypes. (Genet Med 2013:15(1):64-69.) |
Disclosure, sex and moral agency: a response to Groves, Maman and Moodley
O'Leary A , Wolitski RJ . Glob Public Health 2013 8 (1) 120-2 In their recent article, Groves et al. (Citation2012) describe the complexity of six HIV-positive women's relationships with their male partners and the barriers to HIV disclosure to these partners that they face.Footnote The authors make the case that these challenging realities and higher rates of HIV testing among women argue against using ‘the language of morality’ in addressing HIV disclosure among women in South Africa. In presenting their research, we believe that they have inadequately represented our own and others’ research on the experiences of other people living with HIV and the role that moral agency plays in reducing HIV transmission risk and increasing HIV disclosure to sex partners. | Groves et al. quoted from our paper (O'Leary and Wolitski Citation2009) but failed to identify it as a systematic review of the literature. This paper was not an opinion piece. It was based on more than 30 qualitative and quantitative studies on the role of moral agency in HIV transmission risk behaviour and disclosure of HIV status to sex partners. Our review showed that concern about infecting others is central to the sexual decision-making of people living with HIV. It also showed that beliefs about personal responsibility and other aspects of moral agency are associated with decreased HIV transmission risk and increased HIV disclosure to sex partners. In making their case, Groves et al. have failed to adequately represent this broader literature. |
Listeria monocytogenes in donated platelets: a potential transfusion-transmitted pathogen intercepted through screening
Menon M , Graves L , McCombs K , Hise K , Silk B , Kuehnert M , Lynch M . Transfusion 2013 53 (9) 1974-8 BACKGROUND: Bacterial contamination of blood components is a potentially life-threatening complication of transfusions. In October 2005, the Centers for Disease Control and Prevention (CDC) noted four Listeria monocytogenes (Lm) isolates cultured from four different units of donated apheresis platelets (PLTs) among Lm isolates sent to the CDC National Listeria Reference Laboratory for subtyping as part of routine surveillance activities. STUDY DESIGN AND METHODS: We describe an investigation to determine possible common sources of infection among donors or factors associated with PLT collection or storage and to determine whether human transfusion-associated listeriosis cases had been reported. We also reviewed all isolates with PLTs as a source sent to the CDC National Listeria Reference Laboratory between November 1, 2005, and December 31, 2011. RESULTS: Each PLT donor-associated isolate had a distinct pulsed-field gel electrophoresis pattern combination. Other than these four cases, no other cases of Lm-contaminated PLTs were identified by the American Red Cross or by CDC during 2005. However, two additional cases of Lm isolated from donated PLTs were detected, one in 2008 and one in 2011. CONCLUSION: Although the source of contamination for these PLT units is unclear, and a source common to all units was not identified, this investigation underscores the value of screening for bacterial contaminants of PLTs. |
Estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal
Upreti SR , Janusz K , Schluter WW , Bichha RP , Shakya G , Biggerstaff BJ , Shrestha MM , Sedai TR , Fischer M , Gibbons RV , Shrestha S , Hills SL . Am J Trop Med Hyg 2013 88 (3) 464-8 Wider availability of the live, attenuated SA 14-14-2 Japanese encephalitis (JE) vaccine has facilitated introduction or expansion of immunization programs in many countries. However, information on their impact is limited. In 2006, Nepal launched a JE immunization program, and by 2009, mass campaigns had been implemented in 23 districts. To describe the impact, we analyzed surveillance data from 2004 to 2009 on laboratory-confirmed JE and clinical acute encephalitis syndrome (AES) cases. The post-campaign JE incidence rate of 1.3 per 100,000 population was 72% lower than expected if no campaigns had occurred, and an estimated 891 JE cases were prevented. In addition, AES incidence was 58% lower, with an estimated 2,787 AES cases prevented, suggesting that three times as many disease cases may have been prevented than indicated by the laboratory-confirmed JE cases alone. These results provide useful information on preventable JE disease burden and the potential value of JE immunization programs. |
Cost-effectiveness of hepatitis B vaccination in adults with diagnosed diabetes
Hoerger TJ , Schillie S , Wittenborn JS , Bradley CL , Zhou F , Byrd K , Murphy TV . Diabetes Care 2013 36 (1) 63-9 OBJECTIVE: To examine the cost-effectiveness of a hepatitis B vaccination program for unvaccinated adults with diagnosed diabetes in the U.S. RESEARCH DESIGN AND METHODS: We used a cost-effectiveness simulation model to estimate the cost-effectiveness of vaccinating adults 20-59 years of age with diagnosed diabetes not previously vaccinated for or infected by hepatitis B virus (HBV). The model estimated acute and chronic HBV infections, complications, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and vaccine prices. RESULTS: With a 10% uptake rate, the intervention will vaccinate 528,047 people and prevent 4,271 acute and 256 chronic hepatitis B infections. Net health care costs will increase by $91.4 million, and 1,218 QALYs will be gained, producing a cost-effectiveness ratio of $75,094 per QALY gained. Results are most sensitive to age, the discount rate, the hepatitis B incidence ratio for people with diabetes, and hepatitis B infection rates. Cost-effectiveness ratios rise with age at vaccination; an alternative intervention that vaccinates adults with diabetes 60 years of age or older had a cost-effectiveness ratio of $2.7 million per QALY. CONCLUSIONS: Hepatitis B vaccination for adults with diabetes 20-59 years of age is modestly cost-effective. Vaccinating older adults with diabetes is not cost-effective. The study did not consider hepatitis outbreak investigation costs, and limited information exists on hepatitis progression among older adults with diabetes. Partly based on these results, the Advisory Committee on Immunization Practices recently recommended hepatitis B vaccination for people 20-59 years of age with diagnosed diabetes. |
Behavioral and attitudinal factors differentiating male intimate partner violence perpetrators with and without a history of childhood family violence
Lee R , Walters M , Hall J , Basile K . J Fam Violence 2013 28 (1) 85-94 This study utilized a sample of men ( N = 340) charged with assault against a female partner to assess differences among IPV perpetrators with and without a history of childhood family violence on factors such as angry, controlling and violent behaviors, substance use related behaviors, and attitudes towards women. Over two-thirds of the sample reported childhood exposure to maltreatment or witnessing IPV. Chi-square analyses and t-tests indicated significant differences between perpetrators with and without a history of family violence on eight of eleven measures. Findings suggest perpetrators with a family violence history more strongly endorse ideas that present women and feminine attributes in a negative light. This research demonstrates that while exposure to family violence during childhood is not necessary for IPV to occur, its presence may be a marker for more severe attitudinal and behavioral problems. Findings highlight the need for primary prevention efforts and can inform secondary prevention strategies. |
The Francisella tularensis FabI enoyl-acyl carrier protein reductase gene is essential to bacterial viability and is expressed during infection.
Kingry LC , Cummings JE , Brookman KW , Bommineni GR , Tonge PJ , Slayden RA . J Bacteriol 2013 195 (2) 351-8 Francisella tularensis is classified as a category A priority pathogen and causes fatal disseminated disease in humans upon inhalation of less than 50 bacteria. Although drugs are available for treatment, they are not ideal because of toxicity and route of delivery, and in some cases patients relapse upon withdrawal. We have an ongoing program to develop novel FAS-II FabI enoyl-ACP reductase enzyme inhibitors for Francisella and other select agents. To establish F. tularensis FabI (FtFabI) as a clinically relevant drug target, we demonstrated that fatty acid biosynthesis and FabI activity are essential for growth even in the presence of exogenous long-chain lipids and that FtfabI is not transcriptionally altered in the presence of exogenous long-chain lipids. Inhibition of FtFabI or fatty acid synthesis results in loss of viability that is not rescued by exogenous long-chain lipid supplementation. Importantly, whole-genome transcriptional profiling of F. tularensis with DNA microarrays from infected tissues revealed that FtfabI and de novo fatty acid biosynthetic genes are transcriptionally active during infection. This is the first demonstration that the FabI enoyl-ACP-reductase enzyme encoded by F. tularensis is essential and not bypassed by exogenous fatty acids and that de novo fatty acid biosynthetic components encoded in F. tularensis are transcriptionally active during infection in the mouse model of tularemia. |
Regulation of apoptosis by Bcl-2 cysteine oxidation in human lung epithelial cells
Luanpitpong S , Chanvorachote P , Stehlik C , Tse W , Callery PS , Wang L , Rojanasakul Y . Mol Biol Cell 2013 24 (6) 858-69 Hydrogen peroxide (H(2)O(2)) is a key mediator of oxidative stress known to be important in various cellular processes including apoptosis. Bcl-2 is an oxidative stress-responsive protein and a key regulator of apoptosis; however, the underlying mechanisms of oxidative regulation of Bcl-2 are not well understood. The present study investigated the direct effect of H(2)O(2) on Bcl-2 cysteine oxidation as a potential mechanism of apoptosis regulation. Exposure of human lung epithelial cells to H(2)O(2) induced apoptosis in concomitant with cysteine oxidation and down-regulation of Bcl-2. Inhibition of Bcl-2 oxidation by antioxidants or by site-directed mutagenesis of Bcl-2 at Cys158 and Cys229 abrogated the effects of H(2)O(2) on Bcl-2 and apoptosis. Immunoprecipitation and confocal microscopic studies showed that Bcl-2 interacts with MAP kinase ERK1/2 to suppress apoptosis and that such interaction is modulated by cysteine oxidation of Bcl-2. H(2)O(2)-induced Bcl-2 cysteine oxidation interferes with Bcl-2 and ERK1/2 interaction. Mutation of the cysteine residues inhibited the disruption of Bcl-2-ERK complex as well as the induction of apoptosis by H(2)O(2). Together, these results demonstrate the critical role of Bcl-2 cysteine oxidation in the regulation of apoptosis through ERK signaling. This new finding reveals crucial redox regulatory mechanisms that control the antiapoptotic function of Bcl-2. |
Seasonal trivalent inactivated influenza vaccine does not protect against newly emerging variants of influenza A (H3N2v) virus in ferrets
Houser KV , Katz JM , Tumpey TM . J Virol 2013 87 (2) 1261-3 The recent increase in human cases of influenza A H3N2 variant virus [A(H3N2)v] highlights the need to assess whether seasonal influenza vaccination provides cross-protection against A(H3N2)v virus. Our data demonstrate that the 2011-2012 trivalent inactivated influenza vaccine (TIV) protected ferrets against homologous H3N2 virus challenge but provided minimal to no protection against A(H3N2)v virus. The complete absence of specific hemagglutination inhibition antibody response to A(H3N2)v is consistent with the poor cross-protection observed among TIV-immune animals. |
Measurements of human herpesvirus 8 viral load in blood before and after leukoreduction filtration
Dollard SC , Roback JD , Gunthel C , Amin MM , Barclay S , Patrick E , Kuehnert MJ . Transfusion 2013 53 (10) 2164-7 BACKGROUND: Human herpesvirus 8 (HHV-8) is likely transmitted through blood transfusion in high-prevalence areas. The efficacy of leukoreduction filtration for reducing HHV-8 in blood has not been reported. STUDY DESIGN AND METHODS: Blood was drawn from 45 human immunodeficiency virus-positive men either with Kaposi's sarcoma (KS; n = 21) or without KS (n = 24) and subject to leukoreduction filtration. HHV-8 viral load was measured in plasma and in blood before and after filtration. RESULTS: Twelve subjects, all with KS, had detectable HHV-8 viremia before filtration with viral loads of 10(2) to 10(5) copies/mL (mean, 3 x 10(4) copies/mL). After filtration, seven of 12 subjects no longer had detectable HHV-8 in their blood, and five of 12 subjects had detectable HHV-8 that was 90% reduced on average from prefiltration levels. The presence of HHV-8 in the blood after filtration was strongly associated with prefiltration viral loads greater than 1000 copies/mL and the presence of cell-free virus in plasma. None of the subjects without KS had detectable levels of HHV-8 virus in blood before or after filtration. CONCLUSION: Cell-associated HHV-8 appeared to be effectively removed by leukoreduction filtration. Cell-free HHV-8 was present in 42% of subjects as 1% to 20% of the total virus which was not removed by filtration. |
Bioluminescent imaging and histopathologic characterization of WEEV neuroinvasion in outbred CD-1 mice
Phillips AT , Stauft CB , Aboellail TA , Toth AM , Jarvis DL , Powers AM , Olson KE . PLoS One 2013 8 (1) e53462 Western equine encephalitis virus (WEEV; Alphavirus) is a mosquito-borne virus that can cause severe encephalitis in humans and equids. Previous studies have shown that intranasal infection of outbred CD-1 mice with the WEEV McMillan (McM) strain result in high mortality within 4 days of infection. Here in vivo and ex vivo bioluminescence (BLM) imaging was applied on mice intranasally infected with a recombinant McM virus expressing firefly luciferase (FLUC) to track viral neuroinvasion by FLUC detection and determine any correlation between BLM and viral titer. Immunological markers of disease (MCP-1 and IP-10) were measured and compared to wild type virus infection. Histopathology was guided by corresponding BLM images, and showed that neuroinvasion occurred primarily through cranial nerves, mainly in the olfactory tract. Olfactory bulb neurons were initially infected with subsequent spread of the infection into different regions of the brain. WEEV distribution was confirmed by immunohistochemistry as having marked neuronal infection but very few infected glial cells. Axons displayed infection patterns consistent with viral dissemination along the neuronal axis. The trigeminal nerve served as an additional route of neuroinvasion showing significant FLUC expression within the brainstem. The recombinant virus WEEV.McM.FLUC had attenuated replication kinetics and induced a weaker immunological response than WEEV.McM but produced comparable pathologies. Immunohistochemistry staining for FLUC and WEEV antigen showed that transgene expression was present in all areas of the CNS where virus was observed. BLM provides a quantifiable measure of alphaviral neural disease progression and a method for evaluating antiviral strategies. |
Comparison of serum cystatin C, serum creatinine, measured GFR, and estimated GFR to assess the risk of kidney failure in American Indians with diabetic nephropathy
Pavkov ME , Knowler WC , Hanson RL , Williams DE , Lemley KV , Myers BD , Nelson RG . Am J Kidney Dis 2013 62 (1) 33-41 BACKGROUND: We compared values of baseline serum cystatin C (SCysC), serum creatinine (SCr), and measured glomerular filtration rate (mGFR) for predicting end-stage renal disease (ESRD) in patients with type 2 diabetes and elevated albuminuria. STUDY DESIGN: Observational longitudinal study. SETTING & PARTICIPANTS: Pima Indians with type 2 diabetes and elevated albumin-creatinine ratio (ACR ≥30 mg/g). PREDICTORS: Baseline SCysC, SCr, and mGFR. OUTCOMES & MEASUREMENTS: Individuals were followed up from their first examination with diabetes and ACR ≥30 mg/g until December 2010, onset of ESRD, or death, whichever came first. Incidence rates adjusted for age and sex were computed by Mantel-Haenszel stratification. The abilities of SCysC, SCr, and mGFR values to predict ESRD were compared with receiver operating characteristic curves. RESULTS: Of 234 Pima Indians with a mean age of 42.8 years who were followed up for a median of 10.7 (range, 0.6-21.3) years, 68 (29%) developed ESRD. The incidence of ESRD was significantly higher in patients in the lowest versus highest tertile of 1/SCysC (incidence rate ratio, 2.43; 95% CI, 1.31-4.50). By contrast, mGFR and 1/SCr had J-shaped associations with ESRD. In unadjusted analyses, 1/SCysC had the highest area under the receiver operating characteristic curve (AUROC; 0.719 +/- 0.035) and mGFR had the lowest (0.585 +/- 0.042; P < 0.001); the AUROC for 1/SCr was intermediate (0.672 +/- 0.040; P = 0.1 and P = 0.03 vs 1/SCysC and mGFR, respectively). In analyses adjusted for age, sex, diabetes duration, height, weight, hemoglobin A(1c) level, and ACR, 1/SCysC had the highest AUROC (0.845 +/- 0.026). Models with mGFR or 1/SCr alone had similar AUROCs (P = 0.9) and both were lower than the model with 1/SCysC alone (P = 0.02 and P = 0.03, respectively). LIMITATIONS: The predictive values of the filtration markers are limited to the extent that their precision is based on a single measurement. CONCLUSIONS: SCysC level was a better predictor of ESRD than mGFR or SCr level in Pima Indians with type 2 diabetes and elevated albuminuria. |
State-based and demographic variation in parent-reported medication rates for attention-deficit/hyperactivity disorder, 2007-2008
Visser SN , Blumberg SJ , Danielson ML , Bitsko RH , Kogan MD . Prev Chronic Dis 2013 10 E09 Medication is the most effective treatment of attention-deficit/hyperactivity disorder (ADHD), a common neurobehavioral disorder of childhood. We used data from the 2007-2008 National Survey of Children's Health to calculate weighted estimates of parent-reported ADHD and medication treatment among US children aged 4 to 17 years, by state and sex-stratified age. State-based rates of ADHD medication treatment ranged from 33% in Nevada to 79% in Mississippi; rates of medicated ADHD were higher among boys than girls at every age. State-based investigations of ADHD medication treatment factors are needed, and our findings may inform these public health efforts. |
Dietary supplement use and folate status during pregnancy in the United States
Branum AM , Bailey R , Singer BJ . J Nutr 2013 143 (4) 486-92 Adequate folate and iron intake during pregnancy is critical for maternal and fetal health. No previous studies to our knowledge have reported dietary supplement use and folate status among pregnant women sampled in NHANES, a nationally representative, cross-sectional survey. We analyzed data on 1296 pregnant women who participated in NHANES from 1999 to 2006 to characterize overall supplement use, iron and folic acid use, and RBC folate status. The majority of pregnant women (77%) reported use of a supplement in the previous 30 d, most frequently a multivitamin/-mineral containing folic acid (mean 817 mug/d) and iron (48 mg/d). Approximately 55-60% of women in their first trimester reported taking a folic acid- or iron-containing supplement compared with 76-78% in their second trimester and 89% in their third trimester. RBC folate was lowest in the first trimester and differed by supplement use across all trimesters. Median RBC folate was 1628 nmol/L among users and 1041 nmol/L among nonusers. Among all pregnant women, median RBC folate increased with trimester (1256 nmol/L in the first, 1527 nmol/L in the second, and 1773 nmol/L in the third). Given the role of folic acid in the prevention of neural tube defects, it is notable that supplement use and median RBC folate was lowest in the first trimester of pregnancy, with 55% of women taking a supplement containing folic acid. Future research is needed to determine the reasons for low compliance with supplement recommendations, particularly folic acid, in early pregnancy. |
Protein energy malnutrition decreases immunity and increases susceptibility to influenza infection in mice
Taylor AK , Cao W , Vora KP , Cruz Jde L , Shieh WJ , Zaki SR , Katz JM , Sambhara S , Gangappa S . J Infect Dis 2013 207 (3) 501-10 BACKGROUND: Protein energy malnutrition (PEM), a common cause of secondary immune deficiency in children, is associated with an increased risk of infections. Very few studies have addressed the relevance of PEM as a risk factor for influenza. METHODS: We investigated the influence of PEM on susceptibility to, and immune responses following, influenza virus infection using isocaloric diets providing either adequate protein (AP; 18%) or very low protein (VLP; 2%) in a mouse model. RESULTS: We found that mice maintained on the VLP diet, when compared to mice fed with the AP diet, exhibited more severe disease following influenza infection based on virus persistence, trafficking of inflammatory cell types to the lung tissue, and virus-induced mortality. Furthermore, groups of mice maintained on the VLP diet showed significantly lower virus-specific antibody response and a reduction in influenza nuclear protein-specific CD8(+) T cells compared with mice fed on the AP diet. Importantly, switching diets for the group maintained on the VLP diet to the AP diet improved virus clearance, as well as protective immunity to viral challenge. CONCLUSIONS: Our results highlight the impact of protein energy on immunity to influenza infection and suggest that balanced protein energy replenishment may be one strategy to boost immunity against influenza viral infections. |
Reflecting on the 5th National Occupational Injury Research Symposium and looking forward
Castillo DN , Collins J . J Safety Res 2013 For 2-1/2 days in October, 2011, more than 200 researchers convened at the 5th National Occupational Injury Research Symposium (NOIRS) to celebrate advances and successes in the field, to learn from each other about recent and ongoing occupational injury research, and to network and establish new professional relationships to advance occupational injury research in the future. This special issue highlights some of the research presented at that meeting. There has been considerable progress in research and worker safety since the first NOIRS in 1997, with demonstrated reductions in worker deaths and injury, an increased depth and breadth of research, and the development and validation of prevention strategies. Despite this progress, occupational injuries continue to exert too high a toll on workers, employers and society, and there are numerous challenges that need to be addressed to continue advancements in worker safety. |
Flu-like illness among workers at a soy processing plant
Cummings KJ , Gaughan DM , Green BJ , Beezhold DH . Am J Ind Med 2013 56 (5) 520-1 Harris-Roberts et al. [2012] described associations between chest symptoms and soy sensitization among workers at South African soy processing plants. These findings were similar to our recently reported observations in workers at a US soy processing plant [Cummings et al., 2010]. Harris-Roberts et al. also described associations between work and flu-like illness, prompting us to examine our unpublished data on flu-like illness in US soy processing workers. These data were collected in a NIOSH IRB-approved research study from participants who provided informed consent. | We asked 147 study participants, all current soy plant employees, whether they had flu-like illness with aches, pains, fever, chills, and night sweats during the past 12 months and whether their symptoms were different away from work. Our determination of soy sensitization, work classification, and exposure categories has been described previously [Cummings et al., 2010]. We calculated frequencies and used logistic regression to examine associations. We considered two-sided P ≤ 0.05 to be statistically significant. Analyses were conducted with SAS version 9.2 (SAS Institute, Cary, NC). | A total of 55 (37%) participants reported flu-like illness and 20 (14%) reported flu-like illness that was better away from work (“work-related flu-like illness”). Work-related flu-like illness was not associated with soy-specific IgE (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 0.5–4.9). Production workers had a higher odds of work-related flu-like illness than non-production workers (OR = 4.4, 95% CI = 0.9–21.0). Work-related flu-like illness was not associated with exposure categories for inhalable dust (P = 0.33), inhalable soy antigen (P = 0.33), or peak dust (P = 0.41). When examined linearly, soy-specific IgG was not associated with work-related flu-like illness (P = 0.44). Workers in the second distributional tertile of soy-specific IgG had a higher odds of work-related flu-like illness than other workers, including those in the third distributional tertile (OR = 4.6; 95% CI = 0.9–23.4). This finding may reflect immune tolerance or a healthy worker effect. |
Assessment of hand-transmitted vibration exposure from motorized forks used for beach-cleaning operations
McDowell TW , Welcome DE , Warren C , Xu XS , Dong RG . Ann Occup Hyg 2013 57 (1) 43-53 Motorized vibrating manure forks were used in beach-cleaning operations following the massive Deepwater Horizon oil spill in the Gulf of Mexico during the summer of 2010. OBJECTIVES: The objectives of this study were to characterize the vibration emissions of these motorized forks and to provide a first approximation of hand-transmitted vibration exposures to workers using these forks for beach cleaning. METHODS: Eight operators were recruited to operate the motorized forks during this laboratory study. Four fork configurations were used in the study; two motor speeds and two fork basket options were evaluated. Accelerations were measured near each hand as the operators completed the simulated beach-cleaning task. RESULTS: The dominant vibration frequency for these tools was identified to be around 20 Hz. Because acceleration was found to increase with motor speed, workers should consider operating these tools with just enough speed to get the job done. These forks exhibited considerable acceleration magnitudes when unloaded. CONCLUSIONS: The study results suggest that the motor should not be operated with the fork in the unloaded state. Anti-vibration gloves are not effective at attenuating the vibration frequencies produced by these forks, and they may even amplify the transmitted vibration and increase hand/arm fatigue. While regular work gloves are suitable, vibration-reducing gloves may not be appropriate for use with these tools. These considerations may also be generally applicable for the use of motorized forks in other workplace environments. |
Campylobacter infection in poultry-processing workers, Virginia, USA, 2008-2011
de Perio MA , Niemeier RT , Levine SJ , Gruszynski K , Gibbins JD . Emerg Infect Dis 2013 19 (2) 286-8 During a health hazard evaluation, we investigated 29 cases of laboratory-diagnosed Campylobacter infection among workers at a poultry-processing plant. Most infected employees worked at the plant <1 month, worked as live hangers, and lived at a state-operated center. To lessen the infection risk, we recommended improvements to engineering and administrative controls at the plant. |
Disparities in work-related homicide rates in selected retail industries in the United States, 2003-2008
Menendez CC , Konda S , Hendricks S , Amandus H . J Safety Res 2012 44 25-9 PROBLEM: Segments within the retail industry have a substantially higher rate of work-related fatality due to workplace violence compared to the retail industry overall. Certain demographic subgroups may be at higher risk. METHOD: National traumatic injury surveillance data were analyzed to characterize the distribution of fatality rates due to workplace violence among selected retail workers in the United States from 2003 through 2008. RESULTS: Overall, the highest fatality rates due to work-related homicide occurred among men, workers aged ≥ 65 years, black, Asian, foreign-born and Southern workers. Among foreign-born workers, those aged 16-24 years, non-Hispanic whites and Asians experienced substantially higher fatality rates compared to their native-born counterparts. CONCLUSIONS: The burden of work-related homicide in the retail industry falls more heavily on several demographic groups, including racial minorities and the foreign-born. Further research should examine the causes of these trends. Interventions designed to prevent workplace violence should target these groups. |
Plasmodium vivax congenital malaria in an area of very low endemicity in Guatemala: implications for clinical and epidemiological surveillance in a malaria elimination context
Castellanos ME , Bardaji A , Menegon M , Mayor A , Desai M , Severini C , Menendez C , Padilla N . Malar J 2012 11 411 This is a report of the first Plasmodium vivax congenital malaria case in Guatemala and the first case in Latin America with genotypical, histological and clinical characterization. The findings show that maternal P. vivax infection still occurs in areas that are in the pathway towards malaria elimination, and can be associated with detrimental health effects for the neonate. It also highlights the need in very low transmission areas of not only maintaining, but increasing awareness of the problem and developing surveillance strategies, based on population risk, to detect the infection especially in this vulnerable group of the population. |
The first 6 months: transitioning into a new position
Ruiz R , Baker EL . J Public Health Manag Pract 2013 19 (2) 187-9 This column describes 3 strategies that are related to transitioning into a new position, particularly the crucial first 6 months in a new job: understanding resource availability, understanding people, and understanding the organization and its mission. | In a recent Management Moment column, we focused on issues related to job transitions. Whether engaging in succession planning,1 handling the process of successfully transitioning out of a job (a subject for a future column), or settling into a new position, transitions are increasingly common among public health care professionals. Each phase presents its unique challenges and opportunities. In this column, we focus on 3 strategies related to transitioning into a new position, particularly the crucial first 6 months in a new job. In addition to reading this article, we recommend an in-depth treatment of the subject in a classic publication—The First 90 Days in Government—by Peter Daly and Michael Watkins.2 |
Preconception health indicators: a comparison between non-Appalachian and Appalachian women
Short VL , Oza-Frank R , Conrey EJ . Matern Child Health J 2012 16 S238-S249 To compare preconception health indicators (PCHIs) among non-pregnant women aged 18-44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997-2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with C1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting < high school education (adjusted odds ratio (AOR) 1.19, 95 % confidence interval (CI) 1.10-1.29), fair/poor health (AOR 1.14, 95 % CI 1.06-1.22), no health insurance (AOR 1.12, 95 % CI 1.05-1.19), no annual checkup (AOR 1.12, 95 % CI 1.04-1.20), no recent Pap test (AOR 1.20, 95 % CI 1.08-1.33), smoking (AOR 1.08, 95 % CI 1.03-1.14), < 5 daily fruits/vegetables (AOR 1.11, 95 % CI 1.02-1.21), and overweight/obesity (AOR 1.05, 95 % CI 1.01-1.09). Appalachian women in counties with weaker economies had significantly higher odds of reporting less education, no health insurance, < 5 daily fruits/vegetables, overweight/obesity, and poor mental health compared to Appalachian women in counties with the strongest economies. For many PCHIs, Appalachian women did not fare as well as non-Appalachians. Interventions sensitive to Appalachian culture to improve preconception health may be warranted for this population. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract). |
Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006)
Algren DA , Monteilh CP , Punja M , Schier JG , Belson M , Hepler BR , Schmidt CJ , Miller CE , Patel M , Paulozzi LJ , Straetemans M , Rubin C . J Med Toxicol 2013 9 (1) 106-15 BACKGROUND: During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroin-associated fatalities (FHFs) with non-fentanyl, heroin-associated fatalities (NFHFs) among illicit drug users. METHODS: Baseline prevalence of fentanyl- and heroin-associated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status. RESULTS: Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p = 0.003). Women aged over 44 years (OR = 4.67;95 % CI = 1.29-16.96) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n = 96; 95 %): fentanyl was detected in most (n = 91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n = 37; 40.7 %). About half of these samples had detectable cocaine concentrations (n = 20; 54 %). Median fentanyl concentration in central blood samples was 0.02 mcg/ml (n = 91, range <0.002-0.051 mcg/ml) and 0.02 mcg/ml (n = 32, range <0.004-0.069 mcg/ml) in peripheral blood samples. The geometric mean of the ratio of central to peripheral values was 2.10 (median C/P = 1.75). At autopsy, pulmonary edema was the most frequently encountered finding for both groups (77 %). CONCLUSION: Illicit drugs may contain undeclared ingredients that may increase the likelihood of fatality in users. Gender differences in fentanyl-related mortality may be modified by age and/or marital status. These findings may help inform public health and prevention activities if fatalities associated with fentanyl-contaminated illicit drugs reoccur. |
Alaska Native smokers and smokeless tobacco users with slower CYP2A6 activity have lower tobacco consumption, lower tobacco-specific nitrosamine exposure and lower tobacco-specific nitrosamine bioactivation
Zhu AZ , Binnington MJ , Renner CC , Lanier AP , Hatsukami DK , Stepanov I , Watson CH , Sosnoff CS , Benowitz NL , Tyndale RF . Carcinogenesis 2013 34 (1) 93-101 Nicotine, the psychoactive ingredient in tobacco, is metabolically inactivated by CYP2A6 to cotinine. CYP2A6 also activates procarcinogenic tobacco-specific nitrosamines (TSNA). Genetic variation in CYP2A6 is known to alter smoking quantity and lung cancer risk in heavy smokers. Our objective was to investigate how CYP2A6 activity influences tobacco consumption and procarcinogen levels in light smokers and smokeless tobacco users. Cigarette smokers (n = 141), commercial smokeless tobacco users (n = 73) and iqmik users (n = 20) were recruited in a cross-sectional study of Alaska Native people. The participants' CYP2A6 activity was measured by both endophenotype and genotype, and their tobacco and procarcinogen exposure biomarker levels were also measured. Smokers, smokeless tobacco users and iqmik users with lower CYP2A6 activity had lower urinary total nicotine equivalents (TNE) and (methylnitrosamino)-1-(3)pyridyl-1-butanol (NNAL) levels (a biomarker of TSNA exposure). Levels of N-nitrosonornicotine (NNN), a TSNA metabolically bioactivated by CYP2A6, were higher in smokers with lower CYP2A6 activities. Light smokers and smokeless tobacco users with lower CYP2A6 activity reduce their tobacco consumption in ways (e.g. inhaling less deeply) that are not reflected by self-report indicators. Tobacco users with lower CYP2A6 activity are exposed to lower procarcinogen levels (lower NNAL levels) and have lower procarcinogen bioactivation (as indicated by the higher urinary NNN levels suggesting reduced clearance), which is consistent with a lower risk of developing smoking-related cancers. This study demonstrates the importance of CYP2A6 in the regulation of tobacco consumption behaviors, procarcinogen exposure and metabolism in both light smokers and smokeless tobacco users. |
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