Nonfasting sample for the determination of routine lipid profile: Is it an idea whose time has come?
Rifai N , Young IS , Nordestgaard BG , Wierzbicki AS , Vesper H , Mora S , Stone NJ , Genest J , Miller G . Clin Chem 2016 62 (3) 428-35 For many years the determination of a routine lipid profile (total, LDL, and HDL cholesterol and triglycerides) has been done routinely in the clinical laboratory using a blood specimen that is collected in the fasting state. The rationale for such a requirement includes 1) the postprandial changes in lipoprotein composition known to occur, particularly the increases in triglycerides (TG)10 concentration which have a direct relation to the meal fat and carbohydrate content, 2) the clinically significant effects of increased TG (>400 mg/dL; 4.5 mmol/L) on the calculation of LDL cholesterol (LDL-C) when using the Friedewald equation, and 3) the use of fasting samples for lipid measurement in many clinical trials and epidemiological studies on which treatment goals are based. However, because most of each person's lifetime is spent in the postprandial state, the wisdom of collecting a fasting sample to determine future risk of cardiovascular disease has been challenged. In addition, recent evidence has demonstrated that nonfasting TG concentrations are a better predictor of future coronary events compared to fasting TG, in both men and women. The Danish Society for Clinical Biochemistry, in 2009, and the UK National Institute of Clinical Excellence (NICE), in 2014, recommended the use of a nonfasting specimen for the determination of routine lipid profile; both entities acknowledge that in certain situations a fasting sample is required. The European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine will be making a similar recommendation. In contrast, the 2013 guidelines released by the American College of Cardiology/American Heart Association (ACC/AHA) preferred a fasting specimen for lipid testing. Such inconsistencies in published guidelines will complicate the interpretation of the literature and confound metaanalyses. The decision of whether to use a fasting or nonfasting sample, however, will be driven not only by the strong epidemiologic and clinical evidence and the convenience to clinicians and patients but also by the reliability of the analytical techniques used in the measurement of these analytes. To address this issue, we invited a group of experts consisting of cardiologists, epidemiologists, clinical researchers, and clinical chemists to share their views on this topic. |
The effect of comorbidity on the use of adjuvant chemotherapy and type of regimen for curatively resected stage III colon cancer patients
Hsieh MC , Thompson T , Wu XC , Styles T , O'Flarity MB , Morris CR , Chen VW . Cancer Med 2016 5 (5) 871-80 Postsurgical chemotherapy is guideline-recommended therapy for stage III colon cancer patients. Factors associated with patients not receiving adjuvant chemotherapy were identified in numerous studies; comorbidity was recognized as an important factor besides patient's age. We assessed the association between comorbidity and the use of adjuvant chemotherapy and type of chemotherapy regimen. Stage III colon cancer patients who underwent surgical resection were obtained from ten Centers for Disease Control and Prevention (CDC)-NPCR Specialized Registries which participated in the Comparative Effectiveness Research (CER) project. Comorbidity was classified into no comorbidity recorded, Charlson, non-Charlson comorbidities, number, and severity of Charlson comorbidity. Pearson chi-square test and multivariable logistic regression were employed. Of 3180 resected stage III colon cancer patients, 64% received adjuvant chemotherapy. After adjusting for patient's demographic and tumor characteristics, there were no significant differences in receipt of chemotherapy between Charlson and non-Charlson comorbidity. However, patients who had two or more Charlson comorbidities or had moderate to severe disease were significantly less likely to have chemotherapy (ORs 0.69 [95% CI, 0.51-0.92] and 0.62 [95% CI, 0.42-0.91], respectively) when compared with those with non-Charlson comorbidity. In addition, those with moderate or severe comorbidities were more likely to receive single chemotherapy agent (P < 0.0001). Capecitabine and FOLFOX were the most common single- and multi-agent regimens regardless of type of comorbidity grouping. Both the number and severity of comorbidity were significantly associated with receipt of guideline-recommended chemotherapy and type of agent in stage III resected colon cancer patients. Better personalized care based on individual patient's condition ought to be recognized. |
Reasons for missing antiretroviral therapy: results from a multi-country study in Tanzania, Uganda, and Zambia
Koole O , Denison JA , Menten J , Tsui S , Wabwire-Mangen F , Kwesigabo G , Mulenga M , Auld A , Agolory S , Mukadi YD , van Praag E , Torpey K , Williams S , Kaplan J , Zee A , Bangsberg DR , Colebunders R . PLoS One 2016 11 (1) e0147309 OBJECTIVES: To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence. METHODS: Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients' medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months. RESULTS: Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2-7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1-1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms. CONCLUSIONS: Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes. |
Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014
Alraddadi BM , Watson JT , Almarashi A , Abedi GR , Turkistani A , Sadran M , Housa A , Almazroa MA , Alraihan N , Banjar A , Albalawi E , Alhindi H , Choudhry AJ , Meiman JG , Paczkowski M , Curns A , Mounts A , Feikin DR , Marano N , Swerdlow DL , Gerber SI , Hajjeh R , Madani TA . Emerg Infect Dis 2016 22 (1) 49-55 Risk factors for primary Middle East respiratory syndrome coronavirus (MERS-CoV) illness in humans are incompletely understood. We identified all primary MERS-CoV cases reported in Saudi Arabia during March-November 2014 by excluding those with history of exposure to other cases of MERS-CoV or acute respiratory illness of unknown cause or exposure to healthcare settings within 14 days before illness onset. Using a case-control design, we assessed differences in underlying medical conditions and environmental exposures among primary case-patients and 2-4 controls matched by age, sex, and neighborhood. Using multivariable analysis, we found that direct exposure to dromedary camels during the 2 weeks before illness onset, as well as diabetes mellitus, heart disease, and smoking, were each independently associated with MERS-CoV illness. Further investigation is needed to better understand animal-to-human transmission of MERS-CoV. |
School-based sexually transmitted disease screening: review and programmatic guidance
Lewis FM , Dittus P , Salmon ME , Nsuami MJ . Sex Transm Dis 2016 43 S18-27 School-based sexually transmitted disease (STD) screening (SBSS) was designed to provide chlamydia and gonorrhea testing, treatment, and counseling to adolescents in a school setting to overcome some of the difficulties of screening in this population. To inform STD control programs and other entities on decision making about potentially implementing this intervention, we reviewed existing published and gray literature on SBSS from 1998 to 2014. Although they are work-intensive to establish, school-based STD screening programs are a feasible and cost-effective way of testing large numbers of male and female adolescents for chlamydia and gonorrhea, and to provide counseling and treatment to almost all those who are found infected. School-based STD screening programs do not seem to reduce prevalence in either the school or the general adolescent population, although there are currently relatively few studies on large-scale SBSS. More research in this field is needed. |
Linkage and referral to HIV and other medical and social services: A focused literature review for sexually transmitted disease prevention and control programs
Carter MW , Wu H , Cohen S , Hightow-Weidman L , Lecher SL , Peters PJ . Sex Transm Dis 2016 43 S76-82 BACKGROUND: Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. METHODS: Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. RESULTS: Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. CONCLUSIONS: Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain. |
Multiorgan WU polyomavirus infection in bone marrow transplant recipient
Siebrasse EA , Nguyen NL , Willby MJ , Erdman DD , Menegus MA , Wang D . Emerg Infect Dis 2016 22 (1) 24-31 WU polyomavirus (WUPyV) was detected in a bone marrow transplant recipient with severe acute respiratory distress syndrome who died in 2001. Crystalline lattices of polyomavirus-like particles were observed in the patient's lung by electron microscopy. WUPyV was detected in the lung and other tissues by real-time quantitative PCR and identified in the lung and trachea by immunohistochemistry. A subset of WUPyV-positive cells in the lung had morphologic features of macrophages. Although the role of WUPyV as a human pathogen remains unclear, these results clearly demonstrate evidence for infection of respiratory tract tissues in this patient. |
Prevalence and correlates of heterosexual anal intercourse among men and women, 20 U.S. cities
Hess KL , DiNenno E , Sionean C , Ivy W , Paz-Bailey G . AIDS Behav 2016 20 (12) 2966-2975 Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data from heterosexuals recruited in 20 US cities for the 2013 National HIV Behavioral Surveillance system. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. Thirty percent of women and 35 % of men reported HAI in the past year. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. Information that highlights the risk of HIV transmission associated with HAI would complement existing HIV prevention messages focused on heterosexuals in the U.S. |
The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11
Lesko CR , Cole SR , Hall HI , Westreich D , Miller WC , Eron JJ , Li J , Mugavero MJ . Int J Epidemiol 2016 45 (1) 140-50 BACKGROUND: Although antiretroviral therapy (ART) is known to be protective against HIV-related mortality, the expected magnitude of effect is unclear because existing estimates of the effect of ART may not directly generalize to recently HIV-diagnosed persons. METHODS: In this study, we estimated 5-year mortality risks for immediate versus no ART initiation among patients (n = 12 547) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) using the complement of adjusted Kaplan-Meier survival functions. We subsequently standardized estimates to persons diagnosed with HIV in the USA between 2009 and 2011, who were enumerated using national surveillance data. RESULTS: The 5-year mortality, had all patients in the CNICS immediately initiated ART, was 10.6% [95% confidence interval (CI): 9.3%, 11.9%] compared with 28.3% (95% CI: 19.1%, 37.5%) had ART initiation been delayed at least 5 years. The 5-year mortality risk difference due to ART among patients in the CNICS was -17.7% (95% CI: -27.0%, -8.4%). Based on methods for generalizing an estimate from a study sample to a different target population, the expected risk difference due to ART initiation among recently HIV-diagnosed persons in the USA was -19.1% (95% CI: -30.5%, -7.8%). CONCLUSIONS: Immediate ART initiation substantially lowers mortality among persons in the CNICS and this benefit is expected to be similar among persons recently diagnosed with HIV in the USA. We demonstrate a method by which concerns about generalizability can be addressed and evaluated quantitatively. |
Effective interventions to reduce sexually transmitted disease: introduction to the special issue
Peterman TA , Carter MW . Sex Transm Dis 2016 43 S1-2 When the U. S. National Gonorrhea Control Program was launched in 1973, it added a layer of complexity to Programs that had previously focused almost entirely on syphilis.1 Now, there are over 35 sexually transmitted or transmissible pathogens,2 and counting only 8 of them, the prevalence was estimated to be 110 million in the United States in 2008.3 Although interventions to control these infections still fit into the general categories outlined by Thomas Parran in the 1930s,4 there are now more options and approaches, including vaccination, pre-exposure prophylaxis, treatment, education, screening, providing condoms, and more. These interventions are accomplished using partners from community based organizations, federally qualified health centers, departments of corrections, schools, private providers, and business partners like MTV. The mix of STD and potential control strategies varies across populations so programs are quite different in Maine, Montana, Miami, and Memphis. It is now common for programs to be pulled in multiple directions. | Compared to the complexity of navigating through all the issues faced by programs, the goal of this special issue was simple: to summarize the published evidence for effectiveness of various kinds of interventions to control STD, with today’s STD program staff in mind. What does the latest evidence say is more (or less) effective for meeting a program’s goals? How does the literature suggest programs can accomplish more while spending less? We sought to develop a menu of options to help programs identify effective interventions that meet their needs. |
Epidemiology of Haemophilus ducreyi infections
Gonzalez-Beiras C , Marks M , Chen CY , Roberts S , Mitja O . Emerg Infect Dis 2016 22 (1) 1-8 The global epidemiology of Haemophilus ducreyi infections is poorly documented because of difficulties in confirming microbiological diagnoses. We evaluated published data on the proportion of genital and nongenital skin ulcers caused by H. ducreyi before and after introduction of syndromic management for genital ulcer disease (GUD). Before 2000, the proportion of GUD caused by H. ducreyi ranged from 0.0% to 69.0% (35 studies in 25 countries). After 2000, the proportion ranged from 0.0% to 15.0% (14 studies in 13 countries). In contrast, H. ducreyi has been recently identified as a causative agent of skin ulcers in children in the tropical regions; proportions ranged from 9.0% to 60.0% (6 studies in 4 countries). We conclude that, although there has been a sustained reduction in the proportion of GUD caused by H. ducreyi, this bacterium is increasingly recognized as a major cause of nongenital cutaneous ulcers. |
HIV testing among US high school students and young adults
Van Handel M , Kann L , Olsen EO , Dietz P . Pediatrics 2016 137 (2) e20152700 BACKGROUND: We assessed HIV testing trends among high school students and young adults. METHODS: We analyzed National Youth Risk Behavior Survey (YRBS) and Behavioral Risk Factor Surveillance System (BRFSS) data to assess HIV testing prevalence among high school students and young adults aged 18 to 24, respectively. Logistic regression models for each sample stratified by gender and race/ethnicity were estimated to assess trends in the percentages ever tested, with year as a continuous linear variable. We report absolute differences in HIV testing prevalence and model results for 2005-2013 (YRBS) and 2011-2013 (BRFSS). RESULTS: During the study periods, an average of 22% of high school students (17% of male and 27% of female students) who ever had sexual intercourse and 33% of young adults reported ever being tested for HIV. Among high school students, no change was detected in HIV testing prevalence during 2005-2013, regardless of gender or race/ethnicity. Among young adult males, an average of 27% had ever been tested, and no significant changes were detected overall or by race/ethnicity during 2011-2013. Significant decreases in testing prevalence were detected during 2011-2013 among young adult females overall (from 42.4% to 39.5%), young adult white females (from 37.2% to 33.9%), and young adult black females (from 68.9% to 59.9%). CONCLUSIONS: HIV testing prevalence was low among high school students and young adults. No increase in testing among young adult males and decreased testing among young adult black females is concerning given their higher risk of HIV infection. |
Interventions to improve sexually transmitted disease screening in clinic-based settings
Taylor MM , Frasure-Williams J , Burnett P , Park IU . Sex Transm Dis 2016 43 S28-41 BACKGROUND: The asymptomatic nature and suboptimal screening rates of sexually transmitted diseases (STD) call for implementation of successful interventions to improve screening in community-based clinic settings with attention to cost and resources. METHODS: We used MEDLINE to systematically review comparative analyses of interventions to improve STD (chlamydia, gonorrhea, or syphilis) screening or rescreening in clinic-based settings that were published between January 2000 and January 2014. Absolute differences in the percent of the target population screened between comparison groups or relative percent increase in the number of tests or patients tested were used to score the interventions as highly effective (>20% increase) or moderately effective (5%-19% increase) in improving screening. Published cost of the interventions was described where available and, when not available, was estimated. RESULTS: Of the 4566 citations reviewed, 38 articles describing 42 interventions met the inclusion criteria. Of the 42 interventions, 16 (38.1%) were categorized as highly effective and 14 (33.3%) as moderately effective. Effective low-cost interventions (<$1000) included the strategic placement of specimen collection materials or automatic collection of STD specimens as part of a routine visit (7 highly effective and 1 moderately effective) and the use of electronic health records (EHRs; 3 highly effective and 4 moderately effective). Patient reminders for screening or rescreening (via text, telephone, and postcards) were highly effective (3) or moderately effective (2) and low or moderate cost (<$1001-10,000). Interventions with dedicated clinic staff to improve STD screening were highly effective (2) or moderately effective in improving STD screening (1) but high-cost ($10,001-$100,000). CONCLUSIONS: Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be tailored to different clinic settings to improve screening at a low cost. |
Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention
Harris AM , Hicks LA , Qaseem A . Ann Intern Med 2016 164 (6) 425-34 BACKGROUND: Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI. METHODS: A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following MEDICAL SUBJECT HEADINGS TERMS: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold." HIGH-VALUE CARE ADVICE 1: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. HIGH-VALUE CARE ADVICE 2: Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis. HIGH-VALUE CARE ADVICE 3: Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 degrees C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening). HIGH-VALUE CARE ADVICE 4: Clinicians should not prescribe antibiotics for patients with the common cold. |
Assessing the utility of Xpert((R)) MTB/RIF as a screening tool for patients admitted to medical wards in South Africa
Heidebrecht CL , Podewils LJ , Pym AS , Cohen T , Mthiyane T , Wilson D . Sci Rep 2016 6 19391 Many hospital inpatients in South Africa have undiagnosed active and drug-resistant tuberculosis (TB). Early detection of TB is essential to inform immediate infection control actions to minimize transmission risk. We assessed the utility of Xpert((R)) MTB/RIF (GeneXpert) as a screening tool for medical admissions at a large public hospital in South Africa. Consecutive adult patients admitted to medical wards between March-June 2013 were enrolled; sputum specimens were collected and tested by GeneXpert, smear microscopy, and culture. Chest X-rays (CXRs) were conducted as standard care for all patients admitted. We evaluated the proportion of patients identified with TB disease through each diagnostic method. Among enrolled patients whose medical charts were available for review post-discharge, 61 (27%) were diagnosed with TB; 34 (56% of diagnosed TB cases) were GeneXpert positive. When patients in whom TB was identified by other means were excluded, GeneXpert yielded only four additional TB cases. However, GeneXpert identified rifampicin-resistant TB in one patient, who was initially diagnosed based on CXR. The utility of GeneXpert for TB screening was limited in an institution where CXR is conducted routinely and which serves a population in which TB and TB/HIV co-infection are highly prevalent, but it allowed for rapid detection of rifampicin resistance. |
Can we use antibodies to Chlamydia trachomatis as a surveillance tool for national trachoma control programs? Results from a district survey
West SK , Munoz B , Weaver J , Mrango Z , Dize L , Gaydos C , Quinn TC , Martin DL . PLoS Negl Trop Dis 2016 10 (1) e0004352 BACKGROUND: Trachoma is targeted for elimination by 2020. World Health Organization advises districts to undertake surveillance when follicular trachoma (TF) <5% in children 1-9 years and mass antibiotic administration has ceased. There is a question if other tools could be used for surveillance as well. We report data from a test for antibodies to C. trachomatis antigen pgp3 as a possible tool. METHODOLOGY: We randomly sampled 30 hamlets in Kilosa district, Tanzania, and randomly selected 50 children ages 1-9 per hamlet. The tarsal conjunctivae were graded for trachoma (TF), tested for C. trachomatis infection (Aptima Combo2 assay: Hologic, San Diego, CA), and a dried blood spot processed for antibodies to C. trachomatis pgp3 using a multiplex bead assay on a Luminex 100 platform. PRINCIPAL FINDINGS: The prevalence of trachoma (TF) was 0.4%, well below the <5% indicator for re-starting a program. Infection was also low, 1.1%. Of the 30 hamlets, 22 had neither infection nor TF. Antibody positivity overall was low, 7.5% and increased with age from 5.2% in 1-3 year olds, to 9.3% in 7-9 year olds (p = 0.015). In 16 of the 30 hamlets, no children ages 1-3 years had antibodies to pgp3. CONCLUSIONS: The antibody status of the 1-3 year olds indicates low cumulative exposure to infection during the surveillance period. Four years post MDA, there is no evidence for re-emergence of follicular trachoma. |
Careful conversations and careful sex: HIV posttesting experiences among African American men in rural Florida
Aholou TM , Sutton MY , Brown EE . J Rural Health 2016 33 (1) 62-70 PURPOSE: In the United States, black/African American (black) men bear the greatest burden of human immunodeficiency virus (HIV), accounting for 42% of new HIV infections in 2012 despite being 6% of the population. In Florida, heterosexual HIV transmission has increased among black men. Few studies have examined HIV testing experiences for black heterosexual men (BHM) in the rural South. This study describes the post-HIV-testing trial experiences of BHM in rural Florida. METHODS: We conducted 12 focus groups (4-7 participants per group) in 3 rural Florida counties with BHM who participated in a larger randomized HIV testing trial. Interviews were professionally transcribed and data were analyzed using NVivo 10. The qualitative analysis was informed by the strengths perspective (ie, emphasis on abilities rather than risks) and used a thematic analytical approach. RESULTS: Sixty-seven men participated (median age 41.5 years); 39 (58%) earned a monthly income of less than $500, 38 (57%) attained education through high school or higher, 37 (55%) were unmarried, and 40 (60%) reported practicing monogamy; all who tested for HIV were negative for HIV. We identified 3 main themes based on self-reported actions: (1) risk reduction (eg, more consistent condom use, fewer sex partners), (2) sexual health communications with sex partners (eg, negotiating HIV testing with sex partners, getting to know partners better), and (3) health communications with peers and family (eg, disclosing test results, encouraging others to get tested). CONCLUSIONS: Among BHM, being in this HIV testing study facilitated increased protective behaviors and communications for HIV prevention. Interventions for BHM in rural areas warrant incorporating these strategies to encourage routine HIV testing. |
Divergent seasonal patterns of influenza types A and B across latitude gradient in tropical Asia
Saha S , Chadha M , Shu Y , Lijie W , Chittaganpitch M , Waicharoen S , Lindblade KA , Phengta V , Phonekeo D , Corwin A , Touch S , Buchy P , Lin R , Low C , Kheong CC , Yusof AB , Tandoc A 3rd , Roque V Jr , Arguelles V , Dawood FS , Moen A , Widdowson MA , Cox NJ , Lal RB . Influenza Other Respir Viruses 2016 10 (3) 176-84 METHODS: We analyzed influenza surveillance data from nine countries around southern and southeastern Asia spanning latitudinal gradient from equatorial to temperate zones to further characterize influenza type specific seasonality in the region. We calculated proportion of positives by month out of positives during that year and adjust for variation in samples tested and positivity in these countries. RESULTS: Influenza A epidemics were identified between November-March during winters in areas lying above 30o N latitude; during monsoon months of June-November in areas between 10o -30o N latitude, and no specific seasonality for influenza A virus circulation in areas lying closer to the equator. Influenza B circulation coincided with influenza A circulation in areas lying above 30o N latitude; however in areas south of 30o N Asia, influenza B circulated year round at 3-8% of annual influenza B positives during most months with less pronounced peaks during post-monsoon period. CONCLUSION: Even though influenza B circulates round the year in most areas of the tropical southern and southeastern Asia region, the most appropriate time for influenza vaccination would be prior to the monsoon season conferring protection against influenza A and B peaks using the most recent WHO recommended vaccine. This article is protected by copyright. All rights reserved. |
A matter of perspective: Comparison of the characteristics of persons with HIV infection in the United States from the HIV Outpatient Study, Medical Monitoring Project, and National HIV Surveillance System
Buchacz K , Frazier EL , Hall HI , Hart R , Huang P , Franklin D , Hu X , Palella FJ , Chmiel JS , Novak RM , Wood K , Yangco B , Armon C , Brooks JT , Skarbinski J . Open AIDS J 2015 9 123-133 Comparative analyses of the characteristics of persons living with HIV infection (PLWH) in the United States (US) captured in surveillance and other observational databases are few. To explore potential joint data use to guide HIV treatment and prevention in the US, we examined three CDC-funded data sources in 2012: the HIV Outpatient Study (HOPS), a multisite longitudinal cohort; the Medical Monitoring Project (MMP), a probability sample of PLWH receiving medical care; and the National HIV Surveillance System (NHSS), a surveillance system of all PLWH. Overall, data from 1,697 HOPS, 4,901 MMP, and 865,102 NHSS PLWH were analyzed. Compared with the MMP population, HOPS participants were more likely to be older, non-Hispanic/Latino white, not using injection drugs, insured, diagnosed with HIV before 2009, prescribed antiretroviral therapy, and to have most recent CD4+ T-lymphocyte cell count ≥ 500 cells/mm(3) and most recent viral load <200 copies/mL. The MMP population was demographically similar to all PLWH in NHSS, except it tended to be slightly older, HIV diagnosed more recently, and to have AIDS. Our comparative results provide an essential first step for combined epidemiologic data analyses to inform HIV care and prevention for PLWH in the US. |
Consistency of condom use during receptive anal intercourse among women and men who have sex with men: Findings from the Safe in the City behavioral study
D'Anna LH , Warner L , Margolis AD , Korosteleva OA , O'Donnell L , Rietmeijer CA , Klausner JD , Malotte CK . Sex Transm Dis 2015 42 (7) 393-9 BACKGROUND: Unprotected receptive anal intercourse poses HIV risk for men who have sex with men (MSM) and heterosexual women. Little is known about differences in consistent condom use during anal intercourse among these populations. METHODS: Data were analyzed from a nested study conducted from 2004 to 2005 within a behavioral intervention trial of approximately 40,000 urban US sexually transmitted disease clinic patients. Analyses were restricted to women and MSM who reported receptive anal intercourse with at least 1 partner in the prior 3 months at baseline, or 3-month follow-up surveys. Condom use was categorized as consistent (100% of receptive acts) or inconsistent/nonuse (0-99% of receptive acts). Multivariable regression with general estimating equations was used to identify factors associated with consistent condom use within each population. RESULTS: Approximately 31% of women and 70% of MSM reported receptive anal intercourse at least once in the past 3 months. Men who have sex with men were significantly more likely to report consistent condom use compared with women. For women, intention to use condoms, partner support for condom use, the belief they could stop having sex when condoms were unavailable, and believing their partner had not given them a sexually transmitted infection (STI) were associated with using condoms consistently. For MSM, intention to use condoms, condom use self-efficacy, perceived partner support for condom use, having a nonmain partner, believing their partner had not given them an STI, and fewer sex acts were associated with consistent condom use. CONCLUSIONS: Findings confirm the importance of considering anal intercourse when assessing STI/HIV risk in MSM and heterosexual women. |
County-scale distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the continental United States
Eisen RJ , Eisen L , Beard CB . J Med Entomol 2016 53 (2) 349-86 The blacklegged tick, Ixodes scapularis Say, is the primary vector to humans in the eastern United States of the Lyme disease spirochete Borrelia burgdorferi, as well as causative agents of anaplasmosis and babesiosis. Its close relative in the far western United States, the western blacklegged tick Ixodes pacificus Cooley and Kohls, is the primary vector to humans in that region of the Lyme disease and anaplasmosis agents. Since 1991, when standardized surveillance and reporting began, Lyme disease case counts have increased steadily in number and in geographical distribution in the eastern United States. Similar trends have been observed for anaplasmosis and babesiosis. To better understand the changing landscape of risk of human exposure to disease agents transmitted by I. scapularis and I. pacificus, and to document changes in their recorded distribution over the past two decades, we updated the distribution of these species from a map published in 1998. The presence of I. scapularis has now been documented from 1,420 (45.7%) of the 3,110 continental United States counties, as compared with 111 (3.6%) counties for I. pacificus. Combined, these vectors of B. burgdorferi and other disease agents now have been identified in a total of 1,531 (49.2%) counties spread across 43 states. This marks a 44.7% increase in the number of counties that have recorded the presence of these ticks since the previous map was presented in 1998, when 1,058 counties in 41 states reported the ticks to be present. Notably, the number of counties in which I. scapularis is considered established (six or more individuals or one or more life stages identified in a single year) has more than doubled since the previous national distribution map was published nearly two decades ago. The majority of county status changes occurred in the North-Central and Northeastern states, whereas the distribution in the South remained fairly stable. Two previously distinct foci for I. scapularis in the Northeast and North-Central states appear to be merging in the Ohio River Valley to form a single contiguous focus. Here we document a shifting landscape of risk for human exposure to medically important ticks and point to areas of re-emergence where enhanced vector surveillance and control may be warranted. |
Reconstruction of bisphenol A intake using a simple pharmacokinetic model
Christensen KL , Lorber M , Ye X , Calafat AM . J Expo Sci Environ Epidemiol 2015 25 (3) 240-8 Bisphenol A (BPA) is used in the manufacture of a range of consumer products, and human biomonitoring studies suggest that exposure to BPA is nearly ubiquitous. We constructed and calibrated a simple pharmacokinetic model to predict urinary concentrations of BPA based on a known initial dose. This descriptive (rather than physiologically based) model has three compartments: "stomach/liver," "blood," and "bladder." We calibrated and validated the model parameters using blood and urine measurements from nine volunteers who consumed 5 mg of d(1)(6)-BPA. We then applied the model to a second group of eight persons, who supplied full volumes of urine over 7 consecutive days and a diary identifying times and types of food and beverage consumed, to "reconstruct" the time and mass of BPA intakes. These reconstructed daily intakes ranged on average from 60 to 100 ng/kg-day, within the range of, but slightly higher than, those surmised from other studies. About two-thirds of intakes occurred within an hour of reported food or drink consumption, supporting the hypothesis that diet is the main pathway of exposure to BPA. However, one-third of all reconstructed intakes took place outside this time window, suggesting that other sources of BPA exposure may also be relevant. |
International travellers from New Jersey: piloting a travel health module in the 2011 Behavioral Risk Factor Surveillance System survey
Stoney RJ , Kozarsky P , Bostick RM , Sotir MJ . J Travel Med 2016 23 (1) BACKGROUND: In 2011, the Centers for Disease Control and Prevention and the New Jersey Department of Health used the New Jersey Behavioral Risk Factor Survey (NJBRFS), a state component of the national Behavioral Risk Factor Surveillance System (BRFSS) to pilot a travel health module designed to collect population-based data on New Jersey residents travelling internationally. Our objective was to use this population-based travel health information to serve as a baseline to evaluate trends in US international travellers. METHODS: A representative sample of New Jersey residents was identified through a random-digit-dialing method and administered the travel health module, which asked five questions: travel outside of USA during the previous year; destination; purpose; if a healthcare provider was visited before travel and any travel-related illness. Additional health variables from the larger NJBRFS were considered and included in bivariate analyses and multiple logistic regression; weights were assigned to variables to account for survey design complexity. RESULTS: Of 4029 participants, 841 (21%) travelled internationally. Top destinations included Mexico (10%), Canada (9%), Dominican Republic (6%), Bahamas (5%) and Italy (5%). Variables positively associated with travel included foreign birth, ≥$75 000 annual household income, college education and no children living in the household. One hundred fifty (18%) of 821 travellers with known destinations went to high-risk countries; 40% were visiting friends and relatives and only 30% sought pre-travel healthcare. Forty-eight (6%) of 837 responding travellers reported travel-related illness; 44% visited high-risk countries. CONCLUSIONS: Approximately one in five NJBRFS respondents travelled internationally during the previous year, a sizeable proportion to high-risk destinations. Few reported becoming ill as a result of travel but almost one-half of those ill had travelled to high-risk destinations. Population-based surveillance data on travellers can help document trends in destinations, traveller type and disease prevalence and evaluate the effectiveness of disease prevention programmmes. |
World Health Organization estimates of the relative contributions of food to the burden of disease due to selected foodborne hazards: a structured expert elicitation
Hald T , Aspinall W , Devleesschauwer B , Cooke R , Corrigan T , Havelaar AH , Gibb HJ , Torgerson PR , Kirk MD , Angulo FJ , Lake RJ , Speybroeck N , Hoffmann S . PLoS One 2016 11 (1) e0145839 BACKGROUND: The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. METHODS AND FINDINGS: We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. CONCLUSIONS: For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives. |
Multilocus sequence typing analysis reveals that Cryptococcus neoformans var. neoformans is a recombinant population.
Cogliati M , Zani A , Rickerts V , McCormick I , Desnos-Ollivier M , Velegraki A , Escandon P , Ichikawa T , Ikeda R , Bienvenue AL , Tintelnot K , Tore O , Akcaglar S , Lockhart S , Tortorano AM , Varma A . Fungal Genet Biol 2016 87 22-29 Cryptococcus neoformans var. neoformans (serotype D) represents about 30% of the clinical isolates in Europe and is present less frequently in the other continents. It is the prevalent etiological agent in primary cutaneous cryptococcosis as well as in cryptococcal skin lesions of disseminated cryptococcosis. Very little is known about the genotypic diversity of this Cryptococcus subtype. The aim of this study was to investigate the genotypic diversity among a set of clinical and environmental C. neoformans var. neoformans isolates and to evaluate the relationship between genotypes, geographical origin and clinical manifestations. A total of 83 globally collected C. neoformans var. neoformans isolates from Italy, Germany, France, Belgium, Denmark, Greece, Turkey, Thailand, Japan, Colombia, and the USA, recovered from different sources (primary and secondary cutaneous cryptococcosis, disseminated cryptococcosis, the environment, and animals), were included in the study. All isolates were confirmed to belong to genotype VNIV by molecular typing and they were further investigated by MLST analysis. Maximum likelihood phylogenetic as well as network analysis strongly suggested the existence of a recombinant rather than a clonal population structure. Geographical origin and source of isolation were not correlated with a specific MLST genotype. The comparison with a set of outgroup C. neoformans var. grubii isolates provided clear evidence that the two varieties have different population structures. |
Whole genome multilocus sequence typing as an epidemiologic tool for Yersinia pestis.
Kingry LC , Rowe LA , Respicio-Kingry LB , Beard CB , Schriefer ME , Petersen JM . Diagn Microbiol Infect Dis 2015 84 (4) 275-80 Human plague is a severe and often fatal zoonotic disease caused by Yersinia pestis. For public health investigations of human cases, nonintensive whole genome molecular typing tools, capable of defining epidemiologic relationships, are advantageous. Whole genome multilocus sequence typing (wgMLST) is a recently developed methodology that simplifies genomic analyses by transforming millions of base pairs of sequence into character data for each gene. We sequenced 13 US Y. pestis isolates with known epidemiologic relationships. Sequences were assembled de novo, and multilocus sequence typing alleles were assigned by comparison against 3979 open reading frames from the reference strain CO92. Allele-based cluster analysis accurately grouped the 13 isolates, as well as 9 publicly available Y. pestis isolates, by their epidemiologic relationships. Our findings indicate wgMLST is a simplified, sensitive, and scalable tool for epidemiologic analysis of Y. pestis strains. |
Characterization of Bacterial Communities in Selected Smokeless Tobacco Products Using 16S rDNA Analysis.
Tyx RE , Stanfill SB , Keong LM , Rivera AJ , Satten GA , Watson CH . PLoS One 2016 11 (1) e0146939 The bacterial communities present in smokeless tobacco (ST) products have not previously reported. In this study, we used Next Generation Sequencing to study the bacteria present in U.S.-made dry snuff, moist snuff and Sudanese toombak. Sample diversity and taxonomic abundances were investigated in these products. A total of 33 bacterial families from four phyla, Actinobacteria, Firmicutes, Proteobacteria and Bacteroidetes, were identified. U.S.-produced dry snuff products contained a diverse distribution of all four phyla. Moist snuff products were dominated by Firmicutes. Toombak samples contained mainly Actinobacteria and Firmicutes (Aerococcaceae, Enterococcaceae, and Staphylococcaceae). The program PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) was used to impute the prevalence of genes encoding selected bacterial toxins, antibiotic resistance genes and other pro-inflammatory molecules. PICRUSt also predicted the presence of specific nitrate reductase genes, whose products can contribute to the formation of carcinogenic nitrosamines. Characterization of microbial community abundances and their associated genomes gives us an indication of the presence or absence of pathways of interest and can be used as a foundation for further investigation into the unique microbiological and chemical environments of smokeless tobacco products. |
Treatment costs of breast cancer among younger women aged 19-44 years enrolled in Medicaid
Ekwueme DU , Allaire BT , Guy GP Jr , Arnold S , Trogdon JG . Am J Prev Med 2016 50 (2) 278-85 INTRODUCTION: A few studies have examined the costs of breast cancer treatment in a Medicaid population at the state level. However, no study has estimated medical costs for breast cancer treatment at the national level for women aged 19-44 years enrolled in Medicaid. METHODS: A sample of 5,542 younger women aged 19-44 years enrolled in fee-for-service Medicaid with diagnosis codes for breast cancer in 2007 were compared with 4.3 million women aged 19-44 years enrolled in fee-for-service Medicaid without breast cancer. Nonlinear regression methods estimated prevalent treatment costs for younger women with breast cancer compared with those without breast cancer. Individual medical costs were estimated by race/ethnicity and by type of services. Analyses were conducted in 2013 and all medical treatment costs were adjusted to 2012 U.S. dollars. RESULTS: The estimated monthly direct medical costs for breast cancer treatment among younger women enrolled in Medicaid was $5,711 (95% CI=$5,039, $6,383) per woman. The estimated monthly cost for outpatient services was $4,058 (95% CI=$3,575, $4,541), for inpatient services was $1,003 (95% CI=$708, $1,298), and for prescription drugs was $539 (95% CI=$431, $647). By race/ethnicity, non-Hispanic white women had the highest monthly total medical costs, followed by Hispanic women and non-Hispanic women of other race. CONCLUSIONS: Cost estimates demonstrate the substantial medical costs associated with breast cancer treatment for younger Medicaid beneficiaries. As the Medicaid program continues to evolve, the treatment cost estimates could serve as important inputs in decision making regarding planning for treatment of invasive breast cancer in this population. |
Zimbabwe's national AIDS levy: A case study
Bhat N , Kilmarx PH , Dube F , Manenji A , Dube M , Magure T . SAHARA J 2016 13 (1) 1-7 BACKGROUND: We conducted a case study of the Zimbabwe National AIDS Trust Fund ('AIDS Levy') as an approach to domestic government financing of the response to HIV and AIDS. METHODS: Data came from three sources: a literature review, including a search for grey literature, review of government documents from the Zimbabwe National AIDS Council (NAC), and key informant interviews with representatives of the Zimbabwean government, civil society and international organizations. FINDINGS: The literature search yielded 139 sources, and 20 key informants were interviewed. Established by legislation in 1999, the AIDS Levy entails a 3% income tax for individuals and 3% tax on profits of employers and trusts (which excluded the mining industry until 2015). It is managed by the parastatal NAC through a decentralized structure of AIDS Action Committees. Revenues increased from inception to 2006 through 2008, a period of economic instability and hyperinflation. Following dollarization in 2009, annual revenues continued to increase, reaching US$38.6 million in 2014. By policy, at least 50% of funds are used for purchase of antiretroviral medications. Other spending includes administration and capital costs, HIV prevention, and monitoring and evaluation. Several financial controls and auditing systems are in place. Key informants perceived the AIDS Levy as a 'homegrown' solution that provided country ownership and reduced dependence on donor funding, but called for further increased transparency, accountability, and reduced administrative costs, as well as recommended changes to increase revenue. CONCLUSIONS: The Zimbabwe AIDS Levy has generated substantial resources, recently over US$35 million per year, and signals an important commitment by Zimbabweans, which may have helped attract other donor resources. Many key informants considered the Zimbabwe AIDS Levy to be a best practice for other countries to follow. |
Medical care costs of breast cancer in privately insured women aged 18-44 years
Allaire BT , Ekwueme DU , Guy GP Jr , Li C , Tangka FK , Trivers KF , Sabatino SA , Rodriguez JL , Trogdon JG . Am J Prev Med 2016 50 (2) 270-7 INTRODUCTION: Breast cancer in women aged 18-44 years accounts for approximately 27,000 newly diagnosed cases and 3,000 deaths annually. When tumors are diagnosed, they are usually aggressive, resulting in expensive treatment costs. The purpose of this study is to estimate the prevalent medical costs attributable to breast cancer treatment among privately insured younger women. METHODS: Data from the 2006 MarketScan(R) database representing claims for privately insured younger women were used. Costs for younger breast cancer patients were compared with a matched sample of younger women without breast cancer, overall and for an active treatment subsample. Analyses were conducted in 2013 with medical care costs expressed in 2012 U.S. dollars. RESULTS: Younger women with breast cancer incurred an estimated $19,435 (SE=$415) in additional direct medical care costs per person per year compared with younger women without breast cancer. Outpatient expenditures comprised 94% of the total estimated costs ($18,344 [SE=$396]). Inpatient costs were $43 (SE=$10) higher and prescription drug costs were $1,048 (SE=$64) higher for younger women with breast cancer than in younger women without breast cancer. For women in active treatment, the burden was more than twice as high ($52,542 [SE=$977]). CONCLUSIONS: These estimates suggest that breast cancer is a costly illness to treat among younger, privately insured women. This underscores the potential financial vulnerability of women in this age group and the importance of health insurance during this time in life. |
Productivity costs associated with breast cancer among survivors aged 18-44 years
Ekwueme DU , Trogdon JG , Khavjou OA , Guy GP Jr . Am J Prev Med 2016 50 (2) 286-94 INTRODUCTION: No study has quantified productivity losses associated with breast cancer in younger women aged 18-44 years. This study estimated productivity costs, including work and home productivity losses, among younger women who reported ever receiving a breast cancer diagnosis. METHODS: A two-part regression model and 2000-2010 National Health Interview Survey data were used to estimate the number of work and home productivity days missed because of breast cancer, adjusted for socioeconomic characteristics and comorbidities. Estimates for younger women were compared with those for women aged 45-64 years. Data were analyzed in 2013-2014. RESULTS: Per capita, younger women with breast cancer had annual losses of $2,293 (95% CI=$1,069, $3,518) from missed work and $442 (95% CI=$161, $723) from missed home productivity. Total annual breast cancer-associated productivity costs for younger women were $344 million (95% CI=$154 million, $535 million). Older women with breast cancer had lower per capita work loss productivity costs of $1,407 (95% CI=$899, $1,915) but higher total work loss productivity costs estimated at $1,072 million (95% CI=$685 million, $1,460 million) than younger women. CONCLUSIONS: Younger women with a history of breast cancer face a disproportionate share of work and home productivity losses. Although older women have lower per capita costs, total productivity costs were higher for older women because the number of older women with breast cancer is higher. The results underscore the importance of continued efforts by the public health community to promote and support the unique needs of younger breast cancer survivors. |
Economic evaluation of community water fluoridation: A Community Guide systematic review
Ran T , Chattopadhyay SK . Am J Prev Med 2016 50 (6) 790-796 CONTEXT: A recently updated Community Guide systematic review of the effectiveness of community water fluoridation once again found evidence that it reduces dental caries. Although community water fluoridation was found to save money in a 2002 Community Guide systematic review, the conclusion was based on studies conducted before 1995. Given the update to the effectiveness review, re-examination of the benefit and cost of community water fluoridation is necessary. EVIDENCE ACQUISITION: Using methods developed for Community Guide economic reviews, 564 studies were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering community fluoridation benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost effectiveness of community water fluoridation. All currencies were converted to 2013 dollars. EVIDENCE SYNTHESIS: The analysis was conducted in 2014. The benefit-only studies used regression analysis, showing that different measures of dental costs were always lower in communities with water fluoridation. For the six cost-benefit studies, per capita annual intervention cost ranged from $0.11 to $4.92 for communities with at least 1,000 population, and per capita annual benefit ranged from $5.49 to $93.19. Benefit-cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size. CONCLUSIONS: Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit-cost ratio increases with the community population size. |
The economics of breast cancer in younger women in the U.S.: The present and future
Ekwueme DU , Trogdon JG . Am J Prev Med 2016 50 (2) 249-54 In the past four decades, substantial progress has been made in breast cancer survival in part because of advances in early detection and treatment following diagnosis.1,2 Further, recent studies3,4 have reported that the observed improvement in breast cancer mortality and survival between the 1970s and 2000s is also the result of changes in the distribution of tumor characteristics, which include the identification of the human epidermal growth factor receptor 2 and the development of the targeted agent such as trastuzumab that extends survival in both the adjuvant and metastatic settings for a range of 15%–25% of patients with human epidermal growth factor receptor 2–positive tumors. For example, in 2012, the annual age-adjusted breast cancer mortality was approximately 21 per 100,000 and 5-year relative survival exceeded 90%.5 Despite this progress, not all age, racial/ethnic, or socioeconomic groups have benefited equally, and disparities in incidence and mortality still exist.6 During the past four decades, incidence of breast cancer was much higher in older women (aged >50 years) and the survival rate was lower in younger women (aged <50 years).7 This is in part because breast cancer in women aged 15–44 years (henceforth referred to as younger women) is often characterized by aggressive tumor subtypes that are less likely to be amenable to treatment at the time of diagnosis and have poorer survival outcomes.8–11 As a result, these breast cancers could result in more devastating health outcomes and economic burden to younger women, their families, and society. |
Health state utility impact of breast cancer in U.S. women aged 18-44 years
Brown DS , Trogdon JG , Ekwueme DU , Chamiec-Case L , Guy GP Jr , Tangka FK , Li C , Trivers KF , Rodriguez JL . Am J Prev Med 2016 50 (2) 255-61 INTRODUCTION: Breast cancer affects women's health-related quality of life negatively, but little is known about how breast cancer affects this in younger women aged 18-44 years. This study measures preference-based health state utility (HSU) values, a scaled index of health-related quality of life for economic evaluation, for younger women with breast cancer and compares these values with same-age women with other cancers and older women (aged ≥45 years) with breast cancer. METHODS: Data from the 2009 and 2010 Behavioral Risk Factor Surveillance System were analyzed in 2014. The sample included 218,852 women; 7,433 and 18,577 had histories of breast and other cancers. HSU values were estimated using Healthy Days survey questions and a published mapping algorithm. Linear regression models for HSU were estimated by age group (18-44 and ≥45 years). RESULTS: The adjusted breast cancer HSU impact was four times larger for younger women than for older women (-0.097 vs -0.024, p<0.001). For younger women, the effect of breast cancer on HSU was 70% larger than that of other cancers (-0.097 vs -0.057, p=0.024). CONCLUSIONS: Younger breast cancer survivors reported lower HSU values than older survivors, highlighting the impact of breast cancer on the physical and mental health of younger women. The estimates may be used to evaluate quality-adjusted life-years or expectancy for prevention or treatment of breast cancer. This study also indicates that separate quality of life adjustments for women by age group are important for economic analysis of public health breast cancer interventions. |
Breast cancer in young women: Health state utility impacts by race/ethnicity
Trogdon JG , Ekwueme DU , Chamiec-Case L , Guy GP Jr . Am J Prev Med 2016 50 (2) 262-9 INTRODUCTION: Little is known about the effect of breast cancers on health-related quality of life among women diagnosed between age 18 and 44 years. The goal of this study is to estimate the effect of breast cancer on health state utility by age at diagnosis (18-44 years versus ≥45 years) and by race/ethnicity. METHODS: The analytic sample, drawn from the 2009 and 2010 Behavioral Risk Factor Surveillance System and analyzed in 2013, included women diagnosed with breast cancer between age 18 and 44 years (n=1,389) and age ≥45 years (n=6,037). Health state utility values were estimated using Healthy Days variables and a published algorithm. Regression analysis was conducted separately by age at diagnosis and race/ethnicity. RESULTS: The breast cancer health state utility decrement within 1 year from date of diagnosis was larger for women diagnosed at age 18-44 years than for women diagnosed at age ≥45 years (-0.116 vs -0.070, p<0.05). Within the younger age-at-diagnosis group, Hispanic women 2-4 years after diagnosis had the largest health state utility decrement (-0.221, p<0.01), followed by non-Hispanic white women within 1 year of diagnosis (-0.126, p<0.01). CONCLUSIONS: This study is the first to report estimates of health state utility values for breast cancer by age at diagnosis and race/ethnicity from a nationwide sample. The results highlight the need for separate quality of life adjustments for women by age at diagnosis and race/ethnicity when conducting cost-effectiveness analysis of breast cancer prevention, detection, and treatment. |
Retrospective assessment of cost savings from prevention. Folic acid fortification and spina bifida in the US
Grosse SD , Berry RJ , Mick Tilford J , Kucik JE , Waitzman NJ . Am J Prev Med 2015 50 S74-S80 INTRODUCTION: Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997-1998. METHODS: Estimates of annual numbers of live-born spina bifida cases in 1995-1996 relative to 1999-2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings. RESULTS: The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million. CONCLUSIONS: The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries. |
Factors associated with a successful expansion of influenza vaccination among pregnant women in Nicaragua
Arriola CS , Vasconez N , Thompson M , Mirza S , Moen AC , Bresee J , Talavera I , Ropero AM . Vaccine 2016 34 (8) 1086-90 BACKGROUND: Pregnant women are at risk of severe influenza disease and are a priority group for influenza vaccination programs. Nicaragua expanded recommendations to include influenza vaccination to all pregnant women in the municipality of Managua in 2013. METHODS: We carried out a survey among 1,807 pregnant women who delivered at public hospitals in the municipality of Managua to evaluate the uptake of influenza vaccination and factors associated with vaccination. RESULTS: We observed a high (71%) uptake of influenza vaccination among this population, with no differences observed by age, education or parity of the women. Having four antenatal visits and five or more visits were associated with receipt of influenza vaccination (AORs: 2.58; 95% CI: 1.15, 5.81, and 2.37; 95% CI: 1.12, 5.0, respectively). Also, receipt of influenza vaccination recommendation from a health care provider was positively associated with receipt of influenza vaccination (AOR: 14.22; 95% CI: 10.45, 19.33). CONCLUSIONS: The successful expansion of influenza vaccination among pregnant women in the municipality of Managua may be due to ready access to free medical care and health care providers' recommendation for vaccination at health care clinics that received influenza vaccine. |
High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction
Conklin LM , Bigogo G , Jagero G , Hampton L , Junghae M , da Gloria Carvalho M , Pimenta F , Beall B , Taylor T , Plikaytis B , Laserson KF , Vulule J , Van Beneden C , Whitney CG , Breiman RF , Feikin DR . BMC Infect Dis 2016 16 (1) 18 BACKGROUND: Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and sepsis in developing countries, particularly among children and HIV-infected persons. Pneumococcal oropharyngeal (OP) or nasopharyngeal (NP) colonization is a precursor to development of invasive disease. New conjugate vaccines hold promise for reducing colonization and disease. METHODS: Prior to introduction of 10-valent pneumococcal conjugate vaccine (PCV10), we conducted a cross-sectional survey among HIV-infected parents of children <5 years old in rural Kenya. Other parents living with an HIV-infected adult were also enrolled. After broth enrichment, NP and OP swabs were cultured for pneumococcus. Serotypes were identified by Quellung. Antimicrobial susceptibility was performed using broth microdilution. RESULTS: We enrolled 973 parents; 549 (56.4 %) were HIV-infected, 153 (15.7 %) were HIV-uninfected and 271 (27.9 %) had unknown HIV status. Among HIV-infected parents, the median age was 32 years (range 15-74) and 374/549 (68 %) were mothers. Pneumococci were isolated from 237/549 (43.2 %) HIV-infected parents and 41/153 (26.8 %) HIV-non-infected parents (p = 0.0003). Colonization with PCV10 serotypes was not significantly more frequent in HIV-infected (12.9 %) than HIV-uninfected parents (11.8 %; p = 0.70). Among HIV-infected parents, cooking site separate from sleeping area and CD4 count >250 were protective (OR = 0.6; 95 % CI 0.4, 0.9 and OR = 0.5; 95 % CI 0.2, 0.9, respectively); other associations were not identified. Among 309 isolates tested from all parents, 255 (80.4 %) were penicillin non-susceptible (MIC ≥0.12 mug/ml). CONCLUSIONS: Prevalence of pneumococcal colonization is high among HIV-infected parents in rural Kenya. If young children are the pneumococcal reservoir for this population, PCV10 introduction may reduce vaccine-type colonization and disease among HIV-infected parents through indirect protection. |
HPV vaccination and complex regional pain syndrome: lack of evidence
Weinbaum CM , Cano M . EBioMedicine 2015 2 (9) 1014-5 Many studies have documented the reduction of HPV vaccine type prevalence, cervical lesions, and genital warts in adolescent girls in the years since the introduction of the first HPV vaccine in 2006 (Markowitz et al., 2014, Hariri et al., 2015, Smith et al., 2015). In addition, HPV vaccines have been found to be quite safe: clinical trials and numerous post-licensure safety studies have found no consistent evidence of causal association of HPV vaccination with prespecified health conditions including Guillain–Barré syndrome, stroke, venous thromboembolism, appendicitis, seizures, allergic reactions, anaphylaxis, autoimmune disorders, or a variety of neurologic conditions (Markowitz et al., 2014). However, a number of countries have received, and continue to receive, reports alleging the association of HPV vaccination with a variety of adverse health events, many of which have been systematically investigated and no causal relationships found (Wilson et al., 2015). Reports have engendered a spectrum of immunization program responses (Wilson et al., 2015). In 2013, subsequent to a concern about Complex Regional Pain Syndrome (CRPS) after receipt of HPV 16/18 vaccine, Japan temporarily suspended the national HPV vaccination recommendation. In this issue of EBioMedicine, the risk of CRPS after receipt of HPV 16/18 vaccine is explored in a study by Huygen et al. (2015). |
The predictive influence of youth assets on drinking and driving behaviors in adolescence and young adulthood
Haegerich TM , Shults RA , Oman RF , Vesely SK . J Prim Prev 2016 37 (3) 231-45 Drinking and driving among adolescents and young adults remains a significant public health burden. Etiological research is needed to inform the development and selection of preventive interventions that might reduce alcohol-involved crashes and their tragic consequences. Youth assets-that is, skills, competencies, relationships, and opportunities-can help youth overcome challenges, successfully transition into adulthood, and reduce problem behavior. We examined the predictive influence of individual, relationship, and community assets on drinking and driving (DD) and riding with a drinking driver (RDD). We assessed prospective relationships through analysis of data from the Youth Assets Study, a community-based longitudinal study of socio-demographically diverse youth. Results from calculation of marginal models using a Generalized Estimating Equation approach revealed that parent and peer relationship and school connectedness assets reduced the likelihood of both drinking and driving and riding with a drinking driver approximately 1 year later. The most important and consistent asset that influenced DD and RDD over time was parental monitoring, highlighting the role of parental influence extending beyond the immediate teen driving context into young adulthood. Parenting-focused interventions could influence factors that place youth at risk for injury from DD to RDD, complementing other evidence-based strategies such as school-based instructional programs and zero tolerance Blood Alcohol Concentration laws for young and inexperienced drivers. |
Life expectancy after inpatient rehabilitation for traumatic brain injury in the United States
Harrison-Felix C , Pretz C , Hammond FM , Cuthbert JP , Bell J , Corrigan J , Miller AC , Haarbauer-Krupa J . J Neurotrauma 2015 32 (23) 1893-901 This study characterized life expectancy after traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those ≥16 years of age completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. Results indicated that a total of 1325 deaths occurred in the weighted cohort of 6913 individuals. Individuals with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of 9 years. Independent risk factors for death were: older age, male gender, less-than-high school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death from seizures; accidental poisonings; sepsis; aspiration pneumonia; respiratory, mental/behavioral, or nervous system conditions; and other external causes of injury and poisoning, compared with individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US. There is an increased risk of death for individuals with TBI requiring inpatient rehabilitation. |
Cryptosporidium proliferans n. sp. (Apicomplexa: Cryptosporidiidae): Molecular and Biological Evidence of Cryptic Species within Gastric Cryptosporidium of Mammals.
Kvac M , Havrdova N , Hlaskova L , Dankova T , Kandera J , Jezkova J , Vitovec J , Sak B , Ortega Y , Xiao L , Modry D , Chelladurai JR , Prantlova V , McEvoy J . PLoS One 2016 11 (1) e0147090 The morphological, biological, and molecular characteristics of Cryptosporidium muris strain TS03 are described, and the species name Cryptosporidium proliferans n. sp. is proposed. Cryptosporidium proliferans obtained from a naturally infected East African mole rat (Tachyoryctes splendens) in Kenya was propagated under laboratory conditions in rodents (SCID mice and southern multimammate mice, Mastomys coucha) and used in experiments to examine oocyst morphology and transmission. DNA from the propagated C. proliferans isolate, and C. proliferans DNA isolated from the feces of an African buffalo (Syncerus caffer) in Central African Republic, a donkey (Equus africanus) in Algeria, and a domestic horse (Equus caballus) in the Czech Republic were used for phylogenetic analyses. Oocysts of C. proliferans are morphologically distinguishable from C. parvum and C. muris HZ206, measuring 6.8-8.8 (mean = 7.7 mum) x 4.8-6.2 mum (mean = 5.3) with a length to width ratio of 1.48 (n = 100). Experimental studies using an isolate originated from T. splendens have shown that the course of C. proliferans infection in rodent hosts differs from that of C. muris and C. andersoni. The prepatent period of 18-21 days post infection (DPI) for C. proliferans in southern multimammate mice (Mastomys coucha) was similar to that of C. andersoni and longer than the 6-8 DPI prepatent period for C. muris RN66 and HZ206 in the same host. Histopatologicaly, stomach glands of southern multimammate mice infected with C. proliferans were markedly dilated and filled with necrotic material, mucus, and numerous Cryptosporidium developmental stages. Epithelial cells of infected glands were atrophic, exhibited cuboidal or squamous metaplasia, and significantly proliferated into the lumen of the stomach, forming papillary structures. The epithelial height and stomach weight were six-fold greater than in non-infected controls. Phylogenetic analyses based on small subunit rRNA, Cryptosporidium oocyst wall protein, thrombospondin-related adhesive protein of Cryptosporidium-1, heat shock protein 70, actin, heat shock protein 90 (MS2), MS1, MS3, and M16 gene sequences revealed that C. proliferans is genetically distinct from C. muris and other previously described Cryptosporidium species. |
The investigational fungal Cyp51 inhibitor VT-1129 demonstrates potent in vitro activity against Cryptococcus neoformans and Cryptococcus gattii
Lockhart SR , Fothergill AW , Iqbal N , Bolden CB , Grossman NT , Garvey EP , Brand SR , Hoekstra WJ , Schotzinger RJ , Ottinger E , Patterson TF , Wiederhold NP . Antimicrob Agents Chemother 2016 60 (4) 2528-31 The in vitro activity of the novel fungal Cyp51 inhibitor VT-1129 was evaluated against a large panel of C. neoformans and C. gattii isolates. VT-1129 demonstrated potent activity against both Cryptococcus species as demonstrated by low MIC50 and MIC90 values. Against C. gattii, the in vitro potency was maintained against all genotypes. In addition, significantly lower geometric mean MICs were observed for VT-1129 compared to fluconazole against C. neoformans, including isolates with reduced fluconazole susceptibility. |
Assessment of penile erection methods in rhesus macaques to model pharmacokinetics of antiretroviral drugs and penile infection with simian immunodeficiency virus
Hayes J , Powell N , Lathrop G , Heneine W , Dobard CW . J Med Primatol 2016 45 (1) 34-41 BACKGROUND: An established macaque model to assess HIV interventions against penile transmission is currently not available. Physiological changes during penile erections may affect susceptibility to infection and drug pharmacokinetics (PK). Here, we identify methods to establish erections in macaques to evaluate penile transmission, PK, and efficacy under physiologic conditions. METHODS: Penile rigidity and length were evaluated in eight rhesus macaques following rectal electrostimulation (RES), vibratory stimulation (VS), or pharmacological treatment with Sildenafil Citrate (Viagra) or Alprostadil. RESULTS: Rectal electrostimulation treatment increased penile rigidity (>82%) and length (2.5 +/- 0.58 cm), albeit the response was transient. In contrast, VS alone or coupled with Viagra or Alprostadil failed to elicit an erection response. CONCLUSION: Rectal electrostimulation treatment elicits transient but consistent penile erections in macaques. High rigidity following RES treatment demonstrates increased blood flow and may provide a functional model for penile PK evaluations and possibly simian immunodeficiency virus (SIV) transmission under erect conditions. |
An international survey of cerebral palsy registers and surveillance systems
Goldsmith S , McIntyre S , Smithers-Sheedy H , Blair E , Cans C , Watson L , Yeargin-Allsopp M . Dev Med Child Neurol 2016 58 Suppl 2 11-7 AIM: To describe cerebral palsy (CP) surveillance programmes and identify similarities and differences in governance and funding, aims and scope, definition, inclusion/exclusion criteria, ascertainment and data collection, to enhance the potential for research collaboration. METHOD: Representatives from 38 CP surveillance programmes were invited to participate in an online survey and submit their data collection forms. Descriptive statistics were used to summarize information submitted. RESULTS: Twenty-seven surveillance programmes participated (25 functioning registers, two closed owing to lack of funding). Their aims spanned five domains: resource for CP research, surveillance, aetiology/prevention, service planning, and information provision (in descending order of frequency). Published definitions guided decision making for the definition of CP and case eligibility for most programmes. Consent, case identification, and data collection methods varied widely. Ten key data items were collected by all programmes and a further seven by at least 80% of programmes. All programmes reported an interest in research collaboration. INTERPRETATION: Despite variability in methodologies, similarities exist across programmes in terms of their aims, definitions, and data collected. These findings will facilitate harmonization of data and collaborative research efforts, which are so necessary on account of the heterogeneity and relatively low prevalence of CP. |
Update on NHANES dietary data: Focus on collection, release, analytical considerations, and uses to inform public policy
Ahluwalia N , Dwyer J , Terry A , Moshfegh A , Johnson C . Adv Nutr 2016 7 (1) 121-34 NHANES is the cornerstone for national nutrition monitoring to inform nutrition and health policy. Nutritional assessment in NHANES is described with a focus on dietary data collection, analysis, and uses in nutrition monitoring. NHANES has been collecting thorough data on diet, nutritional status, and chronic disease in cross-sectional surveys with nationally representative samples since the early 1970s. Continuous data collection began in 1999 with public data release in 2-y cycles on approximately 10,000 participants. In 2002, the Continuing Survey of Food Intakes by Individuals and the NHANES dietary component were merged, forming a consolidated dietary data collection known as What We Eat in America; since then, 24-h recalls have been collected on 2 d using the USDA's Automated Multiple-Pass Method. Detailed and targeted food-frequency questionnaires have been collected in some NHANES cycles. Dietary supplement use data have been collected (in detail since 2007) so that total nutrient intakes can be described for the population. The continuous NHANES can adapt its content to address emerging public health needs and reflect federal priorities. Changes in data collection methods are made after expert input and validation/crossover studies. NHANES dietary data are used to describe intake of foods, nutrients, food groups, and dietary patterns by the US population and large sociodemographic groups to plan and evaluate nutrition programs and policies. Usual dietary intake distributions can be estimated after adjusting for day-to-day variation. NHANES remains open and flexible to incorporate improvements while maintaining data quality and providing timely data to track the nation's nutrition and health status. In summary, NHANES collects dietary data in the context of its broad, multipurpose goals; the strengths and limitations of these data are also discussed in this review. |
Toxicological assessment of CoO and La2O3 metal oxide nanoparticles in human small airway epithelial cells
Sisler JD , Pirela SV , Shaffer J , Mihalchik AL , Chisholm WP , Andrew ME , Schwegler-Berry D , Castranova V , Demokritou P , Qian Y . Toxicol Sci 2016 150 (2) 418-28 Cobalt monoxide (CoO) and lanthanum oxide (La2O3) nanoparticles are two metal oxide nanoparticles with different redox potentials according to their semiconductor properties. By utilizing these two nanoparticles, this study sought to determine how metal oxide nanoparticle's mode of toxicological action is related to their physio-chemical properties in human small airway epithelial cells (SAEC). We investigated cellular toxicity, production of superoxide radicals and alterations in gene expression related to oxidative stress and cellular death at 6 and 24 h following exposure to CoO and La2O3 (administered doses: 0, 5, 25, and 50 microg/ml) nanoparticles. CoO nanoparticles induced gene expression related to oxidative stress at 6 h. After characterizing the nanoparticles, transmission electron microscope (TEM) analysis showed SAEC engulfed CoO and La2O3 nanoparticles. CoO nanoparticles were toxic after 6 h and 24 h of exposure to 25.0 and 50.0 microg/ml administered doses, whereas, La2O3 nanoparticles were toxic only after 24 h using the same administered doses. Based upon the Volumetric Centrifugation Method in vivo Sedimentation, Diffusion and Dosimetry (VCM-ISDD), the dose of CoO and La2O3 nanoparticles delivered at 6 and 24 h were determined to be: CoO: 1.25, 6.25, and 12.5 microg/ml; La2O3: 5, 25, and 50 microg/mland CoO: 4, 20, and 40 microg/ml; and La2O3: 5, 25, 50 microg/ml respectively. CoO nanoparticles produced more superoxide radicals and caused greater stimulation of total tyrosine and threonine phosphorylation at both 6 h and 24 h when compared to La2O3 nanoparticles. Taken together, these data provide evidence that different toxicological modes of action were involved in CoO and La2O3 metal oxide nanoparticle-induced cellular toxicity. |
Utility of a work process classification system for characterizing non-fatal injuries in the Alaskan commercial fishing industry
Syron LN , Lucas DL , Bovbjerg VE , Bethel JW , Kincl LD . Int J Circumpolar Health 2016 75 30070 BACKGROUND: The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers' lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. OBJECTIVES: This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. DESIGN: Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. RESULTS: We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. CONCLUSIONS: The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken. |
Magnitude and characteristics of acute paraquat- and diquat-related illnesses in the US: 1998-2013
Fortenberry GZ , Beckman J , Schwartz A , Prado JB , Graham LS , Higgins S , Lackovic M , Mulay P , Bojes H , Waltz J , Mitchell Y , Leinenkugel K , Oriel MS , Evans E , Calvert GM . Environ Res 2016 146 191-199 BACKGROUND: Paraquat and diquat are among the most commonly used herbicides in the world. OBJECTIVES: Determine the magnitude, characteristics, and root causes for acute paraquat- and diquat-related illnesses in the US. METHODS: Illnesses associated with paraquat or diquat exposure occurring from 1998 through 2011 were identified from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program, the California Department of Pesticide Regulation (CDPR) Pesticide Illness Surveillance Program (PISP), and the Incident Data System (IDS). Cases identified by the National Poison Data System (NPDS) were reviewed for the years 1998-2003 and 2006-2013. RESULTS: A total of 300 paraquat- and 144 diquat-related acute illnesses were identified by SENSOR, PISP, and IDS. NPDS identified 693 paraquat- and 2128 diquat-related acute illnesses. In SENSOR/PISP/IDS, illnesses were commonly low severity (paraquat=41%; diquat=81%); however, SENSOR/PISP/IDS identified 24 deaths caused by paraquat and 5 deaths associated with diquat. Nineteen paraquat-related deaths were due to ingestion, seven of which were unintentional, often due to improper storage in beverage bottles. In SENSOR/PISP/IDS, paraquat and diquat-related acute illnesses were work-related in 68% (n=203) and 29% (n=42) of cases, respectively. When herbicide application site was known, the vast majority of acute paraquat-related illnesses (81%) arose from agricultural applications. Common root causes of illness were failure to use adequate personal protective equipment (PPE), application equipment failure, and spill/splash of herbicide. CONCLUSIONS: Although the magnitude of acute paraquat/diquat-related illnesses was relatively low, several fatalities were identified. Many illnesses could be prevented through stricter compliance with label requirements (e.g. ensuring proper herbicide storage and PPE use), and through enhanced training of certified applicators. |
Enzymatic oxidative biodegradation of nanoparticles: Mechanisms, significance and applications
Vlasova II , Kapralov AA , Michael ZP , Burkert SC , Shurin MR , Star A , Shvedova AA , Kagan VE . Toxicol Appl Pharmacol 2016 299 58-69 Biopersistence of carbon nanotubes, graphene oxide (GO) and several other types of carbonaceous nanomaterials is an essential determinant of their health effects. Successful biodegradation is one of the major factors defining the life span and biological responses to nanoparticles. Here, we review the role and contribution of different oxidative enzymes of inflammatory cells - myeloperoxidase, eosinophil peroxidase, lactoperoxidase, hemoglobin, and xanthine oxidase - to the reactions of nanoparticle biodegradation. We further focus on interactions of nanomaterials with hemoproteins dependent on the specific features of their physico-chemical and structural characteristics. Mechanistically, we highlight the significance of immobilized peroxidase reactive intermediates vs diffusible small molecule oxidants (hypochlorous and hypobromous acids) for the overall oxidative biodegradation process in neutrophils and eosinophils. We also accentuate the importance of peroxynitrite-driven pathways realized in macrophages via the engagement of NADPH oxidase- and NO synthase-triggered oxidative mechanisms. We consider possible involvement of oxidative machinery of other professional phagocytes such as microglial cells, myeloid-derived suppressor cells, in the context of biodegradation relevant to targeted drug delivery. We evaluate the importance of genetic factors and their manipulations for the enzymatic biodegradation in vivo. Finally, we emphasize a novel type of biodegradation realized via the activation of the "dormant" peroxidase activity of hemoproteins by the nano-surface. This is exemplified by the binding of GO to cyt c causing the unfolding and 'unmasking' of the peroxidase activity of the latter. We conclude with the strategies leading to safe by design carbonaceous nanoparticles with optimized characteristics for mechanism-based targeted delivery and regulatable life-span of drugs in circulation. |
Development of the chemical exposure monitor with indoor positioning (CEMWIP) for workplace VOC surveys
Brown KK , Shaw PB , Mead KR , Kovein RJ , Voorhees RT , Brandes AR . J Occup Environ Hyg 2016 13 (6) 1-37 The purpose of this project was to research and develop a direct-reading exposure assessment method that combined a real-time location system with a wireless direct-reading personal chemical sensor. The personal chemical sensor was a photoionization device for detecting volatile organic compounds. The combined system was calibrated and tested against the same four standard gas concentrations and calibrated at one standard location and tested at four locations that included the standard locations. Data were wirelessly collected from the chemical sensor every 1.4 seconds, for volatile organic compounds concentration, location, temperature, humidity, and time. Regression analysis of the photo-ionization device voltage response against calibration gases showed the chemical sensor had a limit of detection of 0.2 ppm. The real-time location system was accurate to 13 cm +/- 6 cm (standard deviation) in an open area and to 57 cm +/- 31 cm in a closed room where the radio frequency has to penetrate drywall-finished walls. The streaming data were collected and graphically displayed as a three-dimensional hazard map for assessment of peak exposure with location. A real-time personal exposure assessment device with indoor positioning was practical and provided new knowledge on direct reading exposure assessment methods. |
Slip potential for commonly used inclined grated metal walkways
Pollard JP , Heberger JR , Dempsey PG . IIE Trans Occup 2015 3 (2) 115-126 BACKGROUND: No specific guidelines or regulations are provided by the Mine Safety and Health Administration for the use of inclined grated metal walkways in mining plants. Mining and other companies may be using walkway materials that do not provide sufficient friction, contributing to slip and fall injuries. PURPOSE: The purpose of this study was to determine if there are significant differences in the required friction for different grated metal walkways during walking in diverse conditions. METHODS: The normalized coefficients of friction were measured for 12 participants while walking up and down an instrumented walkway with different inclinations (0 degrees , 5 degrees , 10 degrees , 15 degrees , and 20 degrees ) and with and without the presence of a contaminant (glycerol). Self-reported slip events were recorded and the required coefficients of friction were calculated considering only the anterior/posterior components of the shear forces. Additionally, the available coefficients of friction for these walkway materials were measured at the 0 degrees orientation using a tribometer, with and without the presence of the contaminant, using a boot heel as well as Neolite as the test feet. RESULTS: The number of slips increased when the inclination angle reached 10 degrees and above. Of all materials tested, the diamond weave grating was found to have the best performance at all inclines and when contaminated or dry. A high number of slips occurred for the perforated grating and serrated bar grating at 20 degrees when contaminated. CONCLUSIONS: Results of this study suggest that the diamond weave grating provides significantly better friction compared to serrated bar and perforated gratings, especially at inclines greater than 10 degrees . |
Molecular characterization reveals diverse and unknown malaria vectors in the western Kenyan highlands
St Laurent B , Cooke M , Krishnankutty SM , Asih P , Mueller JD , Kahindi S , Ayoma E , Oriango RM , Thumloup J , Drakeley C , Cox J , Collins FH , Lobo NF , Stevenson JC . Am J Trop Med Hyg 2016 94 (2) 327-35 The success of mosquito-based malaria control is dependent upon susceptible bionomic traits in local malaria vectors. It is crucial to have accurate and reliable methods to determine mosquito species composition in areas subject to malaria. An unexpectedly diverse set of Anopheles species was collected in the western Kenyan highlands, including unidentified and potentially new species carrying the malaria parasite Plasmodium falciparum. This study identified 2,340 anopheline specimens using both ribosomal DNA internal transcribed spacer region 2 and mitochondrial DNA cytochrome oxidase subunit 1 loci. Sixteen distinct sequence groups were identified. Of these, only eight could be molecularly identified through comparison to published and voucher sequences. Of the unidentified species, four were found to carry P. falciparum by circumsporozoite enzyme-linked immunosorbent assay and polymerase chain reaction, the most abundant of which had infection rates comparable to a primary vector in the area, Anopheles funestus. High-quality adult specimens of these unidentified species could not be matched to museum voucher specimens or conclusively identified using multiple keys, suggesting that they may have not been previously described. These unidentified vectors were captured outdoors. Diverse and unknown species have been incriminated in malaria transmission in the western Kenya highlands using molecular identification of unusual morphological variants of field specimens. This study demonstrates the value of using molecular methods to compliment vector identifications and highlights the need for accurate characterization of mosquito species and their associated behaviors for effective malaria control. |
Knowledge and adherence to the National Guidelines for Malaria Case Management in Pregnancy among healthcare providers and drug outlet dispensers in rural, western Kenya
Riley C , Dellicour S , Ouma P , Kioko U , Ter Kuile FO , Omar A , Kariuki S , Buff AM , Desai M , Gutman J . PLoS One 2016 11 (1) e0145616 BACKGROUND: Although prompt, effective treatment is a cornerstone of malaria control, information on provider adherence to malaria in pregnancy (MIP) treatment guidelines is limited. Incorrect or sub-optimal treatment can adversely affect the mother and fetus. This study assessed provider knowledge of and adherence to national case management guidelines for uncomplicated MIP. METHODS: We conducted a cross-sectional study from September to November 2013, in 51 health facilities (HF) and a randomly-selected sample of 39 drug outlets (DO) in the KEMRI/CDC Health and Demographic Surveillance System area in western Kenya. Provider knowledge of national treatment guidelines was assessed with standardized questionnaires. Correct practice required adequate diagnosis, pregnancy assessment, and treatment with correct drug and dosage. In HF, we conducted exit interviews in all women of childbearing age assessed for fever. In DO, simulated clients posing as first trimester pregnant women or as relatives of third trimester pregnant women collected standardized information. RESULTS: Correct MIP case management knowledge and practice were observed in 45% and 31% of HF and 0% and 3% of DO encounters, respectively. The correct drug and dosage for pregnancy trimester was prescribed in 62% of HF and 42% of DO encounters; correct prescription occurred less often in first than in second/ third trimesters (HF: 24% vs. 65%, p<0.01; DO: 0% vs. 40%, p<0.01). Sulfadoxine-pyrimethamine, which is not recommended for malaria treatment, was prescribed in 3% of HF and 18% of DO encounters. Exposure to artemether-lumefantrine in first trimester, which is contraindicated, occurred in 29% and 49% of HF and DO encounters, respectively. CONCLUSION: This study highlights knowledge inadequacies and incorrect prescribing practices in the treatment of MIP. Particularly concerning is the prescription of contraindicated medications in the first trimester. These issues should be addressed through comprehensive trainings and increased supportive supervision. Additional innovative means to improve care should be explored. |
Characterization of SPECTRUM variable nicotine research cigarettes
Richter P , Steven PR , Bravo R , Lisko JG , Damian M , Gonzalez-Jimenez N , Gray N , Keong LM , Kimbrell JB , Kuklenyik P , Lawler TS , Lee GE , Mendez M , Perez J , Smith S , Tran H , Tyx R , Watson CH . Tob Regul Sci 2016 2 (2) 94-105 OBJECTIVE: To provide researchers an extensive characterization of the SPECTRUM variable nicotine research cigarettes. METHODS: Data on cigarette physical properties, nicotine content, harmful and potentially harmful constituents in the tobacco filler was compiled. RESULTS: Data on physical properties, concentrations of menthol, nicotine and minor alkaloids, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, ammonia, and toxic metals in the filler tobacco for all available varieties of Spectrum research cigarettes are provided. The similarity in the chemistry and physical properties of SPECTRUM cigarettes to commercial cigarettes renders them acceptable for use in behavioral studies. Baseline information on harmful and potentially harmful constituents in research tobacco products, particularly constituent levels such as minor alkaloids that fall outside typical ranges reported for commercial, provide researchers with the opportunity to monitor smoking behavior and to identify biomarkers that will inform efforts to understand the role of nicotine in creating and sustaining addiction. CONCLUSIONS: Well characterized research cigarettes suitable for human consumption are an important tool in clinical studies for investigating the physiological impacts of cigarettes delivering various levels of nicotine, the impact of reduced nicotine cigarettes on nicotine addiction, and the relationship between nicotine dose and smoking behavior. |
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