Secular changes in prediabetes indicators among older-adult Americans, 1999-2010
Caspersen CJ , Thomas GD , Beckles GL , Bullard KM . Am J Prev Med 2015 48 (3) 253-63 BACKGROUND: Sex-specific prediabetes estimates are not available for older-adult Americans. PURPOSE: To estimate prediabetes prevalence, using nationally representative data, in civilian, non-institutionalized, older U.S. adults. METHODS: Data from 7,995 participants aged ≥50 years from the 1999-2010 National Health and Nutrition Examination Surveys were analyzed in 2013. Prediabetes was defined as hemoglobin A1c=5.7%-6.4% (39-47 mmol/mol [HbA1c5.7]), fasting plasma glucose of 100-125 mg/dL (impaired fasting glucose [IFG]), or both. Crude and age-adjusted prevalences for prediabetes, HbA1c5.7, and IFG by sex and three age groups were calculated, with additional adjustment for sex, age, race/ethnicity, poverty status, education, living alone, and BMI. RESULTS: From 1999 to 2005 and 2006 to 2010, prediabetes increased for adults aged 50-64 years (38.5% [95% CI=35.3, 41.8] to 45.9% [42.3, 49.5], p=0.003) and 65-74 years (41.3% [37.2, 45.5] to 47.9% [44.5, 51.3]; p=0.016), but not significantly for adults aged ≥75 years (45.1% [95% CI=41.1, 49.1] to 48.9% [95% CI=45.2, 52.6]; p>0.05). Prediabetes increased significantly for women in the two youngest age groups, and HbA1c5.7 for both sexes (except men aged ≥75 years), but IFG remained stable for both sexes. Men had higher prevalences than women for prediabetes and IFG among adults aged 50-64 years, and for IFG among adults aged ≥75 years. Across demographic subgroups, adjusted prevalence gains for both sexes were similar and most pronounced for HbA1c5.7, virtually absent for IFG, but greater for women than men for prediabetes. CONCLUSIONS: Given the large, growing prediabetes prevalence and its anticipated burden, older adults, especially women, are likely intervention targets. |
Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012
Kit BK , Kuklina E , Carroll MD , Ostchega Y , Freedman DS , Ogden CL . JAMA Pediatr 2015 169 (3) 272-9 IMPORTANCE: Recent national data suggest there were improvements in serum lipid concentrations among US children and adolescents between 1988 and 2010 but an increase in or stable blood pressure (BP) during a similar period. OBJECTIVE: To describe the prevalence of and trends in dyslipidemia and adverse BP among US children and adolescents. DESIGN: The National Health and Nutrition Examination Survey, a cross-sectional survey. Setting: Noninstitutionalized US population. PARTICIPANTS: Children and adolescents aged 8 to 17 years with measured lipid concentrations (n = 1482) and BP (n = 1665). MAIN OUTCOMES AND MEASURES: Adverse concentrations of total cholesterol (TC) (≥200 mg/dL), high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), and non-HDL-C (≥145 mg/dL) (to convert TC, HDL-C, and non-HDL-C to millimoles per liter, multiply by 0.0259) and high or borderline BP were examined. Definitions of BP were informed by the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Analyses of linear trends in dyslipidemias and BP were conducted overall and separately by sex across 7 periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012). RESULTS: In 2011-2012, 20.2% (95% CI, 16.3-24.6) of youths had an adverse concentration of TC, HDL-C, or non-HDL-C and 11.0% (95% CI, 8.8-13.4) had either high or borderline BP. The prevalences of adverse concentrations decreased between 1999-2000 and 2011-2012 for TC (10.6% [95% CI, 8.3-13.2] vs 7.8% [95% CI, 5.7-10.4]; P = .006), HDL-C (17.9% [95% CI, 15.0-21.0] vs 12.8% [95% CI, 9.8-16.2]; P = .003), and non-HDL-C (13.6% [95% CI, 11.3-16.2] vs 8.4% [95% CI, 5.9-11.5]; P < .001). There was a decrease in high BP between 1999-2000 (3.0% [95% CI, 2.0-4.3]) and 2011-2012 (1.6% [95% CI, 1.0-2.4]) (P = .003). There was no change from 1999-2000 to 2011-2012 in borderline high BP (7.6% [95% CI, 5.8-9.8] vs 9.4% [95% CI, 7.2-11.9]; P = .90) or either high or borderline high BP (10.6% [8.4-13.1] vs 11.0% [95% CI, 8.8-13.4]; P = .26). CONCLUSIONS AND RELEVANCE: In 2011-2012, approximately 1 in 5 children and adolescents aged 8 to 17 years had an adverse lipid concentration of TC, HDL-C, or non-HDL-C and slightly more than 1 in 10 had either borderline high or high BP. The prevalence of dyslipidemia modestly decreased between 1999-2000 and 2011-2012, but either high or borderline high BP remained stable. The reasons for these trends require further study. |
Prevalence of undiagnosed diabetes among non-pregnant women of reproductive age in the United States, 1999-2010
Razzaghi H , Marcinkevage J , Peterson C . Prim Care Diabetes 2015 9 (1) 71-3 Undiagnosed diabetes has particularly harmful consequences among women of reproductive age. We assessed the prevalence of undiagnosed diabetes among non-pregnant women of reproductive age. In our data 30 women had A1C≥6.5 and 28 had FPG≥126mg/dl values suggesting approximately 300,000 women of reproductive age nationwide may have undiagnosed diabetes. |
Risk factors for HIV infection among circumcised men in Uganda: a case-control study
Ediau M , Matovu JK , Byaruhanga R , Tumwesigye NM , Wanyenze RK . J Int AIDS Soc 2015 18 (1) 19312 INTRODUCTION: Male circumcision (MC) reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious) and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision) is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches. METHODS: This was a case-control study which enrolled 155 cases (HIV-infected) and 155 controls (HIV-uninfected), all of whom were men aged 18-35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection. RESULTS: Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p<0.01). Risk factors for HIV infection prior to circumcision were:being in a polygamous marriage (AOR: 6.6, CI: 2.3-18.8) and belonging to the Bagisu ethnic group (AOR: 6.1, CI: 2.6-14.0). After circumcision, HIV infection was associated with: being circumcised at >18 years (AOR: 5.0, CI: 2.4-10.2); resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6-7.3); inconsistent use of condoms (AOR: 2.7, CI: 1.5-5.1); and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5-5.5). Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2-0.9) than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1-1.1). CONCLUSIONS: Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent condom use and having sex under the influence of peers were significant risk factors for HIV infection. Risk reduction messages should address these risk factors, especially among traditionally circumcised men. |
Risk for tuberculosis disease among contacts with prior positive tuberculin skin test: a retrospective cohort study, New York City
Gounder PP , Harris TG , Anger H , Trieu L , Meissner JS , Cadwell BL , Shashkina E , Ahuja SD . J Gen Intern Med 2015 30 (6) 742-8 BACKGROUND: Patients with prior positive tuberculin skin test (TST) results may benefit from prophylaxis after repeat exposure to infectious tuberculosis (TB). OBJECTIVE: To evaluate factors associated with active TB disease among persons with prior positive TST results named as contacts of persons with infectious TB. DESIGN: Population-based retrospective cohort study. PARTICIPANTS: A total of 2,933 contacts with prior positive TST results recently exposed to infectious TB identified in New York City's TB registry during the period from January 1, 1997 through December 31, 2003. MAIN MEASUREMENTS: Contacts developing active TB disease ≤ 4 years after exposure were identified and compared with those who did not, using Poisson regression analysis. Genotyping was performed on selected Mycobacterium tuberculosis-positive isolates. KEY RESULTS: Among contacts with prior positive TST results, 39 (1.3 %) developed active TB disease ≤ 4 years after exposure (≤2 years: 34). Risk factors for contacts that were independently associated with TB were age < 5 years (adjusted prevalence ratio [aPR] = 19.48; 95 % confidence interval [CI] = 7.15-53.09), household exposure (aPR = 2.60;CI = 1.30-5.21), exposure to infectious patients (i.e., cavities on chest radiograph, acid-fast bacilli on sputum smear; aPR = 1.9 3;CI = 1.01-3.71), and exposure to a U.S.-born index patient (aPR = 4.04; CI = 1.95-8.38). Receipt of more than1 month of treatment for latent TB infection following the current contact investigation was found to be protective (aPR = 0.27; CI = 0.08-0.93). Genotype results were concordant with the index patients among 14 of 15 contacts who developed active TB disease and had genotyping results available. CONCLUSIONS: Concordant genotype results and a high proportion of contacts developing active TB disease within 2 years of exposure indicate that those with prior positive TST results likely developed active TB disease from recent rather than remote infection. Healthcare providers should consider prophylaxis for contacts with prior TB infection, especially young children and close contacts of TB patients (e.g., those with household exposure). |
Noroviruses: epidemiology, immunity and prospects for prevention
Pringle K , Lopman B , Vega E , Vinje J , Parashar UD , Hall AJ . Future Microbiol 2015 10 (1) 53-67 In recent years, noroviruses have become recognized as an important cause of both sporadic and epidemic acute gastroenteritis (AGE), largely due to the improved availability of broadly reactive real-time RT-PCR (TaqMan-based RT-PCR) assays. While there is substantial diversity among noroviruses, one specific genotype, GII.4, is the most common etiology in sporadic and epidemic AGE. Outbreaks of norovirus AGE most commonly occur in healthcare facilities and restaurants and result in significant morbidity and mortality and substantial healthcare costs. Norovirus vaccine development is progressing, and Phase I and II human trials have shown proof-of-principle that norovirus vaccines can reduce illness and infection. |
Point-of-prescription interventions to improve antimicrobial stewardship
Hamilton KW , Gerber JS , Moehring R , Anderson DJ , Calderwood MS , Han JH , Mehta JM , Pollack LA , Zaoutis T , Srinivasan A , Camins BC , Schwartz DN , Lautenbach E . Clin Infect Dis 2015 60 (8) 1252-8 Antimicrobial stewardship is pivotal to improving patient outcomes, reducing adverse events, decreasing healthcare costs, and preventing further emergence of antimicrobial resistance. In an era in which antimicrobial resistance is increasing, judicious antimicrobial use is the responsibility of every healthcare provider. While antimicrobial stewardship programs (ASPs) have made headway in improving antimicrobial prescribing using such "top-down" methods as formulary restriction and prospective audit with feedback, engagement of prescribers has not been fully explored. Strategies that include frontline prescribers and other unit-based healthcare providers have the potential to expand stewardship, both to augment existing centralized ASPs and to provide alternative approaches to perform stewardship at healthcare facilities with limited resources. This review discusses interventions focusing on antimicrobial prescribing at the point of prescription as well as a pilot project to engage unit-based healthcare providers in antimicrobial stewardship. |
Exposure to theory-driven text messages is associated with HIV risk reduction among methamphetamine-using men who have sex with men
Reback CJ , Fletcher JB , Shoptaw S , Mansergh G . AIDS Behav 2015 19 Suppl 2 130-41 Fifty-two non-treatment-seeking methamphetamine-using men who have sex with men were enrolled in Project Tech Support, an open-label pilot study to evaluate whether exposure to theory-based [social support theory (SST), social cognitive theory (SCT), and health belief model (HBM)] text messages could promote reductions in HIV sexual risk behaviors and/or methamphetamine use. Multivariable analyses revealed that increased relative exposure to HBM or SCT (vs. SST) text messages was associated with significant reductions in the number of HIV serodiscordant unprotected (i.e., without a condom) anal sex partners, engagement in sex for money and/or drugs, and frequency of recent methamphetamine use; additionally, increased relative exposure to HBM (vs. SCT or SST) messages was uniquely associated with reductions in the overall number of non-primary anal sex partners (all p ≤ 0.05, two-tailed). Pilot data demonstrated that text messages based on the principles of HBM and SCT reduced sentinel HIV risk and drug use behaviors in active methamphetamine users. |
The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a U.S. treated public drinking water system
Cope JR , Ratard RC , Hill VR , Sokol T , Causey JJ , Yoder JS , Mirani G , Mull B , Mukerjee KA , Narayanan J , Doucet M , Qvarnstrom Y , Poole CN , Akingbola OA , Ritter J , Xiong Z , da Silva A , Roellig D , Van Dyke R , Stern H , Xiao L , Beach MJ . Clin Infect Dis 2015 60 (8) e36-42 BACKGROUND: Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old child died of meningoencephalitis of unknown etiology in a Louisiana hospital. METHODS: Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures. RESULTS: Based on testing of CSF and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri were identified in water samples from both the home and the water distribution system. CONCLUSIONS: This case is the first reported PAM death associated with culturable N. fowleri in tap water from a U.S. treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures. |
Gender role discrepancy stress, high-risk sexual behavior, and sexually transmitted disease
Reidy DE , Brookmeyer KA , Gentile B , Berke DS , Zeichner A . Arch Sex Behav 2015 45 (2) 459-65 Nearly 20 million new sexually transmitted infections occur every year in the United States. Traditionally, men have demonstrated much greater risk for contraction of and mortality from STDs perhaps because they tend to engage in a number of risky sexual activities. Research on masculinity suggests that gender roles influence males' sexual health by encouraging risk-taking behavior, discouraging access to health services, and narrowly defining their roles as partners. However, despite the propensity of highly masculine men to engage in high-risk sexual behavior, there is reason to suspect that men at the other end of the continuum may still be driven to engage in similar high-risk behaviors as a consequence of gender socialization. Discrepancy stress is a form of gender role stress that occurs when men fail to live up to the ideal manhood derived from societal prescriptions (i.e., Gender Role Discrepancy). In the present study, we surveyed a national sample of 600 men via Amazon Mechanical Turk to assess perceived gender role discrepancy, experience of discrepancy stress, and the associations with risky sexual behavior and potential contraction of STDs. Results indicated that men who believe they are less masculine than the typical man (i.e., gender role discrepancy) and experience distress stemming from this discrepancy (i.e., discrepancy stress) engage in high-risk sexual behavior and are subsequently diagnosed with more STDs. Findings are discussed in relation to implications for primary prevention strategies. |
Hepatitis C virus (HCV) antibody positivity and predictors among previously undiagnosed adult primary care outpatients: cross-sectional analysis of a multi-site retrospective cohort study
Smith BD , Yartel AK , Krauskopf K , Massoud OI , Brown KA , Fallon MB , Rein DB . Clin Infect Dis 2015 60 (8) 1145-52 BACKGROUND: HCV testing guidance issued by CDC in 1998 recommends HCV antibody (anti-HCV) testing for persons with specified risk factors. The purpose of this study was to determine the prevalence and predictors of anti-HCV positivity among primary care outpatients and estimate the proportion of unidentified anti-HCV+ persons using risk-based testing. METHODS: We analyzed electronic medical record data from a four-site retrospective study. Patients were aged ≥18 years, utilized ≥1 outpatient primary care service(s) between 2005 and 2010, and had no documented evidence of prior HCV diagnosis. Among persons tested for anti-HCV, we fit a multilevel logistic regression model to identify patient-level independent predictors of anti-HCV positivity. We estimated the proportion of unidentified anti-HCV+ persons by using multiple imputation to assign anti-HCV results to untested patients. RESULTS: We observed 209,076 patients for a median of 5 months (interquartile range: 1-23). Among 17,464 (8.4%) patients who were tested for anti-HCV, 6.4% (n=1,115) were positive. We identified history of injection drug use (adjusted odds ratio, 95%CI: 6.3, 5.2-7.6), 1945-1965 birth cohort (4.4, 3.8-5.1), and elevated alanine aminotransferase levels (4.8, 4.2-5.6) as independently associated with anti-HCV positivity. We estimated that 81% (n=4,890/6,005) of anti-HCV+ patients were unidentified using risk-based testing. CONCLUSIONS: In these outpatient primary care settings, risk-based testing may have missed four of five newly enrolled patients who are anti-HCV+. Without knowing their status, unidentified anti-HCV+ persons cannot receive further clinical evaluation, antiviral treatment, and are unlikely to benefit from secondary prevention recommendations to limit disease progression and mortality. |
Internet-based partner services in US sexually transmitted disease prevention programs: 2009-2013
Moody V , Hogben M , Kroeger K , Johnson J . J Public Health Manag Pract 2015 21 (6) 526-30 BACKGROUND: Social networking sites have become increasingly popular venues for meeting sex partners. Today, some sexually transmitted disease (STD) programs conduct Internet-based partner services (IPS). The purpose of the study was to explore how the Internet is being used by STD prevention programs to perform partner services. METHODS: We assessed US STD prevention programs receiving funds through the 2008-2013 Comprehensive STD Prevention Systems cooperative agreement. We (1) reviewed 2009 IPS protocols in 57 funding applications against a benchmark of national guidelines and (2) surveyed persons who conducted IPS in jurisdictions conducting IPS in 2012. RESULTS: Of the 57 project areas receiving Comprehensive STD Prevention Systems funds, 74% provided an IPS protocol. States with IPS protocols had larger populations and more gonorrhea and syphilis cases (t = 2.2-2.6; all Ps < .05), although not higher rates of infection. Most protocols included staffing (92%) and IPS documentation (87%) requirements, but fewer had evaluation plans (29%) or social networking site engagement strategies (16%). Authority to perform a complete range of IPS activities (send e-mail, use social networking sites) was associated with contacting more partners via IPSs (P < .05). CONCLUSIONS: This study provides a snapshot of IPS activities in STD programs in the United States. Further research is needed to move from assessment to generating data that can assist training efforts and program action and, finally, to enable efficient IPS programs that are integrated into STD prevention and control efforts. |
Cost-benefit comparison of two proposed overseas programs for reducing chronic hepatitis B infection among refugees: is screening essential?
Jazwa A , Coleman MS , Gazmararian J , Wingate LT , Maskery B , Mitchell T , Weinberg M . Vaccine 2015 33 (11) 1393-9 BACKGROUND: Refugees are at an increased risk of chronic Hepatitis B virus (HBV) infection because many of their countries of origin, as well as host countries, have intermediate-to-high prevalence rates. Refugees arriving to the US are also at risk of serious sequelae from chronic HBV infection because they are not routinely screened for the virus overseas or in domestic post-arrival exams, and may live in the US for years without awareness of their infection status. METHODS: A cohort of 26,548 refugees who arrived in Minnesota and Georgia during 2005-2010 was evaluated to determine the prevalence of chronic HBV infection. This prevalence information was then used in a cost-benefit analysis comparing two variations of a proposed overseas program to prevent or ameliorate the effects of HBV infection, titled 'Screen, then vaccinate or initiate management' (SVIM) and 'Vaccinate only' (VO). The analyses were performed in 2013. All values were converted to US 2012 dollars. RESULTS: The estimated six year period-prevalence of chronic HBV infection was 6.8% in the overall refugee population arriving to Minnesota and Georgia and 7.1% in those ≥6 years of age. The SVIM program variation was more cost beneficial than VO. While the up-front costs of SVIM were higher than VO ($154,084 vs. $73,758; n=58,538 refugees), the SVIM proposal displayed a positive net benefit, ranging from $24 million to $130 million after only 5 years since program initiation, depending on domestic post-arrival screening rates in the VO proposal. CONCLUSIONS: Chronic HBV infection remains an important health problem in refugees resettling to the United States. An overseas screening policy for chronic HBV infection is more cost-beneficial than a 'Vaccination only' policy. The major benefit drivers for the screening policy are earlier medical management of chronic HBV infection and averted lost societal contributions from premature death. |
Testing for human immunodeficiency virus among cancer survivors under age 65 in the United States
Li J , Thompson TD , Tai E , Zhao G , Oster AM . Prev Chronic Dis 2014 11 E200 INTRODUCTION: Knowing the human immunodeficiency virus (HIV) serostatus of patients at the time of cancer diagnosis or cancer recurrence is prerequisite to coordinating HIV and cancer treatments and improving treatment outcomes. However, there are no published data about HIV testing among cancer survivors in the United States. We sought to provide estimates of the proportion of cancer survivors tested for HIV and to characterize factors associated with having had HIV testing. METHODS: We used data from the 2009 Behavioral Risk Factor Surveillance System to calculate the proportion of cancer survivors under age 65 who had undergone HIV testing, by demographic and health-related factors and by state. Adjusted proportion estimates were calculated by multivariable logistic regression. RESULTS: Only 41% of cancer survivors in the United States under the age of 65 reported ever having had an HIV test. The highest proportion of survivors tested was among patients aged 25 to 34 years (72.2%), non-Hispanic blacks (59.5%), and cervical cancer survivors (51.2%). The proportion tested was highest in the District of Columbia (68.3%) and lowest in Nebraska (24.1%). Multivariable analysis showed that factors associated with HIV testing included being non-Hispanic black or Hispanic, being younger, having higher education, not being married or living with a partner, not being disabled, and having medical cost concerns. Having an AIDS-related cancer was associated with HIV testing only among females. CONCLUSION: The proportions of HIV testing varied substantially by demographic and health-related factors and by state. Our study points to the need for public health interventions to promote HIV testing among cancer survivors. |
Cytomegalovirus viral and antibody correlates in young children
Dollard SC , Keyserling H , Radford K , Amin MM , Stowell J , Winter J , Schmid DS , Cannon MJ , Hyde TB . BMC Res Notes 2014 7 776 BACKGROUND: Young, healthy children shedding cytomegalovirus (CMV) in urine and saliva appear to be the leading source of CMV in primary infection of pregnant women. FINDINGS: We screened 48 children 6 months - 5 years old for CMV IgG and measured levels of CMV IgG, IgM and IgG avidity antibodies, frequency of CMV shedding, and viral loads in blood, urine, and saliva. Thirteen of the 48 children (27%) were CMV IgG positive, among whom 3 were also CMV IgM positive with evidence of recent primary infection. Nine of the 13 seropositive children (69%) were shedding 102-105 copies/ml of CMV DNA in one or more bodily fluid. Among seropositive children, low IgG antibody titer (1:20-1:80) was associated with the absence of shedding (p = 0.014), and enrollment in daycare was associated with the presence of CMV shedding (p = 0.037). CONCLUSIONS: CMV antibody profiles correlated with CMV shedding. The presence of CMV IgM more often represents primary infection in children than in adults. Correlating antibodies with primary infection and viral shedding in healthy children adds to the understanding of CMV infection in children that can inform the prevention of CMV transmission to pregnant women. |
Spatial-temporal variation and primary ecological drivers of Anopheles sinensis human biting rates in malaria epidemic-prone regions of China
Ren Z , Wang D , Hwang J , Bennett A , Sturrock HJ , Ma A , Huang J , Xia Z , Feng X , Wang J . PLoS One 2015 10 (1) e0116932 BACKGROUND: Robust malaria vector surveillance is essential for optimally selecting and targeting vector control measures. Sixty-two vector surveillance sites were established between 2005 and 2008 by the national malaria surveillance program in China to measure Anopheles sinensis human biting rates. Using these data to determine the primary ecological drivers of malaria vector human biting rates in malaria epidemic-prone regions of China will allow better targeting of vector control resources in space and time as the country aims to eliminate malaria. METHODS: We analyzed data from 62 malaria surveillance sentinel sites from 2005 to 2008. Linear mixed effects models were used to identify the primary ecological drivers for Anopheles sinensis human biting rates as well as to explore the spatial-temporal variation of relevant factors at surveillance sites throughout China. RESULTS: Minimum semimonthly temperature (beta = 2.99; 95% confidence interval (CI) 2.07- 3.92), enhanced vegetation index (beta =1.07; 95% CI 0.11-2.03), and paddy index (the percentage of rice paddy field in the total cultivated land area of each site) (beta = 0.86; 95% CI 0.17-1.56) were associated with greater An. Sinensis human biting rates, while increasing distance to the nearest river was associated with lower An. Sinensis human biting rates (beta = -1.47; 95% CI -2.88, -0.06). The temporal variation ([Formula: see text]) in biting rates was much larger than the spatial variation ([Formula: see text]), with 19.3% of temporal variation attributable to differences in minimum temperature and enhanced vegetation index and 16.9% of spatial variance due to distance to the nearest river and the paddy index. DISCUSSION: Substantial spatial-temporal variation in An. Sinensis human biting rates exists in malaria epidemic-prone regions of China, with minimum temperature and enhanced vegetation index accounting for the greatest proportion of temporal variation and distance to nearest river and paddy index accounting for the greatest proportion of spatial variation amongst observed ecological drivers. CONCLUSIONS: Targeted vector control measures based on these findings can support the ongoing malaria elimination efforts in China more effectively. |
Long-lasting insecticide-treated house screens and targeted treatment of productive breeding-sites for dengue vector control in Acapulco, Mexico
Che-Mendoza A , Guillermo-May G , Herrera-Bojorquez J , Barrera-Perez M , Dzul-Manzanilla F , Gutierrez-Castro C , Arredondo-Jimenez JI , Sanchez-Tejeda G , Vazquez-Prokopec G , Ranson H , Lenhart A , Sommerfeld J , McCall PJ , Kroeger A , Manrique-Saide P . Trans R Soc Trop Med Hyg 2015 109 (2) 106-15 BACKGROUND: Long-lasting insecticidal net screens (LLIS) fitted to domestic windows and doors in combination with targeted treatment (TT) of the most productive Aedes aegypti breeding sites were evaluated for their impact on dengue vector indices in a cluster-randomised trial in Mexico between 2011 and 2013. METHODS: Sequentially over 2 years, LLIS and TT were deployed in 10 treatment clusters (100 houses/cluster) and followed up over 24 months. Cross-sectional surveys quantified infestations of adult mosquitoes, immature stages at baseline (pre-intervention) and in four post-intervention samples at 6-monthly intervals. Identical surveys were carried out in 10 control clusters that received no treatment. RESULTS: LLIS clusters had significantly lower infestations compared to control clusters at 5 and 12 months after installation, as measured by adult (male and female) and pupal-based vector indices. After addition of TT to the intervention houses in intervention clusters, indices remained significantly lower in the treated clusters until 18 (immature and adult stage indices) and 24 months (adult indices only) post-intervention. CONCLUSIONS: These safe, simple affordable vector control tools were well-accepted by study participants and are potentially suitable in many regions at risk from dengue worldwide. |
Urinary polycyclic aromatic hydrocarbon metabolites as biomarkers to woodsmoke exposure - results from a controlled exposure study
Li Z , Trinidad D , Pittman EN , Riley EA , Sjodin A , Dills RL , Paulsen M , Simpson CD . J Expo Sci Environ Epidemiol 2015 26 (3) 241-8 Woodsmoke contains harmful components - such as fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs) - and impacts more than half of the global population. We investigated urinary hydroxylated PAH metabolites (OH-PAHs) as woodsmoke exposure biomarkers in nine non-smoking volunteers experimentally exposed to a wood fire. Individual urine samples were collected from 24-h before to 48-h after the exposure and personal PM2.5 samples were collected during the 2-h woodsmoke exposure. Concentrations of nine OH-PAHs increased by 1.8-7.2 times within 2.3-19.3 h, and returned to baseline approximately 24 h after the exposure. 2-Naphthol (2-NAP) had the largest post-exposure increase and exhibited a clear excretion pattern in all participants. The level of urinary OH-PAHs, except 1-hydroxypyrene (1-PYR), correlated with those of PM2.5, levoglucosan and PAHs in personal PM2.5 samples. This finding suggests that several urinary OH-PAHs, especially 2-NAP, are potential exposure biomarkers to woodsmoke; by contrast, 1-PYR may not be a suitable biomarker. Compared with levoglucosan and methoxyphenols - two other urinary woodsmoke biomarkers that were measured in the same study and reported previously - OH-PAHs might be better biomarkers based on sensitivity, robustness and stability, particularly under suboptimal sampling and storage conditions, like in epidemiological studies carried out in less developed areas. |
Acute gastrointestinal illness following a prolonged community-wide water emergency
Gargano JW , Freeland AL , Morrison MA , Stevens K , Zajac L , Wolkon A , Hightower A , Miller MD , Brunkard JM . Epidemiol Infect 2015 143 (13) 1-11 The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for 7 days (aPR 2.4, 95% CI 1.1-5.2) and experienced low water pressure for 7 days (aPR 3.6, 95% CI 1.4-9.0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts. |
Using health and demographic surveillance system (HDSS) data to analyse geographical distribution of socio-economic status; an experience from KEMRI/CDC HDSS
Amek N , Vounatsou P , Obonyo B , Hamel M , Odhiambo F , Slutsker L , Laserson K . Acta Trop 2015 144 24-30 BACKGROUND: Continuous monitoring in Health and Demographic Surveillance sites (HDSS) allows for collection of longitudinal demographic data, health related and socio-economic indicators of the site population. We sought to use household survey data collected between 2002-2006 in the Kenya Medical Research Institute in collaboration with Centers for Disease Control and prevention (KEMRI/CDC) HDSS site in Asembo and Gem western Kenya to estimate socio-economic status (SES) and assess changes of SES over time and space. METHODS: Data on household assets and characteristics, mainly source of drinking water, cooking fuel and occupation of household head was annually collected from 44,313 unique households during the study period. An SES index was calculated as a weighted average of assets using weights generated via Principal Component Analysis (PCA), Polychoric PCA and Multiple Correspondence Analysis (MCA) methods applied to the pooled data. The index from the best method was used to rank households into SES quintiles and assess their transition over time across SES categories. Kriging was employed to produce SES maps at the start and the end of the study period. RESULTS: First component of PCA, Polychoric PCA and MCA accounted for 13.7%, 31.8% and 47.3% respectively of the total variance of all variables. The gap between the poorest and the least poor increased from 1% at the start to 6% at the end of the study period. Spatial analysis revealed that the increase in least poor households was centered in the lower part of study area (Asembo) over time. No significant changes were observed in Gem. CONCLUSION: The HDSS sites can provide a platform to assess spatial-temporal changes in the SES status of the population. Evidence on how SES varied over time and space within the same geographical area may provide a useful tool to design interventions in health and other areas that have a close bearing to the SES of the population. |
Notifiable disease reporting among public sector physicians in Nigeria: a cross-sectional survey to evaluate possible barriers and identify best sources of information
Lafond KE , Dalhatu I , Shinde V , Ekanem EE , Ahmed S , Peebles P , Kudumu M , Bynum M , Salami K , Okeibunor J , Schwingl P , Mounts A , Nasidi A , Gross D . BMC Health Serv Res 2014 14 (1) 568 BACKGROUND: Since 2001, Nigeria has collected information on epidemic-prone and other diseases of public health importance through the Integrated Disease Surveillance and Response system (IDSR). Currently 23 diseases are designated as inverted question marknotifiable inverted question mark through IDSR, including human infection with avian influenza (AI). Following an outbreak of highly pathogenic avian influenza A(H5N1) in Nigerian poultry populations in 2006 and one laboratory confirmed human infection in 2007, a study was carried out to describe knowledge, perceptions, and practices related to infectious disease reporting through the IDSR system, physicians inverted question mark preferred sources of heath information, and knowledge of AI infection in humans among public sector physicians in Nigeria. METHODS: During November to December 2008, 245 physicians in six Nigerian cities were surveyed through in-person interviews. Survey components included reporting practices for avian influenza and other notifiable diseases, perceived obstacles to disease reporting, methods for obtaining health-related information, and knowledge of avian influenza among participating physicians. RESULTS: All 245 respondents reported that they had heard of AI and that humans could become infected with AI. Two-thirds (163/245) had reported a notifiable disease. The most common perceived obstacles to reporting were lack of infrastructure/logistics or reporting system (76/245, 31%), lack of knowledge among doctors about how to report or to whom to report (64/245, 26%), and that doctors should report certain infectious diseases (60/245, 24%). Almost all participating physicians (>99%) reported having a cell phone that they currently use, and 86% reported using the internet at least weekly. CONCLUSIONS: Although the majority of physicians surveyed were knowledgeable of and had reported notifiable diseases, they identified many perceived obstacles to reporting. In order to effectively identify human AI cases and other infectious diseases through IDSR, reporting system requirements need to be clearly communicated to participating physicians, and perceived obstacles, such as lack of infrastructure, need to be addressed. Future improvements to the reporting system should account for increased utilization of the internet, as well as cell phone and email-based communication. |
Early-warning health and process indicators for sentinel surveillance in Madagascar 2007-2011
Rajatonirina S , Rakotomanana F , Randrianasolo L , Razanajatovo NH , Andriamandimby SF , Ravolomanana L , Randrianarivo-Solofoniaina AE , Reynes JM , Piola P , Finlay-Vickers A , Heraud JM , Richard V . Online J Public Health Inform 2014 6 (3) e197 BACKGROUND: Epidemics pose major threats in resource-poor countries, and surveillance tools for their early detection and response are often inadequate. In 2007, a sentinel surveillance system was established in Madagascar, with the aim of rapidly identifying potential epidemics of febrile or diarrhoeal syndromes and issuing alerts. We present the health and process indicators for the five years during which this system was constructed, showing the spatiotemporal trends, early-warning sign detection capability and process evaluation through timely analyses of high-quality data. METHODS: The Malagasy sentinel surveillance network is currently based on data for fever and diarrhoeal syndromes collected from 34 primary health centres and reported daily via the transmission of short messages from mobile telephones. Data are analysed daily at the Institut Pasteur de Madagascar to make it possible to issue alerts more rapidly, and integrated process indicators (timeliness, data quality) are used to monitor the system. RESULTS: From 2007 to 2011, 917,798 visits were reported. Febrile syndromes accounted for about 11% of visits annually, but the trends observed differed between years and sentinel sites. From 2007 to 2011, 21 epidemic alerts were confirmed. However, delays in data transmission were observed (88% transmitted within 24 hours in 2008; 67% in 2011) and the percentage of forms transmitted each week for validity control decreased from 99.9% in 2007 to 63.5% in 2011. CONCLUSION: A sentinel surveillance scheme should take into account both epidemiological and process indicators. It must also be governed by the main purpose of the surveillance and by local factors, such as the motivation of healthcare workers and telecommunication infrastructure. Permanent evaluation indicators are required for regular improvement of the system. |
Genomic epidemiology of multidrug-resistant Mycobacterium tuberculosis during transcontinental spread.
Coscolla M , Barry PM , Oeltmann JE , Koshinsky H , Shaw T , Cilnis M , Posey J , Rose J , Weber T , Fofanov VY , Gagneux S , Kato-Maeda M , Metcalfe JZ . J Infect Dis 2015 212 (2) 302-10 The transcontinental spread of multidrug-resistant tuberculosis (MDR-TB) is poorly characterized in molecular epidemiologic studies. We utilized genomic sequencing to understand the establishment and dispersion of MDR-Mycobacterium tuberculosis within an immigrant group to the United States. We used a genomic epidemiology approach to study a genotypically-matched (spoligotype, IS6110, MIRU-VNTR) Lineage 2/Beijing MDR strain implicated in an outbreak among refugees in Thailand and consecutive cases within California, USA. All 46 MDR genomes from both Thailand and California were highly related with a median difference of 10 single nucleotide polymorphisms (SNPs). The WTK strain is a new sequence type distinguished from all known Beijing strains by 55 SNPs and a genomic deletion (Rv1267c) associated with increased fitness. Sequence data revealed a highly prevalent MDR strain that included several closely related but distinct allelic variants within Thailand, rather than a single outbreak. In California, sequencing data supported multiple independent introductions of WTK with subsequent transmission and reactivation within the state, and a potential "super spreader" with a prolonged infectious period. Twenty-seven drug resistance-conferring mutations and four putative compensatory mutations were found within WTK strains. Genomic sequencing has substantial epidemiologic value in both low- and high-burden settings in understanding transmission chains of highly prevalent MDR strains. |
Mosquito genomics. Highly evolvable malaria vectors: the genomes of 16 Anopheles mosquitoes.
Neafsey DE , Waterhouse RM , Abai MR , Aganezov SS , Alekseyev MA , Allen JE , Amon J , Arca B , Arensburger P , Artemov G , Assour LA , Basseri H , Berlin A , Birren BW , Blandin SA , Brockman AI , Burkot TR , Burt A , Chan CS , Chauve C , Chiu JC , Christensen M , Costantini C , Davidson VL , Deligianni E , Dottorini T , Dritsou V , Gabriel SB , Guelbeogo WM , Hall AB , Han MV , Hlaing T , Hughes DS , Jenkins AM , Jiang X , Jungreis I , Kakani EG , Kamali M , Kemppainen P , Kennedy RC , Kirmitzoglou IK , Koekemoer LL , Laban N , Langridge N , Lawniczak MK , Lirakis M , Lobo NF , Lowy E , MacCallum RM , Mao C , Maslen G , Mbogo C , McCarthy J , Michel K , Mitchell SN , Moore W , Murphy KA , Naumenko AN , Nolan T , Novoa EM , O'Loughlin S , Oringanje C , Oshaghi MA , Pakpour N , Papathanos PA , Peery AN , Povelones M , Prakash A , Price DP , Rajaraman A , Reimer LJ , Rinker DC , Rokas A , Russell TL , Sagnon N , Sharakhova MV , Shea T , Simao FA , Simard F , Slotman MA , Somboon P , Stegniy V , Struchiner CJ , Thomas GW , Tojo M , Topalis P , Tubio JM , Unger MF , Vontas J , Walton C , Wilding CS , Willis JH , Wu YC , Yan G , Zdobnov EM , Zhou X , Catteruccia F , Christophides GK , Collins FH , Cornman RS , Crisanti A , Donnelly MJ , Emrich SJ , Fontaine MC , Gelbart W , Hahn MW , Hansen IA , Howell PI , Kafatos FC , Kellis M , Lawson D , Louis C , Luckhart S , Muskavitch MA , Ribeiro JM , Riehle MA , Sharakhov IV , Tu Z , Zwiebel LJ , Besansky NJ . Science 2015 347 (6217) 1258522 Variation in vectorial capacity for human malaria among Anopheles mosquito species is determined by many factors, including behavior, immunity, and life history. To investigate the genomic basis of vectorial capacity and explore new avenues for vector control, we sequenced the genomes of 16 anopheline mosquito species from diverse locations spanning ~100 million years of evolution. Comparative analyses show faster rates of gene gain and loss, elevated gene shuffling on the X chromosome, and more intron losses, relative to Drosophila. Some determinants of vectorial capacity, such as chemosensory genes, do not show elevated turnover but instead diversify through protein-sequence changes. This dynamism of anopheline genes and genomes may contribute to their flexible capacity to take advantage of new ecological niches, including adapting to humans as primary hosts. |
A review of the differences in developmental, psychiatric, and medical endophenotypes between males and females with autism spectrum disorder
Rubenstein E , Wiggins LD , Lee LC . J Dev Phys Disabil 2014 27 (1) 119-139 Autism spectrum disorder (ASD) is over four times more prevalent in males compared to females. Increased understanding of sex differences in ASD endophenotypes could add insight into possible etiologies and the assessment and management of the disorder. Consequently, the purpose of this review is to describe current literature regarding sex differences in the developmental, psychiatric, and medical endophenotypes of ASD in order to illustrate current knowledge and areas in need of further research. Our review found that repetitive behaviors and restricted interests are more common in males than females with ASD. Intellectual disability is more common in females than males with ASD. Attention to detail may be more common in males than females with ASD and epilepsy may be more common in females than males with ASD, although limited research in these areas prevent definitive conclusions from being drawn. There does not appear to be a sex difference in other developmental, psychiatric, and medical symptoms associated with ASD, or the research was contradictory or too sparse to establish a sex difference. Our review is unique in that it offers detailed discussion of sex differences in three major endophenotypes of ASD. Further research is needed to better understand why sex differences exist in certain ASD traits and to evaluate whether phenotypic sex differences are related to different pathways of development, assessment, and treatment of the disorder. |
Adverse events following Haemophilus influenzae type b vaccines in the Vaccine Adverse Event Reporting System, 1990-2013.
Moro PL , Jankosky C , Menschik D , Lewis P , Duffy J , Stewart B , Shimabukuro TT . J Pediatr 2015 166 (4) 992-7 OBJECTIVE: To characterize adverse events (AEs) after Haemophilus influenzae type b (Hib) vaccines reported to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting surveillance system. STUDY DESIGN: We searched VAERS for US reports after Hib vaccines among reports received from January 1, 1990, to December 1, 2013. We reviewed a random sample of reports and accompanying medical records for reports classified as serious. All reports of death were reviewed. Physicians assigned a primary clinical category to each reviewed report. We used empirical Bayesian data mining to identify AEs that were disproportionally reported after Hib vaccines. RESULTS: VAERS received 29 747 reports after Hib vaccines; 5179 (17%) were serious, including 896 reports of deaths. Median age was 6 months (range 0-1022 months). Sudden infant death syndrome was the stated cause of death in 384 (51%) of 749 death reports with autopsy/death certificate records. The most common nondeath serious AE categories were neurologic (80; 37%), other noninfectious (46; 22%) (comprising mainly constitutional signs and symptoms); and gastrointestinal (39; 18%) conditions. No new safety concerns were identified after clinical review of reports of AEs that exceeded the data mining statistical threshold. CONCLUSION: Review of VAERS reports did not identify any new or unexpected safety concerns for Hib vaccines. |
Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008
Cavallaro KF , Sandhu HS , Hyde TB , Johnson BW , Fischer M , Mayer LW , Clark TA , Pallansch MA , Yin Z , Zuo S , Hadler SC , Diorditsa S , Hasan AS , Bose AS , Dietz V . Vaccine 2015 33 (9) 1168-75 BACKGROUND: Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. METHODS: We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. RESULTS: Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. CONCLUSIONS: Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity. |
Influenza vaccination coverage and effectiveness in young children in Thailand, 2011-2013
Kittikraisak W , Suntarattiwong P , Levy J , Fernandez S , Dawood FS , Olsen SJ , Chotpitayasunondh T . Influenza Other Respir Viruses 2015 9 (2) 85-93 BACKGROUND: Since 2009, Thailand has recommended influenza vaccine for children aged 6 months through 2 years, but no estimates of influenza vaccine coverage or effectiveness are available for this target group. METHODS: During August 2011-May 2013, high-risk and healthy children aged ≤36 months were enrolled in a 2-year prospective cohort study. Parents were contacted weekly about acute respiratory illness (ARI) in their child. Ill children had combined nasal and throat swabs tested for influenza viruses by real-time reverse transcription-polymerase chain reaction. Influenza vaccination status was verified with vaccination cards. The Cox proportional hazards approach was used to estimate hazard ratios. Vaccine effectiveness (VE) was estimated as 100% x (1-hazard ratio). RESULTS: During 2011-2013, 968 children were enrolled (median age, 10.3 months); 948 (97.9%) had a vaccination record and were included. Of these, 394 (41.6%) had ≥1 medical conditions. Vaccination coverage for the 2011-2012 and 2012-2013 seasons was 29.3% (93/317) and 30.0% (197/656), respectively. In 2011-2012, there were 213 ARI episodes, of which 10 (4.6%) were influenza positive (2.3 per 1000 vaccinated and 3.8 per 1000 unvaccinated child-weeks). The VE was 55% (95% confidence interval [CI], -72, 88). In 2012-2013, there were 846 ARIs, of which 52 (6.2%) were influenza positive (1.8 per 1000 vaccinated and 4.5 per 1000 unvaccinated child-weeks). The VE was 64% (CI, 13%, 85%). CONCLUSION: Influenza vaccination coverage among young children in Thailand was low, although vaccination was moderately effective. Continued efforts are needed to increase influenza vaccination coverage and evaluate VE among young children in Thailand. |
Is vaccine type seropositivity a marker for human papillomavirus vaccination? - National Health and Nutrition Examination Survey, 2003-2010
Petrosky EY , Hariri S , Markowitz LE , Panicker G , Unger ER , Dunne EF . Int J Infect Dis 2015 33 137-41 OBJECTIVE: Since 2006, human papillomavirus (HPV) vaccination has been routinely recommended for U.S. adolescent females. The quadrivalent vaccine induces long-term seropositivity to HPV 6/11/16, which may be useful as a marker of HPV vaccine coverage. METHODS: We evaluated vaccine type seropositivity (i.e., seropositivity to HPV 6/11/16 with or without HPV 18) among females aged 14-59 years participating in 2003-2010 National Health and Nutrition Examination Survey (cross-sectional, nationally representative surveys). We compared pre-vaccine era (2003-2006) to vaccine era (2007-2010) seropositivity and assessed agreement between vaccine era seropositivity and reported vaccination by kappa statistic. RESULTS: Seropositivity was 1.0% among 2,151 females in the pre-vaccine era and 22.1% among 1,420 females in the vaccine era (P <0.001); 23.1% of vaccine era females reported receipt of ≥1 HPV vaccine dose. Seropositivity and reported vaccination had high agreement (kappa=0.79; 95% confidence interval: 0.74-0.84). Among seropositive females, 14.5% reported no vaccination. CONCLUSION: The increase in vaccine era seropositivity likely reflects vaccination uptake. Our study suggests seropositivity to HPV 6/11/16 may be a useful marker of vaccination coverage in adolescent and young adult females. Discordance between seropositivity and reported vaccination may be explained by inaccurate reporting and/or natural exposure to HPV. |
Relative sensitivity of conventional and real-time PCR assays for detection of SFG Rickettsia in blood and tissue samples from laboratory animals.
Zemtsova GE , Montgomery M , Levin ML . PLoS One 2015 10 (1) e0116658 Studies on the natural transmission cycles of zoonotic pathogens and the reservoir competence of vertebrate hosts require methods for reliable diagnosis of infection in wild and laboratory animals. Several PCR-based applications have been developed for detection of infections caused by Spotted Fever group Rickettsia spp. in a variety of animal tissues. These assays are being widely used by researchers, but they differ in their sensitivity and reliability. We compared the sensitivity of five previously published conventional PCR assays and one SYBR green-based real-time PCR assay for the detection of rickettsial DNA in blood and tissue samples from Rickettsia- infected laboratory animals (n = 87). The real-time PCR, which detected rickettsial DNA in 37.9% of samples, was the most sensitive. The next best were the semi-nested ompA assay and rpoB conventional PCR, which detected as positive 18.4% and 14.9% samples respectively. Conventional assays targeting ompB, gltA and hrtA genes have been the least sensitive. Therefore, we recommend the SYBR green-based real-time PCR as a tool for the detection of rickettsial DNA in animal samples due to its higher sensitivity when compared to more traditional assays. |
A review of sleep deprivation studies evaluating the brain transcriptome
Elliott AS , Huber JD , O'Callaghan JP , Rosen CL , Miller DB . Springerplus 2015 3 728 Epidemiological studies show a positive association between adequate sleep and good health. Further, disrupted sleep may increase the risk for CNS diseases, such as stroke and Alzheimer's disease. However, there has been limited progress in determining how sleep is linked to brain health or how sleep disruption may increase susceptibility to brain insult and disease. Animal studies can aid in understanding these links. In reviewing the animal literature related to the effects of sleep disruption on the brain, we found most of the work was directed toward investigating and characterizing the role of various brain areas or structures in initiating and regulating sleep. In contrast, limited effort has been directed towards understanding how sleep disruption alters the brain's health or susceptibility to insult. We also note many current studies have determined the changes in the brain following compromised sleep by examining, for example, the brain transcriptome or to a more limited extent the proteome. However, these studies have utilized almost exclusively total sleep deprivation (e.g., 24 out of 24 hours) paradigms or single short periods of limited acute sleep deprivation (e.g., 3 out of 24 hours). While such strategies are beneficial in understanding how sleep is controlled, they may not have much translational value for determining links between sleep and brain health or for determining how sleep disruption may increase brain susceptibility to insult. Surprisingly, few studies have determined how the duration and recurrence of sleep deprivation influence the effects seen after sleep deprivation. Our aim in this review was to identify relevant rodent studies from 1980 through 2012 and analyze those that use varying durations of sleep deprivation or restriction in their effort to evaluate the effects of sleep deprivation on the brain transcriptome and to a more limited extent the proteome. We examined how differences in the duration of sleep deprivation affect gene and protein expression to better understand the full consequences of repeated sleep disruption on the brain. Future research needs to consider and emphasize how the type and extent of the sleep deprivation exposure impacts the conclusions reached concerning the influence of sleep disruption on the brain. We identified relevant studies between 1980 and 2012 by searching the electronic databases of PubMed, Medline (Ovid), Embase (Ovid), and Web of Science using the terms "sleep" AND "disrupt", "deprivation", "restrict", "fragment","loss", "disturb", "disorder", "dysfunction", "brain", "cortex", striatum", hypothalamus", "hippocampus", "gene", "protein","genomics", "proteomics", "polymerase chain reaction", "pcr", "microarray", "molecular", "rodent" "rat", "rats", "mouse","mice". All searches were limited to rodent studies in English and the reference lists of retrieved articles were searched for additional pertinent studies. |
Seroepidemiology of Toxoplasma in a coastal region of Haiti: multiplex bead assay detection of immunoglobulin G antibodies that recognize the SAG2A antigen
Priest JW , Moss DM , Arnold BF , Hamlin K , Jones CC , Lammie PJ . Epidemiol Infect 2015 143 (3) 618-30 Toxoplasma gondii is a globally distributed parasitic protozoan that infects most warm-blooded animals. We incorporated a bead coupled with recombinant SAG2A protein into our Neglected Tropical Disease (NTD) multiplex bead assay (MBA) panel and used it to determine Toxoplasma infection rates in two studies in Haiti. In a longitudinal cohort study of children aged 0-11 years, the infection rate varied with age reaching a maximum of 0.131 infections/year in children aged 3 years [95% confidence interval (CI) 0.065-0.204]. The median time to seroconversion was estimated to be 9.7 years (95% CI 7.6-infinity). In a cross-sectional, community-wide survey of residents of all ages, we determined an overall seroprevalence of 28.2%. The seroprevalence age curve from the cross-sectional study also suggested that the force of infection varied with age and peaked at 0.057 infections/year (95% CI 0.033-0.080) at age 2.6 years. Integration of the Toxoplasma MBA into NTD surveys may allow for better estimates of the potential burden of congenital toxoplasmosis in underserved regions. |
The transient dermal exposure II: post-exposure absorption and evaporation of volatile compounds
Frasch HF , Bunge AL . J Pharm Sci 2015 104 (4) 1499-507 The transient dermal exposure is one where the skin is exposed to chemical for a finite duration, after which the chemical is removed and no residue remains on the skin's surface. Chemical within the skin at the end of the exposure period can still enter the systemic circulation. If it has some volatility, a portion of it will evaporate from the surface before it has a chance to be absorbed by the body. The fate of this post-exposure "skin depot" is the focus of this theoretical study. Laplace domain solutions for concentration distribution, flux, and cumulative mass absorption and evaporation are presented, and time domain results are obtained through numerical inversion. The Final Value Theorem is applied to obtain the analytical solutions for the total fractional absorption by the body and evaporation from skin at infinite time following a transient exposure. The solutions depend on two dimensionless variables: chi, the ratio of evaporation rate to steady-state dermal permeation rate; and the ratio of exposure time to membrane lag time. Simple closed form algebraic equations are presented that closely approximate the complete analytical solutions. Applications of the theory to the dermal risk assessment of pharmaceutical, occupational, and environmental exposures are presented for four example chemicals. |
Monitoring the quality of HIV-1 viral load testing through proficiency testing program using dried tube specimens in resource-limited settings
Nguyen S , Ramos A , Chang J , Li B , Shanmugam V , Boeras D , Nkengasong JN , Yang C , Ellenberger D . J Clin Microbiol 2015 53 (4) 1129-36 BACKGROUND: HIV-1 RNA viral load (VL) levels are used for monitoring disease progression and antiretroviral therapy outcomes in HIV-infected patients. To assess the performance of laboratories conducting HIV-1 VL testing in resource-limited settings, the US Centers for Disease Control and Prevention implemented a voluntary, free-of-charge, external quality assurance program using dried tube specimens (DTSs). METHODS: DTS proficiency test (PT) panels consisting of 5 specimens were distributed between 2010 and 2012 at ambient temperature to participants. The results from participants (N ≥ 6) using the same assay were grouped, analyzed, and graded as acceptable within a group mean +/- 3SDs. Mean proficiency scores were calculated by dividing the combined PT scores with the number of testing cycles using a linear regression model. RESULTS: Between 2010 and 2012, the number of participants enrolled increased from 32 in 16 countries to 114 in 44 countries. 78.2% of participants reported results using 10 different VL assays. The rates of participants reporting acceptable results were 96.6% (Abbott), 96.3% (Roche COBAS), 94.5% (Roche Amplicor), 93.0% (Biocentric), and 89.3% (NucliSENS). The overall mean proficiency scores improved over time (p = 0.024). CONCLUSION: DTSs are a good alternative specimen type to plasma specimens for VL PT programs as they do not require cold chain transportation and can be used on polymerase chain reaction (PCR)-based assays. Our data suggest that the CDC HIV-1 VL PT program using DTSs positively impacts the testing performance of the participants which might translate into better and accurate VL testing services to patients. |
Cardiovascular effects in rats after intratracheal instillation of metal welding particles
Zheng W , Antonini JM , Lin YC , Roberts JR , Kashon ML , Castranova V , Kan H . Inhal Toxicol 2015 27 (1) 45-53 Studies have indicated that pulmonary exposure to welding fumes can induce a series of adverse effects in the respiratory system, including infection, bronchitis, siderosis and decreased pulmonary function. Recent clinical and epidemiological studies have found that pulmonary exposure to welding fumes is also associated with a higher incidence of cardiovascular events. However, there is insufficient evidence to confirm a direct effect of welding fumes on the cardiovascular system. The present study investigated the effects of pulmonary exposure to welding fumes on the heart and the vascular system in rats. Two chemically distinct welding fumes generated from manual metal arc-hard surfacing (MMA-HS) and gas metal arc-mild steel (GMA-MS) welding were tested. Three groups of rats were instilled intratracheally with MMA-HS (2 mg/rat), GMA-MS (2 mg/rat) or saline as control once a week for seven weeks. On days 1 and 7 after the last treatment, basal cardiovascular function and the cardiovascular response to increasing doses of adrenoreceptor agonists were assessed. MMA-HS treatment reduced the basal levels of left ventricle end-systolic pressure and dP/dtmax at 1 day post-treatment, and decreased dP/dtmin in response to isoproterenol (ISO) at 7 days post-treatment. Unlike MMA-HS, GMA-MS only affected left ventricular end-diastolic pressure in response to ISO at 7 days post-treatment. Treatment with MMA-HS or GMA-MS did not alter heart rate and blood pressure. Our findings suggest that exposure to different welding fumes can induce different adverse effects on the cardiovascular system, and that cardiac contractility may be a sensitive indicator of cardiovascular dysfunction. |
Serologic testing for syphilis: benefits and challenges of a reverse algorithm
Soreng K , Levy R , Fakile Y . Clin Microbiol Newsl 2014 36 (24) 195-202 Syphilis is a human infection of global importance. Its diagnosis can be challenging, requiring construction of a serologic profile based on the results of at least two types of antibody tests: treponemal and nontreponemal. The traditional approach to the serodiagnosis of syphilis has been the use of a nontreponemal screening assay followed by the performance of a treponemal confirmatory test if the initial nontreponemal screening test was reactive. With the increasing availability of automated, easier-to-perform, and rapid treponemal assays, an increasing number of laboratory testing sites are adopting reverse sequence screening for the serodiagnosis of syphilis: screening with a treponemal assay first, then confirmation with a nontreponemal assay and, when necessary, discrepant resolution using another treponemal test. In addition to offering automation and increased throughput, a reverse algorithm can increase disease detection, especially in late latent and early primary stages of infection when the nontreponemal antibody test may be nonreactive. However, a disadvantage to this approach is that there can be an increase in false-positive test results. This article reviews the clinical and workflow benefits and limitations of a reverse testing algorithm and discusses current guidance available from the Centers for Disease Control and Prevention. |
Pathogen security-help or hindrance?
Morse SA . Front Bioeng Biotechnol 2014 2 83 Events over the past 15 years have resulted in the promulgation of regulations in the United States to enhance biosecurity by restricting the access to pathogens and toxins (i.e., biological select agents and toxins [BSATs]), which pose a severe threat to human being, animal, or plant health or to animal or plant products, to qualified institutions, laboratories, and scientists. These regulations also reduce biosafety concerns by imposing specific requirements on laboratories working with BSATs. Furthermore, they provide a legal framework for prosecuting someone who possesses a BSAT illegally. With the implementation of these regulations has come discussion in the scientific community about the potential of these regulations to affect the cost of doing BSAT research, hamper research and international collaborations, or whether it would stop someone with a microbiological background from isolating many of the select agents from nature. |
Opioid prescription claims among women of reproductive age - United States, 2008-2012
Ailes EC , Dawson AL , Lind JN , Gilboa SM , Frey MT , Broussard CS , Honein MA . MMWR Morb Mortal Wkly Rep 2015 64 (2) 37-41 Prescription opioid use in the United States has become widespread, and studies of opioid exposure in pregnancy suggest increased risk for adverse pregnancy outcomes, including neonatal abstinence syndrome and birth defects (e.g., neural tube defects, gastroschisis, and congenital heart defects). The development of birth defects often results from exposures during the first few weeks of pregnancy, which is a critical period for organ formation. Given that many pregnancies are not recognized until well after the first few weeks and half of all U.S. pregnancies are unplanned, all women who might become pregnant are at risk. Therefore, it is important to assess opioid medication use among all women of reproductive age. CDC used Truven Health's MarketScan Commercial Claims and Encounters and Medicaid data to estimate the number of opioid prescriptions dispensed by outpatient pharmacies to women aged 15-44 years. During 2008-2012, opioid prescription claims were consistently higher among Medicaid-enrolled women when compared with privately insured women (39.4% compared with 27.7%, p<0.001). The most frequently prescribed opioids among women in both groups were hydrocodone, codeine, and oxycodone. Efforts are needed to promote interventions to reduce opioid prescriptions among this population when safer alternative treatments are available. |
Dietary patterns and maternal anthropometry in HIV-infected, pregnant Malawian women
Ramlal RT , Tembo M , King CC , Ellington S , Soko A , Chigwenembe M , Chasela C , Jamieson DJ , van der Horst C , Bentley M , Adair L , The Ban Study Team . Nutrients 2015 7 (1) 584-94 Diet is a modifiable factor that can contribute to the health of pregnant women. In a sample of 577 HIV-positive pregnant women who completed baseline interviews for the Breastfeeding, Antiretrovirals, and Nutrition Study in Lilongwe, Malawi, cluster analysis was used to derive dietary patterns. Multiple regression analysis was used to identify associations between the dietary patterns and mid-upper arm circumference (MUAC), arm muscle area (AMA), arm fat area (AFA), and hemoglobin at baseline. Three key dietary patterns were identified: animal-based, plant-based, and grain-based. Women with relatively greater wealth were more likely to consume the animal-based diet, which had the highest intake of energy, protein, and fat and was associated with higher hemoglobin levels compared to the other diets. Women with the lowest wealth were more likely to consume the grain-based diet with the lowest intake of energy, protein, fat, and iron and were more likely to have lower AFA than women on the animal-based and plant-based diets, but higher AMA compared to women on the animal-based diet. Pregnant, HIV-infected women in Malawi could benefit from nutritional support to ensure greater nutrient diversity during pregnancy, when women face increased nutrient demands to support fetal growth and development. |
Modeling and analysis of gas capture from sealed sections of abandoned coal mines
Karacan CT . Int J Coal Geol 2015 138 30-41 All coal mines eventually complete their economic life, stop production, and are abandoned completely. Ventilation shafts and access drifts of these mines are usually sealed by plugging with concrete to isolate the mine environment from the outside atmosphere (surface) and also to prevent unauthorized access to old workings. Although large areas of access to the mine can be isolated, the void space left behind can never be isolated from surrounding coal and other formations. The void spaces act as a huge sink and start accumulating gas, perhaps groundwater as well, over time to form a methane reservoir. Understanding methane emission into old workings from surrounding strata, and the leakage characteristics of in-place mine seals, and analyzing gas production potential from such areas can improve ventilation designs in mines operating in similar settings, and can also enable the possibility of using abandoned mine methane (AMM) as an energy source. To meet these objectives, data acquired from different sources and utilized in the context of flow modeling and reservoir simulation, along with productions of AMM wells, can be invaluable tools. However, modeling of abandoned mines for gas emission and capture may not be an easy task. The difficulties in estimating spatial variability in various properties of the surrounding coal and mine environment, the complex geometry of the mine boundary and its details, and the initial conditions at the time of abandonment and when analysis begins all add to the challenge.In this paper, a reservoir modeling study that aims to characterize methane extraction from an abandoned room-and-pillar mine in the Springfield coal, Indiana, is demonstrated. The analyses related to interactions of surrounding coal with the abandoned mine environment were performed though history matching, initially, of two AMM wells drilled into two sealed sections. Analyses were then extended to evaluate different well locations to understand potential changes in gas emission from the coal, as well as leakage from the seals. Data required for establishing a detailed reservoir environment were obtained from mine maps, analysis of well productions by using a composite model, and by geostatistical modeling of point-wise data to create property maps.Results showed that wells drilled in larger sealed sections of the mine and away from previous workings performed better. Furthermore, the location of the well in the sealed section can be important as locations close to surrounding coal can have a better chance of promoting more gas in-flow from the coal seam, whereas locations close to the seal can take advantage of leakage through the seal and can benefit from higher rates of the gas contributed from other parts of the mine. Since gas emissions from coal and leakage through seals vary with the pressure differential, simulations of AMM can also be used in ventilation design of mines operating in similar settings as estimates and thus can also help improving safety of mines with quantified understanding of leakage. |
Caffeine intake from food and beverage sources and trends among children and adolescents in the United States: review of national quantitative studies from 1999 to 2011
Ahluwalia N , Herrick K . Adv Nutr 2015 6 (1) 102-11 There is increasing concern about potential adverse effects of caffeine in children. Our understanding of caffeine intake relies on studies dating to the late 1990s. This article synthesizes information from national studies since then to describe caffeine consumption, its association with sociodemographic factors, key dietary sources including caffeine-containing energy drinks (CCEDs), and trends in caffeine intake and sources among US children. Findings from the Kanter Worldpanel (KWP) Beverage Consumption Panel and the NHANES showed that caffeine consumption prevalence was generally consistent across studies and over time; more than one-half of 2- to 5-y-olds and approximately 75% of older children (>5 y) consumed caffeine. The usual intakes of caffeine were 25 and 50 mg/d for children and adolescents aged 2-11 and 12-17 y, respectively (NHANES 2007-2010). Caffeine consumption correlated with age and was higher in non-Hispanic white children. The key sources of caffeine were soda and tea as well as flavored dairy (for children aged <12 y) and coffee (for those aged ≥12 y). The frequency of CCED use varied (2-30%) depending on study setting, methods, and demographic characteristics. A statistically significant but small decline in caffeine intake was noted in children overall during the 10- to 12-y period examined; intakes remained stable among older children (≥12 y). A significant increasing trend in CCED and coffee consumption and a decline in soda intake were noted (1999-2010). In 2009-2010, 10% of 12- to 19-y-olds and 10-25% of caffeine consumers (aged 12-19 y) had intakes exceeding Canadian maximal guidelines. Continued monitoring can help better understand changes in caffeine consumption patterns of youth. |
Worker illness related to newly marketed pesticides - Douglas County, Washington, 2014
Calvert GM , Rodriguez L , Prado JB . MMWR Morb Mortal Wkly Rep 2015 64 (2) 42-44 On April 10, 2014 the Washington State Department of Agriculture (WSDA) was notified by a local newspaper of a suspected pesticide poisoning incident in Douglas County involving pesticides not previously reported in the published literature to be associated with human illness. On that same day, WSDA notified the Washington State Department of Health, which investigated this incident by conducting a site visit, reviewing medical and applicator records, and interviewing affected farmworkers, pesticide applicators, and the farmworkers' employer. In addition, on April 11, WSDA collected swab, foliage, and clothing samples and tested them for residues of pyridaben, novaluron, and triflumizole. In this incident, all 20 farmworkers working in a cherry orchard became ill from off-target drift of a pesticide mixture that was being applied to a neighboring pear orchard. Sixteen sought medical treatment for neurologic, gastrointestinal, ocular, and respiratory symptoms. This event highlights the need for greater efforts to prevent off-target drift exposures and promote awareness about the toxicity of some recently marketed pesticides. Incidents such as this could be prevented if farm managers planning pesticide applications notify their neighbors of their plans. |
Miscarriage among flight attendants
Grajewski B , Whelan EA , Lawson CC , Hein MJ , Waters MA , Anderson JL , MacDonald LA , Mertens CJ , Tseng CY , Cassinelli RT 2nd , Luo L . Epidemiology 2015 26 (2) 192-203 BACKGROUND: Cosmic radiation and circadian disruption are potential reproductive hazards for flight attendants. METHODS: Flight attendants from 3 US airlines in 3 cities were interviewed for pregnancy histories and lifestyle, medical, and occupational covariates. We assessed cosmic radiation and circadian disruption from company records of 2 million individual flights. Using Cox regression models, we compared respondents (1) by levels of flight exposures and (2) to teachers from the same cities, to evaluate whether these exposures were associated with miscarriage. RESULTS: Of 2654 women interviewed (2273 flight attendants and 381 teachers), 958 pregnancies among 764 women met study criteria. A hypothetical pregnant flight attendant with median first-trimester exposures flew 130 hours in 53 flight segments, crossed 34 time zones, and flew 15 hours during her home-base sleep hours (10 pm-8 am), incurring 0.13 mGy absorbed dose (0.36 mSv effective dose) of cosmic radiation. About 2% of flight attendant pregnancies were likely exposed to a solar particle event, but doses varied widely. Analyses suggested that cosmic radiation exposure of 0.1 mGy or more may be associated with increased risk of miscarriage in weeks 9-13 (odds ratio = 1.7 [95% confidence interval = 0.95-3.2]). Risk of a first-trimester miscarriage with 15 hours or more of flying during home-base sleep hours was increased (1.5 [1.1-2.2]), as was risk with high physical job demands (2.5 [1.5-4.2]). Miscarriage risk was not increased among flight attendants compared with teachers. CONCLUSIONS: Miscarriage was associated with flight attendant work during sleep hours and high physical job demands and may be associated with cosmic radiation exposure. |
Overview of the National Occupational Mortality Surveillance (NOMS) system: leukemia and acute myocardial infarction risk by industry and occupation in 30 US states 1985-1999, 2003-2004, and 2007
Robinson CF , Walker JT , Sweeney MH , Shen R , Calvert GM , Schumacher PK , Ju J , Nowlin S . Am J Ind Med 2015 58 (2) 123-37 BACKGROUND: Cancer and chronic disease are leading causes of death in the US with an estimated cost of $46 billion. METHODS: We analyzed 11 million cause-specific deaths of US workers age 18-64 years in 30 states during 1985-1999, 2003-2004, and 2007 by occupation, industry, race, gender, and Hispanic origin. RESULTS: The highest significantly elevated proportionate leukemia mortality was observed in engineers, protective service, and advertising sales manager occupations and in banks/savings & loans/credit agencies, public safety, and public administration industries. The highest significantly elevated smoking-adjusted acute myocardial infarction mortality was noted in industrial and refractory machinery mechanics, farmers, mining machine operators, and agricultural worker occupations; and wholesale farm supplies, agricultural chemical, synthetic rubber, and agricultural crop industries. CONCLUSIONS: Significantly elevated risks for acute myocardial infarction and leukemia were observed across several occupations and industries that confirm existing reports and add new information. Interested investigators can access the NOMS website at http://www.cdc.gov/niosh/topics/NOMS/. |
Hospital respiratory protection practices in 6 U.S. states: a public health evaluation study
Peterson K , Novak D , Stradtman L , Wilson D , Couzens L . Am J Infect Control 2015 43 (1) 63-71 BACKGROUND: Lessons learned from the influenza A (H1N1) virus revealed a need to better understand hospitals' respiratory protection programmatic practice gaps. This article reports findings from a multistate assessment of hospitals' adherence to the Occupational Safety and Health Administration's respiratory protection program (RPP) requirements and the Centers for Disease Control and Prevention's infection control guidance. METHODS: Onsite surveys were conducted in 98 acute care hospitals in 6 U.S. states, including >1,500 hospital managers, unit managers, and health care workers. Descriptive statistics were used to assess hospital adherence. RESULTS: Most acute care hospitals adhere to requirements for initial medical evaluations, fit testing, training, and recommended respiratory protection when in close contact with patients who have suspected or confirmed seasonal influenza. Low hospital adherence was found for respiratory protection with infectious diseases requiring airborne precautions, aerosol-generating procedures with seasonal influenza, and checking of the respirator's user seal. Hospitals' adherence was also low with follow-up program evaluations, medical re-evaluations, and respirator maintenance. CONCLUSION: Efforts should be made to closely examine ways of strengthening hospitals' RPPs to ensure the program's ongoing effectiveness and workers' proper selection and use of respiratory protection. Implications for improved RPPs and practice are discussed. |
Investing in prospective cohorts for etiologic study of occupational exposures
Blair A , Hines CJ , Thomas KW , Alavanja MC , Freeman LE , Hoppin JA , Kamel F , Lynch CF , Lubin JH , Silverman DT , Whelan E , Zahm SH , Sandler DP . Am J Ind Med 2015 58 (2) 113-22 Prospective cohorts have played a major role in understanding the contribution of diet, physical activity, medical conditions, and genes to the development of many diseases, but have not been widely used for occupational exposures. Studies in agriculture are an exception. We draw upon our experience using this design to study agricultural workers to identify conditions that might foster use of prospective cohorts to study other occupational settings. Prospective cohort studies are perceived by many as the strongest epidemiologic design. It allows updating of information on exposure and other factors, collection of biologic samples before disease diagnosis for biomarker studies, assessment of effect modification by genes, lifestyle, and other occupational exposures, and evaluation of a wide range of health outcomes. Increased use of prospective cohorts would be beneficial in identifying hazardous exposures in the workplace. Occupational epidemiologists should seek opportunities to initiate prospective cohorts to investigate high priority, occupational exposures. |
Examination of controlled recirculation implementation in an underground nonmetal mine
Pritchard CJ , Scott DF . Min Eng 2015 66 (12) 49-55 Controlled recirculation of ventilation air in underground metal and nonmetal mines has the potential to improve airflow and the health and safety of miners when implemented properly. Previous research by Robinson, Marks, Cecala and others concluded that the success of a district recirculation system is predicated upon an adequate supply of fresh air and the use of a reliable monitoring system for safe operation. This recent research also showed that contaminant levels will not exceed pre-recirculation levels, and that district recirculation can improve the dilution of face contaminants, especially methane gas. |
Malaria chemoprophylaxis: a proven public health intervention for international travelers
Westercamp N , Arguin PM . Travel Med Infect Dis 2015 13 (1) 8-9 The most notable finding in Luthi and Shlagenhauf’s [1] recent review - that failure to use chemoprophylaxis while traveling to malaria-endemic areas is a major risk factor for severe malaria and death - is concerning, but not at all surprising. This conclusion should be so obvious to the travel medicine community that one might think it did not merit publication at all. But clearly it does. | Malaria chemoprophylaxis is an effective means of preventing both morbidity and mortality among international travelers to malaria endemic countries. It is a proven public health intervention, but unfortunately it is not being utilized sufficiently. There are, of course, many reasons for this. Some travelers are not aware of the risk or do not have access to appropriate preventive health services. People sometimes forget their medicines, or are non-adherent to the correct chemoprophylaxis schedule. Repeat and frequent travelers to malaria-endemic countries may become complacent about malaria prevention in general or may be reluctant to use specific medications for malaria prevention due to side effects they might have experienced, perceived, or simply heard about. But the more concerning one is the travel medicine health care provider who misses the opportunity to recommend effective chemoprophylaxis for the travelers who actually made it in to the clinic seeking such advice. Despite clear and consistent evidence that lack of chemoprophylaxis is a risk factor for severe malaria and death [1], risk-benefit analyses, special considerations for certain types of travelers and settings, promotion of standby emergency medicine, and cost-effectiveness calculations are proffered—all of which have the potential to undermine the use of malaria chemoprophylaxis [2–5]. Luthi and Schlagenhauf [1] demonstrated that even in instances where malaria was not prevented, suboptimal chemoprophylaxis (wrong medications or incorrect usage) reduced mortality and the risk of severe disease. The travel medicine specialist should be advocating for malaria prevention rather than looking for opportunities to avoid prescribing effective chemoprophylaxis. This should include educating the travelers on different available options and choosing the chemoprophylaxis that would be most suitable for each traveler. |
Abundance, natural infection with trypanosomes, and food source of an endemic species of triatomine, Panstrongylus howardi (Neiva 1911), on the Ecuadorian central coast
Villacis AG , Ocana-Mayorga S , Lascano MS , Yumiseva CA , Baus EG , Grijalva MJ . Am J Trop Med Hyg 2015 92 (1) 187-92 The elimination of domestic triatomines is the foundation of Chagas disease control. Regional initiatives are eliminating introduced triatomine species. In this scenario, endemic triatomines can occupy the ecological niches left open and become a threat to long-term Chagas disease control efforts. This study determined the abundance, colonization, and Trypanosoma cruzi infection rate of the endemic Panstrongylus howardi in 10 rural communities located in Ecuador's Manabi Province. In total, 518 individuals of P. howardi were collected. Infestation indices of 1.4% and 6.6% were found in the domestic and peridomestic environments, respectively. We determined a T. cruzi infection rate of 53.2% (N = 47) in this species. P. howardi has a high capacity to adapt to different habitats, especially in the peridomicile. This implies a considerable risk of transmission because of the frequency of intradomicile invasion. Therefore, this species needs to be taken into account in Chagas control and surveillance efforts in the region. |
Opportunities for public health to increase physical activity among youths
Piercy KL , Dorn JM , Fulton JE , Janz KF , Lee SM , McKinnon RA , Pate RR , Pfeiffer KA , Young DR , Troiano RP , Lavizzo-Mourey R . Am J Public Health 2015 105 (3) e1-e6 Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity. |
Immunology careers at the NIH, FDA and CDC: different paths that focus on advancing public health
Catalfamo M , Mawle A , Verthelyi D . Nat Immunol 2015 16 (2) 129-32 The NIH, FDA and CDC offer a wide spectrum of job opportunities focused on improving public health through the discovery and translation of research, the regulation of safe and effective medicines, and the protection of health security. |
Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection
Boulet SL , Mehta A , Kissin DM , Warner L , Kawwass JF , Jamieson DJ . JAMA 2015 313 (3) 255-63 IMPORTANCE: Intracytoplasmic sperm injection (ICSI) is increasingly used in patients without severe male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). OBJECTIVE: To assess national trends and reproductive outcomes for fresh IVF cycles (embryos transferred without being frozen) following the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. DESIGN, SETTING, AND POPULATION: Retrospective cohort study using data on fresh IVF and ICSI cycles reported to the US National Assisted Reproductive Technology Surveillance System during 1996-2012. MAIN OUTCOMES AND MEASURES: Trends in ICSI use during 1996-2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield, and 2 or more prior assisted reproductive technology cycles; reproductive outcomes for conventional IVF and ICSI cycles during 2008-2012, stratified by the presence or absence of male factor infertility. RESULTS: Of the 1,395,634 fresh IVF cycles from 1996 through 2012, 908,767 (65.1%) used ICSI and 499,135 (35.8%) reported male factor infertility. Among cycles with male factor infertility, ICSI use increased from 76.3% (10,876/14,259) to 93.3% (32,191/34,506) (P < .001) during 1996-2012; for those without male factor infertility, ICSI use increased from 15.4% (4197/27,191) to 66.9% (42,321/63,250) (P < .001). During 2008-2012, male factor infertility was reported for 35.7% (176,911/494,907) of fresh cycles. Among those cycles, ICSI use was associated with a lower multiple birth rate compared with conventional IVF (30.9% vs 34.2%; adjusted relative risk [RR], 0.87; 95% CI, 0.83-0.91). Among cycles without male factor infertility (n = 317,996), ICSI use was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91-0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93-0.97), and multiple live birth (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91-0.95) vs conventional IVF. CONCLUSIONS AND RELEVANCE: Among fresh IVF cycles in the United States, ICSI use increased from 36.4% in 1996 to 76.2% in 2012, with the largest relative increase among cycles without male factor infertility. Compared with conventional IVF, ICSI use was not associated with improved postfertilization reproductive outcomes, irrespective of male factor infertility diagnosis. |
Public perceptions about risk and protective factors for cognitive health and impairment: a review of the literature
Friedman DB , Becofsky K , Anderson LA , Bryant LL , Hunter RH , Ivey SL , Belza B , Logsdon RG , Brannon S , Vandenberg AE , Lin SY . Int Psychogeriatr 2015 27 (8) 1-13 BACKGROUND: Preventing and/or delaying cognitive impairment is a public health priority. To increase awareness of and participation in behaviors that may help maintain cognitive function or reduce risk of impairment, we need to understand public perceptions about risk and protective factors. METHODS: We conducted a scoping review of studies examining the public's perceptions about risk and protective factors related to cognitive health and impairment published since the 2007 National Public Health Road Map to Maintaining Cognitive Health. RESULTS: A search of five databases yielded 1,115 documents published between June 2007 and December 2013. Initial review of abstracts identified 90 potentially eligible studies. After full-article review, 30 met inclusion criteria; four additional articles identified in reference lists also met inclusion criteria. Of the 34, 16 studies addressed Alzheimer's disease (AD) specifically, 15 dementia broadly, 5 mild to moderate cognitive impairment, and 8 normal functioning, with some content overlap. Across studies, respondents reported genetics (n = 14 studies), older age (n = 8), stress (n = 7), brain/head injury (n = 6), and mental illness/brain disease (n = 6) as perceived risk factors for AD and dementia. Protective factors most commonly identified for maintaining cognitive health were intellectual/mental stimulation (n = 13), physical activity (n = 12), healthy diet (n = 10), and social/leisure activities (n = 10). CONCLUSIONS: Studies identified genetics and older age as key perceived risk factors more so than behaviors such as smoking. Individuals perceived that numerous lifestyle factors (e.g. intellectual stimulation, physical activity) could protect against cognitive impairment, AD, and/or dementia. Results can inform national and international education efforts about AD and other dementias. |
A comprehensive approach to address the prescription opioid epidemic in Washington state: milestones and lessons learned
Franklin G , Sabel J , Jones CM , Mai J , Baumgartner C , Banta-Green CJ , Neven D , Tauben DJ . Am J Public Health 2015 105 (3) e1-e7 An epidemic of morbidity and mortality has swept across the United States related to the use of prescription opioids for chronic noncancer pain. More than 100 000 people have died from unintentional overdose, making this one of the worst manmade epidemics in history. Much of health care delivery in the United States is regulated at the state level; therefore, both the cause and much of the cure for the opioid epidemic will come from state action. We detail the strong collaborations across executive health care agencies, and between those public agencies and practicing leaders in the pain field that have led to a substantial reversal of the epidemic in Washington State. |
Content Index (Achived Edition)
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- Immunity and Immunization
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