Epidemiology and prevention of stroke: a worldwide perspective
Kuklina EV , Tong X , George MG , Bansil P . Expert Rev Neurother 2012 12 (2) 199-208 This paper reviews how epidemiological studies during the last 5 years have advanced our knowledge in addressing the global stroke epidemic. The specific objectives were to review the current evidence supporting management of ten major modifiable risk factors for prevention of stroke: hypertension, current smoking, diabetes, obesity, poor diet, physical inactivity, atrial fibrillation, excessive alcohol consumption, abnormal lipid profile and psychosocial stress/depression. |
Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States
Ford ES , Greenlund KJ , Hong Y . Circulation 2012 125 (8) 987-95 BACKGROUND: Recently, the American Heart Association (AHA) developed a set of seven ideal health metrics that will be used to measure progress towards their 2020 goals for cardiovascular health. The objective of the present study was to examine how well these metrics predicted mortality from all-causes and diseases of the circulatory system in a national sample of adults in the United States. METHODS AND RESULTS: We used data from 7622 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2002 and whose mortality through 2006 was determined via linkage to the National Death Index. For the dietary and glycemic metrics, we used alternative measures. During a median follow-up of 5.8 years, 532 deaths (186 deaths from diseases of the circulatory system) occurred. About 1.5% of participants met none of the seven ideal cardiovascular health metrics, and 1.1% of participants met all seven metrics. The number of ideal metrics was significantly and inversely related to mortality from all-causes and diseases of the circulatory system. Compared to participants who met none of the ideal metrics, those meeting five or more metrics had a reduction of 78% (adjusted hazard ratio [aHR]: 0.22; 95% confidence interval [CI]: 0.10, 0.50) in the risk for all-cause mortality and 88% (aHR: 0.12; 95% CI: 0.03, 0.57) in the risk for mortality from diseases of the circulatory system. CONCLUSIONS: The number of ideal cardiovascular health metrics is a strong predictor of mortality from all-causes and diseases of the circulatory system. |
Transmission of hepatitis C virus infection through tattooing and piercing: a critical review
Tohme RA , Holmberg SD . Clin Infect Dis 2012 54 (8) 1167-78 Tattoos and piercings are increasing, especially among youths, but the risk of hepatitis C virus (HCV) infection from these practices has not been adequately assessed and there are conflicting findings in the literature. We evaluated the risk of HCV infection from tattooing and piercing using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies that specified the venue of tattooing and/or piercing showed no definitive evidence for an increased risk of HCV infection when tattoos and piercings were received in professional parlors. However, the risk of HCV infection is significant, especially among high-risk groups (adjusted odds ratio, 2.0-3.6), when tattoos are applied in prison settings or by friends. Prevention interventions are needed to avoid the transmission of hepatitis C from tattooing and piercing in prisons, homes, and other potentially nonsterile settings. Youths also should be educated on the need to have tattoos and piercings performed under sterile conditions to avoid HCV infection. |
Long-term trends in Chlamydia trachomatis infections and related outcomes in a US managed care population
Scholes D , Satterwhite CL , Yu O , Fine D , Weinstock H , Berman S . Sex Transm Dis 2012 39 (2) 81-8 BACKGROUND: Given recent increasing case rates of Chlamydia trachomatis infection, we evaluated trends in chlamydia rates and related health outcomes in women and men aged 15 to 44 years who were enrolled in a Pacific Northwest health plan. METHODS: We identified chlamydia, pelvic inflammatory disease (PID), ectopic pregnancy, and male urethritis cases occurring annually during 1997-2007 using computerized health plan databases, calculating rates per 100,000 person-years (py) by gender and 5-year age groups. We also calculated annual chlamydia testing rates. RESULTS: In women, chlamydia testing rates increased by approximately 23% (220 tests per 1000 py in 1997 to 270 tests per 1000 in 2007). Chlamydia diagnosis rates rose from 449 cases/100,000 py in 1997 to 806/100,000 in 2007, a 79% increase (P = 0.01). Increases were greatest during 2005-2007, also the period of major conversion to nucleic acid amplification test. PID rates in this interval declined steadily from 823 cases/100,000 py to 473/100,000 (P < 0.01). Ectopic pregnancy rates remained unchanged. In men, chlamydia testing rates increased nearly 3.5-fold, from 12 to 42 tests per 1000 py. Chlamydia rates for men also rose significantly throughout the study interval (from 91 cases/100,000 py to 218/100,000; P < 0.01) as did urethritis diagnosis rates (P < 0.01). CONCLUSION: Between 1997 and 2007, annual health plan chlamydia rates increased significantly for both women and men. These trends may be due in part to increased testing rates and increased use of more sensitive tests, but they likely do not explain the increased urethritis rates. During this same interval, we observed steady declines in PID rates, consistent with other national data sources. |
Global isoniazid resistance patterns in rifampin-resistant and rifampin-susceptible tuberculosis
Smith SE , Kurbatova EV , Cavanaugh JS , Cegielski JP . Int J Tuberc Lung Dis 2012 16 (2) 203-205 Following the World Health Organization's endorsement of the Xpert((R)) MTB/RIF assay, which rapidly and simultaneously diagnoses tuberculosis (TB) and detects resistance to rifampin (RMP), the question arises to what extent RMP resistance is an adequate marker for multidrug-resistant TB (MDR-TB). A retrospective analysis of data from >81 countries and subnational settings demonstrated that >40% of RMP-resistant isolates from new TB cases did not display resistance to isoniazid (INH) in settings with relatively low MDR-TB prevalence (one third of all countries and subnational settings). Results indicated the need for INH susceptibility testing in addition to RMP susceptibility testing. |
Changing trends in viral hepatitis-associated hospitalizations in the American Indian/Alaska Native population, 1995-2007
Byrd KK , Redd JT , Holman RC , Haberling DL , Cheek JE . Public Health Rep 2011 126 (6) 816-25 OBJECTIVE: We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care. METHODS: We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995-2007 and summary periods 1995-1997 and 2005-2007. RESULTS: Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995-1997 to 0.8 per 100,000 population during 2005-2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45-64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45-64 years, males, and those in the Alaska region. CONCLUSIONS: Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment. |
Survey of Legionella species found in Thai soil
Travis TC , Brown EW , Peruski LF , Siludjai D , Jorakate P , Salika P , Yang G , Kozak NA , Kodani M , Warner AK , Lucas CE , Thurman KA , Winchell JM , Thamthitiwat S , Fields BS . Int J Microbiol 2012 2012 218791 Members of the Gram-negative genus Legionella are typically found in freshwater environments, with the exception of L. longbeachae, which is present in composts and potting mixes. When contaminated aerosols are inhaled, legionellosis may result, typically as either the more serious pneumonia Legionnaires' disease or the less severe flu-like illness Pontiac fever. It is presumed that all species of the genus Legionella are capable of causing disease in humans. As a followup to a prior clinical study of legionellosis in rural Thailand, indigenous soil samples were collected proximal to cases' homes and workplaces and tested for the presence of legionellae by culture. We obtained 115 isolates from 22/39 soil samples and used sequence-based methods to identify 12 known species of Legionella represented by 87 isolates. |
Polyfluorinated compounds in serum linked to indoor air in office environments
Fraser AJ , Webster TF , Watkins DJ , Nelson JW , Stapleton HM , Calafat AM , Kato K , Shoeib M , Vieira VM , McClean MD . Environ Sci Technol 2012 46 (2) 1209-15 We aimed to investigate the role of indoor office air on exposure to polyfluorinated compounds (PFCs) among office workers. Week-long, active air sampling was conducted during the winter of 2009 in 31 offices in Boston, MA. Air samples were analyzed for fluorotelomer alcohols (FTOHs), sulfonamides (FOSAs), and sulfonamidoethanols (FOSEs). Serum was collected from each participant (n = 31) and analyzed for 12 PFCs including PFOA and PFOS. In air, FTOHs were present in the highest concentrations, particularly 8:2-FTOH (GM = 9920 pg/m(3)). FTOHs varied significantly by building with the highest levels observed in a newly constructed building. PFOA in serum was significantly correlated with air levels of 6:2-FTOH (r = 0.43), 8:2-FTOH (r = 0.60), and 10:2-FTOH (r = 0.62). Collectively, FTOHs in air significantly predicted PFOA in serum (p < 0.001) and explained approximately 36% of the variation in serum PFOA concentrations. PFOS in serum was not associated with air levels of FOSAs/FOSEs. In conclusion, FTOH concentrations in office air significantly predict serum PFOA concentrations in office workers. Variation in PFC air concentrations by building is likely due to differences in the number, type, and age of potential sources such as carpeting, furniture, and/or paint. |
Impact of dust from multiple microenvironments and diet on PentaBDE body burden
Watkins DJ , McClean MD , Fraser AJ , Weinberg J , Stapleton HM , Sjodin A , Webster TF . Environ Sci Technol 2012 46 (2) 1192-200 Our objectives were to determine relative contributions of diet and dust exposure from multiple microenvironments to PentaBDE body burden, and to explore the role of handwipes as a measure of personal exposure to PentaBDE. We administered a food frequency questionnaire and collected serum, dust (office, main living area, bedroom, and vehicle), and handwipe samples from 31 participants. SigmaPentaBDEs (sum of BDE 28/33, 47, 99, 100, and 153) in handwipes collected in the office environment were weakly correlated with dust collected from offices (r = 0.35, p = 0.06) and bedrooms (r = 0.39, p = 0.04), but not with dust from main living areas (r = -0.05, p = 0.77) or vehicles (r = 0.17, p = 0.47). SigmaPentaBDEs in serum were correlated with dust from main living areas (r = 0.42, p = 0.02) and bedrooms (r = 0.49, p = 0.008), but not with dust from offices (r = 0.22, p = 0.25) or vehicles (r = 0.20, p = 0.41). Our final regression model included variables for main living area dust and handwipes, and predicted 55% of the variation in serum SigmaPentaBDE concentrations (p = 0.0004). Diet variables were not significant predictors of SigmaPentaBDEs in serum. Our research suggests that exposure to dust in the home environment may be the most important factor in predicting PentaBDE body burden in North Americans, and potential exposure pathways may involve PBDE residues on hands. |
Validation of self-reported epilepsy for purposes of community surveillance
Brooks DR , Avetisyan R , Jarrett KM , Hanchate A , Shapiro GD , Pugh MJ , Berlowitz DR , Thurman D , Montouris G , Kazis LE . Epilepsy Behav 2012 23 (1) 57-63 We evaluated the validity of questions designed to identify lifetime and active epilepsy, medication use, and seizure occurrence on population-based surveys. Subjects were interviewed by telephone, and responses were compared with information in their medical records. Prevalence, sensitivity, specificity, and positive predictive value (PPV) were calculated. The prevalence of ever having been diagnosed with epilepsy was 3.1% by self-report and 2.7% by medical record review. Sensitivity was 84.2%, specificity was 99.2%, and PPV was 73.5% for self-reported lifetime epilepsy, and values were similar for active epilepsy. By comparison, sensitivity was higher and specificity was lower for epilepsy medication use and seizure occurrence. The PPV for seizure occurrence was substantially higher for a recall period of 12 months than for 3 months. These results compare favorably with results for other chronic conditions, such as diabetes and arthritis, and indicate that questionnaires can be used to identify epilepsy at a population level. |
Impact of using multiple causes of death codes to compute site-specific, death certificate-based cancer mortality statistics in the United States
Fink AK , German RR , Heron M , Stewart SL , Johnson CJ , Finch JL , Yin D , Schaeffer PE . Cancer Epidemiol 2012 36 (1) 22-28 BACKGROUND: Cancer mortality statistics, an important indicator for monitoring cancer burden, are traditionally restricted to instances when cancer is determined to be the underlying cause of death (UCD) based on information recorded on standard certificates of death. This study's objective was to determine the impact of using multiple causes of death codes to compute site-specific cancer mortality statistics. METHODS: The state cancer registries of California, Colorado and Idaho provided linked cancer registry and death certificate data for individuals who died between 2002 and 2004, had at least one cancer listed on their death certificate and were diagnosed with cancer between 1993 and 2004. These linked data were used to calculate the site-specific proportion of cancers not selected as the UCD (non-UCD) among all cancer-related deaths (any mention on the death certificate). In addition, the retrospective concordance between the death certificate and the population-based cancer registry, measured as confirmations rates, was calculated for deaths with cancer as the UCD, as a non-UCD, and for any mention. RESULTS: Overall, non-UCD deaths comprised 9.5 percent of total deaths; 11 of the 79 cancer sites had proportions greater than 3 standard deviations from 9.5 percent. The confirmation rates for UCD and for any mention did not differ significantly for any of the cancer sites. CONCLUSION AND IMPACT: The site-specific variation in proportions and rates suggests that for a few cancer sites, death rates might be computed for both UCD and any mention of the cancer site on the death certificate. Nevertheless, this study provides evidence that, in general, restricting to UCD deaths will not under report cancer mortality statistics. |
An outbreak of Salmonella serotype Typhimurium infections with an unusually long incubation period
Brooks JT , Matyas BT , Fontana J , Degroot MA , Beuchat LR , Hoekstra M , Friedman CR . Foodborne Pathog Dis 2012 9 (3) 245-8 A 1998 investigation of an outbreak of Salmonella serotype Typhimurium infections among children tasting unpasteurized milk during tours of a dairy farm demonstrated a distribution of unusually long incubation periods (median, 8 days; interquartile range [IQR], 6-14 days). Bacterial isolates were highly acid tolerant and contained genes associated with protection against destructive phagocytic reactive oxygen intermediates. We hypothesize that exposure to low-dose oral inoculum of a pathogen with these properties could have contributed to cases of non-typhoidal salmonellosis with the longest incubation period reported to the Centers for Disease Control and Prevention (CDC). |
Ground beef consumption patterns in the United States, FoodNet, 2006 through 2007
Taylor EV , Holt KG , Mahon BE , Ayers T , Norton D , Gould LH . J Food Prot 2012 75 (2) 341-6 Infection resulting from foodborne pathogens, including Escherichia coli O157:H7, is often associated with consumption of raw or undercooked ground beef. However, little is known about the frequency of ground beef consumption in the general population. The objective of this study was to describe patterns of self-reported ground beef and pink ground beef consumption using data from the 2006 through 2007 FoodNet Population Survey. From 1 July 2006 until 30 June 2007, residents of 10 FoodNet sites were contacted by telephone and asked about foods consumed within the previous week. The survey included questions regarding consumption of ground beef patties both inside and outside the home, the consumption of pink ground beef patties and other types of ground beef inside the home, and consumption of ground beef outside the home. Of 8,543 survey respondents, 75.3% reported consuming some type of ground beef in the home. Of respondents who ate ground beef patties in the home, 18.0% reported consuming pink ground beef. Consumption of ground beef was reported most frequently among men, persons with incomes from $40,000 to $75,000 per year, and persons with a high school or college education. Ground beef consumption was least often reported in adults ≥65 years of age. Men and persons with a graduate level education most commonly reported eating pink ground beef in the home. Reported consumption of ground beef and pink ground beef did not differ by season. Ground beef is a frequently consumed food item in the United States, and rates of consumption of pink ground beef have changed little since previous studies. The high rate of consumption of beef that has not been cooked sufficiently to kill pathogens makes pasteurization of ground beef an important consideration, especially for those individuals at high risk of complications from foodborne illnesses such as hemolytic uremic syndrome. |
The association of variants in the FTO gene with longitudinal body mass index profiles in non-Hispanic white children and adolescents.
Hallman DM , Friedel VC , Eissa MA , Boerwinkle E , Huber JC Jr , Harrist RB , Srinivasan SR , Chen W , Dai S , Labarthe DR , Berenson GS . Int J Obes (Lond) 2012 36 (1) 61-8 OBJECTIVE: To investigate possible age-related changes in associations between polymorphisms in the fat mass and obesity-associated (FTO) gene and higher body mass index (BMI). DESIGN AND SUBJECTS: Multilevel mixed regression models were used to examine associations between four FTO variants and longitudinal BMI profiles in non-Hispanic white and African American children and adolescents 8-17 years of age from two different longitudinal cohort studies, the Bogalusa Heart Study (BHS) and Project HeartBeat! (PHB). In the BHS, there were 1551 examinations of 478 African Americans and 3210 examinations of 1081 non-Hispanic whites; in PHB, there were 971 examinations of 131 African Americans and 4458 examinations of 505 non-Hispanic whites. RESULTS: In African Americans, no significant FTO associations with BMI were found. In non-Hispanic whites, linkage disequilibrium among all four variants made haplotype analysis superfluous, so we focused on the single-nucleotide polymorphism, rs9939609. In longitudinal multilevel models, the A/A genotype of rs9939609 was associated with higher BMI in non-Hispanic whites in both cohorts at all ages. A significant age-by-genotype interaction found only in the BHS cohort predicted that in those with the A/A genotype, BMI would be approximately 0.7 kg m(-2) higher at age 8 and approximately 1.6 kg m(-2) higher at age 17 than in those with A/T or T/T genotypes. The design of PHB limited follow-up of any single individual to 4 years, and may have reduced the ability to detect any age-by-genotype interaction in this cohort. CONCLUSIONS: The A/A genotype of rs9939609 in the FTO gene is associated with higher longitudinal BMI profiles in non-Hispanic whites from two different cohorts. The association may change with age, with the A/A genotype being associated with a larger BMI difference in late adolescence than in childhood, though this was observed only in the BHS cohort and requires verification. |
Genetic diversity of HA1 domain of hemagglutinin gene of pandemic influenza H1N1pdm09 viruses in New Delhi, India.
Mir MA , Lal RB , Sullender W , Singh Y , Garten R , Krishnan A , Broor S . J Med Virol 2012 84 (3) 386-93 Genetic analysis of pandemic 2009 influenza A (H1N1; H1N1pdm09) virus was undertaken to understand virus evolution during 2009 and 2010 in India. Surveillance of influenza viruses from July 2009 to December 2010 revealed major peaks of circulating H1N1pdm09 viruses in August-September and December-January 2009 and then in August-September 2010. To understand the diversity of the H1N1pdm09 virus, selected specimens (n = 23) from 2009 or 2010 were characterized by nucleotide sequence determination of the HA1 subunit of the HA gene. Phylogenetic analysis revealed that 22 clustered with clade 7 viruses characterized by S203T mutations, whereas one virus from 2010 fell within clade 6. None of the viruses from either 2009 or 2010 formed a monophyletic group, suggesting a continuum of independent introduction of circulating viral strains. Amino acid analysis revealed minor amino acid changes in the antigenic or receptor-binding domains. Importantly, we observed mutations that were also present in 1918 pandemic virus, which includes S183P in 4 and S185T mutation in 3 of 13 viruses analyzed from 2010, while none of the 2009 viruses carried these mutations. Whether antibody-mediated pressure is imposing such changes remains to be determined. Continued genetic surveillance is warranted to monitor pathogenicity as the virus evolves to acquire new features. (J. Med. Virol. 84:386-393, 2012. (c) 2011 Wiley Periodicals, Inc.) |
Permanent genetic resources added to Molecular Ecology Resources Database 1 October 2011-30 November 2011.
Molecular Ecology Resources Primer Development Consortium , Abreu AG , Albaina A , Alpermann TJ , Apkenas VE , Bankhead-Dronnet S , Bergek S , Berumen ML , Cho CH , Clobert J , Coulon A , DEFeraudy D , Estonba A , Hankeln T , Hochkirch A , Hsu TW , Huang TJ , Irigoien X , Iriondo M , Kay KM , Kinitz T , Kothera L , LEHenanff M , Lieutier F , Lourdais O , Macrini CM , Manzano C , Martin C , Morris VR , Nanninga G , Pardo MA , Plieske J , Pointeau S , Prestegaard T , Quack M , Richard M , Savage HM , Schwarcz KD , Shade J , Simms EL , Solferini VN , Stevens VM , Veith M , Wen MJ , Wicker F , Yost JM , Zarraonaindia I . Mol Ecol Resour 2012 12 (2) 374-6 This article documents the addition of 139 microsatellite marker loci and 90 pairs of single-nucleotide polymorphism sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Aglaoctenus lagotis, Costus pulverulentus, Costus scaber, Culex pipiens, Dascyllus marginatus, Lupinus nanus Benth, Phloeomyzus passerini, Podarcis muralis, Rhododendron rubropilosum Hayata var. taiwanalpinum and Zoarces viviparus. These loci were cross-tested on the following species: Culex quinquefasciatus, Rhododendron pseudochrysanthum Hay. ssp. morii (Hay.) Yamazaki and R. pseudochrysanthum Hayata. This article also documents the addition of 48 sequencing primer pairs and 90 allele-specific primers for Engraulis encrasicolus. |
Investigation and control of an outbreak of Achromobacter xylosoxidans bacteremia
Behrens-Muller B , Conway J , Yoder J , Conover CS . Infect Control Hosp Epidemiol 2012 33 (2) 180-4 OBJECTIVE: To define the extent of an outbreak of Achromobacter xylosoxidans bacteremia, determine the source of the outbreak, and implement control measures. DESIGN: An outbreak investigation, including environmental and infection control assessment, and evaluation of hypotheses using the binomial distribution and case control studies. SETTING: A 50-bed medical surgical unit in a hospital in Illinois during the period January 1-July 15, 2006. INTERVENTIONS: Discontinuation of use of opioid delivery via patient-controlled analgesia (PCA) until the source of the outbreak was identified and implementation of new protocols to ensure more rigorous observation of PCA pump cartridge manipulations. RESULTS: Calculations based on the binomial distribution indicated the probability that all 9 patients with A. xylosoxidans bacteremia were PCA pump users by chance alone was <.001. A subsequent case control study identified PCA pump use for administration of morphine as a risk factor for A. xylosoxidans bacteremia (odds ratio, undefined; [Formula: see text]). Having a PCA pump cartridge with morphine started by nurse C was significantly associated with becoming a case-patient (odds ratio, 46; 95% confidence interval, 4.0-525.0; [Formula: see text]). CONCLUSIONS: We hypothesize that actions related to diversion of morphine by nurse C were the likely cause of the outbreak. An aggressive pain control program involving the use of opioid medication warrants an equally aggressive policy to prevent diversion of medication by staff. |
Genetic diversity and antibiotic resistance in Shigella dysenteriae and Shigella boydii strains isolated from children aged <5 years in Egypt.
El-Gendy AM , Mansour A , Weiner MA , Pimentel G , Armstrong AW , Young SY , Elsayed N , Klena JD . Epidemiol Infect 2012 140 (2) 299-310 Diversity within Shigella dysenteriae (n=40) and Shigella boydii (n=30) isolates from children living in Egypt aged <5 years was investigated. Shigella-associated diarrhoea occurred mainly in summer months and in children aged <3 years, it commonly presented with vomiting and fever. Serotypes 7 (30%), 2 (28%), and 3 (23%) accounted for most of S. dysenteriae isolates; 50% of S. boydii isolates were serotype 2. S. dysenteriae and S. boydii isolates were often resistant to ampicillin, chloramphenicol and tetracycline (42%, 17%, respectively), although resistance varied among serotypes. Pulsed-field gel electrophoresis separated the isolates into distinct clusters correlating with species and serotype. Genetic differences in trimethoprim/sulfamethoxazole and beta-lactam-encoding resistance genes were also evident. S. dysenteriae and S. boydii are genetically diverse pathogens in Egypt; the high level of multidrug resistance associated with both pathogens and resistance to the most available inexpensive antibiotics underlines the importance of continuing surveillance. |
Receptor-binding specificity of the human parainfluenza virus type 1 hemagglutinin-neuraminidase glycoprotein
Alymova IV , Portner A , Mishin VP , McCullers JA , Freiden P , Taylor GL . Glycobiology 2012 22 (2) 174-80 The hemagglutinin-neuraminidase (HN) glycoprotein is utilized by human parainfluenza viruses for binding to the host cell. By the use of glycan array assays, we demonstrate that, in addition to the first catalytic-binding site, the HN of human parainfluenza virus type 1 has a second site for binding covered by N-linked glycan. Our data suggest that attachment of the first site to sialic acid (SA)-linked receptors triggers exposure of the second site. We found that both sites bind to alpha2-3-linked SAs with a preference for a sialyl-Lewis(x) motif. Binding to alpha2-3-linked SAs with a sulfated sialyl-Lewis motif as well as to alpha2-8-linked SAs was unique for the second binding site. Neither site recognizes alpha2-6-linked oligosaccharides. |
Serology and cytokine profiles in patients infected with the newly discovered Bundibugyo ebolavirus
Gupta M , Macneil A , Reed ZD , Rollin PE , Spiropoulou CF . Virology 2012 423 (2) 119-24 A new species of Ebolavirus, Bundibugyo ebolavirus, was discovered in an outbreak in western Uganda in November 2007. To study the correlation between fatal infection and immune response in Bundibugyo ebolavirus infection, viral antigen, antibodies, and 17 soluble factors important for innate immunity were examined in 44 patient samples. Using Luminex assays, we found that fatal infection was associated with high levels of viral antigen, low levels of pro-inflammatory cytokines, such as IL-1alpha, IL-1beta, IL-6, TNF-alpha, and high levels of immunosuppressor cytokines like IL-10. Also, acute infected patients died in spite of generating high levels of antibodies against the virus. Thus, our results imply that disease severity in these patients is not due to the multi-organ failure and septic shock caused by a flood of inflammatory cytokines, as seen in infections with other Ebolavirus species. |
Specificity of the tuberculin skin test and the T-SPOT.TB assay among students in a low-tuberculosis incidence setting
Talbot EA , Harland D , Wieland-Alter W , Burrer S , Adams LV . J Am Coll Health 2012 60 (1) 94-6 OBJECTIVE: Interferon-gamma release assays (IGRAs) are an important tool for detecting latent Mycobacterium tuberculosis infection (LTBI). Insufficient data exist about IGRA specificity in college health centers, most of which screen students for LTBI using the tuberculin skin test (TST). PARTICIPANTS: Students at a low-TB incidence college health center. METHODS: TST and T-SPOT.TB were performed on prospectively recruited students. TB exposure risk was assessed using a questionnaire: Those at low risk were assumed to not have LTBI in order to calculate test specificity. RESULTS: Of 184 students enrolled, 143 had results available for both TST and T-SPOT.TB. Agreement of the tests was 97% (kappa statistic 0.717; 95% confidence interval, 0.399-1.00). Among 124 low-risk students, specificity for TST and T-SPOT.TB were 98.4% and 100%, respectively. CONCLUSIONS: T-SPOT.TB specificity was high among low-risk students. Additional studies such as cost-effectiveness analyses using T-SPOT.TB as a single or confirmatory test to TST are needed to contribute to LTBI screening policy decisions. |
Comparison of HIV-1 detection in plasma specimens and dried blood spots using the Roche COBAS Ampliscreen HIV-1 test in Kisumu, Kenya
Okonji JA , Basavaraju SV , Mwangi J , Shiraishi RW , Odera M , Ouma K , Pitman JP , Marum LH , Ou CY , Zeh C . J Virol Methods 2012 179 (1) 21-5 The World Health Organization recommends screening donor blood for HIV in centralized laboratories. This recommendation contributes to quality, but presents specimen transport challenges for resource-limited settings which may be relieved by using dried blood spots (DBS). In sub-Saharan Africa, most countries screen donor blood with serologic assays only. Interest in window period reduction has led blood services to consider adding HIV nucleic acid testing (NAT). The U.S. Food and Drug Administration (FDA) mandates that HIV-1 NAT blood screening assays have a 95% detection limit at or below 100copies/ml and 5000copies/ml for pooled and individual donations, respectively. The Roche COBAS Ampliscreen HIV-1 test, version 1.5, used for screening whole blood or components for transfusion, has not been tested with DBS. We compared COBAS Ampliscreen HIV-1 RNA detection limits in DBS and plasma. An AIDS Clinical Trials Group, Viral Quality Assurance laboratory HIV-1 standard with a known viral load was used to create paired plasma and DBS standard nine member dilution series. Each was tested in 24 replicates with the COBAS Ampliscreen. A probit analysis was conducted to calculate 95% detection limits for plasma and DBS, which were 23.8copies/ml (95% CI 15.1-51.0) for plasma and 106.7copies/ml (95% CI 73.8-207.9) for DBS. The COBAS Ampliscreen detection threshold with DBS suggests acceptability for individual donations, but optimization may be required for pooled specimens. |
Mice completely lacking immunoproteasomes show major changes in antigen presentation
Kincaid EZ , Che JW , York I , Escobar H , Reyes-Vargas E , Delgado JC , Welsh RM , Karow ML , Murphy AJ , Valenzuela DM , Yancopoulos GD , Rock KL . Nat Immunol 2011 13 (2) 129-35 The importance of immunoproteasomes to antigen presentation has been unclear because animals totally lacking immunoproteasomes had not been available. Having now developed mice lacking the three immunoproteasome catalytic subunits, we found that the dendritic cells of these mice had defects in presenting several major histocompatibility complex (MHC) class I epitopes. During viral infection in vivo, the presentation of a majority of MHC class I epitopes was markedly reduced in immunoproteasome-deficient animals compared with wild-type animals, whereas presentation of MHC class II peptides was unaffected. According to mass spectrometry, the repertoire of MHC class I-presented peptides was approximately 50% different from that in wild-type mice, and these differences were sufficient to stimulate robust transplant rejection of wild-type cells in mutant mice. These results indicated that immunoproteasomes were more important in antigen presentation than previously thought. |
Racial/ethnic variations in the prevalence of selected major birth defects, metropolitan Atlanta, 1994-2005
Kucik JE , Alverson CJ , Gilboa SM , Correa A . Public Health Rep 2012 127 (1) 52-61 OBJECTIVES: Birth defects are the leading cause of infant mortality and are responsible for substantial child and adult morbidity. Documenting the variation in prevalence of birth defects among racial/ethnic subpopulations is critical for assessing possible variations in diagnosis, case ascertainment, or risk factors among such groups. METHODS: We used data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects registry with active case ascertainment. We estimated the racial/ethnic variation in prevalence of 46 selected major birth defects among live births, stillbirths, and pregnancy terminations at >20 weeks gestation among mothers residing in the five central counties of metropolitan Atlanta between 1994 and 2005, adjusting for infant sex, maternal age, gravidity, and socioeconomic status (SES). We also explored SES as a potential effect measure modifier. RESULTS: Compared with births to non-Hispanic white women, births to non-Hispanic black women had a significantly higher prevalence of five birth defects and a significantly lower prevalence of 10 birth defects, while births to Hispanic women had a significantly higher prevalence of four birth defects and a significantly lower prevalence of six birth defects. The racial/ethnic disparities in the prevalence of some defects varied by SES, but no clear pattern emerged. CONCLUSIONS: Racial/ethnic disparities were suggested in 57% of included birth defects. Disparities in the prevalence of birth defects may result from different underlying genetic susceptibilities; exposure to risk factors; or variability in case diagnosis, ascertainment, or reporting among the subpopulations examined. Policies that improve early diagnosis of birth defects could reduce associated morbidity and mortality. |
Obesity-related coagulation changes in pregnancy
Smrtka MP , Thames B , Beckman M , Rajgor D , Gandhi M , James AH . Thromb Res 2012 129 (2) 204-6 Obesity, a health concern of increasing importance in developed countries, is associated with a four- to five-fold increased risk of venous thromboembolism (VTE) in pregnancy [1], [2]. In one study, obese pregnant women were three times more likely to suffer a pulmonary embolism (PE) than a deep vein thrombosis (DVT), placing them at greater risk for mortality than non-obese gravidas [2]. Obesity is also associated with poor pregnancy outcomes, including a 40 percent increased risk for stillbirth compared to non-obese gravidas [3]. | A respectable body of literature has documented many of the changes in clotting and fibrinolysis during normal pregnancy, but little has been reported on the effect of obesity on these processes [4], [5], [6], [7], [8]. We hypothesize that the increased risk of VTE in pregnancy associated with obesity, while likely multifactorial, is partly explained by changes in coagulation proteins. We compared clotting factor levels in obese and non-obese pregnant women with the purpose of identifying specific changes in obese gravidas that might place them at higher risk for VTE than non-obese gravidas. |
Overview of maternal mortality in the United States
Callaghan WM . Semin Perinatol 2012 36 (1) 2-6 Although dramatic improvements in pregnancy care and in general population health facilitated a dramatic decline in maternal mortality in the United States during the 20th century, women still die from complications of pregnancy. Moreover, rates appear to have increased during the early 21st century. This overview will provide context for understanding the problem of maternal mortality in the United States by outlining how maternal mortality rates are reported from National Vital Statistics data, and how pregnancy-related mortality ratios are reported from a national surveillance system. Trends and patterns in these deaths as well as emerging issues concerning causes of maternal deaths and the difficulty with interpreting trend data will be discussed. |
From identification and review to action - maternal mortality review in the United States
Berg CJ . Semin Perinatol 2012 36 (1) 7-13 The maternal mortality review process is an ongoing quality improvement cycle with 5 steps: identification of maternal deaths, collection of medical and other data on the events surrounding the death, review and synthesis of the data to identify potentially alterable factors, the development and implementation of interventions to decrease the risk of future deaths, and evaluation of the results. The most important step is utilization of the data to identify and implement evidence-based actions; without this step, the rest of the work will not have an impact. The review committee ideally is based in the health department of a state (or large city) as a core public health function. This provides stability for the process as well as facilitates implementation of the review committees' recommendations. The review committee should be multidisciplinary, with its members being official representatives of their organizations or departments, again to improve buy-in of the stakeholders. |
A call for coordinated and evidence-based action to protect children outside of family care
Clay R , CdeBaca L , De Cock KM , Goosby E , Guttmacher A , Jacobs S , Pablos-Mendez A , Polaski S , Sheldon G , Steinberg D . Lancet 2012 379 (9811) e6-8 A caring and protective family, immediate and extended, is central to effective child protection. Children in the most dire straits, however, live without protective family care. These children may be found living on the streets or in institutions, trafficked, participating in armed groups, or exploited for their labour. Children in such circumstances often experience abuse, neglect, lack of stimulation, and extreme and toxic stress, all of which have a profoundly negative effect on a child's development and adult outcomes.1 | Children living outside of family care have largely fallen off the statistical map. There are only limited data about how many children live in such precarious circumstances, except for scattered estimates from some specific countries. Such children are often not covered in household-based surveys. Some international data collection activities provide useful information about these children, including USAID's Demographic and Health Surveys,2 UNICEF's Multiple Indicator Cluster Surveys,3 the Statistical Information and Monitoring Program on Child Labor surveys sponsored by the International Labour Organization,4 and the US Centers for Disease Control and Prevention's Violence Against Children surveys.5 Although there is a need for more evidence-based research, rough global estimates indicate that 17 800 000 children have lost both parents;6 2 000 000 children are in institutional care;7 1 800 000 children are victims of sex trafficking or involvement in pornography;8 and 1 100 000 children are trafficked for forced labour.9 |
Lack of periconceptional vitamins or supplements that contain folic acid and diabetes mellitus-associated birth defects
Correa A , Gilboa SM , Botto LD , Moore CA , Hobbs CA , Cleves MA , Riehle-Colarusso TJ , Waller DK , Reece EA , National Birth Defects Prevention Study . Am J Obstet Gynecol 2011 206 (3) 218 e1-13 OBJECTIVE: The purpose of this study was to examine the risk of birth defects in relation to diabetes mellitus and the lack of use of periconceptional vitamins or supplements that contain folic acid. STUDY DESIGN: The National Birth Defects Prevention Study (1997-2004) is a multicenter, population-based case-control study of birth defects (14,721 cases and 5437 control infants). Cases were categorized into 18 types of heart defects and 26 noncardiac birth defects. We estimated odds ratios for independent and joint effects of preexisting diabetes mellitus and a lack of periconceptional use of vitamins or supplements that contain folic acid. RESULTS: The pattern of odds ratios suggested an increased risk of defects that are associated with diabetes mellitus in the absence vs the presence of the periconceptional use of vitamins or supplements that contain folic acid. CONCLUSION: The lack of periconceptional use of vitamins or supplements that contain folic acid may be associated with an excess risk for birth defects due to diabetes mellitus. |
Thermal burden of N95 filtering facepiece respirators
Roberge R , Benson S , Kim JH . Ann Occup Hyg 2012 56 (7) 808-14 Increased thermal perceptions that affect comfort are a leading reason for intolerance to wearing respiratory protective equipment. Despite their popularity and use for decades, relatively little is known about the thermal burden imposed by the use of N95 filtering facepiece respirators (FFR) at normal work rates. Twenty healthy subjects exercised at a low-moderate work rate for 1 and 2 h while wearing four models of N95 FFR (two with an exhalation valve) as core and skin temperatures were monitored wirelessly. N95 FFR use resulted in non-significant minimal increases in core temperature and uncovered facial skin (cheek) temperatures. Facial skin temperature under the FFR was significantly increased over baseline values (P < 0.001). Wearing N95 FFR for up to 2 h at a low-moderate work rate does not impose a significant thermal burden on core temperature and uncovered facial skin temperature but significantly increases the temperature of the facial skin that is covered by the FFR. Perceptions of increased body heat when wearing N95 FFR under the test conditions are likely not due to effects on core temperature but may relate more to warming of the facial skin covered by the respirator and warming of the inspired air. |
Nanoparticle penetration through filter media and leakage through face seal interface of N95 filtering facepiece respirators
Rengasamy S , Eimer BC . Ann Occup Hyg 2012 56 (5) 568-80 National Institute for Occupational Safety and Health recommends the use of particulate respirators for protection against nanoparticles (<100 nm size). Protection afforded by a filtering facepiece particulate respirator is a function of the filter efficiency and the leakage through the face-to-facepiece seal. The combination of particle penetration through filter media and particle leakage through face seal and any component interfaces is considered as total inward leakage (TIL). Although the mechanisms and extent of nanoparticle penetration through filter media have been well documented, information concerning nanoparticle leakage through face seal is lacking. A previous study in our laboratory measured filter penetration and TIL for specific size particles. The results showed higher filter penetration and TIL for 50 nm size particles, i.e. the most penetrating particle size (MPPS) than for 8 and 400 nm size particles. To better understand the significance of particle penetration through filter media and through face seal leakage, this study was expanded to measure filter penetration at sealed condition and TIL with artificially introduced leaks for 20-800 nm particles at 8-40 l minute volumes for four N95 models of filtering facepiece respirators (FFRs) using a breathing manikin. Results showed that the MPPS was approximately 45 nm for all four respirator models. Filter penetration for 45 nm size particles was significantly (P < 0.05) higher than the values for 400 nm size particles. A consistent increase in filter penetrations for 45 and 400 nm size particles was obtained with increasing breathing minute volumes. Artificial leakage of test aerosols (mode size approximately 75 nm) through increasing size holes near the sealing area of FFRs showed higher TIL values for 45 nm size particles at different minute volumes, indicating that the induced leakage allows the test aerosols, regardless of particle size, inside the FFR, while filter penetration determines the TIL for different size particles. TIL values obtained for 45 nm size particles were significantly (P < 0.05) higher than the values obtained for 400 nm size particles for all four models. Models with relatively small filter penetration values showed lower TIL values than the models with higher filter penetrations at smaller leak sizes indicating the dependence of TIL values on filter penetration. When the electrostatic charge was removed, the FFRs showed a shift in the MPPS to approximately 150 nm with the same test aerosols (mode size approximately 75 nm) at different hole sizes and breathing minute volumes, confirming the interaction between filter penetration and face seal leakage processes. The shift in the MPPS from 45 to 150 nm for the charge removed filters indicates that mechanical filters may perform better against nanoparticles than electrostatic filters rated for the same filter efficiency. The results suggest that among the different size particles that enter inside the N95 respirators, relatively high concentration of the MPPS particles in the breathing zone of respirators can be expected in workplaces with high concentration of nanoparticles. Overall, the data obtained in the study suggest that good fitting respirators with lower filter penetration values would provide better protection against nanoparticles. |
Plasma dioxin levels and cause-specific mortality in an occupational cohort of workers exposed to chlorophenoxy herbicides, chlorophenols and contaminants
Boers D , Portengen L , Turner WE , Bueno-de-Mesquita HB , Heederik D , Vermeulen R . Occup Environ Med 2012 69 (2) 113-8 BACKGROUND: We recently reported increased risks for all cancers and urinary cancers in workers exposed to chlorophenoxy herbicides using data from the Dutch herbicide cohort study. These risks could not be linked to the qualitative exposure proxies available. Here, we re-investigate exposure-response relationships using a (semi)quantitative measure of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure. METHODS: Plasma TCDD levels of 187 workers were used to develop a predictive model for TCDD exposure. Cox proportional hazards model was used to investigate associations between time-varying TCDD exposure and cause-specific mortality. Sensitivity analyses were performed to assess the impact of key assumptions in exposure assessment. RESULTS: Predicted TCDD levels were associated with mortality from all causes (HR 1.08; 95% CI 1.03 to 1.13), ischaemic heart disease (IHD; HR 1.19; 95% CI 1.08 to 1.32) and non-Hodgkin's lymphoma (NHL; HR 1.36; 95% CI 1.06 to 1.74). No relationships were found between TCDD exposure and mortality from all cancers, respiratory or urinary cancers, which were previously linked to qualitative proxies of TCDD exposure in this cohort. Sensitivity analyses showed that results were relatively robust to slight changes in exposure estimation. CONCLUSIONS: Modelled TCDD exposure does not explain the previously reported increased risks for cancer mortality in this cohort except for a possible association with NHL. A small increase in ischaemic heart disease was observed, however we cannot exclude that this finding was due to residual confounding. Although risk estimates for some of the rarer outcomes were still rather imprecise, we do not expect more precise estimates from longer follow-up of this cohort due to the long time-span since last exposure to TCDD. |
Body mass index, playing position, race, and the cardiovascular mortality of retired professional football players
Baron SL , Hein MJ , Lehman E , Gersic CM . Am J Cardiol 2012 109 (6) 889-96 Concern exists about cardiovascular disease (CVD) in professional football players. We examined whether playing position and size influence CVD mortality in 3,439 National Football League players with ≥5 pension-credited playing seasons from 1959 to 1988. Standardized mortality ratios (SMRs) compared player mortality through 2007 to the United States population of men stratified by age, race, and calendar year. Cox proportional hazards models evaluated associations of playing-time body mass index (BMI), race, and position with CVD mortality. Overall player mortality was significantly decreased (SMR 0.53, 95% confidence interval [CI] 0.48 to 0.59) as was mortality from cancer (SMR 0.58, 95% CI 0.46 to 0.72), and CVD (SMR 0.68, 95% CI 0.56 to 0.81). CVD mortality was increased for defensive linemen (SMR 1.42, 95% CI 1.02 to 1.92) but not for offensive linemen (SMR 0.70, 95% CI 0.45 to 1.05). Defensive linemen's cardiomyopathy mortality was also increased (SMR 5.34, 95% CI 2.30 to 10.5). Internal analyses found that CVD mortality was increased for players of nonwhite race (hazard ratio 1.69, 95% CI 1.13 to 2.51). After adjusting for age, race, and calendar year, CVD mortality was increased for those with a playing-time BMI ≥30 kg/m(2) (hazard ratio 2.02, 95% CI 1.06 to 3.85) and for defensive linemen compared to offensive linemen (hazard ratio 2.07, 95% CI 1.24 to 3.46). In conclusion, National Football League players from the 1959 through 1988 seasons had decreased overall mortality but those with a playing-time BMI ≥30 kg/m(2) had 2 times the risk of CVD mortality compared to other players and African-American players and defensive linemen had higher CVD mortality compared to other players even after adjusting for playing-time BMI. |
Chagas heart disease: report on recent developments
Machado FS , Jelicks LA , Kirchhoff LV , Shirani J , Nagajyothi F , Mukherjee S , Nelson R , Coyle CM , Spray DC , de Carvalho AC , Guan F , Prado CM , Lisanti MP , Weiss LM , Montgomery SP , Tanowitz HB . Cardiol Rev 2012 20 (2) 53-65 Chagas disease, caused by the parasite Trypanosoma cruzi, is an important cause of cardiac disease in endemic areas of Latin America. It is now being diagnosed in non-endemic areas due to immigration. Typical cardiac manifestations of Chagas disease include dilated cardiomyopathy, congestive heart failure, arrhythmias, cardioembolism and stroke. Clinical and laboratory-based research to define the pathology resulting from T. cruzi infection has shed light on many of the cellular and molecular mechanisms leading to these manifestations. Antiparasitic treatment may not be appropriate for patients with advanced cardiac disease. Clinical management of Chagas heart disease is similar to that used for cardiomyopathies due to other processes. Cardiac transplantation has been successfully performed in a small number of patients with Chagas heart disease. |
Factors associated with mosquito net use by individuals in households owning nets in Ethiopia
Graves PM , Ngondi JM , Hwang J , Getachew A , Gebre T , Mosher AW , Patterson AE , Shargie EB , Tadesse Z , Wolkon A , Reithinger R , Emerson PM , Richards FO Jr . Malar J 2011 10 354 BACKGROUND: Ownership of insecticidal mosquito nets has dramatically increased in Ethiopia since 2006, but the proportion of persons with access to such nets who use them has declined. It is important to understand individual level net use factors in the context of the home to modify programmes so as to maximize net use. METHODS: Generalized linear latent and mixed models (GLLAMM) were used to investigate net use using individual level data from people living in net-owning households from two surveys in Ethiopia: baseline 2006 included 12,678 individuals from 2,468 households and a sub-sample of the Malaria Indicator Survey (MIS) in 2007 included 14,663 individuals from 3,353 households. Individual factors (age, sex, pregnancy); net factors (condition, age, net density); household factors (number of rooms [2006] or sleeping spaces [2007], IRS, women's knowledge and school attendance [2007 only], wealth, altitude); and cluster level factors (rural or urban) were investigated in univariate and multi-variable models for each survey. RESULTS: In 2006, increased net use was associated with: age 25-49 years (adjusted (a) OR = 1.4, 95% confidence interval (CI) 1.2-1.7) compared to children U5; female gender (aOR = 1.4; 95% CI 1.2-1.5); fewer nets with holes (Ptrend = 0.002); and increasing net density (Ptrend < 0.001). Reduced net use was associated with: age 5-24 years (aOR = 0.2; 95% CI 0.2-0.3). In 2007, increased net use was associated with: female gender (aOR = 1.3; 95% CI 1.1-1.6); fewer nets with holes (aOR [all nets in HH good] = 1.6; 95% CI 1.2-2.1); increasing net density (Ptrend < 0.001); increased women's malaria knowledge (Ptrend < 0.001); and urban clusters (aOR = 2.5; 95% CI 1.5-4.1). Reduced net use was associated with: age 5-24 years (aOR = 0.3; 95% CI 0.2-0.4); number of sleeping spaces (aOR [per additional space] = 0.6, 95% CI 0.5-0.7); more old nets (aOR [all nets in HH older than 12 months] = 0.5; 95% CI 0.3-0.7); and increasing household altitude (Ptrend < 0.001). CONCLUSION: In both surveys, net use was more likely by women, if nets had fewer holes and were at higher net per person density within households. School-age children and young adults were much less likely to use a net. Increasing availability of nets within households (i.e. increasing net density), and improving net condition while focusing on education and promotion of net use, especially in school-age children and young adults in rural areas, are crucial areas for intervention to ensure maximum net use and consequent reduction of malaria transmission. |
Annual summary of vital statistics: 2009
Kochanek KD , Kirmeyer SE , Martin JA , Strobino DM , Guyer B . Pediatrics 2012 129 (2) 338-48 The number of births in the United States decreased by 3% between 2008 and 2009 to 4,130,665 births. The general fertility rate also declined 3% to 66.7 per 1000 women. The teenage birth rate fell 6% to 39.1 per 1000. Birth rates also declined for women 20 to 39 years and for all 5-year groups, but the rate for women 40 to 44 years continued to rise. The percentage of all births to unmarried women increased to 41.0% in 2009, up from 40.6% in 2008. In 2009, 32.9% of all births occurred by cesarean delivery, continuing its rise. The 2009 preterm birth rate declined for the third year in a row to 12.18%. The low-birth-weight rate was unchanged in 2009 at 8.16%. Both twin and triplet and higher order birth rates increased. The infant mortality rate was 6.42 infant deaths per 1000 live births in 2009. The rate is significantly lower than the rate of 6.61 in 2008. Linked birth and infant death data from 2007 showed that non-Hispanic black infants continued to have much higher mortality rates than non-Hispanic white and Hispanic infants. Life expectancy at birth was 78.2 years in 2009. Crude death rates for children and adolescents aged 1 to 19 years decreased by 6.5% between 2008 and 2009. Unintentional injuries and homicide, the first and second leading causes of death jointly accounted for 48.6% of all deaths to children and adolescents in 2009. |
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