Receipt of systemic corticosteroids during asthma visits to U.S. emergency departments, 2007-2009
Simon AE , Akinbami LJ . J Asthma 2013 50 (4) 419-26 BACKGROUND: National Asthma Education and Prevention Program recommended emergency department (ED) asthma treatment includes both providing systemic corticosteroids (steroids) in the ED and a steroid prescription at discharge. OBJECTIVE: To examine the prevalence of three types of sub-standard ED asthma care--providing a discharge prescription only, providing steroids in the ED only, and providing neither--and how care varies with exacerbation severity. METHODS: We used the National Hospital Ambulatory Medical Care Survey-Emergency Department (2007-2009) to identify ED asthma visits (ICD-9-CM code 493.xx) for patients aged 1 to <65 years. The primary outcome was the percent of visits receiving each type of substandard care, both overall and by exacerbation severity. Multinomial logistic regressions with predictive margins were used to obtain estimates adjusted for patient, visit, and hospital characteristics. RESULTS: For 27.1% (CI: 24.0-30.2%) of visits, patients received steroids both in the ED and as a discharge prescription. A discharge prescription only was provided for 12.3% of visits (CI: 10.2-14.6%), steroids were provided in the ED only for 18.2% (CI: 15.6-21.2%), and no steroids were provided for 42.4% (CI: 38.8-46.2%). Even among visits by patients with abnormal overall respiratory status (fast respiratory rates, pulse-oximetry values <97%, or both), only 32.3% (CI: 27.8-36.8) were provided steroids both in the ED and as a prescription, while the remainder received some type of sub-standard care. Adjusted and unadjusted results were similar. CONCLUSIONS: Sub-standard ED asthma care is common, even among visits by patients with more severe asthma exacerbations. |
Aspirin in the secondary prevention of cardiovascular disease
Parekh AK , Galloway JM , Hong Y , Wright JS . N Engl J Med 2013 368 (3) 204-5 Cardiovascular disease causes one of every three deaths in the United States and costs this country about $450 billion annually.1 Each year, despite recent improvements in prevention and treatment, heart disease kills nearly 600,000 Americans, and stroke kills nearly 130,000. People with a history of atherosclerotic cardiovascular disease (e.g., myocardial infarction, stroke, or peripheral arterial disease) are at significantly elevated risk for a new or recurrent cardiovascular event and associated illness and death. It is estimated that more than 16 million U.S. adults are living with coronary heart disease, including prior myocardial infarction and angina, another 7 million have had a stroke, and approximately 8 million currently have peripheral arterial disease.2 | Effective interventions for secondary prevention in these patients include lifestyle modifications such as smoking cessation, weight control, increased physical activity, and dietary modifications, as well as pharmacotherapy to control blood pressure and cholesterol levels. Another important evidence-based intervention is the use of aspirin and other antiplatelet agents (Table in the Supplementary Appendix, available with the full text of this article at NEJM.org). With few exceptions, patients with coronary heart disease, peripheral arterial disease, or a history of ischemic stroke are candidates for aspirin use. |
Molecular characterization of Streptococcus pneumoniae serotype 12F isolates associated with rural community outbreaks in Alaska.
Zulz T , Wenger JD , Rudolph K , Robinson DA , Rakov AV , Bruden D , Singleton RJ , Bruce MG , Hennessy TW . J Clin Microbiol 2013 51 (5) 1402-7 Outbreaks of invasive pneumococcal disease (IPD) caused by serotype 12F Streptococcus pneumoniae were observed in two neighboring regions of rural Alaska in 2003-2006 and 2006-2008. IPD surveillance data from 1986-2009 and carriage survey data from 1998-2004 and 2008-2009 were reviewed to identify patterns of 12F transmission. Pulsed field gel electrophoresis was performed on all available isolates, and selected isolates were characterized by additional genetic subtyping methods. Serotype 12F IPD occurred in two waves in Alaska between 1986 and 2008. While cases of disease occurred nearly every year in Anchorage, in rural regions 12F IPD occurred with rates 10 to 20-fold higher than in Anchorage, often with many years between disease peaks, and generally caused by a single predominant genetic clone. Carriage occurred predominantly in adults, except early in rural outbreaks when most carriage was in persons <18 years old. In rural regions, carriage of 12F disappeared completely after outbreaks. Different 12F clones appear to have been introduced episodically into rural populations, spread widely in young, immunologically naive populations, leading to outbreaks of IPD lasting 1-3 years, then rapidly disappeared from the population. Larger population centers may have been the reservoir for these clones. This epidemiologic pattern is consistent with a highly virulent, but immunogenic, form of pneumococcus. |
Reaching beyond our Xpert potential: reflections on the 43rd Union World Conference
Auld SC , Pevzner E . Int J Tuberc Lung Dis 2013 17 (3) 423-4 The 43rd Union World Conference on Lung Health | could also have been called the fi rst Union World | Conference on GeneXpert®. If you search the digital | abstract book you will fi nd the term ‘Xpert’ mentioned a remarkable 325 times compared to 84 times | in 2011 and 12 times in 2010.1–3 After nearly half a | century without notable advances in the diagnosis | and treatment of tuberculosis (TB), the TB community is understandably excited about the potential for | Xpert to contribute to substantial gains in the ongoing fi ght against this global killer. At the same time, | we must temper our excitement and prepare for the | continuing challenges of diagnosing, treating, and | preventing TB, with or without Xpert. | Unlike human immunodefi ciency virus prevention | and control programs, for whom diagnostics and | treatments have evolved rapidly over the last several | decades, TB control programs have witnessed few | changes since the 1970s.4,5 This long-term stability | has fostered the development of well-established national TB programs (NTPs) with straightforward diagnostic algorithms, decentralized treatment, and robust recording and reporting systems. Yet these very | strengths have the potential to become weaknesses as | we embark upon an era of innovation and discovery. | In addition to the many conference sessions on Xpert, | we also heard about the various ‘pipelines’ for new | diagnostics and biomarkers, novel drug regimens for | treating childhood and multidrug-resistant TB, and, | hopefully, a new TB vaccine. Unfortunately, our wellestablished model for NTPs may be ill-equipped to | integrate and benefi t from these anticipated advances. |
Using the HIV surveillance system to monitor the National HIV/AIDS Strategy
Gray KM , Tang T , Shouse L , Li J , Mermin J , Hall HI . Am J Public Health 2013 103 (1) 141-7 OBJECTIVES: To report on indicators of the National HIV/AIDS Strategy, we analyzed data collected through the national HIV surveillance system. METHODS: We analyzed data from adults and adolescents aged 13 years or older diagnosed with HIV in 13 US jurisdictions that have laboratory reporting of CD4+ T-lymphocyte (CD4) and viral load (VL) test results and enter CD4 and VL test results into the national surveillance system. RESULTS: Of 4899 people diagnosed in 2009, 81.7% had at least 1 CD4 or VL test performed within 3 months of diagnosis. A higher proportion of Whites (86.2%) than Blacks (78.4%) and Hispanics (82.6%) had a CD4 or VL test. Of 53,642 people diagnosed through 2008 and living with HIV at the end of 2009 who had a VL test, 69.4% had a most recent VL of 200 copies per milliliter or less. The proportion of people with suppressed VLs differed among Blacks (60.2%), Hispanics (70.3%), and Whites (77.4%) and among people aged 13 to 24 years (44.3%) compared with people aged 65 years or older (84.2%). Of men who have sex with men, 74.2% had a suppressed VL. CONCLUSIONS: The findings highlight disparities in access to and success of care. |
Prevalence of HIV and other sexually transmitted infections among female sex workers in Kisumu, western Kenya, 1997 and 2008
Vandenhoudt HM , Langat L , Menten J , Odongo F , Oswago S , Luttah G , Zeh C , Crucitti T , Laserson K , Vulule J , Buve A . PLoS One 2013 8 (1) e54953 BACKGROUND: In 1997, a survey in Kisumu found a prevalence of HIV infection among female sex workers (FSW) of 75%. Only 50% reported using a condom with the last client. In 2008, we conducted another survey to collect data to inform an intervention targeting FSW in Kisumu. METHODS: In 2008 FSW were recruited by respondent-driven sampling. Women completed a questionnaire and were tested for HIV and other sexually transmitted infections (STIs). Multiple logistic regression analysis was done to explore factors associated with HIV-infection, and with condom use. Prevalence of HIV infection was compared in the two surveys from 1997 and 2008. Multivariate analysis was used to assess whether a change in HIV prevalence between the two surveys could be explained by changes in socio-demographic characteristics and/or behavioral factors. RESULTS: 481 FSW participated in the 2008 study. HIV prevalence was 56.5% (95% CI 52.0-61.6). Factors independently associated with HIV were age older than 29 years; being a widow; STI treatment in the past year; herpes simplex virus Type-2 infection; bacterial vaginosis; and trichomoniasis. Condom use with last client was reported by 75.0% (95% CI 70.9-78.9). Predictors of condom use with the last client were age older than 29 years; higher price paid by last client; ever having been tested for HIV. Predictors of unprotected sex were being drunk during last sex act; usually having sex during menses; and STI treatment in the past year. The odds ratio of HIV infection associated with year of survey was 0.49 (95% CI 0.33-0.75) after adjusting for socio-demographic and behavioral factors. CONCLUSIONS: The prevalence of HIV among FSW in Kisumu was found to be lower in 2008 than in 1997, while reported condom use was higher. However, access to HIV/STI prevention and care services needs to improve to further decrease HIV transmission between FSW and their clients. |
Prevalence of Neisseria gonorrhoeae among persons 14 to 39 years of age, United States, 1999 to 2008
Torrone EA , Johnson RE , Tian LH , Papp JR , Datta SD , Weinstock HS . Sex Transm Dis 2013 40 (3) 202-5 BACKGROUND: Prevalence estimates from population-based surveys do not suffer from the same biases as case-report and clinic positivity data and may be better to monitor sexually transmitted disease morbidity over time. METHODS: We estimated the prevalence of Neisseria gonorrhoeae in a nationally representative sample of persons aged 14 to 39 years participating in the National Health and Nutrition Examination Survey. RESULTS: From 1999 to 2008, the overall prevalence of gonorrhea was 0.27% (95% confidence interval, 0.13%-0.47%). In the 2005 to 2006 and 2007 to 2008 cycles, prevalence approached 0% and was based on too few positive sample persons to obtain reliable estimates. In 2004, most infections were found in 1 survey location. DISCUSSION: Given the low prevalence and geographic clustering of disease, gonorrhea estimates from national probability surveys are often imprecise and unstable. In 2008, gonorrhea testing in National Health and Nutrition Examination Survey was discontinued. Continued surveillance of gonorrhea should include case reporting and prevalence estimates from local surveys and sentinel surveillance systems. |
Impact of port of entry referrals on initiation of follow-up evaluations for immigrants with suspected tuberculosis: Illinois
Bell TR , Molinari NM , Blumensaadt S , Selent MU , Arbisi M , Shah N , Christiansen D , Philen R , Puesta B , Jones J , Lee D , Vang A , Cohen NJ . J Immigr Minor Health 2013 15 (4) 673-9 US-bound immigrants with suspected non-infectious TB are encouraged to be medically re-evaluated after arrival in the United States. We evaluated the Centers for Disease Control and Prevention's immigrant referral process, designed to facilitate timely post-arrival evaluations. Over 1,200 immigrants with suspected TB arriving during October 1, 2008-September 30, 2010 were identified. In 2011, differences in days to evaluation initiation were assessed by referral type using survival analysis and Cox proportional hazard models. Among those receiving any referral, median time to post-arrival evaluation was significantly lower compared with immigrants receiving no referral (16 vs. 69 days, respectively; p < 0.0001). After adjusting for the covariates, immigrants receiving any referral initiated follow-up at 4 times the rate (adjusted hazard ratio = 4.0; p < 0.0001) of those receiving no referral. Implementing a referral system at US ports of entry will improve timeliness and increase the proportion of immigrants initiating domestic evaluation. |
Community mortality from cholera: urban and rural districts in Zimbabwe
Morof D , Cookson ST , Laver S , Chirundu D , Desai S , Mathenge P , Shambare D , Charimari L , Midzi S , Blanton C , Handzel T . Am J Trop Med Hyg 2013 88 (4) 645-50 In 2008-2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case-control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54-14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00-1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06-0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02-0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56-16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04-0.53) and being married (AOR = 0.26, 95% CI = 0.08-0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral. |
Community-associated Clostridium difficile infection: how real is it?
Lessa FC . Anaerobe 2013 24 121-3 Community-associated Clostridium difficile infection (CA-CDI) represents 32% of all CDI cases based on U.S. population-based data. The current epidemic strain, NAP1, is the most prevalent strain causing these infections. Although complications, recurrence and death are uncommon, one fourth of the CA-CDI patients are hospitalized within 7 days after the diagnosis. |
Community-onset invasive methicillin-resistant Staphylococcus aureus infections following hospital discharge
Duffy J , Dumyati G , Bulens S , Namburi S , Gellert A , Fridkin SK , Lessa FC . Am J Infect Control 2013 41 (9) 782-6 BACKGROUND: The majority of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States are community-onset and occur in persons with recent health care exposure. METHODS: We performed a matched case-control study to identify risk factors for invasive MRSA infection among recently discharged patients. Cases had MRSA cultured from a normally sterile body site within 100 days following hospital discharge. Controls were matched on hospital, week of admission, and age. RESULTS: Among 77 cases, the most common types of invasive MRSA infection were bloodstream infection and osteomyelitis. Independent risk factors were a history of a MRSA-positive clinical culture from a superficial body site in the 12 months preceding the invasive infection (matched odds ratio [mOR], 23; 95% confidence interval [CI]: 3.7-142), hemodialysis (mOR, 21; 95% CI: 1.7-257), prior hospitalization length of stay >5 days (mOR, 4.5; 95% CI: 1.6-12), and male sex (mOR, 2.9; 95% CI: 1.1-7.9). CONCLUSION: Risk factors for postdischarge invasive MRSA infections can be identified prior to discharge and remain with the patient after the hospitalization ends. Measures to prevent community-onset invasive MRSA infections might start in the hospital but should also be evaluated in postdischarge settings. |
Molecular evolution of lineage 2 West Nile virus.
McMullen AR , Albayrak H , May FJ , Davis CT , Beasley DW , Barrett AD . J Gen Virol 2013 94 318-25 Since the 1990s West Nile virus (WNV) has become an increasingly important public health problem and the cause of outbreaks of neurological disease. Genetic analyses have identified multiple lineages with many studies focusing on lineage 1 due to its emergence in New York in 1999 and its neuroinvasive phenotype. Until recently, viruses in lineage 2 were not thought to be of public health importance due to few outbreaks of disease being associated with viruses in this lineage. However, recent epidemics of lineage 2 in Europe (Greece and Italy) and Russia have shown the increasing importance of this lineage. There are very few genetic studies examining isolates belonging to lineage 2. We have sequenced the full-length genomes of four older lineage 2 WNV isolates, compared them to 12 previously published genomic sequences and examined the evolution of this lineage. Our studies show that this lineage has evolved over the past 300-400 years and appears to correlate with a change from mouse attenuated to virulent phenotype based on previous studies by our group. This evolution mirrors that which is seen in lineage 1 isolates, which have also evolved to a virulent phenotype over the same period of time. |
Surveillance of parapoxvirus among ruminants in Virginia and Connecticut.
Roess AA , McCollum AM , Gruszynski K , Zhao H , Davidson W , Lafon N , Engelmeyer T , Moyer B , Godfrey C , Kilpatrick H , Labonte A , Murphy J , Carroll DS , Li Y , Damon IK . Zoonoses Public Health 2013 60 (8) 543-8 In 2008, two deer hunters in Virginia and Connecticut were infected with a unique strain of pseudocowpox virus, a parapoxvirus. To estimate the prevalence of this virus, and in an attempt to define the reservoir, Parapoxvirus surveillance was undertaken between November 2009 and January 2010. 125 samples from four ruminant species (cows, goat, sheep and white-tailed deer) were collected in Virginia, and nine samples from white-tailed deer were collected in Connecticut. We found no evidence that the parapoxvirus species that infected the deer hunters is circulating among domesticated ruminants or white-tailed deer. However, parapoxvirus DNA of a different parapoxvirus species, bovine papular stomatitis virus (BPSV), was detected in 31 samples obtained from asymptomatic cattle in Virginia. Parapoxvirus DNA-positive cattle originated from the same counties indicating probable transmission among animals. Molecular analysis identified BPSV as the parapoxvirus affecting animals. Asymptomatic parapoxvirus infections in livestock, particularly young animals, may be common, and further investigation will inform our knowledge of virus transmission. |
Consistently high estimates for the proportion of human exposure to malaria vector populations occurring indoors in rural Africa
Huho B , Briet O , Seyoum A , Sikaala C , Bayoh N , Gimnig J , Okumu F , Diallo D , Abdulla S , Smith T , Killeen G . Int J Epidemiol 2013 42 (1) 235-47 BACKGROUND: Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are highly effective tools for controlling malaria transmission in Africa because the most important vectors, from the Anopheles gambiae complex and the A. funestus group, usually prefer biting humans indoors at night. METHODS: Matched surveys of mosquito and human behaviour from six rural sites in Burkina Faso, Tanzania, Zambia, and Kenya, with ITN use ranging from 0.2% to 82.5%, were used to calculate the proportion of human exposure to An. gambiae sensu lato and An. funestus s.l. that occurs indoors (pi(i)), as an indicator of the upper limit of personal protection that indoor vector control measures can provide...... |
Studies on the origin of Culex pipiens pipiens form molestus in New York City
Kading RC . J Am Mosq Control Assoc 2012 28 100-5 Culex pipiens pipiens is comprised of two forms: Cx. pipiens pipiens form pipiens and Culex pipiens pipiens form molestus. One population of Cx. p. pipiens form molestus in the United States, located in the 91st Street sewer of New York City (NYC), has been relatively well-characterized. The objective of this review is to summarize the results of multiple independent studies on Cx. p. pipiens form molestus in NYC and present the current understanding of the origin of this population. While solid evidence exists supporting the genetic differentiation and population structuring between Cx. p. pipiens form pipiens and form molestus in NYC, the possibility that the 91st St. sewer population of form molestus was founded by local aboveground Cx. p. pipiens form pipiens cannot be ruled out based on available data to date. Future studies in the US should include sympatric populations of both forms of Cx. p. pipiens from around the world in order to provide the necessary context to resolve these phylogenetic relationships. |
A comparison of above-ground and below-ground populations of Culex pipiens pipiens in Chicago, Illinois, and New York City, New York, using 2 microsatellite assays
Kothera L , Godsey M , Mutebi JP , Savage HM . J Am Mosq Control Assoc 2012 28 106-12 Aboveground and belowground populations of the mosquito Culex pipiens pipiens are traditionally classified as form (f.) pipiens and f. molestus, respectively, and gene flow between forms is thought to be limited. Relatively few f. molestus populations have been found in the United States, which has hindered their study in North America. In this investigation, we used microsatellites to characterize a recently discovered population of f. molestus in Chicago, IL, and compared levels of genetic diversity and differentiation in above-ground and below-ground populations from Chicago and New York City, NY. Levels of genetic diversity were markedly lower in both f. molestus populations. Pairwise F(ST) values between populations indicated that f. molestus populations were highly divergent from each other, as well as from their associated aboveground populations. The most likely number of genetic clusters depended on the number of loci used; we began with a set of 8, and reanalyzed the specimens with 17. Using a panel of 17 loci, there were 4 clusters, 1 for each below-ground population, and 1 for each pair of above-ground populations. Our findings are supportive of the hypothesis that f. molestus populations in Chicago and New York City arose from local aboveground populations. |
The Culex pipiens complex in the Mississippi River basin: identification, distribution, and bloodmeal hosts
Savage HM , Kothera L . J Am Mosq Control Assoc 2012 28 93-9 Members of the Culex pipiens complex are the primary vectors of St. Louis encephalitis virus and West Nile virus in the Mississippi River basin (MRB). The Cx. pipiens complex in the MRB is composed of 4 taxa: Cx. p. pipiens form pipiens, Cx. p. quinquefasciatus, hybrids between Cx. p. pipiens f. pipiens and Cx. p. quinquefasciatus, and Cx. p. pipiens form molestus. Three studies on bloodmeal hosts with large sample sizes have been conducted on members of the Cx. pipiens complex in the MRB including 1 each on Cx. p. quinquefasciatus from Louisiana, Cx. p. pipiens-quinquefasciatus hybrids from Tennessee, and Cx. p. pipiens from Illinois. The top 8 bloodmeal hosts from each of the 3 sites accounted for 68-92% of bloodmeals. Only 14 species accounted for the top 8 bloodmeal hosts at each of the 3 sites. The most often utilized bloodmeal hosts for members of the Culex pipiens complex within the MRB are the American robin, Northern cardinal, human, raccoon, common grackle, house sparrow, mourning dove, dog, Northern mockingbird, blue jay, opossum, domestic horse, house finch and European starling. Human feeding varied widely among sites from 1% to 15.7% of bloodmeals. The proportion of bloodmeals taken on humans is an important epidemiological variable and future studies are needed to define the primary genetic and environmental factors that influence host utilization by members of the Cx. pipiens complex. |
Secular trends in diagnostic code density in electronic healthcare data from health care systems in the Vaccine Safety Datalink Project
Hechter RC , Qian L , Sy LS , Greene SK , Weintraub ES , Naleway AL , Rowhani-Rahbar A , Donahue JG , Daley MF , Vazquez-Benitez G , Lugg MM , Jacobsen SJ . Vaccine 2013 31 (7) 1080-5 Large observational vaccine safety studies often use automated diagnoses extracted from medical care databases to identify pre-specified potential adverse events following immunization (AEFI). We assessed the secular trends and variability in the number of diagnoses per encounter regardless of immunization status referred as diagnostic code density, by healthcare setting, age, and pre-specified condition in eight large health care systems of the Vaccine Safety Datalink project during 2001-2009. An increasing trend in diagnostic code density was observed in all healthcare settings and age groups, with variations across the sites. Sudden increases in diagnostic code density were observed at certain sites when changes in coding policies or data inclusion criteria took place. When vaccine safety studies use an historical comparator, the increased diagnostic code density over time may generate low expected rates (based on historical data) and high observed rates (based on current data), suggesting a false positive association between a vaccine and AEFI. The ongoing monitoring of the diagnostic code density can provide guidance on study design and choice of appropriate comparison groups. It can also be used to ensure data quality and allow timely correction of errors in an active safety surveillance system. |
Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008
Satterwhite CL , Torrone E , Meites E , Dunne EF , Mahajan R , Ocfemia MC , Su J , Xu F , Weinstock H . Sex Transm Dis 2013 40 (3) 187-93 BACKGROUND: Most sexually active people will be infected with a sexually transmitted infection (STI) at some point in their lives. The number of STIs in the United States was previously estimated in 2000. We updated previous estimates to reflect the number of STIs for calendar year 2008. METHODS: We reviewed available data and literature and conservatively estimated incident and prevalent infections nationally for 8 common STIs: chlamydia, gonorrhea, syphilis, herpes, human papillomavirus, hepatitis B, HIV, and trichomoniasis. Where available, data from nationally representative surveys such as the National Health and Nutrition Examination Survey were used to provide national estimates of STI prevalence or incidence. The strength of each estimate was rated good, fair, or poor, according to the quality of the evidence. RESULTS: In 2008, there were an estimated 110 million prevalent STIs among women and men in the United States. Of these, more than 20% of infections (22.1 million) were among women and men aged 15 to 24 years. Approximately 19.7 million incident infections occurred in the United States in 2008; nearly 50% (9.8 million) were acquired by young women and men aged 15 to 24 years. Human papillomavirus infections, many of which are asymptomatic and do not cause disease, accounted for most of both prevalent and incident infections. CONCLUSIONS: Sexually transmitted infections are common in the United States, with a disproportionate burden among young adolescents and adults. Public health efforts to address STIs should focus on prevention among at-risk populations to reduce the number and impact of STIs. |
Evolution of cervical cancer screening and prevention in United States and Canada: implications for public health practitioners and clinicians
Saraiya M , Steben M , Watson M , Markowitz L . Prev Med 2013 57 (5) 426-33 OBJECTIVE: Declines in cervical cancer incidence and mortality in the US and Canada have been widely attributed to introduction of the Papanicolaou (Pap) test. This article reviews evolution of screening towards HPV testing and primary prevention through HPV vaccination. METHOD: Sentinel events in the evolution of cervical cancer screening and primary prevention through HPV vaccination in the US and Canada are described. RESULTS: Despite commonalities, cervical cancer screening and prevention differ between the two countries. Canada has a combination of opportunistic and organized programs at the provincial and territorial level, while the US has opportunistic screening and vaccination systems. In the US, the HPV test along with the Pap test (co-testing) is part of national recommendations for routine cervical cancer screening for women age 30 and older. Co-testing is not being considered anywhere in Canada, but primary HPV testing is currently recommended (but not implemented) in one province in Canada. CONCLUSION: Many prevention strategies are available for cervical cancer. Continued public health efforts should work to increase vaccine coverage in the target age groups and cervical cancer screening for women at risk, at appropriate intervals. Ongoing evaluation will be needed to ensure appropriate use of health resources, as vaccinated women become eligible for screening. |
Exploring the feasibility of alternative STD-testing venues and results delivery channels for a national screening campaign
Friedman AL , Bloodgood B . Health Promot Pract 2013 14 (1) 96-104 Annual chlamydia screening is recommended for sexually active women aged 25 years and younger, though less than half of eligible women are screened each year. If acceptable to young women, nontraditional testing venues and new communication technologies could promote efficiencies in sexually transmitted disease (STD) screening and facilitate screening by overcoming barriers at systems and patient levels. OBJECTIVES. This study sought to explore young women's technology use, preferences for STD-testing venues, attitudes toward nontraditional venues, and acceptability of test results delivery options. METHOD: A total of 80 ethnographic one-on-one telephone interviews were conducted with African American, Caucasian, and Latina women, aged 15 to 25 years, in 10 metropolitan areas of the United States. Interviews were recorded, transcribed, and analyzed using NVivo2. RESULTS: Alternative STD-testing venues and results delivery channels are valued by young women for their convenience and accessibility, but they must also offer privacy, confidentiality, and emotional/informational support to be acceptable. Assuring provider (or self) competence and valid/accurate test results is also important. CONCLUSIONS: Although new technologies have been embraced by young women for personal and social uses, they may not be as readily embraced for the provision of STD-related services. Additional social marketing efforts may be needed to promote acceptance of nontraditional STD-testing settings and results delivery methods. |
Development of an influenza virologic risk assessment tool
Trock SC , Burke SA , Cox NJ . Avian Dis 2012 56 1058-61 Influenza pandemics pose a continuous risk to human and animal health and may engender food security issues worldwide. As novel influenza A virus infections in humans are identified, pandemic preparedness strategies necessarily involve decisions regarding which viruses should be included for further studies and mitigation efforts. Resource and time limitations dictate that viruses determined to pose the greatest risk to public or animal health should be selected for further research to fill information gaps and, potentially, for development of vaccine candidates that could be put in libraries, manufactured and stockpiled, or even administered to protect susceptible populations of animals or people. A need exists to apply an objective, science-based risk assessment to the process of evaluating influenza viruses. During the past year, the Centers for Disease Control and Prevention began developing a tool to evaluate influenza A viruses that are not circulating in the human population but pose a pandemic risk. The objective is to offer a standardized set of considerations to be applied when evaluating prepandemic viruses. The tool under consideration is a simple, additive model, based on multiattribute decision analysis. The model includes elements that address the properties of the virus itself and population attributes, considers both veterinary and human findings, and integrates both laboratory and field observations. Additionally, each element is assigned a weight such that all elements are not considered of equal importance within the model. |
The eyes have it
Rao AK , Jackson KA , Mahon BE . N Engl J Med 2013 368 (4) 392 As Vasa et al. mention in the Clinical Problem-Solving case of foodborne botulism (Sept. 6 issue),1 botulinum antitoxin is most effective when given early in the course of illness.2 Antitoxin is available only from the Centers for Disease Control and Prevention (CDC) through state public health departments. Clinicians suspecting botulism should contact their state health department immediately, even if other possible diagnoses are still being evaluated. Unfortunately, in many cases ultimately confirmed as botulism, antitoxin is not requested until several days after hospitalization, by which time symptoms may have progressed to respiratory failure. Botulism should be suspected in any patient with bilateral cranial-nerve palsies followed by descending paralysis, regardless of the order of onset of cranial-nerve palsies or the presence of such known risk factors as eating home-canned food or the traditional foods of Alaska natives or using black-tar heroin. Although the authors report that loss of pupillary reactivity is a common finding in botulism, this finding has appeared relatively infrequently among cases of confirmed botulism reported to the CDC since 1990, with a lack of pupillary reactivity reported in only 60 of 298 patients (20%) (unpublished data). | Since March 2010, a heptavalent botulinum antitoxin (HBAT), which covers all seven known types of botulinum toxin, has been the only antitoxin available in the United States.3 Through referral from state health departments, botulism consultation and HBAT are available 24/7 from the CDC (770-488-7100). |
A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM)
Higa DH , Crepaz N , Marshall KJ , Kay L , Vosburgh HW , Spikes P , Lyles CM , Purcell DW . AIDS Behav 2013 17 (4) 1231-44 Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples. |
Network analysis among HIV-infected young black men who have sex with men demonstrates high connectedness around few venues
Oster AM , Wejnert C , Mena LA , Elmore K , Fisher H , Heffelfinger JD . Sex Transm Dis 2013 40 (3) 206-12 BACKGROUND: Network analysis is useful for understanding sexual transmission of HIV and other sexually transmitted infections. We conducted egocentric and affiliation network analysis among HIV-infected young black men who have sex with men (MSM) in the Jackson, Mississippi, area to understand networks and connectedness of this population. METHODS: We interviewed 22 black MSM aged 17 to 25 years diagnosed as having HIV in 2006 to 2008. Participants provided demographic and geographic information about each sex partner during the 12 months before diagnosis and identified venues where they met these partners. We created affiliation network diagrams to understand connectedness of this population and identify venues that linked participants. RESULTS: The median number of partners reported was 4 (range, 1-16); a total of 97 partners (88 of whom were male) were reported. All but 1 participant were connected through a network of venues where they had met partners during the 12 months before diagnosis. Three venues were named as places for meeting partners by 13 of 22 participants. Participants reported having partners from all regions of Mississippi and 5 other states. CONCLUSIONS: HIV-infected young black MSM in this analysis were linked by a small number of venues. These venues should be targeted for testing and prevention interventions. The pattern of meeting sex partners in a small number of venues suggests densely connected networks that propagate infection. This pattern, in combination with sexual partnerships with persons from outside Jackson, may contribute to spread of HIV and other sexually transmitted infections into or out the Jackson area. |
Detection of human monkeypox in the Republic of the Congo following intensive community education
Reynolds MG , Emerson GL , Pukuta E , Karhemere S , Muyembe JJ , Bikindou A , McCollum AM , Moses C , Wilkins K , Zhao H , Damon IK , Karem KL , Li Y , Carroll DS , Mombouli JV . Am J Trop Med Hyg 2013 88 (5) 982-985 Monkeypox is an acute viral infection with a clinical course resembling smallpox. It is endemic in northern and central Democratic Republic of the Congo (DRC), but it is reported only sporadically in neighboring Republic of the Congo (ROC). In October 2009, interethnic violence in northwestern DRC precipitated the movement of refugees across the Ubangi River into ROC. The influx of refugees into ROC heightened concerns about monkeypox in the area, because of the possibility that the virus could be imported, or that incidence could increase caused by food insecurity and over reliance on bush meat. As part of a broad-based campaign to improve health standards in refugee settlement areas, the United Nations International Children's Emergency Fund (UNICEF) sponsored a program of intensive community education that included modules on monkeypox recognition and prevention. In the 6 months immediately following the outreach, 10 suspected cases of monkeypox were reported to health authorities. Laboratory testing confirmed monkeypox virus infection in two individuals, one of whom was part of a cluster of four suspected cases identified retrospectively. Anecdotes collected at the time of case reporting suggest that the outreach campaign contributed to detection of suspected cases of monkeypox. |
Narcolepsy as an adverse event following immunization: case definition and guidelines for data collection, analysis and presentation
Poli F , Overeem S , Lammers GJ , Plazzi G , Lecendreux M , Bassetti CL , Dauvilliers Y , Keene D , Khatami R , Li Y , Mayer G , Nohynek H , Pahud B , Paiva T , Partinen M , Scammell TE , Shimabukuro T , Sturkenboom M , van Dinther K , Wiznitzer M , Bonhoeffer J . Vaccine 2013 31 (6) 994-1007 Narcolepsy is a sleep disorder primarily characterized by excessive daytime sleepiness and cataplexy – episodes of muscle weakness brought on by emotions [1]. Additional symptoms may comprise hypnagogic hallucinations (vivid dream-like experiences occurring during the transition between wakefulness and sleep), sleep paralysis (episodes of inability to move during the onset of sleep or upon awakening, lasting for a few seconds or minutes), fragmented nocturnal sleep, as well as impaired ability for sustained attention and non-sleep symptoms such as obesity, anxiety, cognitive and emotional disturbances, and behavioral problems and precocious puberty in children [2], [3], [4], [5], [6], [7]. Excessive daytime sleepiness can occur in other disorders [8], but most patients suffering from narcolepsy experience their unwanted sleep episodes as short and refreshing [3], [4]. Cataplexy consists of brief episodes of muscle weakness without altered consciousness, usually triggered by emotions. Cataplexy constitutes a virtually pathognomonic symptom for narcolepsy [1], although it must be separated from a specific feeling of muscle weakness with emotions in normal subjects [4]. Cataplexy may rarely occur in some other disorders which are easily distinguished from narcolepsy, such as Niemann-Pick type C, Coffin-Lowry syndrome, and Norrie Disease [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Given its specificity, determining of cataplexy is of paramount importance, although an objective test is not available [9] as of yet. |
Immunity to hepatitis B virus infection two decades after implementation of universal infant hepatitis B vaccination: the association of detectable residual antibody and response to a single hepatitis B vaccine challenge dose
Spradling PR , Xing J , Williams R , Masunu-Faleafaga Y , Dulski T , Mahamud A , Drobeniuc J , Teshale EH . Clin Vaccine Immunol 2013 20 (4) 559-61 Most persons who receive hepatitis B vaccine during infancy will have a level of antibody to hepatitis B surface antigen (anti-HBs) <10 IU/L if measured 10-15 years later; however, most will demonstrate immune memory by an anamnestic response to a vaccine challenge dose. To determine whether there was a difference in anamnestic response among college students vaccinated during infancy, we compared anti-HBs levels after a dose of Engerix-B 20 mcg between those with a residual anti-HBs level of 0 IU/L versus those with a level of 1-9 IU/L. Anti-HBs was measured before (baseline) and two weeks after a challenge dose; response was defined as a level ≥10 IU/L after the dose among those <10 IU/L at baseline. Among 153 students who completed the study, 130 (85%) had an anti-HBs level <10 IU/L at baseline; 72 had a level of 0 IU/L and 58 had a level ranging from 1 to 9 IU/L. Students with a level from 1-9 IU/L were more likely to respond to the challenge dose compared to those with a baseline anti-HBs level of 0 IU/L (83% versus 50%; p<0.001). The presence of any detectable anti-HBs among persons vaccinated in the remote past may indicate the persistence of immune memory. |
Investigation of an outbreak of hypersensitivity-type reactions during the 2004 national measles-mumps-rubella vaccination campaign in Brazil
Freitas DR , Moura E , Araujo G , Cardoso A , Scheidt P , Ferraz E , Madalosso G , Chen RT , Hatch DL . Vaccine 2013 31 (6) 950-4 INTRODUCTION: During Brazil's national measles, mumps, and rubella (MMR) vaccination campaign in August 2004, an unexpectedly high rate of hypersensitivity-type adverse events (HAEs) was reported. MATERIALS AND METHODS: We reviewed information about children with suspected HAEs reported by clinicians to Brazil's national passive surveillance system for adverse events following immunization (AEFI), compared attack rate of HAE by manufacturer of MMR vaccine used in the campaign, and conducted a case-control study to determine possible risk factors for HAEs. RESULTS: During the 2004 national campaign, the rate of HAEs following MMR vaccination was one log higher for manufacturer A (15.2/100,000 doses administered) compared to the other two manufacturers (1.2 and 0.6/100,000 doses; p<0.0001); a similar pattern was observed retrospectively in analysis of the 2000-2003 AEFI surveillance (0.95 vs. 0.07 per 100,000 doses administered; p<0.0001). In the case-control study, among the 49 case-patients with HAEs identified, reported symptoms included conjunctival injection (60%), urticaria (55%), fever (54%), and facial edema (53%); no deaths occurred. The median time interval between vaccination and symptom onset was 42min (range: 5min-24h). We did not identify any differences in the proportion of case-patients and control children with a history of known allergy to food (including egg, egg-containing products or gelatin), drugs, or environmental antigens. DISCUSSION: Our study highlights the importance of a well-functioning routine AEFI surveillance system linked with mass vaccination campaigns. Such a system in Brazil permitted timely detection of HAEs and validation of a safety signal associated with one vaccine manufacturer. Unlike earlier publications, this outbreak linked to a single manufacturer of MMR showed no association with a prior allergic history to eggs or other foods, including gelatin; subsequent studies implicate the dextran stabilizer in MMR from manufacturer A as the likely cause of HAEs. |
Comparison of biochemical and molecular tests for detecting insecticide resistance due to insensitive acetylcholinesterase in Culex quinquefasciatus.
Scott ML , McAllister JC . J Am Mosq Control Assoc 2012 28 (4) 323-6 Insecticide resistance to organophosphates and carbamates can be the result of changes in acetylcholinesterase activity conferred by the ACE-1 mutation. Detection of this altered target site mutation is important in guiding informed decisions for resistance management. In this study we compared a competitive enzyme assay with a polymerase chain reaction assay utilizing a restriction enzyme. Both assays detected the ACE-1 mutation in Culex quinquefasciatus and agreement was 100%. The costs and benefits of each assay are presented. |
Transmissibility of the monkeypox virus clades via respiratory transmission: investigation using the prairie dog-monkeypox virus challenge system
Hutson CL , Gallardo-Romero N , Carroll DS , Clemmons C , Salzer JS , Nagy T , Hughes CM , Olson VA , Karem KL , Damon IK . PLoS One 2013 8 (2) e55488 Monkeypox virus (MPXV) is endemic within Africa where it sporadically is reported to cause outbreaks of human disease. In 2003, an outbreak of human MPXV occurred in the US after the importation of infected African rodents. Since the eradication of smallpox (caused by an orthopoxvirus (OPXV) related to MPXV) and cessation of routine smallpox vaccination (with the live OPXV vaccinia), there is an increasing population of people susceptible to OPXV diseases. Previous studies have shown that the prairie dog MPXV model is a functional animal model for the study of systemic human OPXV illness. Studies with this model have demonstrated that infected animals are able to transmit the virus to naive animals through multiple routes of exposure causing subsequent infection, but were not able to prove that infected animals could transmit the virus exclusively via the respiratory route. Herein we used the model system to evaluate the hypothesis that the Congo Basin clade of MPXV is more easily transmitted, via respiratory route, than the West African clade. Using a small number of test animals, we show that transmission of viruses from each of the MPXV clade was minimal via respiratory transmission. However, transmissibility of the Congo Basin clade was slightly greater than West African MXPV clade (16.7% and 0% respectively). Based on these findings, respiratory transmission appears to be less efficient than those of previous studies assessing contact as a mechanism of transmission within the prairie dog MPXV animal model. |
Performance of a novel high throughput method for the determination of VX in drinking water samples
Knaack JS , Zhou Y , Magnuson M , Silvestri E , Johnson RC . Anal Chem 2013 85 (5) 2611-6 VX (O-ethyl-S-(2-diisopropylaminoethyl) methylphosphonothioate) is a highly toxic organophosphorus nerve agent, and even low levels of contamination in water can be harmful. Measurement of low concentrations of VX in aqueous matrixes is possible using an immunomagnetic scavenging technique and detection using liquid chromatography/tandem-mass spectrometry. Performance of the method was characterized in high-performance liquid chromatography (HPLC)-grade water preserved with sodium omadine, an antimicrobial agent, and sodium thiosulfate, a dechlorinating agent, over eight analytical batches with quality control samples analyzed over 10 days. The minimum reportable level was 25 ng/L with a linear dynamic range up to 4.0 mcg/L. The mean accuracies for two quality control samples containing VX at concentrations of 0.250 and 2.00 mcg/L were 102 +/- 3% and 103 +/- 6%, respectively. The stability of VX was determined in five tap water samples representing a range of water quality parameters and disinfection practices over a 91 day period. In preserved tap water samples, VX recovery was between 81 and 92% of the fortified amount, 2.0 mcg/L, when analyzed immediately after preparation. Recovery of VX decreased to between 31 and 45% of the fortified amount after 91 days, indicating hydrolysis of VX. However, the preservatives minimized the hydrolysis rate to close to the theoretical limit. The ability to detect low concentrations of VX in preserved tap water 91 days after spiking suggests applicability of this method for determining water contamination with VX and utility during environmental remediation. |
Hemagglutinin homologue from H17N10 bat influenza virus exhibits divergent receptor-binding and pH-dependent fusion activities
Zhu X , Yu W , McBride R , Li Y , Chen LM , Donis RO , Tong S , Paulson JC , Wilson IA . Proc Natl Acad Sci U S A 2013 110 (4) 1458-63 Bat influenza virus H17N10 represents a distinct lineage of influenza A viruses with gene segments coding for proteins that are homologs of the surface antigens, hemagglutinin (HA) and neuraminidase (NA). Our recent study of the N10 NA homolog revealed an NA-like structure, but with a highly divergent putative active site exhibiting little or no NA activity, and provided strong motivation for performing equivalent structural and functional analyses of the H17 HA protein. The overall structure of the H17 HA homolog from A/little yellow-shouldered bat/Guatemala/060/2010 at 3.18 A resolution is very similar to other influenza HAs, with a putative receptor-binding site containing some conserved aromatic residues that form the base of the sialic acid binding site. However, the rest of the H17 receptor-binding site differs substantially from the other HA subtypes, including substitution of other conserved residues associated with receptor binding. Significantly, electrostatic potential analyses reveal that this putative receptor-binding site is highly acidic, making it unfavorable to bind any negatively charged sialylated receptors, consistent with the recombinant H17 protein exhibiting no detectable binding to sialylated glycans. Furthermore, the fusion mechanism is also distinct; trypsin digestion with recombinant H17 protein, when exposed to pH 4.0, did not degrade the HA1 and HA2, in contrast to other HAs. These distinct structural features and functional differences suggest that the H17 HA behaves very differently compared with other influenza HAs. |
Inactivation of infectious virus and serological detection of virus antigen in Rift Valley fever virus-exposed mosquitoes fixed with paraformaldehyde
Kading R , Crabtree M , Miller B . J Virol Methods 2013 189 (1) 184-8 Formaldehyde is routinely used to fix tissues in preparation for pathology studies, however concerns remain that treatment of tissues with cellular fixatives may not entirely inactivate infectious virus particles. This concern is of particular regulatory importance for research involving viruses that are classified as select agents such as Rift Valley fever virus (RVFV). Therefore, the specific aims of this study were to 1) assay RVFV-exposed Aedes aegypti mosquitoes fixed in 4% paraformaldehyde for the presence of infectious RVFV particles at various time points following infection and 2) demonstrate the utility of immunofluorescence assay (IFA) for the detection of RVFV antigen in various tissues of paraformaldehyde-fixed mosquitoes. Mosquitoes were administered an infectious blood meal containing one of two strains of RVFV, harvested at various time points following infection, intrathoracically-inoculated with 4% paraformaldehyde, and fixed overnight at 4 degrees C. The infection status of a subset of mosquitoes was verified by IFA on leg tissues prior to fixation, and infectivity of RVFV in fixed mosquito carcasses was determined by Vero cell plaque assay. Paraformaldehyde-fixed mosquitoes harvested 14 days post infection were also paraffin-embedded and sectioned for detection of RVFV antigen to particular tissues by IFA. None of the RVFV-exposed mosquitoes tested by Vero cell plaque assay contained infectious RVFV after fixation. Furthermore, incubation of mosquito sections with trypsin prior to antibody staining is recommended for optimal visualization of RVFV antigen in infected mosquito tissues by IFA. |
Proportion of neural tube defects attributable to known risk factors.
Agopian AJ , Tinker SC , Lupo PJ , Canfield MA , Mitchell LE . Birth Defects Res A Clin Mol Teratol 2013 97 (1) 42-46 BACKGROUND: Recognized risk factors for neural tube defects (NTDs) poorly predict population-level NTD risk. However, the proportion of NTDs that can be attributed to these risk factors is uncertain. METHODS: To determine the proportion of NTD cases that is attributable to known or suspected risk factors (i.e., female infant sex, family history of NTDs, and maternal Hispanic ethnicity, obesity, pregestational diabetes, gestational diabetes, low dietary folate intake, lack of folic acid supplementation, anticonvulsant use, and hot tub or sauna use), we estimated the adjusted population attributable fraction (aAF) for each factor, using the method of Eide and Geffler and data from the National Birth Defects Prevention Study. RESULTS: Our analyses of these data indicate that the proportion of cases of spina bifida and anencephaly that can be attributed to known risk factors is 28% and 44%, respectively. For spina bifida, the factor with the greatest attributable fraction was maternal obesity (aAF, 10%), whereas for anencephaly it was Hispanic ethnicity (aAF, 15%). CONCLUSION: Our analyses indicate that known risk factors account for <50% of NTD cases. Hence, the majority of NTD cases are attributable to, as yet, unidentified factors. These findings highlight the need for continued research to identify genetic and additional nongenetic risk factors for NTDs. Further, these findings suggest that strategies that aim to reduce the risk of NTDs associated with maternal Hispanic ethnicity and obesity may have the greatest impact on the population prevalence of these conditions. (Birth Defects Research (Part A), 2013. 2012 Wiley Periodicals, Inc.) |
Vasoactive exposures during pregnancy and risk of microtia
Van Bennekom CM , Mitchell AA , Moore CA , Werler MM . Birth Defects Res A Clin Mol Teratol 2013 97 (1) 53-9 BACKGROUND: Little is known about the etiology of nonsyndromic microtia. This study investigated the hypothesis that microtia is caused by vascular disruption. METHODS: The study analyzed data from the population-based National Birth Defects Prevention Study (NBDPS) for deliveries between 1997 and 2005. Four hundred eleven nonsyndromic cases of microtia, with or without additional defects, were compared to 6560 nonmalformed infants with respect to maternal exposures to vasoactive medications and smoking during the periconceptional period and conditions that have previously been associated with vascular events (multiple gestation, maternal history of type 1, type 2, or gestational diabetes, and hypertension). Odds ratios (ORs) were estimated with multivariable models, controlling for the effects of race/ethnicity, education, periconceptional folic acid use, and study center. RESULTS: Risk estimates for vasoactive medications and smoking were not meaningfully increased. Maternal type 1/2 diabetes was diagnosed before or during the index pregnancy in 4% and 1% of cases, respectively, compared to 1% and 0.05% of controls; the adjusted OR for these two groups combined was 7.2 (95% confidence interval [CI], 3.9-13.1). Gestational diabetes was observed for 9% of cases and 6% of controls; the OR was moderately elevated (OR, 1.4; 95% CI, 0.9-2.0). ORs were also increased for multiple gestations (OR, 2.5; 95% CI, 1.5-4.2) and pre-existing hypertension (OR, 1.6; 95% CI, 1.0-2.5). CONCLUSIONS: Because ORs were only elevated for diabetes and not for vasoactive exposures or other potential vascular events, findings suggest that some microtia occurrences may be part of the diabetic embryopathy rather than manifestations of vascular disruption. (Birth Defects Research (Part A), 2013. (c) 2012 Wiley Periodicals, Inc.) |
Maternity care practices that support breastfeeding: CDC efforts to encourage quality improvement
Grummer-Strawn LM , Shealy KR , Perrine CG , Macgowan C , Grossniklaus DA , Scanlon KS , Murphy PE . J Womens Health (Larchmt) 2013 22 (2) 107-12 Breastfeeding has important consequences for women's health, including lower risk of breast and ovarian cancers as well as type 2 diabetes. Although most pregnant women want to breastfeed, a majority encounter difficulties and are not able to breastfeed as long as they want. Routine maternity care practices can pose significant barriers to successful breastfeeding. To address these practices, CDC has taken on a number of initiatives to promote hospital quality improvements in how new mothers are supported to start breastfeeding. The CDC survey on Maternity Practices in Infant Nutrition and Care is a tool to educate hospitals on how their current practices compare to recommended standards. The Best Fed Beginnings program is working with 90 hospitals across the United States to achieve optimal care and create tools for future hospital changes. CDC-funded programs in numerous state health departments have created programs to instigate improvements across the state. These efforts have begun to show success, with significant hospital quality score increases seen between 2009 and 2011. In 2011, more hospitals were designated as Baby-Friendly than in any previous year. |
Patterns in the prevalence of congenital heart defects, metropolitan Atlanta, 1978 to 2005
Bjornard K , Riehle-Colarusso T , Gilboa SM , Correa A . Birth Defects Res A Clin Mol Teratol 2013 97 (2) 87-94 BACKGROUND: Knowledge of patterns in prevalence of congenital heart defects (CHDs) is important for clinical care, etiologic research, and prevention. We evaluated temporal and racial/ethnic trends in the birth prevalence of CHDs in metropolitan Atlanta from 1978 to 2005. METHODS: Cases of CHDs were obtained from the Metropolitan Atlanta Congenital Defects Program among live born infants, stillborn infants, and pregnancy terminations of at least 20 weeks gestation. We calculated birth prevalence per 10,000 live births and used joinpoint regression analysis to calculate the average annual percent change for total CHDs and for 23 specific subtypes in the total population and among whites and blacks. To evaluate racial/ethnic variations, we calculated prevalence ratios among blacks and Hispanics compared with whites. RESULTS: Between 1978 and 2005, 7301 infants and fetuses with major structural CHDs were ascertained among 1,079,062 live births (67.7 per 10,000). The prevalence of all CHDs in aggregate increased from 50.3 per 10,000 in 1978-1983 to 86.4 per 10,000 in 2000-2005. The prevalence of septal defects and vascular rings increased and the prevalence of tricuspid atresia decreased, while other CHD prevalences were stable. Racial/ethnic prevalence differences were found for all CHDs combined and muscular ventricular septal defects, aortic stenosis, and atrioventricular septal defects. CONCLUSIONS: The prevalence of total CHDs, primarily common, less severe types, are increasing, with some racial/ethnic differences. Further studies could clarify the possible reasons for such variations including differences in ascertainment, risk factors, or susceptibility. (Birth Defects Research (Part A) 2013. (c) 2013 Wiley Periodicals, Inc.) |
PMTCT Option B+: an opportunity for shaping a new service delivery paradigm
Riley PL , Adler MR , Davis MK . Afr J Midwifery Womens Health 2013 7 (1) 6-6 In 2011, the Joint United Nations | Programme on HIV/AIDS (UNAIDS) | and the US Office of the Global AIDS | Coordinator—the office charged with implementing the President’s Emergency Plan for | AIDS Relief (PEPFAR), launched a 4-year | Global Plan Toward the Elimination of New | HIV Infections Among Children by 2015, and | Keeping their Mothers Alive (UNAIDS, 2011). | Focusing on the 22 countries with the highest number of HIV positive pregnant women | globally, this initiative promotes a range of | HIV and maternal, newborn, and child health | (MNCH) interventions aimed at decreasing | new HIV infections among children by 90% | and reducing HIV-related maternal mortality by 50%. The Global Plan emphasises | HIV prevention through timely initiation of | antiretroviral therapy (ART) for pregnant and | breastfeeding mothers, early diagnosis of HIV | exposed infants, and treatment for those who | become HIV infected. The overlap in the timing and frequency of these HIV services with | MNCH interventions, including immunisations, infant feeding support, and family planning, underscores the need for greater synergy | between these programmes. |
How Option B+ is shifting the PMTCT paradigm
Adler MR , Riley PL , Bandazi S , Davis MK . Afr J Midwifery Womens Health 2013 7 (1) 7-13 Affordable and effective interventions have been identified that can prevent new infant HIV infections, maintain the health of mothers, and greatly reduce transmission between discordant partners. Yet, 330 000 HIV-infected infants were born in 2011 worldwide, in part due to operational challenges inherent in the design of current PMTCT programmes. Option B+, the provision of life-long antiretroviral treatment (ART) to all pregnant and breastfeeding women, was recently introduced as a progressive and innovative approach to simplify service delivery and improve maternal and infant outcomes. This emphasis on treatment as the cornerstone of PMTCT has catalysed a shift in thinking about the PMTCT paradigm. No longer can PMTCT viewed as a time-limited intervention around pregnancy and breastfeeding. It must be reconceived as multiple overlapping continua of care that address the health and family planning needs of HIV-positive women throughout their reproductive years. Optimising maternal ART and exposed infant follow-up will require a bridging of maternal, neonatal, and child health programmes with HIV treatment programmes to support alternative service delivery models, develop new health care worker competencies, and address infrastructural constraints. The engagement of nurses and midwives in this PMTCT transformation will be critical to meeting the global goal of an AIDS-free generation. |
Indigenous children from three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis
Singleton RJ , Valery PC , Morris P , Byrnes CA , Grimwood K , Redding G , Torzillo PJ , McCallum G , Chikoyak L , Mobberly C , Holman RC , Chang AB . Pediatr Pulmonol 2013 49 (2) 189-200 OBJECTIVE: Indigenous children in developed countries are at increased risk of chronic suppurative lung disease (CSLD), including bronchiectasis. We evaluated sociodemographic and medical factors in indigenous children with CSLD/bronchiectasis from Australia, United States (US), and New Zealand (NZ). METHODS: Indigenous children aged 0.5-8 years with CSLD/bronchiectasis were enrolled from specialist clinics in Australia (n = 97), Alaska (n = 41), and NZ (n = 42) during 2004-2009, and followed for 1-5 years. Research staff administered standardized parent interviews, reviewed medical histories and performed physical examinations at enrollment. RESULTS: Study children in all three countries had poor housing and sociodemographic circumstances at enrollment. Except for increased household crowding, most poverty indices in study participants were similar to those reported for their respective local indigenous populations. However, compared to their local indigenous populations, study children were more often born prematurely and had both an increased frequency and earlier onset of acute lower respiratory infections (ALRIs). Most (95%) study participants had prior ALRI hospitalizations and 77% reported a chronic cough in the past year. Significant differences (wheeze, ear disease and plumbed water) between countries were present. DISCUSSION: Indigenous children with CSLD/bronchiectasis from three developed countries experience significant disparities in poverty indices in common with their respective indigenous population; however, household crowding, prematurity and early ALRIs were more common in study children than their local indigenous population. Addressing equity, especially by preventing prematurity and ALRIs, should reduce risk of CSLD/bronchiectasis in indigenous children. (Pediatr Pulmonol. (c) 2013 Wiley Periodicals, Inc.) |
Regular-soda intake independent of weight status is associated with asthma among US high school students
Park S , Blanck HM , Sherry B , Jones SE , Pan L . J Acad Nutr Diet 2013 113 (1) 106-11 Limited research shows an inconclusive association between soda intake and asthma, potentially attributable to certain preservatives in sodas. This cross-sectional study examined the association between regular (nondiet)-soda intake and current asthma among a nationally representative sample of high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 15,960 students (grades 9 through 12) with data for both regular-soda intake and current asthma status. The outcome measure was current asthma (ie, told by doctor/nurse that they had asthma and still have asthma). The main exposure variable was regular-soda intake (ie, drank a can/bottle/glass of soda during the 7 days before the survey). Multivariable logistic regression was used to estimate the adjusted odds ratios for regular-soda intake with current asthma after controlling for age, sex, race/ethnicity, weight status, and current cigarette use. Overall, 10.8% of students had current asthma. In addition, 9.7% of students who did not drink regular soda had current asthma, and 14.7% of students who drank regular soda three or more times per day had current asthma. Compared with those who did not drink regular soda, odds of having current asthma were higher among students who drank regular soda two times per day (adjusted odds ratio=1.28; 95% CI 1.02 to 1.62) and three or more times per day (adjusted odds ratio=1.64; 95% CI 1.25 to 2.16). The association between high regular-soda intake and current asthma suggests efforts to reduce regular-soda intake among youth might have benefits beyond improving diet quality. However, this association needs additional research, such as a longitudinal examination. |
Food availability en route to school and anthropometric change in urban children
Rossen LM , Curriero FC , Cooley-Strickland M , Pollack KM . J Urban Health 2013 90 (4) 653-66 This study examined food availability along children's paths to and from elementary school, and associations with change in body mass index (BMI) and waist circumference over 1 year. Secondary data from 319 children aged 8-13 years from the "Multiple Opportunities to Reach Excellence" Project was used. Child anthropometry and demographic variables were obtained at baseline (2007) and 1 year follow-up. Food outlet locations (n = 1,410) were obtained from the Baltimore City Health Department and validated by ground-truthing. Secondary data on healthy food availability within select food stores in Baltimore City in 2007 were obtained via a validated food environment assessment measure, the Nutrition Environments Measures Study. Multilevel models were used to examine associations between availability of healthy food and number of various food outlets along paths to school and child anthropometric change over 1 year. Controlling for individual-, neighborhood-, and school-level characteristics, results indicated that higher healthy food availability within a 100 m buffer of paths to school was associated with 0.15 kg/m(2) lower BMI gain (p = 0.015) and 0.47 cm smaller waist circumference gain (p = 0.037) over 1 year. Although prior research has illuminated the importance of healthy food choices within school and home environments, the current study suggests that exposure to the food environment along paths to school should be further explored in relation to child health outcomes. |
Is the body adiposity index (hip circumference/height(1.5)) more strongly related to skinfold thicknesses and risk factor levels than is BMI? The Bogalusa Heart Study
Freedman DS , Blanck HM , Dietz WH , Dasmahapatra P , Srinivasan SR , Berenson GS . Br J Nutr 2013 109 (2) 338-45 Because of its strong association (r 0.85) with percentage of body fat determined by dual-energy X-ray absorptiometry, hip circumference divided by height(1.5) (the body adiposity index) has recently been proposed as an index of body fatness among adults. We examined whether this proposed index was more strongly associated with skinfold thicknesses and levels of CVD risk factors (lipids, fasting insulin and glucose, and blood pressure) than was BMI among 2369 18- to 49-year-olds in the Bogalusa Heart Study. All analyses indicated that the body adiposity index was less strongly associated with skinfold thicknesses and CVD risk factors than was either waist circumference or BMI. Correlations with the skinfold sum, for example, were r 0.81 (BMI) v. r 0.75 (body adiposity index) among men, and r 0.87 (BMI) v. r 0.80 among women; P< 0.001 for both differences. An overall index of seven CVD risk factors was also more strongly associated with BMI (r 0.58) and waist circumference (r 0.61) than with the body adiposity index (r 0.49). The weaker associations with the body adiposity index were observed in analyses stratified by sex, race, age and year of examination. Multivariable analyses indicated that if either BMI or waist circumference were known, the body adiposity index provided no additional information on skinfold thicknesses or risk factor levels. These findings indicate that the body adiposity index is likely to be an inferior index of adiposity than is either BMI or waist circumference. |
Characteristics associated with consumption of sports and energy drinks among US adults: National Health Interview Survey, 2010
Park S , Onufrak S , Blanck HM , Sherry B . J Acad Nutr Diet 2013 113 (1) 112-9 Sales of sports and energy drinks have increased dramatically, but there is limited information on regular consumers of sports and energy drinks. Characteristics associated with sports and energy drink intake were examined among a sample representing the civilian noninstitutionalized US adult population. The 2010 National Health Interview Survey data for 25,492 adults (18 years of age or older; 48% males) were used. Nationwide, 31.3% of adults were sports and energy drink consumers during the past 7 days, with 21.5% consuming sports and energy drinks one or more times per week and 11.5% consuming sports and energy drinks three or more times per week. Based on multivariable logistic regression, younger adults, males, non-Hispanic blacks and Hispanics, not-married individuals, adults with higher family income, those who lived in the South or West, adults who engaged in leisure-time physical activity, current smokers, and individuals whose satisfaction with their social activities/relationships was excellent had significantly higher odds for drinking sports and energy drinks one or more times per week. In this model, the factor most strongly associated with weekly sports and energy drink consumption was age (odds ratio [OR]=10.70 for 18- to 24-year-olds, OR=6.40 for 25- to 39-year-olds, OR=3.17 for 40- to 59-year-olds vs 60 years or older). Lower odds for consuming sports and energy drinks one or more times per week were associated with other/multiracial (OR=0.80 vs non-Hispanic white) and obesity (OR=0.87 vs underweight/normal weight). Separate modeling of the association between other beverage intake and sports and energy drink intake showed that higher intake of regular soda, sweetened coffee/tea drinks, fruit drinks, milk, 100% fruit juice, and alcohol were significantly associated with greater odds for drinking sports and energy drinks one or more times per week. These findings can help medical care providers and public health officials identify adults most in need of encouragement to reduce sports and energy drink intake and increase healthier beverage intake. |
Reducing occupational fatalities by using NIOSH 3rd generation automatically deployable rollover protective structure
Alkhaledi K , Means K , McKenzie E , Smith J . Saf Sci 2013 51 (1) 427-431 Each year tractor rollovers cause injuries or deaths for farmers despite the fact that an effective safeguard was available in the form of a rollover protective structure (ROPS); however, many ROPS were removed by the tractor's owners, because the ROPS is too tall to allow tractors to enter farm fields because it may damage produce located on low hanging tree branches while working in an orchard, and the loss of crops means loss of money for farmers. The NIOSH AutoROPS will provide the same level of protection as the conventional ROPS, but instead of having the post as one solid part as with the ROPS, the AutoROPS has a fixed posts located inside the outside deployable posts to meet the farmer's need of low clearance. This study addressed the need to build and test the NIOSH 3rd generation of the AutoROPS model based on Alkhaledi et al. (2002) model, which was smaller in size with low overhead clearance zone and to insure that the built model would comply with the SAE J2194 standard for static testing. The results showed that the 3rd generation AutoROPS absorbed all applied loads in sequence, thus satisfying the SAE J2194 standard requirements. No signs of failure were shown for the AutoROPS' base and the latching mechanisms. The successful testing the NIOSH designed AutoROPS lead to the development of the ANSI/ASABE S599 industry standard, which was approved November 2010 as an American national standard for standardized deployment performance of an automatically deployable ROPS for turf & landscape equipment. (c) 2012 Elsevier Ltd. All rights reserved. |
Occupational asthma incidence: findings from the Behavioral Risk Factor Surveillance System Asthma Call-back Survey - United States, 2006-2009
Mazurek JM , Knoeller GE , Moorman JE , Storey E . J Asthma 2013 50 (4) 390-4 BACKGROUND: Occupational asthma (OA) is new-onset asthma or the recurrence of previously quiescent asthma caused by workplace exposures. OBJECTIVE: To estimate population-based new-onset OA incidence and the proportion of incident asthma that is work-related. METHODS: Behavioral Risk Factor Surveillance System and Asthma Call-back Survey data collected from persons aged ≥18 years during 2006-2009 in 38 states and the District of Columbia were analyzed. Incident health professional-diagnosed new-onset OA cases were persons with asthma diagnosed within the past 12 months who had health professional-diagnosed work-related asthma. Incident potential new-onset OA cases were persons with asthma diagnosed within the past 12 months who did not have health professional-diagnosed work-related asthma but described their asthma as caused by workplace exposures. The proportion of incident asthma that is work-related was calculated using the 2006-2008 estimate of adult asthma incidence (3800 per million). RESULTS: The estimated annual incidence of health professional-diagnosed new-onset OA was 179 (95% CI: 113-245) per million population. For combined health professional-diagnosed and potential new-onset OA the incidence was 692 (95% CI: 532-853) per million population. The proportion of incident asthma among adults that is work-related was 4.7% for health professional-diagnosed new-onset OA and 18.2% for combined health professional-diagnosed and potential new-onset OA. CONCLUSIONS: New-onset asthma in as many as one of six adult patients might be associated with work. Clinicians should consider the role of occupational exposures when evaluating adults with incident asthma which may uncover opportunities for early intervention and reversal of an otherwise chronic disease. |
Occupational causes of constrictive bronchiolitis
Kreiss K . Curr Opin Allergy Clin Immunol 2013 13 (2) 167-72 PURPOSE OF REVIEW: New literature from 2009 to 2012 regarding occupational constrictive bronchiolitis challenges textbook descriptions of this disease, formerly thought to be limited to fixed airflow limitation arising in the wake of accidental overexposure to noxious chemicals. Indolent evolution of dyspnea without a recognized hazardous exposure is a more common presentation. RECENT FINDINGS: Biopsy-confirmed case series of constrictive bronchiolitis from US soldiers, Iranian survivors of sulfur mustard gassing, hospital-based studies, and flavoring-related cases document that indolent constrictive bronchiolitis cases can have normal spirometry or either restrictive or obstructive abnormalities. High-resolution computerized tomography studies can be normal or reflect air-trapping and mosaic attenuation on expiratory films. Thus, in the absence of noninvasive abnormalities, the diagnosis in dyspneic patients may require thoracoscopic biopsy in settings in which exposure risk has not been recognized. Many workers with occupational constrictive bronchiolitis stabilize with cessation of exposures causing bronchiolar epithelial necrosis. SUMMARY: Clinicians need a high index of suspicion for constrictive bronchiolitis in young patients with rapidly progressing exertional dyspnea, regardless of spirometric and radiologic findings. Identification of novel causes and exposure-response relations for known causes are needed to provide guidance for protecting workers at risk for this largely irreversible lung disease. |
Is the societal burden of fatal occupational injury different among NORA industry sectors?
Biddle EA . J Safety Res 2013 44 7-16 PROBLEM: Since the implementation of the Occupational Safety and Health Act, safety and health in the work environment has seen marked improvement. Although these improvements are laudable, workplace hazards continue to plague the American worker. Understanding the economic burden of fatalities by industry sector is important to setting broad occupational safety and health research priorities. Cost estimates provide additional information about how fatal injuries affect society and hence can improve injury prevention program planning, policy analysis, evaluation, and advocacy. METHOD: This study estimated the total, mean, and median societal costs by worker and case characteristic in 2003-2006 for the industry sectors identified in the National Institute for Occupational Safety and Health National Occupational Research Agenda (NORA). Analyses were conducted with restricted access to the Bureau of Labor Statistics Census of Fatal Occupational Injuries data. These data exclude military personnel, decedents with unknown age or sex, and fatalities occurring in New York City. Societal costs were estimated using the cost-of-illness approach, which combines direct and indirect costs to yield an overall cost of an fatal occupational injury. RESULTS: During this period, the cost of the 22,197 fatal occupational injuries exceeded $21 billion. The mean and median costs of these fatalities were $960,000 and $944,000 respectively. Total societal costs by NORA sector ranged from a high of $5.8 billion in Services to a low of $530 million in Healthcare and Social Assistance with mean costs ranging from the nearly $800,000 in Agriculture, Forestry, and Fishing to almost $1.1 million in Mining. DISCUSSION: The societal costs-total, mean, and median costs-of case and worker characteristics for occupational fatal injuries varied within each NORA sector. IMPACT ON INDUSTRY: To have the greatest societal impact, these costs can be used to target resources for public and private sector research by industry. |
Preparing for bike-sharing: insight from focus groups and surveys, Chattanooga, Tennessee, 2010
Webster KM , Cunningham CJ . Health Promot Pract 2013 14 (1) 62-8 OBJECTIVES: To obtain in-depth community input using qualitative and quantitative methods to guide development and marketing of a bike-share program in Chattanooga, Tennessee. METHOD: Focus groups and surveys assessed bicycling attitudes, beliefs, barriers, and behaviors of residents, workers, and university students. The authors completed nine focus groups (N = 56): five sessions with downtown workers, three with downtown residents, and one with university students. RESULTS: Health, recreation and transportation benefits of bicycling were commonly identified. Concerns regarding bicycling in traffic are apparent because of lack of facilities and a need for public education on safe motorist and bicyclist behavior. Practical limitations can inhibit bicycling during the day, including shower access and personal hygiene concerns. CONCLUSIONS: Public desire for environmental, educational, and enforcement tactics to support safe bicycling was noted. Marketing tactics for bike-share usage should emphasize health, recreational, and transportation benefits. Worksites can reduce barriers related to bicycling and encourage bike-share use. Future studies should assess bike-share impact on perceptions and behavior, as well as the resulting policy and environmental changes. |
Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists
Henderson JT , Harper CC , Gutin S , Saraiya M , Chapman J , Sawaya GF . Am J Obstet Gynecol 2013 208 (2) 109 e1-7 OBJECTIVE: Less-than-annual cervical cancer screening is now recommended for most US women, raising questions about the need for routine annual bimanual pelvic examinations. Little is known about clinicians' bimanual pelvic examination practices, their beliefs about its importance, or the reasoning underlying its performance in asymptomatic women. STUDY DESIGN: We conducted a nationwide survey of US obstetrician-gynecologists. Respondents (n = 521) reported their examination practices and beliefs based on vignettes for asymptomatic women across the lifespan. RESULTS: Nearly all obstetrician-gynecologists perform bimanual pelvic examinations in asymptomatic women across the lifespan, although it is viewed as less important for a newly sexually active 18-year-old. Reasons cited as very important included adherence to standard medical practices (45%), patient reassurance (49%), detection of ovarian cancer (47%), and identification of benign uterine (59%) and ovarian (54%) conditions. CONCLUSION: Obstetrician-gynecologists perform bimanual pelvic examinations in the vast majority of asymptomatic women, but the importance placed on the examinations and reasons for conducting them vary. |
Social participation restriction among U.S. adults with arthritis: a population-based study using the International Classification of Functioning, Disability, and Health (ICF)
Theis KA , Murphy L , Hootman JM , Wilkie R . Arthritis Care Res (Hoboken) 2013 65 (7) 1059-69 OBJECTIVE: To examine arthritis impact among U.S. adults with self-reported, doctor-diagnosed arthritis using the International Classification of Functioning, Disability, and Health (ICF) framework (domains=Impairments, Activity Limitations, Environmental, and Personal factors; outcome=social participation restriction (SPR)) 1) overall and among those with SPR, and 2) to identify correlates of SPR. METHODS: Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were estimated to identify correlates of SPR. Analyses in SAS v9.2 survey procedures accounted for the complex sample design. RESULTS: SPR prevalence was 11% (5.7 million) of adults with arthritis. After initial multivariable adjustment by ICF domain, Serious Psychological Distress (Impairments) (PR=2.5, 95% CI=2.0-3.2, ≥5 medical office visits (Environmental) (PR=3.4, 95% CI=2.5-4.4), and physical inactivity (Personal) (PR=4.8, 95% CI=3.6=6.4) were most strongly associated with SPR. A combined measure, Key Limitations (walking, standing, or carrying) (PR=31.2 (22.3-43.5) represented the Activity Limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were Key Limitations (PR= 24.3 (16.8-35.1), ≥9 hours sleep (PR=1.6, 95% CI=1.3-2.0), and income-to-poverty ratio <2.00 and severe joint pain (PR=1.4, 95% CI=1.2-1.6 for both). CONCLUSION: SPR affects 1-in-9 adults with arthritis. This work is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas for priority intervention to reduce negative arthritis impacts, including SPR. Increased use of existing clinical and public health interventions is warranted. (c) 2013 by the American College of Rheumatology. |
Adverse childhood experiences and frequent insufficient sleep in 5 U.S. states, 2009: a retrospective cohort study
Chapman DP , Liu Y , Presley-Cantrell LR , Edwards VJ , Wheaton AG , Perry GS , Croft JB . BMC Public Health 2013 13 3 BACKGROUND: Although adverse childhood experiences (ACEs) have previously been demonstrated to be adversely associated with a variety of health outcomes in adulthood, their specific association with sleep among adults has not been examined. To better address this issue, this study examines the relationship between eight self-reported ACEs and frequent insufficient sleep among community-dwelling adults residing in 5 U.S. states in 2009. METHODS: To assess whether ACEs were associated with frequent insufficient sleep (respondent did not get sufficient rest or sleep ≥14 days in past 30 days) in adulthood, we analyzed ACE data collected in the 2009 Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey in Arkansas, Louisiana, New Mexico, Tennessee, and Washington. ACEs included physical abuse, sexual abuse, verbal abuse, household mental illness, incarcerated household members, household substance abuse, parental separation/divorce, and witnessing domestic violence before age 18. Smoking status and frequent mental distress (FMD) (≥14 days in past 30 days when self-perceived mental health was not good) were assessed as potential mediators in multivariate logistic regression analyses of frequent insufficient sleep by ACEs adjusted for race/ethnicity, gender, education, and body mass index. RESULTS: Overall, 28.8% of 25,810 respondents reported frequent insufficient sleep, 18.8% were current smokers, 10.8% reported frequent mental distress, 59.5% percent reported ≥1 ACE, and 8.7% reported ≥ 5 ACEs. Each ACE was associated with frequent insufficient sleep in multivariate analyses. Odds of frequent insufficient sleep were 2.5 (95% CI, 2.1-3.1) times higher in persons with ≥5 ACEs compared to those with no ACEs. Most relationships were modestly attenuated by smoking and FMD, but remained significant. CONCLUSIONS: Childhood exposures to eight indicators of child maltreatment and household dysfunction were significantly associated with frequent insufficient sleep during adulthood in this population. ACEs could be potential indicators promoting further investigation of sleep insufficiency, along with consideration of FMD and smoking. |
Relationship of opioid prescription sales and overdoses, North Carolina
Modarai F , Mack K , Hicks P , Benoit S , Park S , Jones C , Proescholdbell S , Ising A , Paulozzi L . Drug Alcohol Depend 2013 132 81-6 BACKGROUND: In the United States, fatal drug overdoses have tripled since 1991. This escalation in deaths is believed to be driven primarily by prescription opioid medications. This investigation compared trends and patterns in sales of opioids, opioid drug overdoses treated in emergency departments (EDs), and unintentional overdose deaths in North Carolina (NC). METHODS: Our ecological study compared rates of opioid sales, opioid related ED overdoses, and unintentional drug overdose deaths in NC. Annual sales data, provided by the Drug Enforcement Administration, for select opioids were converted into morphine equivalents and aggregated by zip code. These opioid drug sales rates were trended from 1997 to 2010. In addition, opioid sales were correlated and compared to opioid related ED visits, which came from a Centers for Disease Control and Prevention syndromic surveillance system, and unintentional overdose deaths, which came from NC Vital Statistics, from 2008 to 2010. Finally, spatial cluster analysis was performed and rates were mapped by zip code in 2010. RESULTS: Opioid sales increased substantially from 1997 to 2010. From 2008 to 2010, the quarterly rates of opioid drug overdoses treated in EDs and opioid sales correlated (r=0.68, p=0.02). Specific regions of the state, particularly in the southern and western corners, had both high rates of prescription opioid sales and overdoses. CONCLUSIONS: Temporal trends in sales of prescription opioids correlate with trends in opioid related ED visits. The spatial correlation of opioid sales with ED visit rates shows that opioid sales data may be a timely way to identify high-risk communities in the absence of timely ED data. |
Annual summary of vital statistics: 2010-2011
Hamilton BE , Hoyert DL , Martin JA , Strobino DM , Guyer B . Pediatrics 2013 131 (3) 548-58 The number of births in the United States declined by 1% between 2010 and 2011, to a total of 3,953,593. The general fertility rate also declined by 1% to 63.2 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 2% in 2011 (to 1894.5 births per 1000 women). The teenage birth rate fell to another historic low in 2011, 31.3 births per 1000 women. Birth rates also declined for women aged 20 to 29 years, but the rates increased for women aged 35 to 39 and 40 to 44 years. The percentage of all births to unmarried women declined slightly to 40.7% in 2011, from 40.8% in 2010. In 2011, the cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year in 2011 to 11.72%; the low birth weight rate declined slightly to 8.10%. The infant mortality rate was 6.05 infant deaths per 1000 live births in 2011, which was not significantly lower than the rate of 6.15 deaths in 2010. Life expectancy at birth was 78.7 years in 2011, which was unchanged from 2010. Crude death rates for children aged 1 to 19 years did not change significantly between 2010 and 2011. Unintentional injuries and homicide were the first and second leading causes of death, respectively, in this age group. These 2 causes of death jointly accounted for 47.0% of all deaths of children and adolescents in 2011. |
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