Life course socioeconomic position, allostatic load, and incidence of type 2 diabetes among African American adults: The Jackson Heart Study, 2000-04 to 2012
Beckles GL , McKeever Bullard K , Saydah S , Imperatore G , Loustalot F , Correa A . Ethn Dis 2019 29 (1) 39-46 Objective: We examined whether life course socioeconomic position (SEP) was associated with incidence of type 2 diabetes (t2DM) among African Americans. Design: Secondary analysis of data from the Jackson Heart Study, 2000-04 to 2012, using Cox proportional hazard regression to estimate hazard ratios (HR) with 95% CI for t2DM incidence by measures of life course SEP. Participants: Sample of 4,012 nondiabetic adults aged 25-84 years at baseline. Outcome Measure: Incident t2DM identified by self-report, hemoglobin A1c >/=6.5%, fasting plasma glucose >/=126 mg/dL, or use of diabetes medication. Results: During 7.9 years of follow-up, 486 participants developed t2DM (incidence rate 15.2/1000 person-years, 95% CI: 13.9-16.6). Among women, but not men, childhood SEP was inversely associated with t2DM incidence (HR=.97, 95% CI: .94-.99) but was no longer associated with adjustment for adult SEP or t2DM risk factors. Upward SEP mobility increased the hazard for t2DM incidence (adjusted HR=1.52, 95% CI: 1.05-2.21) among women only. Life course allostatic load (AL) did not explain the SEP-t2DM association in either sex. Conclusions: Childhood SEP and upward social mobility may influence t2DM incidence in African American women but not in men. |
Onchocerciasis associated epilepsy - A question of causality
Cantey PT , Sejvar J . Int J Infect Dis 2019 79 185-186 Recently there have been many studies reporting the detection of a high prevalence of epilepsy in areas that are hyperendemic for onchocerciasis. In many of these studies, including the manuscript by Mukendi and colleagues in this issue of International Journal of Infectious Diseases a positive association between past or current infection with onchocerciasis has been found. However, not all studies have found such an association. An earlier meta-analysis did not find a statistically significant association (Druet-Cabanac et al., 2004). More recent meta-analyses have generally affirmed the association between onchocerciasis and epilepsy (Kaiser et al., 2013, Pion et al., 2009), but only after pooling data from heterogeneous studies that have used varying methodologies to diagnosis both exposure and outcome. In some cases, including this current study and one of the previously published meta-analyses (Kaiser et al., 2013), the association weakens or disappears when controlling for potential confounders which suggests that confounders may explain part or all of the association. One recent retrospective case-control study found a dose response between a single measurement of microfilarial density in the skin and the development of epilepsy over a period of follow-up of up to 26 years (Chesnais et al., 2018). Unfortunately, the numbers were small, no information about potential confounders was available, and there was potential for misclassification of the outcome as the diagnosis of epilepsy was not confirmed by a neurologist. Although retrospective case-control studies cannot establish causality and no pathophysiologic mechanism has been described which explains how onchocerciasis causes epilepsy, the finding of a potential dose response will keep the debate about causality alive. |
A longitudinal study of sexual function in women with newly diagnosed inflammatory bowel disease
Shmidt E , Suarez-Farinas M , Mallette M , Moniz H , Bright R , Shah SA , Merrick M , Shapiro J , Xu F , Sands B , Saha S . Inflamm Bowel Dis 2019 25 (7) 1262-1270 Background: The literature provides conflicting data on sexual function in women with inflammatory bowel disease (IBD). We aim to describe sexual function at baseline and over time in a prospective inception cohort of adult women with IBD. Methods: Women age 18 years or older enrolled in the Ocean State Crohn's & Colitis Area Registry (OSCCAR) with 2 years of prospective follow-up were included in the study. All subjects were enrolled within 1 year of IBD diagnosis. Female sexual function was assessed using the Female Sexual Function Index (FSFI). Linear mixed effects models were used to assess changes in FSFI by various demographic and clinical factors. Results: One hundred sixteen of 130 eligible women (89%) were included in the study. Ninety-seven percent of women had sexual dysfunction, defined as an FSFI score of <26.55, with a baseline mean FSFI score (SD) of 16.4 (8.4) overall (15.5 [8.6] in Crohn's disease, 17.4 [8.1] in UC, P = 0.22). Despite improvement in overall disease activity, there was no significant change in the FSFI score or individual domain scores over the entire 2-year study period. Among all women with IBD, older age, nonsingle marital status, lower Short Form Health Survey (SF-36) Physical Component Summary score, and the use of biologics were independent risk factors for sexual dysfunction. Conclusions: Almost all women experienced sexual dysfunction that did not improve over time despite improvement in overall disease activity. Future studies are warranted to identify underlying mechanisms that explain the associations between demographic and clinical factors and sexual dysfunction among newly diagnosed women. 10.1093/ibd/izy397_videoizy397_video5999187279001. |
Incomplete use of global data for aetiological attribution of diarrhoeal disease in the Global Burden of Disease study
Lopman B , Hall A . Lancet Infect Dis 2019 19 (2) 128 The Global Burden of Disease study (GBD) for 2016 makes a bold attempt to estimate the aetiology of diarrhoeal disease for all ages.1 Understanding of this burden, especially among non-paediatric populations, has been inadequate, and these necessary estimates will influence policy and prioritisation. However, we are concerned that GBD estimates are highly sensitive to key assumptions, some of which seem arbitrary and do not integrate all relevant data. |
Epidemiology of perinatal HIV transmission in the United States in the era of its elimination
Nesheim SR , FitzHarris LF , Gray KM , Lampe MA . Pediatr Infect Dis J 2019 38 (6) 611-616 The number of infants with HIV born in the United States has decreased for years, approaching the Centers for Disease Control and Prevention's incidence goal for eliminating perinatal HIV transmission. We reviewed recent literature on perinatal HIV in the United States. Among perinatally HIV-exposed infants (whose mothers have HIV, without regard to infants' HIV diagnosis), prenatal and natal antiretroviral use has increased, maternal HIV infection is more frequently diagnosed prior to pregnancy, and breastfeeding is uncommon. In contrast, mothers of infants with HIV are tested at a lower rate for HIV, receive prenatal care less often, receive antiretrovirals (prenatal and natal) less often, and breastfeed more often. The incidence of perinatal HIV remains 5 times as high among black than white infants. The annual number of births to women with HIV was estimated last for 2006 (8,700), but has likely decreased. The numbers of women of childbearing age living with HIV and HIV diagnoses have decreased. The estimated time from HIV infection to diagnosis remains long among women and men who acquired HIV heterosexually. It is important to review the epidemiology and to continue monitoring outcomes and other health indicators for reproductive age adults living with HIV and their infants. |
Strengthening rural states' capacity to prepare for and respond to emerging infectious diseases, 2013-2015
Santibanez S , Bellis KS , Bay A , Chung CL , Bradley K , Gibson D , Shultz A . South Med J 2019 112 (2) 101-105 Because clinicians may be the first to encounter cases of emerging infectious diseases, they need to be able to work together with public health departments to quickly identify and respond to infectious disease outbreaks. Infectious diseases are a constant threat in many parts of the United States, including rural areas. For example, from 2004 to 2016 reports of diseases from mosquito, tick, and flea bites—which are known to affect rural areas—have tripled in the United States.1 During this period, 9 new pathogens spread by infected mosquitoes and ticks were discovered or introduced, and >640,000 cases of these diseases were reported in the United States. Although state and local health departments and vector control organizations are the nation’s main defense against this threat, 84% of local vector control organizations lack at least 1 of 5 core vector control competencies.1 |
Comparative fitness of West Nile virus isolated during California epidemics
Worwa G , Hutton AA , Brault AC , Reisen WK . PLoS Negl Trop Dis 2019 13 (2) e0007135 West Nile virus (WNV) has been circulating in California since its first detection in 2003, causing repeated outbreaks affecting public, wildlife and veterinary health. Epidemics of WNV are difficult to predict due to the multitude of factors influencing transmission dynamics among avian and mosquito hosts. Typically, high levels of WNV amplification are required for outbreaks to occur, and therefore associated viral strains may exhibit enhanced virulence and mortality in competent bird species resulting in increased mosquito infection prevalence. In our previous study, most WNV isolates made from California during 2007-08 showed increased fitness when competed in House Finches (HOFI, Haemorhous mexicanus) and Culex tarsalis Coquillett mosquitoes against COAV997-5nt, a genetically marked recombinant virus derived from a 2003 California strain. Herein, we evaluated the competitive fitness of WNV strains isolated during California epidemics in 2004, 2005, 2007, 2011 and 2012 against COAV997-5nt. These outbreak isolates did not produce elevated mortality in HOFIs, but replicated more efficiently than did COAV997-5nt based on quantification of WNV RNA copies in sera, thereby demonstrating increased competitive fitness. Oral co-infections in Cx. tarsalis resulted in similar virus-specific infection and transmission rates, indicating that outbreak isolates did not have a fitness advantage over COAV997-5nt. Collectively, WNV isolates from outbreaks demonstrated relatively greater avian, but not vector, replicative fitness compared to COAV997-5nt, similar to previously characterized non-outbreak isolates of WNV. Our results indicated that ecological rather than viral factors may facilitate WNV amplification to outbreak levels, but monitoring viral phenotypes through competitive fitness studies may provide insight into altered replication and transmission potential among emerging WNV strains. |
Integrating childhood and adult blood lead surveillance to improve identification and intervention efforts
Egan KB , Tsai RJ , Chuke SO . J Public Health Manag Pract 2019 25 S98-s104 The Centers for Disease Control and Prevention (CDC) collects information on blood lead levels (BLLs) in the United States through the Childhood Blood Lead Surveillance (CBLS) system (<16 years of age) and the Adult Blood Lead Epidemiology and Surveillance (ABLES) program (>/=16 years of age). While both of these state-based national programs share the mutual goal of monitoring and reducing lead exposure in the US population, blood lead data for children and adults are maintained in separate data collection systems. This limits the ability to fully describe lead exposure in the US population across these 2 distinct population groups from sources such as take-home and maternal-child lead exposure. In addition, at the state level, having a unified system to collect, maintain, and analyze child and adult blood lead data provides a more efficient use of limited resources. Based on feedback from state partners, CDC is working to integrate CBLS and ABLES data collection systems at the national level. Several states have developed or are developing an integrated child and adult blood lead data collection system. We highlight efforts undertaken in Wisconsin, Minnesota, North Carolina, Iowa, and Oregon to investigate workplace and take-home lead exposure. Integrating blood lead surveillance data at the national level will enhance CDC's ability to monitor sources of lead exposure from both the home and work environments including paint, water, soil, dust, consumer products, and lead-related industries. Together, an integrated child and adult blood lead surveillance system will offer a coordinated, comprehensive, and systematic public health approach to the surveillance and monitoring of reported BLLs across the US population. |
Lead poisoning prevention: The unfinished agenda
Ettinger AS , Ruckart PZ , Dignam T . J Public Health Manag Pract 2019 25 S1-s2 Overall, US population blood lead levels (BLLs)—as evidenced by NHANES (National Health and Nutrition Examination Survey) data—continue to fall.1 This special issue of the Journal of Public Health Management & Practice on Lead Poisoning Prevention marks a turning point in the nation’s “war on lead” that has spanned over a century and highlights the accomplishments of the Centers for Disease Control and Prevention (CDC) and its state and local partners in preventing and controlling lead poisoning. Ettinger et al in this issue outline CDC’s long-standing role in protecting children from lead exposure. |
ExpoQual: Evaluating measured and modeled human exposure data
LaKind JS , O'Mahony C , Armstrong T , Tibaldi R , Blount BC , Naiman DQ . Environ Res 2019 171 302-312 Recent rapid technological advances are producing exposure data sets for which there are no available data quality assessment tools. At the same time, regulatory agencies are moving in the direction of data quality assessment for environmental risk assessment and decision-making. A transparent and systematic approach to evaluating exposure data will aid in those efforts. Any approach to assessing data quality must consider the level of quality needed for the ultimate use of the data. While various fields have developed approaches to assess data quality, there is as yet no general, user-friendly approach to assess both measured and modeled data in the context of a fit-for-purpose risk assessment. Here we describe ExpoQual, an instrument developed for this purpose which applies recognized parameters and exposure data quality elements from existing approaches for assessing exposure data quality. Broad data streams such as quantitative measured and modeled human exposure data as well as newer and developing approaches can be evaluated. The key strength of ExpoQual is that it facilitates a structured, reproducible and transparent approach to exposure data quality evaluation and provides for an explicit fit-for-purpose determination. ExpoQual was designed to minimize subjectivity and to include transparency in aspects based on professional judgment. ExpoQual is freely available on-line for testing and user feedback (exposurequality.com). |
Response to the US FDA LeadCare Testing Systems Recall and CDC Health Alert
Mason J , Ortiz D , Pappas S , Quigley S , Yendell S , Ettinger AS . J Public Health Manag Pract 2019 25 S91-s97 On May 17, 2017, the Food and Drug Administration issued a safety recall for the Magellan Diagnostics' LeadCare Testing Systems due to the potential for inaccurately low blood lead test results when used with venous blood samples. Concurrently, the Centers for Disease Control and Prevention (CDC) issued a health alert with retesting recommendations for specific high-risk populations. The purpose of the CDC retesting recommendations was to help identify high-risk individuals so that those potentially impacted by falsely low test results could be retested and receive appropriate follow-up care. The CDC's Lead Poisoning Prevention Program sought to understand how the recall and recommendations impacted state and local public health agencies. Childhood lead poisoning prevention programs (CLPPPs) in state and local public health agencies collect blood lead test results for children and had a lead role in identifying children for retesting. Case studies are presented that highlight the experiences of 4 state CLPPPs in responding to the recall and recommendations. Collectively, the case studies point to several lessons learned, including the importance of (1) having a well-functioning surveillance system in place prior to a serious incident; (2) having a clear understanding of the roles partners play in the continuum of care for children potentially exposed to lead; and (3) ensuring effective communications with all staff, both internal and external, to public health agencies that have a role in responding to a serious incident. The ability to respond to public health emergencies or other serious incidents takes the combined effort of federal, state, and local public health agencies as well as others in the health care delivery system. The CDC will continue to support state and local lead poisoning prevention programs so that they have the information and tools they need to address and prevent the health effects of lead exposures in communities. |
Childhood lead poisoning: A perpetual environmental justice issue
Whitehead LS , Buchanan SD . J Public Health Manag Pract 2019 25 S115-s120 As the amount of lead in the environment has significantly decreased with the removal of lead in gasoline and paint, the United States has made great strides in preventing lead poisoning or reducing levels of lead in young children's blood. Even so, lead exposure is not equal for all children-low-income and minority children continue to bear a disproportionate burden of exposure primarily through contact with deteriorating lead-based paint from older housing and potentially through drinking contaminated water resulting from failing leaded pipes, as evidenced by the recent events in Flint, Michigan. These facts suggest that childhood lead poisoning is an environmental justice issue worthy of public health consideration and action; "environmental justice" is focused on identifying and addressing disproportionately high and adverse effects of environmental hazards on low-income and minority communities. The question remains, however, as to whether addressing the quality-of-life "risk" factors associated with lead poisoning might eventually lead to reduction in exposure, as well as potentially resulting in adverse health effects. Utilizing an environmental justice framework and examining this issue through a multidimensional environmental justice lens, we contemplated the quality-of-life factors that may essentially predispose minority children and their families to lead poisoning. Specifically, we examined American Community Survey data (2012-2016) focused on comparing race/ethnicity with other sociodemographic variables known to be associated with risks for childhood lead poisoning. The results provide thought-provoking context for making progress toward eliminating lead poisoning as a major environmental justice concern. |
Draft Genome Sequence of a Clostridium botulinum Isolate from Thailand Harboring the Subtype bont /B8 Gene.
Halpin JL , Wangroongsarb P , Jittaprasartsin C , Dykes JK , Luquez C . Microbiol Resour Announc 2019 8 (5) In 2010, a Clostridium botulinum type B isolate was recovered from fermented soybeans during a foodborne botulism investigation. Molecular investigation of the botulinum neurotoxin (bont) gene operon determined that the sequence was a new subtype, denoted B8. Here, we describe the draft whole-genome sequence of the organism. |
Precision Medicine vs Preventive Medicine.
Khoury MJ . JAMA 2019 321 (4) 406 Dr Psaty and colleagues1 compared precision medicine and preventive medicine as 2 distinct models in medicine. They posited that precision medicine is deterministic, often with a gene-centric approach, while preventive medicine is probabilistic and applies to common conditions such as hypertension and hyperlipidemia. The 2 models are complementary and not competitive. Emerging scientific evidence will guide physicians toward preventive and curative interventions that can work best at the population or individual levels. As envisioned by the All of Us research program,2 precision medicine encompasses both treatment and prevention and is more than genetics: “Precision medicine takes into account individual differences in lifestyle, environment, and biology.” Furthermore, precision does not necessarily imply biologic determinism. Most human diseases are due to complex gene-environment interactions that can lead only to probabilistic approaches to prevention. |
Multiple psychosocial health problems and sexual risk among African American females in juvenile detention: A cross-sectional study
Fasula AM , Gray SC , Vereen RN , Carry M , Sales JM , Abad N , Brown JL , Swartzendruber A , Gelaude DJ . Child Youth Serv Rev 2018 88 74-80 Objectives: African American girls in juvenile detention are disproportionately affected by sexually transmitted diseases (STDs) and other psychosocial health problems, yet few studies have examined associations between experiencing multiple psychosocial health problems and sexual risk behaviors and STD diagnosis. Method: The study included 188 detained African American girls aged 13-17 years. We conducted three sets of logistic regressions. First, bivariate analyses assessed associations among seven psychosocial factors (substance use disorder; depression; post-traumatic stress disorder [PTSD]; emotional abuse; pregnancy coercion; physical abuse; and sexual abuse) and four outcomes (early sexual initiation; condomless sex; multiple sexual partners; self-reported STD) to examine their interrelationships. Second, we examined associations between experiencing multiple psychosocial factors and outcomes. Third, psychosocial factors were categorized into four domains: substance use disorder; mental health (depression, PTSD); psychological abuse (emotional abuse, pregnancy coercion); and violence (physical abuse, sexual abuse) and included as independent associations with each outcome to assess their relative importance. Results: Multiple interrelationships among psychosocial factors and outcomes were identified. An increase of one psychosocial health problem was associated with an 18% to 27% increased odds of sexual risk behaviors or a previous STD diagnosis. Reporting violence was associated with increased odds of having multiple partners (odds ratio = 3.31; confidence interval = 1.57-6.97), and experiencing psychological abuse was associated with increased odds of reporting an STD diagnosis (odds ratio = 3.95; confidence interval = 1.62-9.63). Conclusion: Multiple psychosocial health problems, particularly psychological abuse and violence, are associated with sexual risk and STDs in this vulnerable population. |
Recommended Adult Immunization Schedule, United States, 2019
Kim DK , Hunter P . Ann Intern Med 2019 170 (3) 182-92 In October 2018, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule, United States, 2019, for adults aged 19 years or older. The 2019 adult immunization schedule, available at www.cdc.gov/vaccines/schedules, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2019 schedule has also been approved by the Director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. |
Antibodies against egg- and cell-grown influenza A(H3N2) viruses in adults hospitalized during the 2017-2018 season
Levine MZ , Martin ET , Petrie JG , Lauring AS , Holiday C , Jefferson S , Fitzsimmons WJ , Johnson E , Ferdinands JM , Monto AS . J Infect Dis 2019 219 (12) 1904-1912 Background: Influenza vaccine effectiveness was low in 2017-2018, yet circulating A(H3N2) viruses were antigenically similar to cell-grown vaccine strains. Notably, most influenza vaccines are egg-propagated. Methods: Serum was collected shortly after illness onset from 15 A(H3N2) infected cases and 15 uninfected hospitalized adults. Geometric mean titers against egg- and cell-grown A/Hong Kong/4801/2014 A(H3N2) vaccine strains and representative circulating viruses (including A/Washington/16/2017) were determined by microneutralization (MN). Independent effects of strain-specific titers on susceptibility were estimated by logistic regression. Results: MN titers against egg-A/Hong Kong were significantly higher among vaccinated individuals (173 vs 41; p=0.01). In unadjusted models, a 2-fold increase in titers against egg-A/Hong Kong was not significantly protective (29% reduction; p=0.09), but a similar increase in cell-A/Washington titer (3C.2a2) was protective (60% reduction; p=0.02). Higher egg-A/Hong Kong titers were not significantly associated with infection, when adjusted for titers against A/Washington (15% reduction; p=0.61). A 54% reduction of odds of infection was observed with a 2-fold increase in A/Washington (not significant), adjusted for egg-A/Hong Kong titer. Conclusion: Individuals vaccinated in 2017-2018 had high antibody titers against the egg-adapted vaccine strain and lower titers against circulating viruses. Titers against circulating, but not egg-adapted strains, were correlated with protection. |
Effects of influenza vaccination in the United States during the 2017-2018 influenza season
Rolfes MA , Flannery B , Chung J , O'Halloran A , Garg S , Belongia EA , Gaglani M , Zimmerman R , Jackson ML , Monto AS , Alden NB , Anderson E , Bennett NM , Billing L , Eckel S , Kirley PD , Lynfield R , Monroe ML , Spencer M , Spina N , Talbot HK , Thomas A , Torres S , Yousey-Hindes K , Singleton J , Patel M , Reed C , Fry AM . Clin Infect Dis 2019 69 (11) 1845-1853 Background: The severity of the 2017-2018 influenza season in the U.S. was high with influenza A(H3N2) viruses predominating. We report influenza vaccine effectiveness (VE) and estimate the number of vaccine prevented influenza-associated illnesses, medical visits, hospitalizations, and deaths for the 2017-2018 influenza season. Methods: We used national age-specific estimates of 2017-2018 influenza vaccine coverage and disease burden. We estimated VE, and 95% confidence intervals (CI), against medically-attended RT-PCR confirmed influenza virus infection, in the ambulatory setting, using a test-negative design. We estimated influenza type/subtype-specific burden using multipliers applied to population-based rates of influenza-associated hospitalizations. We used a compartmental model to estimate numbers, with 95% credible intervals (CrI), of influenza-associated outcomes prevented by vaccination. Results: The VE against outpatient medically-attended, laboratory-confirmed influenza was 38% (95% CI: 31-43%) including 22% (95% CI: 12-31%) against influenza A(H3N2), 62% (95% CI: 50-71%) against influenza A(H1N1)pdm09, and 50% (95% CI: 41-57%) against influenza B. We estimated that influenza vaccination prevented 7.1 million (95% CrI: 5.4 million-9.3 million) illnesses, 3.7 million (95% CrI: 2.8 million-4.9 million) medical visits, 109,000 (95% CrI: 39,000-231,000) hospitalizations, and 8,000 (95% CrI: 1,100-21,000) deaths. Vaccination prevented 10% of expected hospitalizations overall and 41% among young children (6 months-4 years). Conclusions: Despite 38% VE, influenza vaccination reduced a substantial burden of influenza-associated illness, medical visits, hospitalizations, and deaths in the U.S. during the 2017-2018 season. Our results demonstrate the benefit of current influenza vaccination and the need for improved vaccines. |
Workplace interventions and vaccination-related attitudes associated with influenza vaccination coverage among healthcare personnel working in long-term care facilities, 2015-2016 influenza season
Yue X , Black C , Ball S , Donahue S , de Perio MA , Laney AS , Greby S . J Am Med Dir Assoc 2019 20 (6) 718-724 OBJECTIVES: Influenza vaccination of healthcare personnel working in long-term care (LTC) facilities can reduce influenza-related morbidity and mortality among healthcare personnel and among resident populations who are at increased risk for complications from influenza and who may respond poorly to vaccination. The objective of this study was to investigate workplace interventions and healthcare personnel vaccination-related attitudes associated with higher influenza vaccination coverage among healthcare personnel working in LTC facilities. SETTING AND PARTICIPANTS: Data were obtained from an online survey of healthcare personnel conducted in April 2016 among a nonprobability sample of 2258 healthcare personnel recruited from 2 preexisting national opt-in Internet panels. Respondents were asked about influenza vaccination status, workplace vaccination policies and interventions, and their attitudes toward vaccination. Analyses were restricted to the 332 healthcare personnel who worked in nursing homes, assisted living facilities, or other LTC facilities. MEASURES: Logistic regression models were used to assess the independent associations between each workplace intervention and higher influenza vaccination coverage compared with referent levels, controlling for occupation, age, and race/ethnicity. Prevalence ratios were calculated under the assumption of simple random sampling. RESULTS: Approximately 77% of healthcare personnel working in LTC facilities reported receiving influenza vaccination in the 20152016 influenza season. Influenza vaccination was independently associated with an employer vaccination requirement (prevalence ratio (PR) [95% confidence interval] = 1.28 [1.11, 1.47]), being offered free onsite vaccination (PR = 1.20 [1.04, 1.39]), and employers publicizing vaccination coverage level to employees (PR = 1.24 [1.09, 1.41]). Vaccination was most highly associated with a combination of 3 or more workplace interventions. Most healthcare personnel working in LTC facilities reported positive attitudes toward the safety and effectiveness of influenza vaccination. CONCLUSIONS/IMPLICATIONS: Implementing employer vaccination interventions in LTC facilities, including employer vaccination requirements and free on-site influenza vaccination that is actively promoted, could increase influenza vaccination among healthcare personnel. |
miRNA-378a as a key regulator of cardiovascular health following engineered nanomaterial inhalation exposure.
Hathaway QA , Durr AJ , Shepherd DL , Pinti MV , Brandebura AN , Nichols CE , Kunovac A , Goldsmith WT , Friend SA , Abukabda AB , Fink GK , Nurkiewicz TR , Hollander JM . Nanotoxicology 2019 13 (5) 1-20 Nano-titanium dioxide (nano-TiO2), though one of the most utilized and produced engineered nanomaterials (ENMs), diminishes cardiovascular function through dysregulation of metabolism and mitochondrial bioenergetics following inhalation exposure. The molecular mechanisms governing this cardiac dysfunction remain largely unknown. The purpose of this study was to elucidate molecular mediators that connect nano-TiO2 exposure with impaired cardiac function. Specifically, we were interested in the role of microRNA (miRNA) expression in the resulting dysfunction. Not only are miRNA global regulators of gene expression, but also miRNA-based therapeutics provide a realistic treatment modality. Wild type and MiRNA-378a knockout mice were exposed to nano-TiO2 with an aerodynamic diameter of 182 +/- 1.70 nm and a mass concentration of 11.09 mg/m(3) for 4 h. Cardiac function, utilizing the Vevo 2100 Imaging System, electron transport chain complex activities, and mitochondrial respiration assessed cardiac and mitochondrial function. Immunoblotting and qPCR examined molecular targets of miRNA-378a. MiRNA-378a-3p expression was increased 48 h post inhalation exposure to nano-TiO2. Knockout of miRNA-378a preserved cardiac function following exposure as revealed by preserved E/A ratio and E/SR ratio. In knockout animals, complex I, III, and IV activities ( approximately 2- to 6-fold) and fatty acid respiration ( approximately 5-fold) were significantly increased. MiRNA-378a regulated proteins involved in mitochondrial fusion, transcription, and fatty acid metabolism. MiRNA-378a-3p acts as a negative regulator of mitochondrial metabolic and biogenesis pathways. MiRNA-378a knockout animals provide a protective effect against nano-TiO2 inhalation exposure by altering mitochondrial structure and function. This is the first study to manipulate a miRNA to attenuate the effects of ENM exposure. |
Maternal titanium dioxide nanomaterial inhalation exposure compromises placental hemodynamics
Abukabda AB , Bowdridge EC , McBride CR , Batchelor TP , Goldsmith WT , Garner KL , Friend S , Nurkiewicz TR . Toxicol Appl Pharmacol 2019 367 51-61 The fetal consequences of gestational engineered nanomaterial (ENM) exposure are unclear. The placenta is a barrier protecting the fetus and allowing transfer of substances from the maternal circulation. The purpose of this study was to determine the effects of maternal pulmonary titanium dioxide nanoparticle (nano-TiO2) exposure on the placenta and umbilical vascular reactivity. We hypothesized that pulmonary nano-TiO2 inhalation exposure increases placental vascular resistance and impairs umbilical vascular responsiveness. Pregnant Sprague-Dawley rats were exposed via whole-body inhalation to nano-TiO2 with an aerodynamic diameter of 188+/-0.36nm. On gestational day (GD) 11, rats began inhalation exposures (6h/exposure). Daily lung deposition was 87.5+/-2.7mug. Animals were exposed for 6days for a cumulative lung burden of 525+/-16mug. On GD 20, placentas, umbilical artery and vein were isolated, cannulated, and treated with acetylcholine (ACh), angiotensin II (ANGII), S-nitroso-N-acetyl-DL-penicillamine (SNAP), or calcium-free superfusate (Ca(2+)-free). Mean outflow pressure was measured in placental units. ACh increased outflow pressure to 53+/-5mmHg in sham-controls but only to 35+/-4mmHg in exposed subjects. ANGII decreased outflow pressure in placentas from exposed animals (17+/-7mmHg) compared to sham-controls (31+/-6mmHg). Ca(2+)-free superfusate yielded maximal outflow pressures in sham-control (63+/-5mmHg) and exposed (30+/-10mmHg) rats. Umbilical artery endothelium-dependent dilation was decreased in nano-TiO2 exposed fetuses (30+/-9%) compared to sham-controls (58+/-6%), but ANGII sensitivity was increased (-79+/-20% vs -36+/-10%). These results indicate that maternal gestational pulmonary nano-TiO2 exposure increases placental vascular resistance and impairs umbilical vascular reactivity. |
Differential effects of therapeutic complement Inhibitors on serum bactericidal activity against nongroupable meningococcal isolates recovered from patients treated with eculizumab
Granoff DM , Kim H , Topaz N , MacNeil J , Wang X , McNamara LA . Haematologica 2019 104 (8) e340-e344 Eculizumab is licensed for the treatment of paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, and generalized myasthenia gravis. By blocking C5, eculizumab inhibits meningococcal serum bactericidal activity (SBA), leaving patients at an approximately 2000-fold higher risk of meningococcal disease than the general population.1 This increased risk includes invasive disease caused by unencapsulated (non-groupable, NG) strains,1,2 which rarely cause invasive disease in normal hosts.3 | | ACH-44714 targets complement factor D in the alternative pathway (Online Supplementary Figure S1), and is being developed to treat paroxysmal nocturnal hemoglobinuria and C3 glomerulopathy. Since the terminal pathway remains intact, SBA can occur in the presence of ACH-4471 via the classical and lectin pathways (Online Supplementary Figure S1). In a previous study, eculizumab completely blocked whole blood opsonophagocytic killing of encapsulated serogroup B and C meningococcal strains while blocking factor D with ACH-4471 gave less impairment.5 Here we describe 18 cases of invasive meningococcal disease in eculizumab recipients reported to the US Centers for Disease Control and Prevention between January 2008 and July 2018 (Online Supplementary Table S1), and the effect of eculizumab and ACH-4471 on SBA against NG meningococcal isolates recovered from eight of these patients. |
Optimization of a rapid test for antibodies to the Chlamydia trachomatis antigen Pgp3
Gwyn S , Mkocha H , Randall JM , Kasubi M , Martin DL . Diagn Microbiol Infect Dis 2018 93 (4) 293-298 Serological surveillance for trachoma could allow monitoring of transmission levels in areas that have achieved elimination targets. Platforms that allow testing in basic laboratories or testing of easy-to-manage samples such as dried blood spots would contribute to the feasibility of serologic testing. Blood from 506 1-12-year-olds in 2 villages in Kongwa district, Tanzania, was tested for antibodies against the antigen Pgp3. Whole blood, plasma, and dried blood spots (DBS) were tested in lab and field settings using a cassette-enclosed Pgp3 lateral flow assay (LFA-cassette) and a pared-back "dipstick" assay (LFA-dipstick). DBS were also tested with a bead-based multiplex assay (MBA). There was no significant difference in antibody positivity between the MBA and either LFA format (ranging from 42.5% to 48.4%). Interrater agreement between an expert rater and 3 different raters in field and lab settings was uniformly good, with Cohen's kappa >0.81 in all cases. |
In vitro antiviral activity of new oxazoline derivatives as potent poliovirus inhibitors
Madia VN , Messore A , Pescatori L , Saccoliti F , Tudino V , De Leo A , Scipione L , Fiore L , Rhoden E , Manetti F , Oberste MS , Di Santo R , Costi R . J Med Chem 2018 62 (2) 798-810 The final stages of polio eradication are proving more difficult than the early phases, and the development of effective drugs and treatments is considered a priority; thus, the research is ongoing. A screening of our in-house chemical library against poliovirus Sabin strains led to the identification of compounds 5 and 6 as hits active at submicromolar concentrations. Derivatives of these compounds were synthesized as a preliminary structure-activity-relationship study. Among them, 7 and 11 were highly active against poliovirus Sabin 1-3. Compound 11 was also very potent against a large panel of wild and vaccine-derived polioviruses. Time-of-addition experiments suggest that 5 and 7 could be active at an early stage of viral replication, whereas 11 was active at same concentration at all stages of viral replication. A ligand-based approach was applied to find the common structural features shared by the new compounds and already-known poliovirus inhibitors. |
Development and evaluation of a multiplexed immunoassay for simultaneous detection of serum IgG antibodies to six human coronaviruses
Trivedi SU , Miao C , Sanchez JE , Caidi H , Tamin A , Haynes L , Thornburg NJ . Sci Rep 2019 9 (1) 1390 Known human coronaviruses (hCoV) usually cause mild to moderate upper-respiratory tract illnesses, except SARS-CoV and MERS-CoV, which, in addition to mild illness can also be associated with severe respiratory diseases and high mortality rates. Well-characterized multiplexed serologic assays are needed to aid in rapid detection and surveillance of hCoVs. The present study describes development and evaluation of a multiplexed magnetic microsphere immunoassay (MMIA) to simultaneously detect immunoglobulin G (IgG) antibodies specific for recombinant nucleocapsid proteins (recN) from hCoVs 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV. We used paired human sera to screen for IgG with reactivity against six hCoVs to determine assay sensitivity, specificity and reproducibility. We found no signal interference between monoplex and multiplex assay formats (R(2) range = 0.87-0.97). Screening of paired human sera using MMIA, resulted in 92 of 106 (sensitivity: 86%) as positive and 68 of 80 (specificity: 84%) as negative. This study serves as a proof of concept that it is feasible to develop and use a multiplexed microsphere immunoassay as a next generation screening tool for use in large scale seroprevalence studies of hCoVs. |
Prevalence of cerebral palsy, intellectual disability, hearing loss, and blindness, National Health Interview Survey, 2009-2016
McGuire DO , Tian LH , Yeargin-Allsopp M , Dowling NF , Christensen DL . Disabil Health J 2019 12 (3) 443-451 BACKGROUND: Developmental disabilities are present in a significant proportion of US children. Surveillance of developmental disabilities is crucial for monitoring population trends, guiding research into risk factors, and informing resource allocation. OBJECTIVE/HYPOTHESIS: We examined overall prevalence, prevalence by demographic characteristics, and trends over time for cerebral palsy (CP), intellectual disability (ID), moderate to severe hearing loss (MSHL), and blindness. METHODS: Data from the 2009-2016 National Health Interview Survey (NHIS) were analyzed for children 3-17 years of age. Question wording was consistent over time except for ID, which changed in 2011 to replace the term "mental retardation." Demographic differences and linear trends (over three time periods) were assessed by Chi-square tests and Wald-F tests. RESULTS: Prevalence estimates per 1000 children ages 3-17 years for CP, ID, MSHL, and blindness were 3.2 (95% CI: 2.7, 3.7), 11.1 (95% CI: 10.2, 12.1), 6.4 (95% CI: 5.6, 7.2), and 1.6 (95% CI: 1.3, 2.0), respectively. Disability prevalence was higher for children with low birthweight and from families of lower parental education, income </=200% of federal poverty level, and public insurance. Older children had higher ID prevalence; boys had significantly higher CP and ID prevalences. Only ID demonstrated a significantly increased trend over time (p=0.0002). CONCLUSIONS: We provide nationally representative prevalence estimates for four developmental disabilities; recent estimates are comparable to those from records-based studies. Prevalences were stable except for ID, which increased after 2010, coincident with the questionnaire change. A substantial number of US children continue to have these disabilities and service needs. |
A description of the educational setting among individuals with fragile X syndrome
Nash R , Riley C , Paramsothy P , Gilbertson K , Raspa M , Wheeler A , Dziuban EJ , Peacock G . Am J Intellect Dev Disabil 2019 124 (1) 57-76 Children with fragile X syndrome (FXS) display wide-ranging intellectual and behavioral abilities that affect daily life. We describe the educational setting of students with FXS and assess the relationships between school setting, co-occurring conditions, and functional ability using a national survey sample ( n = 982). The majority of students with FXS in this sample have formal individualized education plans, spend part of the day outside regular classrooms, and receive modifications when in a regular classroom. Males with FXS and certain co-occurring conditions (autism, aggression, and self-injurious behavior) are more likely to spend the entire day outside regular classrooms, compared to males without these co-occurring conditions. Students who spend more time in regular classrooms are more likely to perform functional tasks without help. |
Developing a virtual reality environment for mining research
Bellanca JL , Orr TJ , Helfrich WJ , Macdonald B , Navoyski J , Demich B . Min Metall Explor 2019 36 (4) 597-606 Recent advances in computing, rendering, and display technologies have generated increased accessibility for virtual reality (VR). VR allows the creation of dynamic, high-fidelity environments to simulate dangerous situations, test conditions, and visualize concepts. Consequently, numerous products have been developed, but many of these are limited in scope. Therefore, the National Institute for Occupational Safety and Health researchers developed a VR framework, called VR Mine, to rapidly create an underground mine for human data collection, simulation, visualization, and training. This paper describes the features of VR Mine using self-escape and proximity detection as case studies. Features include mine generation, simulated networks, proximity detection systems, and the integration and visualization of real-time ventilation models. |
Mineworkers perceptions of mobile proximity detection systems
Bellanca JL , Swanson LR , Helton J , McNinch M . Min Metall Explor 2019 36 (4) 647-655 Accident data indicates that mobile haulage poses a significant pinning, crushing, and striking risk. Proximity detection systems (PDSs) have the potential to protect mineworkers from these risks. However, unintended consequences of mobile PDSs can undermine the safety benefit they provide. Soliciting iterative user input can improve the design process. Users help provide a critical understanding of how mobile PDSs may hinder normal operation and endanger mineworkers. Researchers explored users’ perspectives by conducting interviews with mineworkers from seven mines that have installed mobile PDSs on some of their haulage equipment. Mineworkers reported that mobile PDSs affect loading, tramming, section setup, maintenance, and general work on the section. Mineworkers discussed the operational effects and increased burden, exposure, and risk. Mineworkers also suggested that improved task compatibility, training, logistics, and PDS performance might help address some of these identified issues. This paper also gives additional insights into mobile PDS design and implementation. |
A report of activities related to the Dietary Reference Intakes from the Joint Canada-US Dietary Reference Intakes Working Group
MacFarlane AJ , Cogswell ME , de Jesus JM , Greene-Finestone LS , Klurfeld DM , Lynch CJ , Regan K , Yamini S . Am J Clin Nutr 2019 109 (2) 251-259 The governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes (DRIs) since the mid-1990s. The Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, advance work to resolve methodological issues that is necessary for new reviews, and sponsor DRI-related committees through the National Academies of Sciences, Engineering and Medicine. In recent years, the Joint Canada-US DRI Working Group, consisting of members from both Federal DRI committees, developed an open and transparent nomination process for prioritizing nutrients for DRI review, by which sodium, the omega-3 (n-3) fatty acids, vitamin E, and magnesium were identified. In addition, discussions during the nutrient nomination process prompted the Federal DRI committees to address previously identified issues related to the use of chronic disease endpoints when setting DRIs. The development of guiding principles for setting DRIs based on chronic disease risk reduction will be applied for the first time during the DRI review of sodium and potassium. In summary, the US and Canadian governments have worked collaboratively to adapt our approach to prioritizing nutrients for DRI review and to broaden the scope of the DRIs to better incorporate the concept of chronic disease risk reduction in order to improve public health. |
Predicting occupational exposures to carbon nanotubes and nanofibers based on workplace determinants modeling
Dahm MM , Bertke S , Schubauer-Berigan MK . Ann Work Expo Health 2019 63 (2) 158-172 Background: Recent cross-sectional epidemiologic studies have examined the association between human health effects and carbon nanotube and nanofiber (CNT/F) workplace exposures. However, due to the latency of many health effects of interest, cohort studies with sufficient follow-up will likely be needed. The objective of this study was to identify workplace determinants that contribute to exposure and develop predictive models to estimate CNT/F exposures for future use in epidemiologic studies. Methods: Exposure measurements were compiled from 15 unique facilities for the metrics of elemental carbon (EC) mass at both the respirable and inhalable aerosol size fractions as well as a quantitative analysis performed by transmission electron microscopy (TEM). These metrics served as the dependent variables in model development. Repeated personal samples were collected from most of the 127 CNT/F worker participants for 252 total observations. Determinants were categorized as company-level or worker-level and used to describe the exposure relationship within the dependent variables. The influence of determinants on variance components was explored using mixed linear models that utilized a backwards stepwise selection process with a lowering of the AIC for model determinant selection. Additional ridge regression models were created that examined predictive performance with and without all two-way interactions. Cross-validation was performed on each model to evaluate the generalizability of its predictive capabilities while predictive performance was evaluated according to the corresponding R2 value and root mean square error (RMSE). Results: Determinants at the company-level that increased exposure included an inadequate or semi-adequate engineering control rating, increasing average CNT/F diameter/length, daily quantities of material handled from 101 g to >1 kg and >1 kg, the use of CNF materials, the industry type of hybrid producer/user, and the expert assessment of a high exposure potential. Worker-level determinants associated with higher exposure included handling the dry-powdered form of CNT/F, handling daily quantities of material >1 kg, direct/indirect exposure, having the job title of engineer, using a respirator, using a ventilated or unventilated enclosure, and the job task of powder handling. The mixed linear models explained >60% of the total variance when using all company- and worker-level determinants to create the three exposure models. The cross-validated RMSE values for each of the three mixed models ranged from 2.50 to 4.23. Meanwhile, the ridge regression models, without all two-way interactions, estimated cross-validated RMSE values of 2.85, 2.23, and 2.76 for the predictive models of inhalable EC, respirable EC, and TEM, respectively. Conclusions: The ridge regression models demonstrated the best performance for predicting exposures to CNT/F for each exposure metric, although they only provided a modest predictive capability. Therefore, it was concluded that the models alone would not be adequate in predicting workplace exposures and would need to be integrated with other methods. |
Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA
Hosokawa Y , Casa DJ , Trtanj JM , Belval LN , Deuster PA , Giltz SM , Grundstein AJ , Hawkins MD , Huggins RA , Jacklitsch B , Jardine JF , Jones H , Kazman JB , Reynolds ME , Stearns RL , Vanos JK , Williams AL , Williams WJ . Int J Biometeorol 2019 63 (3) 405-427 Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat. |
A test method for evaluating the thermal environment of underground coal mine refuge alternatives
Yantek DS , Yan L , Damiano NW , Reyes MA , Srednicki JR . Int J Min Sci Technol 2019 29 (3) 343-355 Since 2009, the Mine Safety and Health Administration (MSHA) has required mines to install refuge alternatives (RAs) in underground coal mines. One of the biggest concerns with occupied RAs is the possible severity of the resulting thermal environment. In 30 CFR 7.504, the maximum allowable apparent temperature (AT) for an occupied RA is specified as 35 °C (95 °F). Manufacturers must conduct heat/humidity tests to demonstrate that their RAs meet the 35 °C (95 °F) AT limit. For these tests, heat input devices are used to input the metabolic heat of actual miners. A wide variety of test methods, sensors, and heat input devices could be used when conducting such tests. Since 2012, the National Institute for Occupational Safety and Health (NIOSH) has conducted over thirty 96-hour heat/humidity tests on four different RAs. This paper discusses the test equipment and procedures used during these investigations. This information is useful for RA manufacturers conducting RA heat/humidity tests, for other researchers investigating RA heat/humidity buildup, and for those who need to assess the thermal environment of any confined space where people may be trapped or are seeking refuge. |
Toward mass drug administration stopping criteria for Schistosoma mansoni control programs
Secor WE . Am J Trop Med Hyg 2019 100 (3) 485-486 National control programs for the preventive chemotherapy of neglected tropical diseases (NTDs) use mass drug administration (MDA) to reduce infection levels in communities and rely on diagnostic tests to monitor program progress and inform interventions. Control programs for Schistosoma mansoni have conventionally employed stool examinations using the Kato–Katz method for program monitoring. Limitations of the Kato–Katz technique include the substantial time and effort required to make and read slides, its poor sensitivity at low levels of infection, and the occasional unwillingness of participants to provide stool samples. Nevertheless, it is widely available and has been the most relied-on technique for evaluating the prevalence of intestinal schistosomiasis for decades. Therefore, it is the method recommended by the current WHO guidelines for S. mansoni control programs. |
Schistosomiasis is associated with incident HIV transmission and death in Zambia
Wall KM , Kilembe W , Vwalika B , Dinh C , Livingston P , Lee YM , Lakhi S , Boeras D , Naw HK , Brill I , Chomba E , Sharkey T , Parker R , Shutes E , Tichacek A , Secor WE , Allen S . PLoS Negl Trop Dis 2018 12 (12) e0006902 BACKGROUND: We examined relationships between schistosome infection, HIV transmission or acquisition, and all-cause death. METHODS: We retrospectively tested baseline sera from a heterosexual HIV-discordant couple cohort in Lusaka, Zambia with follow-up from 1994-2012 in a nested case-control design. Schistosome-specific antibody levels were measured by ELISA. Associations between baseline antibody response to schistosome antigens and incident HIV transmission, acquisition, and all-cause death stratified by gender and HIV status were assessed. In a subset of HIV- women and HIV+ men, we performed immunoblots to evaluate associations between Schistosoma haematobium or Schistosoma mansoni infection history and HIV incidence. RESULTS: Of 2,145 individuals, 59% had positive baseline schistosome-specific antibody responses. In HIV+ women and men, baseline schistosome-specific antibodies were associated with HIV transmission to partners (adjusted hazard ratio [aHR] = 1.8, p<0.005 and aHR = 1.4, p<0.05, respectively) and death in HIV+ women (aHR = 2.2, p<0.001). In 250 HIV- women, presence of S. haematobium-specific antibodies was associated with increased risk of HIV acquisition (aHR = 1.4, p<0.05). CONCLUSION: Schistosome infections were associated with increased transmission of HIV from both sexes, acquisition of HIV in women, and increased progression to death in HIV+ women. Establishing effective prevention and treatment strategies for schistosomiasis, including in urban adults, may reduce HIV incidence and death in HIV+ persons living in endemic areas. |
Leisure time and transportation walking among adults with and without arthritis in the United States, 2010
Hootman JM , Theis KA , Barbour KE , Paul P , Carlson SA . Arthritis Care Res (Hoboken) 2019 71 (2) 178-188 OBJECTIVE: Walking is a joint-friendly activity for adults with arthritis. The aim of this study was to estimate, among adults with arthritis, the prevalence of leisure and transportation walking overall (by arthritis status and by sociodemographic and health characteristics), the number of total minutes walking per week in each domain, and the distributions of walking bout length (i.e., short periods of activity) in minutes. METHODS: Data were obtained from the 2010 National Health Interview Survey. Prevalence estimates (percentages and 95% confidence intervals [95% CIs]) of leisure and transportation walking in the past 7 days and walking bout times were calculated (in minutes), as were multivariable Poisson regression models, which account for the complex sample design. RESULTS: Prevalence of leisure walking was 45.9% (95% CI 44.2-47.6) for adults with arthritis versus 51.9% (95% CI 50.9-52.9) for those without. Transportation walking prevalence was 23.0% (95% CI 21.7-24.4) for adults with arthritis versus 32.0% (95% CI 31.0-33.0) for those without. The total time of leisure walking per week did not differ in adults with arthritis compared to those without (77.3 versus 78.3 minutes, respectively; P = 0.62), while total time of transportation walking did differ (49.8 versus 58.1 minutes, respectively; P = 0.03). The most common walking bout length differed between leisure (26-40 minutes) and transportation (10-15 minutes) walking, but not by arthritis status. In separate adjusted multivariable models, obesity was consistently negatively associated with both walking outcomes, and being physically active was positively associated with both; lower extremity joint pain was not associated. CONCLUSION: By adding short bouts, leisure and transportation walking could be adopted by large proportions of adults with arthritis. Existing evidence-based programs can help increase physical activity. |
Public Health Workforce 3.0: Recent progress and what's on the horizon to achieve the 21st-century workforce
Glynn MK , Jenkins ML Jr , Ramsey C , Simone PM . J Public Health Manag Pract 2019 25 Suppl 2 S6-s9 Twenty-five years ago, the 10 essential public health services were defined and disseminated1 and public health was charged with ensuring that our workforce had mastery of the competencies to deliver these services.2,3 Although these essential services remain a useful framework for the practice of public health, the concept of an effective public health worker has evolved in the intervening decades. The necessary skills and aptitudes now extend beyond the traditional competencies (eg, epidemiology) to focus on strategic and systems thinking, communication, and translating science to policy, along with the public health practitioner's role as chief health strategist.4–8 A subcommittee of the Public Health Functions Project Steering Committee laid out an agenda in 1994 to realize the vision of “Healthy People in Healthy Communities” and recommended actions in 5 main areas (national leadership, state and local leadership, workforce composition, curriculum development, and distance learning).1 Progress in each of these 5 areas has been documented,9–11 with particularly substantial advances observed in the last 5 years.12–16 From a federal perspective, we believe that the recent, increasing rate of these advances can be attributed to a few main factors. Collaboration among federal and other partners working at the national level has provided the necessary leadership. Partners have built upon each other's work rather than working in isolation. Accreditation of health departments has provided a consistent approach for strengthening state and local health agencies. Researchers have taken action and are building evidence that informs practice at the federal, state, tribal, local, and territorial levels. Nonetheless, gaps remain. Using the areas for action as a framework and a federal perspective, we highlight recent accomplishments and important areas for future attention to continue the path toward the public health workforce of the 21st century—a public heath workforce 3.0. |
Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity
Clayton HB , Andrzejewski J , Johns M , Lowry R , Ashley C . Addict Behav 2019 93 122-128 OBJECTIVE: Limited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity. METHODS: Data from the 2015 national Youth Risk Behavior Survey (n=15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity. RESULTS: All SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR=2.39;95% CI:2.15,2.65 vs aPR=1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12). CONCLUSIONS: The relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health. |
Syndromic surveillance of emergency department visits for acute adverse effects of marijuana, Tri-County Health Department, Colorado, 2016-2017
Marx GE , Chen Y , Askenazi M , Albanese BA . Public Health Rep 2019 134 (2) 33354919826562 OBJECTIVES:: In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. METHODS:: We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by >/=1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider's clinical impression during the visit. RESULTS:: Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). CONCLUSIONS:: ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM. |
Determination of humectants in tobacco filler by high performance chromatography/single quadrupole mass spectrometry
Xizheng Y , Valentin-Blasini L , Watson C , Cardenas RB . Beitr Tab Int 2018 28 (4) 170-178 Glycerol, and 1,2-propylene glycol are the humectants most commonly used by the tobacco industry. They are found in a variety of tobacco products and are often present at high levels (∼2-5 % w/w). While humectants are generally considered safe, they may serve as precursors in the formation of harmful carbonyl compounds. A selective, precise, and sensitive method for the quantification of several humectants in cigarette filler was developed. The method's sample clean-up is a two-step process consisting of a mechanical extraction, followed by solid phase extraction. Individual humectants are separated, identified, and measured using liquid chromatography coupled to a single quadrupole mass spectrometer as the detector (LC/MS). Detection limits were 0.105, 0.575, and 0.039 mg/cigarette for glycerol, 1,2-propylene glycol and triethylene glycol, respectively. The quantification range for these analytes was 0.4-75.0 mg/cigarette. Twenty-seven brands of domestic commercial cigarettes were evaluated to assess typical levels of humectants in the tobacco filler. |
Clinical presentation of pregnant women in isolation units for Ebola virus disease in Sierra Leone, 2014
Mpofu JJ , Soud F , Lyman M , Koroma AP , Morof D , Ellington S , Kargbo SS , Callaghan W . Int J Gynaecol Obstet 2019 145 (1) 76-82 OBJECTIVES: To examine Ebola virus disease (EVD) symptom prevalence and EVD status among pregnant women in Ebola isolation units in Sierra Leone. METHODS: In an observational study, data were obtained for pregnant women admitted to Ebola isolation units across four districts in Sierra Leone from June 29, 2014, to December 20, 2014. Women were admitted to isolation units if they had suspected EVD exposures or fever (temperature >38 degrees C) and three or more self-reported symptoms suggestive of EVD. Associations were examined between EVD status and each symptom using chi(2) tests and logistic regression adjusting for age/labor status. RESULTS: Of 176 pregnant women isolated, 55 (32.5%) tested positive for EVD. Using logistic regression models adjusted for age, EVD-positive women were significantly more likely to have fever, self-reported fatigue/weakness, nausea/vomiting, headache, muscle/joint pain, chest pain, vaginal bleeding, unexplained bleeding, or sore throat upon admission. In models adjusted for age/labor, only women with fever or vaginal bleeding upon admission were significantly more likely to be EVD-positive. CONCLUSIONS: Several EVD symptoms and complications increased the odds of testing EVD-positive; some of these were also signs and symptoms of labor/pregnancy complications. The study results highlight the need to refine screening for pregnant women with EVD. This article is protected by copyright. All rights reserved. |
Rabies post-exposure prophylaxis initiation and adherence among patients in Vietnam, 2014-2016
Tran CH , Afriyie DO , Pham TN , Otsu S , Urabe M , Dang AD , Tran HGT , Nguyen HV , Le HT , Nguyen HTT . Vaccine 2019 37 Suppl 1 A54-A63 BACKGROUND: Adhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. METHODS: We obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (>/=5 deaths). RESULTS: During 2014-2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. CONCLUSIONS AND RELEVANCE: Vietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Genetics and Genomics
- Health Behavior and Risk
- Immunity and Immunization
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Physical Activity
- Public Health Leadership and Management
- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
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