Physical activity and body mass index: the contribution of age and workplace characteristics
Nelson CC , Wagner GR , Caban-Martinez AJ , Buxton OM , Kenwood CT , Sabbath EL , Hashimoto DM , Hopcia K , Allen J , Sorensen G . Am J Prev Med 2014 46 S42-51 BACKGROUND: The workplace is an important domain for adults, and many effective interventions targeting physical activity and weight reduction have been implemented in the workplace. However, the U.S. workforce is aging, and few studies have examined the relationship of BMI, physical activity, and age as they relate to workplace characteristics. PURPOSE: This paper reports on the distribution of physical activity and BMI by age in a population of hospital-based healthcare workers and investigates the relationships among workplace characteristics, physical activity, and BMI. METHODS: Data from a survey of patient care workers in two large academic hospitals in the Boston area were collected in late 2009 and analyzed in early 2013. RESULTS: In multivariate models, workers reporting greater decision latitude (OR=1.02, 95% CI=1.01, 1.03) and job flexibility (OR=1.05, 95% CI=1.01, 1.10) reported greater physical activity. Overweight and obesity increased with age (p<0.01), even after adjusting for workplace characteristics. Sleep deficiency (OR=1.56, 95% CI=1.15, 2.12) and workplace harassment (OR=1.62, 95% CI=1.20, 2.18) were also associated with obesity. CONCLUSIONS: These findings underscore the persistent impact of the work environment for workers of all ages. Based on these results, programs or policies aimed at improving the work environment, especially decision latitude, job flexibility, and workplace harassment should be included in the design of worksite-based health promotion interventions targeting physical activity or obesity. |
Age and cancer risk: a potentially modifiable relationship
White MC , Holman DM , Boehm JE , Peipins LA , Grossman M , Jane Henley S . Am J Prev Med 2014 46 S7-S15 This article challenges the idea that cancer cannot be prevented among older adults by examining different aspects of the relationship between age and cancer. Although the sequential patterns of aging cannot be changed, several age-related factors that contribute to disease risk can be. For most adults, age is coincidentally associated with preventable chronic conditions, avoidable exposures, and modifiable risk behaviors that are causally associated with cancer. Midlife is a period of life when the prevalence of multiple cancer risk factors is high and incidence rates begin to increase for many types of cancer. However, current evidence suggests that for most adults, cancer does not have to be an inevitable consequence of growing older. Interventions that support healthy environments, help people manage chronic conditions, and promote healthy behaviors may help people make a healthier transition from midlife to older age and reduce the likelihood of developing cancer. Because the number of adults reaching older ages is increasing rapidly, the number of new cancer cases will also increase if current incidence rates remain unchanged. Thus, the need to translate the available research into practice to promote cancer prevention, especially for adults at midlife, has never been greater. |
Assessing asthma severity among children and adults with current asthma
Zahran HS , Bailey C , Qin X , Moorman JE . J Asthma 2014 51 (6) 610-7 BACKGROUND: Asthma severity is a key indicator to assess asthma care and management. Severity status may vary over time. Assessing asthma severity periodically is important for monitoring the health and well-being of people with asthma. OBJECTIVE: To assess population-based asthma severity and to identify related-risk factors among children and adults with asthma. METHODS: We used the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey. Asthma severity was classified as intermittent or persistent. We performed multivariate logistic regression to identify related-risk factors. RESULTS: Overall, 63.8% of persons with asthma had persistent asthma. Persistent asthma was more prevalent among children aged 0-4 years (71.8%; prevalence rate ratio [PR]=1.3). Among adults with current asthma, persistent asthma was more prevalent among those who were 45 years or older (aged 45-54: 69.4%; PR=1.1, aged 55-64: 72.6%; PR=1.2, and aged 65+: 77.8%; PR=1.3); annual household incomes of <$15,000 (74.1%; PR=1.1); and first diagnosed at age 55 years or older (first diagnosed at age 55-64: 80.4%; PR=1.1, at age 65+: 81.5%; PR=1.1). The prevalence of persistent asthma was also higher among current smokers who were also exposed to secondhand smoke (SHS) (74.7%; PR=1.1); and among those with Chronic Obstructive Pulmonary Disease (COPD) (77.1%; PR=1.2). CONCLUSIONS: Nearly two-thirds of children and adults with asthma had persistent asthma. Identifying related-risk factors could help improve targeted interventions or strategies to reduce modifiable predictors (low income, smoking, and SHS) of increased asthma severity. Such strategies could improve asthma care and quality of life. |
Cancer prevention among adults aged 45-64 years: setting the stage
Ory MG , Anderson LA , Friedman DB , Pulczinski JC , Eugene N , Satariano WA . Am J Prev Med 2014 46 S1-6 As part of setting the stage for this supplement to the American Journal of Preventive Medicine, a life-course perspective is presented to assist in understanding the importance of cancer prevention for adults in midlife, a period roughly spanning 20 years between ages 45 and 64 years. Drawing on disciplinary perspectives from the social sciences and public health, several life-course themes are delineated in this article: how specific life transitions present unique opportunities for interventions to inform policy and practice that can improve population health outcomes; how interventions can be focused on those at particular life stages or on the entire life course; and how the onset and progression of chronic conditions such as cancer are dependent on a complex interplay of critical and sensitive periods, and trajectory and accumulation processes. A translational research framework is applied to help promote the movement of applied public health interventions for cancer prevention into practice. Also explored are differences that can affect people at midlife relative to other age cohorts. Specifically, cancer-related risks and care networks are examined, with examples of public health strategies that can be applied to cancer prevention and control. As a conclusion, select methodologic issues and next steps for advancing research and practice are identified. |
Changing hepatocellular carcinoma incidence and liver cancer mortality rates in the United States
Altekruse SF , Henley SJ , Cucinelli JE , McGlynn KA . Am J Gastroenterol 2014 109 (4) 542-53 OBJECTIVES: The objectives were to describe Surveillance, Epidemiology and End Results (SEER) hepatocellular carcinoma (HCC) incidence trends and the US liver cancer mortality trends by geography, age, race/ethnicity, and gender. METHODS: HCC incidence data from SEER 18 registries and liver cancer mortality data from the National Center for Health Statistics were analyzed. Rates and joinpoint trends were calculated by demographic subgroup. State-level liver cancer mortality rates and trends were mapped. RESULTS: HCC incidence rates in SEER registries did not significantly increase during 2007-2010; however, the US liver cancer mortality rates did increase. HCC incidence and liver cancer mortality rates increased among black, Hispanic, and white men aged 50+ years and decreased among 35-49-year-old men in all racial/ethnic groups including Asians/Pacific Islanders. Significantly increasing incidence and mortality rates among women were restricted to blacks, Hispanics, and whites aged 50+ years. Asian/Pacific Islander liver cancer mortality rates decreased during 2000-2010 with decreasing rates among women aged 50-64 years and men aged 35-49 years and stable rates in other groups. During 2006-2010, among individuals 50-64 years of age, blacks and Hispanics had higher incidence and mortality rates than Asians/Pacific Islanders. Liver cancer mortality rates were highest in Louisiana, Mississippi, Texas, and Washington, DC. CONCLUSIONS: Decreasing HCC incidence and liver cancer mortality rates among Asians/Pacific Islanders, men aged 35-49 years, and the nonsignificant increase in overall HCC incidence rates suggest that the peak of the epidemic may be near or have passed. Findings of geographic variation in mortality rates can inform control efforts.Am J Gastroenterol advance online publication, 11 February 2014; doi:10.1038/ajg.2014.11. |
Colorectal cancer incidence and mortality disparities in New Mexico
Hoffman RM , Espey DK , Rhyne RL , Gonzales M , Rajput A , Mishra SI , Stone SN , Wiggins CL . J Cancer Epidemiol 2014 2014 239619 BACKGROUND: Previous analyses indicated that New Mexican Hispanics and American Indians (AI) did not experience the declining colorectal cancer (CRC) incidence and mortality rates observed among non-Hispanic whites (NHW). We evaluated more recent data to determine whether racial/ethnic differences persisted. METHODS: We used New Mexico Surveillance Epidemiology and End Results data from 1995 to 2009 to calculate age-specific incidence rates and age-adjusted incidence rates overall and by tumor stage. We calculated mortality rates using National Center for Health Statistics' data. We used joinpoint regression to determine annual percentage change (APC) in age-adjusted incidence rates. Analyses were stratified by race/ethnicity and gender. RESULTS: Incidence rates continued declining in NHW (APC -1.45% men, -1.06% women), while nonsignificantly increasing for AI (1.67% men, 1.26% women) and Hispanic women (0.24%). The APC initially increased in Hispanic men through 2001 (3.33%, P = 0.06), before declining (-3.10%, P = 0.003). Incidence rates declined in NHW and Hispanics aged 75 and older. Incidence rates for distant-stage cancer remained stable for all groups. Mortality rates declined significantly in NHW and Hispanics. CONCLUSIONS: Racial/ethnic disparities in CRC persist in New Mexico. Incidence differences could be related to risk factors or access to screening; mortality differences could be due to patterns of care for screening or treatment. |
Comorbidity burden and guideline-concordant care for breast cancer
Kimmick G , Fleming ST , Sabatino SA , Wu XC , Hwang W , Wilson JF , Lund MJ , Cress R , Anderson RT . J Am Geriatr Soc 2014 62 (3) 482-8 OBJECTIVES: To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. DESIGN: Cross-sectional. SETTING: National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. PARTICIPANTS: Individuals with stage 0-III breast cancer. MEASUREMENTS: Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment. RESULTS: The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥50) and black race were associated with less guideline concordance, regardless of comorbidity level. CONCLUSION: When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates. |
Intra-host diversity and evolution of hepatitis C virus endemic to Côte d'Ivoire.
Forbi JC , Campo DS , Purdy MA , Dimitrova ZE , Skums P , Xia GL , Punkova LT , Ganova-Raeva LM , Vaughan G , Ben-Ayed Y , Switzer WM , Khudyakov YE . J Med Virol 2014 86 (5) 765-71 Hepatitis C virus (HCV) infection presents an important, but underappreciated public health problem in Africa. In Cote d'Ivoire, very little is known about the molecular dynamics of HCV infection. Plasma samples (n = 608) from pregnant women collected in 1995 from Cote d'Ivoire were analyzed in this study. Only 18 specimens ( approximately 3%) were found to be HCV PCR-positive. Phylogenetic analysis of the HCV NS5b sequences showed that the HCV variants belong to genotype 1 (HCV1) (n = 12, 67%) and genotype 2 (HCV2) (n = 6, 33%), with a maximum genetic diversity among HCV variants in each genotype being 20.7% and 24.0%, respectively. Although all HCV2 variants were genetically distant from each other, six HCV1 variants formed two tight sub-clusters belonging to HCV1a and HCV1b. Analysis of molecular variance (AMOVA) showed that the genetic structure of HCV isolates from West Africa with Cote d'Ivoire included were significantly different from Central African strains (P = 0.0001). Examination of intra-host viral populations using next-generation sequencing of the HCV HVR1 showed a significant variation in intra-host genetic diversity among infected individuals, with some strains composed of sub-populations as distant from each other as viral populations from different hosts. Collectively, the results indicate a complex HCV evolution in Cote d'Ivoire, similar to the rest of West Africa, and suggest a unique HCV epidemic history in the country. |
A multisite study of the prevalence of HIV with rapid testing in mental health settings
Blank MB , Himelhoch SS , Balaji AB , Metzger DS , Dixon LB , Rose CE , Oraka E , Davis-Vogel A , Thompson WW , Heffelfinger JD . Am J Public Health 2014 104 (12) 2377-84 OBJECTIVES: We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. METHODS: We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). RESULTS: Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. CONCLUSIONS: HIV prevalence for individuals receiving mental health services was more than 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. |
Encephalitis-associated hospitalizations among American Indians and Alaska Natives
Mehal JM , Holman RC , Vora NM , Blanton J , Gordon PH , Cheek JE . Am J Trop Med Hyg 2014 90 (4) 755-9 Encephalitis produces considerable morbidity in the United States, but morbidity rates among American Indian/Alaska Native (AI/AN) people have not been described. Hospitalization records listing an encephalitis diagnosis were analyzed by using Indian Health Service direct/contract inpatient data. For 1998-2010, there were 436 encephalitis-associated hospitalizations among AI/AN people, an average annual age-adjusted hospitalization rate of 3.1/100,000 population. The rate for infants (11.9) was more than double that for any other age group. Death occurred for 4.1% of persons hospitalized. Consistent with reports for the general U.S. population, the rate was high among infants and most (53.9%) hospitalizations were of unexplained etiology. The average annual rate during the study period appeared lower than for the general U.S. population, due particularly to lower rates in the elderly. Future community-based surveillance and mortality studies are needed to confirm these findings and examine reasons underlying the low rates of encephalitis in AI/AN people. |
Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study
Otieno FO , Ndivo R , Oswago S , Ondiek J , Pals S , McLellan-Lemal E , Chen RT , Chege W , Gray KM . Int J STD AIDS 2014 25 (12) 851-9 BACKGROUND: While laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections, syndromic management has been presented as a simplified and affordable approach for sexually transmitted infection management in limited resource settings. METHODS: Sexually transmitted infection signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common sexually transmitted infections. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. RESULTS: We screened 846 participants, of whom 88 (10.4%) received syndromic sexually transmitted infection diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent sexually transmitted infection was herpes simplex virus type 2 and the percentage of persons with any sexually transmitted infection was higher among women (48.6%) than men (15.6%, p < 0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of sexually transmitted infections ranged from poor to good. CONCLUSION: Our findings suggest that syndromic management of sexually transmitted infections is not a sufficient tool for sexually transmitted infection diagnosis in this setting; development and improvement of sexually transmitted infection diagnostic capabilities through laboratory confirmation is needed in resource-limited settings. |
Influenza surveillance on cruise ships
Bell TR , Kornylo Duong K , Finelli L , Slaten DD . Am J Prev Med 2014 46 (3) 327-329 Acute respiratory illness, ranging from the common cold to the influenza virus, affects people worldwide. In the U.S., roughly 3000–49,000 people die annually because of complications from influenza.1 Acute respiratory illness is common among international travelers. Respiratory illness is specifically problematic on cruise ships, estimated at approximately 27% of all recorded illnesses.2 The spread of influenza on cruise ships is a particular problem for several reasons. First, the grouping of several thousand people on board for a week or more allows considerable mixing of infected and susceptible individuals. Second, itineraries often involve travel to tropical or semitropical destinations,3 where influenza may circulate year round.4 Third, crew members can be a source of continuing infection for new passenger cohorts as infections may remain on board from one cruise to the next. The popularity of cruise ship travel has been growing over the last decade. The Cruise Lines International Association reports that the average annual passenger growth from 1990 to 2010 was 7.6%.3 With passengers and crew coming together from all over the world, the potential for influenza transmission, with significant morbidity, is substantial. However, little attention has been given to routine influenza surveillance on cruise ships. |
An assessment of the GYT: Get Yourself Tested Campaign: an integrated approach to sexually transmitted disease prevention communication
Friedman AL , Brookmeyer KA , Kachur RE , Ford J , Hogben M , Habel MA , Kantor LM , Clark E , Sabatini J , McFarlane M . Sex Transm Dis 2014 41 (3) 151-7 BACKGROUND: Youth in the United States bear a disproportionate burden of sexually transmitted diseases (STDs). Stigma, misconceptions, and access challenges keep many from getting tested or treated. The GYT: Get Yourself Tested campaign was launched in 2009 to reduce stigma and promote STD communication and testing. This evaluation sought to assess the first 2 years of campaign engagement and associations with STD testing among youth. METHODS: Campaign engagement with select GYT on-the-ground events, social media sites, and STD testing locator tools was measured through process/media tracking metrics. Sexually transmitted disease testing patterns were assessed using data from Planned Parenthood affiliates (2008-2010) and national trend data from clinics participating in national infertility prevention activities (2003-2010). RESULTS: On-the-ground events reached an estimated 20,000 youth in 2009 and 52,000 youth in 2010. Across 2009 to 2010, GYT's Facebook page gained 4477 fans, Twitter feed gained 1994 followers, and more than 140,000 referrals were made to the STD testing locator. From April 2008 to 2010, there was a 71% increase in STD testing and a 41% increase in chlamydia testing at reporting Planned Parenthood affiliates (representing approximately 118 health centers). Chlamydia case positivity rates during this period were stable at 6.6% (2008) and 7.3% (2010). Trend data indicate that testing was higher in spring 2009 and 2010 compared with other periods during those years; this pattern is commensurate with STD Awareness Month/GYT activities. CONCLUSIONS: Data quality is limited in a manner similar to many STD prevention efforts. Within these limitations, evidence suggests that GYT reaches youth and is associated with increased STD testing. |
Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals?
Friedman SR , West BS , Tempalski B , Morton CM , Cleland CM , Des Jarlais DC , Hall HI , Cooper HL . Ann Epidemiol 2014 24 (4) 304-11 PURPOSE: We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS: Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS: Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS: Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations. |
Emerging filoviral disease in Uganda: proposed explanations and research directions
Polonsky JA , Wamala JF , de Clerck H , Van Herp M , Sprecher A , Porten K , Shoemaker T . Am J Trop Med Hyg 2014 90 (5) 790-793 Outbreaks of Ebola and Marburg virus diseases have recently increased in frequency in Uganda. This increase is probably caused by a combination of improved surveillance and laboratory capacity, increased contact between humans and the natural reservoir of the viruses, and fluctuations in viral load and prevalence in this reservoir. The roles of these proposed explanations must be investigated to guide appropriate responses to the changing epidemiological profile. Other African settings in which multiple filoviral outbreaks have occurred could also benefit from such information. |
Using occupancy models to investigate the prevalence of ectoparasitic vectors on hosts: an example with fleas on prairie dogs
Eads DA , Biggins DE , Doherty PF Jr , Gage KL , Huyvaert KP , Long DH , Antolin MF . Int J Parasitol Parasites Wildl 2013 2 246-56 Ectoparasites are often difficult to detect in the field. We developed a method that can be used with occupancy models to estimate the prevalence of ectoparasites on hosts, and to investigate factors that influence rates of ectoparasite occupancy while accounting for imperfect detection. We describe the approach using a study of fleas (Siphonaptera) on black-tailed prairie dogs (Cynomys ludovicianus). During each primary occasion (monthly trapping events), we combed a prairie dog three consecutive times to detect fleas (15 s/combing). We used robust design occupancy modeling to evaluate hypotheses for factors that might correlate with the occurrence of fleas on prairie dogs, and factors that might influence the rate at which prairie dogs are colonized by fleas. Our combing method was highly effective; dislodged fleas fell into a tub of water and could not escape, and there was an estimated 99.3% probability of detecting a flea on an occupied host when using three combings. While overall detection was high, the probability of detection was always <1.00 during each primary combing occasion, highlighting the importance of considering imperfect detection. The combing method (removal of fleas) caused a decline in detection during primary occasions, and we accounted for that decline to avoid inflated estimates of occupancy. Regarding prairie dogs, flea occupancy was heightened in old/natural colonies of prairie dogs, and on hosts that were in poor condition. Occupancy was initially low in plots with high densities of prairie dogs, but, as the study progressed, the rate of flea colonization increased in plots with high densities of prairie dogs in particular. Our methodology can be used to improve studies of ectoparasites, especially when the probability of detection is low. Moreover, the method can be modified to investigate the co-occurrence of ectoparasite species, and community level factors such as species richness and interspecific interactions. |
Mosquitoes of eastern Amazonian Ecuador: biodiversity, bionomics and barcodes
Linton YM , Pecor JE , Porter CH , Mitchell LB , Garzon-Moreno A , Foley DH , Pecor DB , Wilkerson RC . Mem Inst Oswaldo Cruz 2013 108 Suppl 1 100-9 Two snapshot surveys to establish the diversity and ecological preferences of mosquitoes (Diptera: Culicidae) in the terra firme primary rain forest surrounding the Tiputini Biodiversity Station in the UNESCO Yasuni Biosphere Reserve of eastern Amazonian Ecuador were carried out in November 1998 and May 1999. The mosquito fauna of this region is poorly known; the focus of this study was to obtain high quality link-reared specimens that could be used to unequivocally confirm species level diversity through integrated systematic study of all life stages and DNA sequences. A total of 2,284 specimens were preserved; 1,671 specimens were link-reared with associated immature exuviae, all but 108 of which are slide mounted. This study identified 68 unique taxa belonging to 17 genera and 27 subgenera. Of these, 12 are new to science and 37 comprise new country records. DNA barcodes [658-bp of the mtDNA cytochrome c oxidase ( COI ) I gene] are presented for 58 individuals representing 20 species and nine genera. DNA barcoding proved useful in uncovering and confirming new species and we advocate an integrated systematics approach to biodiversity studies in future. Associated bionomics of all species collected are discussed. An updated systematic checklist of the mosquitoes of Ecuador (n = 179) is presented for the first time in 60 years. |
Urinary concentrations of environmental phenols in pregnant women in a pilot study of the National Children's Study
Mortensen ME , Calafat AM , Ye X , Wong LY , Wright DJ , Pirkle JL , Merrill LS , Moye J . Environ Res 2014 129C 32-38 Environmental phenols are a group of chemicals with widespread uses in consumer and personal care products, food and beverage processing, and in pesticides. We assessed exposure to benzophenone-3, bisphenol A (BPA), triclosan, methyl- and propyl parabens, and 2,4- and 2,5-dichlorophenol or their precursors in 506 pregnant women enrolled in the National Children's Study (NCS) Vanguard Study. We measured the urinary concentrations of the target phenols by using online solid-phase extraction-isotope dilution high performance liquid chromatography-tandem mass spectrometry. NCS women results were compared to those of 524 similar-aged women in the National Health and Nutrition Examination Survey (NHANES) 2009-2010, and to 174 pregnant women in NHANES 2005-2010. In the NCS women, we found significant racial/ethnic differences (p<0.05) in regression adjusted mean concentrations of benzophenone-3, triclosan, 2,4- and 2,5-dichlorophenol, but not of BPA. Urinary 2,4- and 2,5-dichlorophenol concentrations were highly correlated (r=0.66, p<0.0001). Except for BPA and triclosan, adjusted mean concentrations were significantly different across the 7 study sites. Education was marginally significant for benzophenone-3, triclosan, propyl paraben, and 2,5-dichlorophenol. Urinary concentrations of target phenols in NCS pregnant women and U.S. women and pregnant women were similar. In NCS pregnant women, race/ethnicity and geographic location determined urinary concentrations of most phenols (except BPA), suggesting differential exposures. NCS Main Study protocols should collect urine biospecimens and information about exposures to environmental phenols. |
A case of abrin toxin poisoning, confirmed via quantitation of L-abrine (N-methyl-L-tryptophan) biomarker
Wooten JV , Pittman CT , Blake TA , Thomas JD , Devlin JJ , Higgerson RA , Johnson RC . J Med Toxicol 2014 10 (4) 392-4 INTRODUCTION: The seeds of Abrus precatorius contain the highly toxic plant protein abrin. There is no antidote for abrin poisoning. Management, largely supportive, may consist of administering intravenous fluids, anti-emetics, and activated charcoal depending on the time of exposure. We report the presentation of a single case of unintentional abrin poisoning confirmed by the quantitation of L-abrine biomarker. CASE REPORT: A previously healthy 22-month-old, 11.5-kg female presented to the hospital after ingesting approximately 20 rosary peas (A. precatorius) sold as a "peace bracelet". Her primary manifestations were episodes of forceful emesis that included food particles progressing to clear gastric fluid. The patient was tachycardic (HR = 134 bpm) but had brisk capillary refill and normal blood pressure (96/60 mmHg). Laboratory testing revealed elevated blood urea nitrogen (16 mg/dL) and serum creatinine (0.4 mg/dL). In the emergency department, the patient was resuscitated with 40 mL/kg normal saline via peripheral IV and received ondansetron (0.15 mg/kg IV) to control retching. The patient was discharged well 24 h after the ingestion. DISCUSSION: This is the first case of human abrin toxin poisoning confirmed by the quantitation of L-abrine as a biomarker. Quantifying the levels of abrin toxin in the body after exposure can help clinicians make informed decisions when managing patients with symptomatic exposures to seeds of A. precatorius. |
Climate change & infectious diseases in India: implications for health care providers
Dhara VR , Schramm PJ , Luber G . Indian J Med Res 2013 138 (6) 847-52 Climate change has the potential to influence the earth's biological systems, however, its effects on human health are not well defined. Developing nations with limited resources are expected to face a host of health effects due to climate change, including vector-borne and water-borne diseases such as malaria, cholera, and dengue. This article reviews common and prevalent infectious diseases in India, their links to climate change, and how health care providers might discuss preventive health care strategies with their patients. |
Mortality among persons in care with hepatitis C virus infection - the Chronic Hepatitis Cohort Study (CHeCS), 2006-2010
Mahajan R , Xing J , Liu SJ , Ly KN , Moorman AC , Rupp L , Xu F , Holmberg SD . Clin Infect Dis 2014 58 (8) 1055-61 BACKGROUND: Numbers of deaths in hepatitis C virus (HCV)-infected persons recorded on US death certificates have been increasing, but actual rates and causes of death in them have not been well elucidated. METHODS: Disease-specific, liver- and non-liver-related, mortality for HCV-infected patients in an observational cohort study, the Chronic Hepatitis Cohort Study (CHeCS) at four US health care systems, were compared with Multiple Cause of Death (MCOD) data in 12 million death certificates in 2006-2010. Pre-mortem diagnoses, liver biopsies, and FIB-4 scores (a non-invasive measure of liver damage) were examined. RESULTS: Of 2,143,369 adult patients seen at CHeCS sites in 2006-2010, 11,703 (0.5%) had diagnosed chronic HCV infection, and 1,590 (14%) died. CHeCS decedents were born from 1945-1965 (75%), white (50%), and male (68%); mean age of death was 59 years, 15 years younger than MCOD deaths. The age-adjusted mortality rate for liver disease in CHeCS was twelve times higher than the MCOD rate. Before death, 63% had medical record evidence of chronic liver disease, 76% had elevated FIB-4 scores, and of those biopsied 70% had moderate or worse liver fibrosis. However, only 19% of all CHeCS decedents and only 30% of those with recorded liver disease had HCV listed on their death certificates. CONCLUSIONS: HCV infection is greatly under-documented on death certificates. The 16,622 persons with HCV listed in 2010 may represent only one-fifth of about 80,000 HCV-infected persons dying that year, at least two-thirds of whom (53,000 patients) would have pre-mortem indications of chronic liver disease. |
Seafood consumption and blood mercury concentrations in adults aged ≥20y, 2007-2010
Nielsen SJ , Kit BK , Aoki Y , Ogden CL . Am J Clin Nutr 2014 99 (5) 1066-70 BACKGROUND: Seafood is part of a healthy diet, but seafood can also contain methyl mercury-a neurotoxin. OBJECTIVE: The objective was to describe seafood consumption in US adults and to explore the relation between seafood consumption and blood mercury. DESIGN: Seafood consumption, obtained from a food-frequency questionnaire, and blood mercury data were available for 10,673 adults who participated in the 2007-2010 NHANES-a cross-sectional nationally representative sample of the US population. Seafood consumption was categorized by type (fish or shellfish) and by frequency of consumption (0, 1-2, 3-4, or ≥5 times/mo). Linear trends in geometric mean blood mercury concentrations by frequency of seafood consumption were tested. Logistic regression analyses examined the odds of blood mercury concentrations ≥5.8 mug/L (as identified by the National Research Council) based on frequency of the specific type of seafood consumed (included in the model as a continuous variables) adjusted for sex, age, and race/Hispanic origin. RESULTS: In 2007-2010, 83.0% +/- 0.7% (+/-SE) of adults consumed seafood in the preceding month. In adults consuming seafood, the blood mercury concentration increased as the frequency of seafood consumption increased (P < 0.001). In 2007-2010, 4.6% +/- 0.39% of adults had blood mercury concentrations ≥5.8 mug/L. Results of the logistic regression on blood mercury concentrations ≥5.8 mug/L showed no association with shrimp (P = 0.21) or crab (P = 0.48) consumption and a highly significant positive association with consumption of high-mercury fish (adjusted OR per unit monthly consumption: 4.58; 95% CI: 2.44, 8.62; P < 0.001), tuna (adjusted OR: 1.14; 95% CI: 1.10, 1.17; P < 0.001), salmon (adjusted OR: 1.14; 95% CI: 1.09, 1.20; P < 0.001), and other seafood (adjusted OR: 1.12; 95% CI: 1.08, 1.15; P < 0.001). CONCLUSION: Most US adults consume seafood, and the blood mercury concentration is associated with the consumption of tuna, salmon, high-mercury fish, and other seafood. |
Development of a genomic DNA reference material panel for Rett syndrome (MECP2-related disorders) genetic testing.
Kalman LV , Tarleton JC , Percy AK , Aradhya S , Bale S , Barker SD , Bayrak-Toydemir P , Bridges C , Buller-Burckle AM , Das S , Iyer RK , Vo TD , Zvereff VV , Toji LH . J Mol Diagn 2014 16 (2) 273-9 Rett syndrome is a dominant X-linked disorder caused by point mutations (approximately 80%) or by deletions or insertions (approximately 15% to 18%) in the MECP2 gene. It is most common in females but lethal in males, with a distinctly different phenotype. Rett syndrome patients have severe neurological and behavioral problems. Clinical genetic testing laboratories commonly use characterized genomic DNA reference materials to assure the quality of the testing process; however, none are commercially available for MECP2 genetic testing. The Centers for Disease Control and Prevention's Genetic Testing Reference Material Coordination Program, in collaboration with the genetic testing community and the Coriell Cell Repositories, established 27 new cell lines and characterized the MECP2 mutations in these and in 8 previously available cell lines. DNA samples from the 35 cell lines were tested by eight clinical genetic testing laboratories using DNA sequence analysis and methods to assess copy number (multiplex ligation-dependent probe amplification, semiquantitative PCR, or array-based comparative genomic hybridization). The eight common point mutations known to cause approximately 60% of Rett syndrome cases were identified, as were other MECP2 variants, including deletions, duplications, and frame shift and splice-site mutations. Two of the 35 samples were from males with MECP2 duplications. These MECP2 and other characterized genomic DNA samples are publicly available from the NIGMS Repository at the Coriell Cell Repositories. |
Robust regression analysis of copy number variation data based on a univariate score.
Satten GA , Allen AS , Ikeda M , Mulle JG , Warren ST . PLoS One 2014 9 (2) e86272 MOTIVATION: The discovery that copy number variants (CNVs) are widespread in the human genome has motivated development of numerous algorithms that attempt to detect CNVs from intensity data. However, all approaches are plagued by high false discovery rates. Further, because CNVs are characterized by two dimensions (length and intensity) it is unclear how to order called CNVs to prioritize experimental validation. RESULTS: We developed a univariate score that correlates with the likelihood that a CNV is true. This score can be used to order CNV calls in such a way that calls having larger scores are more likely to overlap a true CNV. We developed cnv.beast, a computationally efficient algorithm for calling CNVs that uses robust backward elimination regression to keep CNV calls with scores that exceed a user-defined threshold. Using an independent dataset that was measured using a different platform, we validated our score and showed that our approach performed better than six other currently-available methods. AVAILABILITY: cnv.beast is available at http://www.duke.edu/~asallen/Software.html. |
Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012
See I , Nguyen DB , Chatterjee S , Shwe T , Scott M , Ibrahim S , Moulton-Meissner H , McNulty S , Noble-Wang J , Price C , Schramm K , Bixler D , Guh AY . Infect Control Hosp Epidemiol 2014 35 (3) 300-6 OBJECTIVE: To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. DESIGN: Epidemiologic investigation of the outbreak with a case-control study. METHODS: A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. RESULTS: Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. CONCLUSION: Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings. |
Enhancement of health department capacity for health care-associated infection prevention through Recovery Act-funded programs
Ellingson K , McCormick K , Sinkowitz-Cochran R , Woodard T , Jernigan J , Srinivasan A , Rask K . Am J Public Health 2014 104 (4) e27-33 OBJECTIVES: We evaluated capacity built and outcomes achieved from September 1, 2009, to December 31, 2011, by 51 health departments (HDs) funded through the American Recovery and Reinvestment Act (ARRA) for health care-associated infection (HAI) program development. METHODS: We defined capacity for HAI prevention at HDs by 25 indicators of activity in 6 categories: staffing, partnerships, training, technical assistance, surveillance, and prevention. We assessed state-level infection outcomes by modeling quarterly standardized infection ratios (SIRs) for device- and procedure-associated infections with longitudinal regression models. RESULTS: With ARRA funds, HDs created 188 HAI-related positions and supported 1042 training programs, 53 surveillance data validation projects, and 60 prevention collaboratives. All states demonstrated significant declines in central line-associated bloodstream and surgical site infections. States that implemented ARRA-funded catheter-associated urinary tract infection prevention collaboratives showed significantly greater SIR reductions over time than states that did not (P = .02). CONCLUSIONS: ARRA-HAI funding substantially improved HD capacity to reduce HAIs not targeted by other national efforts, suggesting that HDs can play a critical role in addressing emerging or neglected HAIs. |
Activity of commonly used antimicrobial prophylaxis regimens against pathogens causing coronary artery bypass graft and arthroplasty surgical site infections in the United States, 2006-2009
Berrios-Torres SI , Yi SH , Bratzler DW , Ma A , Mu Y , Zhu L , Jernigan JA . Infect Control Hosp Epidemiol 2014 35 (3) 231-9 BACKGROUND: Coronary artery bypass graft (CABG) and primary arthroplasty surgical site infection (SSI) rates are declining slower than other healthcare-associated infection rates. We examined antimicrobial prophylaxis (AMP) regimens used for these operations and compared their spectrum of activity against reported SSI pathogens. METHODS: Pathogen distributions of CABG and hip/knee arthroplasty complex SSIs (deep and organ/space) reported to the National Healthcare Safety Network (NHSN) from 2006 through 2009 and AMP regimens (same procedures and time period) reported to the Surgical Care Improvement Project (SCIP) were analyzed. Regimens were categorized as standard (cefazolin or cefuroxime), beta-lactam allergy (vancomycin or clindamycin with or without an aminoglycoside), and extended spectrum (vancomycin and/or an aminoglycoside with cefazolin or cefuroxime). AMP activity of each regimen was predicted on the basis of pathogen susceptibility reports and published spectra of antimicrobial activity. RESULTS: There were 6,263 CABG and arthroplasty complex SSIs reported (680,489 procedures; 880 NHSN hospitals). Among 6,574 pathogens reported, methicillin-sensitive Staphylococcus aureus (23%), methicillin-resistant S. aureus (18%), coagulase-negative staphylococci (17%), and Enterococcus species (7%) were most common. AMP regimens for 2,435,703 CABG and arthroplasty procedures from 3,330 SCIP hospitals were analyzed. The proportion of pathogens predictably susceptible to standard (used in 75% of procedures), beta-lactam (12%), and extended-spectrum (8%) regimens was 41%-45%, 47%-96%, and 81%-96%, respectively. CONCLUSION: Standard AMP, used in three-quarters of CABG and primary arthroplasty procedures, has inadequate activity against more than half of SSI pathogens reported. Alternative strategies may be needed to prevent SSIs caused by pathogens resistant to standard AMP regimens. |
Deep sequencing of viral genomes provides insight into the evolution and pathogenesis of varicella zoster virus and its vaccine in humans.
Depledge DP , Kundu S , Jensen NJ , Gray ER , Jones M , Steinberg S , Gershon A , Kinchington PR , Schmid DS , Balloux F , Nichols RA , Breuer J . Mol Biol Evol 2014 31 (2) 397-409 Immunization with the vOka vaccine prevents varicella (chickenpox) in children and susceptible adults. The vOka vaccine strain comprises a mixture of genotypes and, despite attenuation, causes rashes in small numbers of recipients. Like wild-type virus, the vaccine establishes latency in neuronal tissue and can later reactivate to cause Herpes zoster (shingles). Using hybridization-based methodologies, we have purified and sequenced vOka directly from skin lesions. We show that alleles present in the vaccine can be recovered from the lesions and demonstrate the presence of a severe bottleneck between inoculation and lesion formation. Genotypes in any one lesion appear to be descended from one to three vaccine-genotypes with a low frequency of novel mutations. No single vOka haplotype and no novel mutations are consistently present in rashes, indicating that neither new mutations nor recombination with wild type are critical to the evolution of vOka rashes. Instead, alleles arising from attenuation (i.e., not derived from free-living virus) are present at lower frequencies in rash genotypes. We identify 11 loci at which the ancestral allele is selected for in vOka rash formation and show genotypes in rashes that have reactivated from latency cannot be distinguished from rashes occurring immediately after inoculation. We conclude that the vOka vaccine, although heterogeneous, has not evolved to form rashes through positive selection in the mode of a quasispecies, but rather alleles that were essentially neutral during the vaccine production have been selected against in the human subjects, allowing us to identify key loci for rash formation. |
Measles resurgence in southern Africa: challenges to measles elimination
Shibeshi ME , Masresha BG , Smit SB , Biellik RJ , Nicholson JL , Muitherero C , Shivute N , Walker O , Reggis K , Goodson JL . Vaccine 2014 32 (16) 1798-807 INTRODUCTION: In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries. METHODS: Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis. RESULTS: In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3. CONCLUSION: The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed. |
Microneedle patches: usability and acceptability for self-vaccination against influenza
Norman JJ , Arya JM , McClain MA , Frew PM , Meltzer MI , Prausnitz MR . Vaccine 2014 32 (16) 1856-62 While therapeutic drugs are routinely self-administered by patients, there is little precedent for self-vaccination. Convenient self-vaccination may expand vaccination coverage and reduce administration costs. Microneedle patches are in development for many vaccines, but no reports exist on usability or acceptability. We hypothesized that naive patients could apply patches and that self-administered patches would improve stated intent to receive an influenza vaccine. We conducted a randomized, repeated measures study with 91 venue-recruited adults. To simulate vaccination, subjects received placebo microneedle patches given three times by self-administration and once by the investigator, as well as an intramuscular injection of saline. Seventy participants inserted patches with thumb pressure alone and the remainder used snap-based devices that closed shut at a certain force. Usability was assessed by skin staining and acceptability was measured with an adaptive-choice analysis. The best usability was seen with the snap device, with users inserting a median value of 93-96% of microneedles over three repetitions. When a self-administered microneedle patch was offered, intent to vaccinate increased from 44% to 65% (CI: 55-74%). The majority of those intending vaccination would prefer to self-vaccinate: 64% (CI: 51-75%). There were no serious adverse events associated with use of microneedle patches. The findings from this initial study indicate that microneedle patches for self-vaccination against influenza are usable and may lead to improved vaccination coverage. |
Factors associated with influenza vaccine receipt in community dwelling adults and their children
Malosh R , Ohmit SE , Petrie JG , Thompson MG , Aiello AE , Monto AS . Vaccine 2014 32 (16) 1841-7 BACKGROUND: Factors associated with influenza vaccine receipt are well studied in healthcare personnel, pregnant women, and the elderly. There has been substantially less research in community dwelling adults and children, and none among entire households. Many studies determine vaccination status by self-report or behavioral intention, outcomes susceptible to misclassification. Given that vaccine is recommended for everyone over six months, re-evaluating these factors is warranted. METHODS: The Household Influenza Vaccine Effectiveness (HIVE) study is a prospective cohort of households with children. In 2010-2011, 549 adults representing 312 households completed surveys evaluating knowledge, attitudes, and practices regarding influenza vaccination for themselves and their children. Using the health belief model (HBM) as a framework, we examined factors associated with documented seasonal influenza vaccine receipt using log-binomial regression models. RESULTS: In multivariate models, cues to action such as doctor recommendation, (RR 1.62, 95% CI: 1.25-2.10), perceived benefits (RR 1.25, 95% CI: 1.04-1.50), and perceived susceptibility (RR 1.21, 95% CI: 1.03-1.42) were significantly associated with increased likelihood of vaccine receipt among adults while high perceived barriers were associated with decreased likelihood (RR 0.38, 95% CI: 0.25-0.59). Similarly, parents reporting higher barriers were less likely (RR 0.58, 95% CI: 0.42-0.79) and those perceiving greater benefits (RR 4.16, 95% CI: 2.28-7.59) and severity (RR 1.13, 95% CI: 1.00-1.27 were more likely to vaccinate their children. The observed effects of perceptions of susceptibility, severity, and benefits were more pronounced at low cues to action for children, as were the effects of perceptions of barriers and severity among adults. CONCLUSION: Perceived benefits and barriers are most strongly associated with vaccine receipt. However, the effects of various factors were most pronounced in the absence of cues to action, which may be an important component of targeted interventions. |
Hepatitis A vaccination for post-exposure prophylaxis in persons aged 40 years and older
Nelson NP , Murphy TV , McMahon BJ . Vaccine 2014 32 (25) 2939 The Centers for Disease Control and Prevention collaborated with state public health officials and the Food and Drug Administration to control a multistate outbreak of hepatitis A virus (HAV) in the United States during May–July 2013 (http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html). Pomegranate seeds from Turkey were determined to be the most likely vehicle. As of August 1, 158 outbreak related cases were confirmed. The age range of cases was 1–84 years. Older adults are more likely to have severe disease. Importantly, 108 (68% of cases) were 40 years of age and older. All hospitalizations, 69 (44% of cases), were in persons older than 18 years of age, and 72% of hospitalized cases were older than 40 years of age. This is the largest hepatitis A outbreak since 2003 when greater than 500 cases in Pennsylvania were associated with contaminated green onions [1]. | Based on the results of a study comparing the efficacy of hepatitis A vaccine and immunoglobulin G (IG) in persons 2–40 years of age [2], the Advisory Committee on Immunization Practices recommends hepatitis A vaccine for post-exposure prophylaxis (PEP) of healthy persons aged 12 months–40 years [3]. Administration of vaccine or IG is recommended within two weeks of exposure since efficacy beyond two weeks is not known. For persons aged greater than 40 years, IG is preferred; vaccine can be used if IG cannot be obtained. During the recent multi-state hepatitis A outbreak, some states opted for hepatitis A vaccine instead of IG for adults aged greater than 40 years. Hepatitis A can be more severe in older adults, and vaccine response might be less robust. However, limited data exist on the immunogenicity and efficacy of hepatitis A vaccine among older adults. |
Cost-effectiveness of a potential group B streptococcal vaccine program for pregnant women in South Africa
Kim SY , Russell LB , Park J , Verani JR , Madhi SA , Cutland CL , Schrag SJ , Sinha A . Vaccine 2014 32 (17) 1954-63 BACKGROUND: In low-/middle-income countries neonatal infections are important causes of infant mortality. Group B streptococcus (GBS) is a major pathogen. A GBS polysaccharide-protein conjugate vaccine, the only option that has the potential to prevent both early and late-onset GBS disease, has completed Phase II trials. Screening-based intrapartum antibiotic prophylaxis (IAP) for pregnant women, an effective strategy in high-income countries, is often not practical in these settings. Risk factor-based IAP (RFB-IAP) for women with risk factors at delivery has had limited success in preventing neonatal infection. We evaluated the cost and health impacts of maternal GBS vaccination in South Africa. METHODS AND FINDINGS: We developed a decision-analytic model for an annual cohort of pregnant women that simulates the natural history of GBS disease in their infants. We compared four strategies: do-nothing, maternal GBS vaccination, RFB-IAP, and vaccination plus RFB-IAP. Assuming vaccine efficacy varies from 50% to 90% against covered serotypes and 75% of pregnant women are vaccinated, GBS vaccination alone prevents 30-54% of infant GBS cases compared to do-nothing. For vaccine prices between $10 and $30, and mid-range efficacy, its cost ranges from $676 to $2390 per disability-adjusted life-year (DALY) averted ($US 2010), compared to do-nothing. RFB-IAP alone, compared to do-nothing, prevents 10% of infant GBS cases at a cost of $240/DALY. Vaccine plus RFB-IAP prevents 48% of cases at a cost of $664-2128/DALY. CONCLUSIONS: Vaccination would substantially reduce the burden of infant GBS disease in South Africa and would be very cost-effective by WHO guidelines. RFB-IAP is also very cost-effective, but prevents only 10% of cases. Vaccination plus RFB-IAP is more effective and more costly than vaccination alone, and consistently very cost-effective. |
Cumulative risk of Guillain-Barre syndrome among vaccinated and unvaccinated populations during the 2009 H1N1 influenza pandemic
Vellozzi C , Iqbal S , Stewart B , Tokars J , Destefano F . Am J Public Health 2014 104 (4) 696-701 OBJECTIVES: We sought to assess risk of Guillain-Barre syndrome (GBS) among influenza A (H1N1) 2009 monovalent (pH1N1) vaccinated and unvaccinated populations at the end of the 2009 pandemic. METHODS: We applied GBS surveillance data from a US population catchment area of 45 million from October 15, 2009, through May 31, 2010. GBS cases meeting Brighton Collaboration criteria were included. We calculated the incidence density ratio (IDR) among pH1N1 vaccinated and unvaccinated populations. We also estimated cumulative GBS risk using life table analysis. Additionally, we used vaccine coverage data and census population estimates to calculate denominators. RESULTS: There were 392 GBS cases; 64 (16%) occurred after pH1N1vaccination. The vaccinated population had lower average risk (IDR = 0.83, 95% confidence interval = 0.63, 1.08) and lower cumulative risk (6.6 vs 9.2 cases per million persons, P = .012) of GBS. CONCLUSIONS: Our findings suggest that at the end of the influenza season cumulative GBS risk was less among the pH1N1 vaccinated than the unvaccinated population, suggesting the benefit of vaccination as it relates to GBS. The observed potential protective effect on GBS attributed to vaccination warrants further study. |
Diarrhoea-related hospitalizations in children before and after implementation of monovalent rotavirus vaccination in Mexico
Esparza-Aguilar M , Gastanaduy PA , Sanchez-Uribe E , Desai R , Parashar UD , Richardson V , Patel M . Bull World Health Organ 2014 92 (2) 117-125 OBJECTIVE: To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico. METHODS: Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea - per 10 000 hospitalizations for any cause - were calculated. Administrative data were used to estimate vaccine coverage. FINDINGS: In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine - among children younger than 5 years - had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea - per 10 000 admissions - fell from 1001, 834 and 1033 in the "prevaccine" period of 2003-2006, to 597, 497 and 705 in the "postvaccine" period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38-43), 41% (95% CI: 38-43) and 32% (95% CI: 29-34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16 500 hospitalizations for childhood diarrhoea in each year of the postvaccine period. CONCLUSION: Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico. |
Validation of the International Labour Office digitized standard images for recognition and classification of radiographs of pneumoconiosis
Halldin CN , Petsonk EL , Laney AS . Acad Radiol 2014 21 (3) 305-11 RATIONALE AND OBJECTIVES: Chest radiographs are recommended for prevention and detection of pneumoconiosis. In 2011, the International Labour Office (ILO) released a revision of the International Classification of Radiographs of Pneumoconioses that included a digitized standard images set. The present study compared results of classifications of digital chest images performed using the new ILO 2011 digitized standard images to classification approaches used in the past. MATERIALS AND METHODS: Underground coal miners (N = 172) were examined using both digital and film-screen radiography (FSR) on the same day. Seven National Institute for Occupational Safety and Health-certified B Readers independently classified all 172 digital radiographs, once using the ILO 2011 digitized standard images (DRILO2011-D) and once using digitized standard images used in the previous research (DRRES). The same seven B Readers classified all the miners' chest films using the ILO film-based standards. RESULTS: Agreement between classifications of FSR and digital radiography was identical, using a standard image set (either DRILO2011-D or DRRES). The overall weighted kappa value was 0.58. Some specific differences in the results were seen and noted. However, intrareader variability in this study was similar to the published values and did not appear to be affected by the use of the new ILO 2011 digitized standard images. CONCLUSIONS: These findings validate the use of the ILO digitized standard images for classification of small pneumoconiotic opacities. When digital chest radiographs are obtained and displayed appropriately, results of pneumoconiosis classifications using the 2011 ILO digitized standards are comparable to film-based ILO classifications and to classifications using earlier research standards. |
Evaluation of automated and manual DNA purification methods for detecting Ricinus communis DNA during ricin investigations.
Hutchins AS , Astwood MJ , Saah JR , Michel PA , Newton BR , Dauphin LA . Forensic Sci Int 2014 236C 10-15 In April of 2013, letters addressed to the President of United States and other government officials were intercepted and found to be contaminated with ricin, heightening awareness about the need to evaluate laboratory methods for detecting ricin. This study evaluated commercial DNA purification methods for isolating Ricinus communis DNA as measured by real-time polymerase chain reaction (PCR). Four commercially available DNA purification methods (two automated, MagNA Pure compact and MagNA Pure LC, and two manual, MasterPure complete DNA and RNA purification kit and QIAamp DNA blood mini kit) were evaluated. We compared their ability to purify detectable levels of R. communis DNA from four different sample types, including crude preparations of ricin that could be used for biological crimes or acts of bioterrorism. Castor beans, spiked swabs, and spiked powders were included to simulate sample types typically tested during criminal and public health investigations. Real-time PCR analysis indicated that the QIAamp kit resulted in the greatest sensitivity for ricin preparations; the MasterPure kit performed best with spiked powders. The four methods detected equivalent levels by real-time PCR when castor beans and spiked swabs were used. All four methods yielded DNA free of PCR inhibitors as determined by the use of a PCR inhibition control assay. This study demonstrated that DNA purification methods differ in their ability to purify R. communis DNA; therefore, the purification method used for a given sample type can influence the sensitivity of real-time PCR assays for R. communis. |
Detection of Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti, with two different multiplex PCR assays.
Hojgaard A , Lukacik G , Piesman J . Ticks Tick Borne Dis 2014 5 (3) 349-51 We have developed 2 real-time multiplex PCR assays for detection of Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti. The efficiency and sensitivity of each multiplex PCR assay was evaluated using field-collected Ixodes scapularis ticks that were positive for each of the pathogens, cloned plasmids harboring each of the PCR targets, and laboratory I. scapularis infected with B. burgdorferi B31. There was no difference in efficiency or sensitivity when comparing the multiplex PCR with the individual PCR reactions. If the 2 multiplex PCR assays are used in the same analysis, field-collected ticks that only harbor B. miyamotoi can also be identified. The multiplex assays are fast and cost-effective methods for screening and detecting pathogens in ticks, when compared to single-target PCR. |
SN79, a sigma receptor antagonist, attenuates methamphetamine-induced astrogliosis through a blockade of OSMR/gp130 signaling and STAT3 phosphorylation
Robson MJ , Turner RC , Naser ZJ , McCurdy CR , O'Callaghan JP , Huber JD , Matsumoto RR . Exp Neurol 2014 254 180-9 Methamphetamine (METH) exposure results in dopaminergic neurotoxicity in striatal regions of the brain, an effect that has been linked to an increased risk of Parkinson's disease. Various aspects of neuroinflammation, including astrogliosis, are believed to be contributory factors in METH neurotoxicity. METH interacts with sigma receptors at physiologically relevant concentrations and treatment with sigma receptor antagonists has been shown to mitigate METH-induced neurotoxicity in rodent models. Whether these compounds alter the responses of glial cells within the central nervous system to METH however has yet to be determined. Therefore, the purpose of the current study was to determine whether the sigma receptor antagonist, SN79, mitigates METH-induced striatal reactive astrogliosis. Male, Swiss Webster mice treated with a neurotoxic regimen of METH exhibited time-dependent increases in striatal gfap mRNA and concomitant increases in GFAP protein, indicative of astrogliosis. This is the first report that similar to other neurotoxicants that induce astrogliosis through the activation of JAK2/STAT3 signaling by stimulating gp-130-linked cytokine signaling resulting from neuroinflammation, METH treatment also increases astrocytic oncostatin m receptor (OSMR) expression and the phosphorylation of STAT3 (Tyr-705) in vivo. Pretreatment with SN79 blocked METH-induced increases in OSMR, STAT3 phosphorylation and astrocyte activation within the striatum. Additionally, METH treatment resulted in striatal cellular degeneration as measured by Fluoro-Jade B, an effect that was mitigated by SN79. The current study provides evidence that sigma receptor antagonists attenuate METH-induced astrocyte activation through a pathway believed to be shared by various neurotoxicants. |
Structural stability of influenza A(H1N1)pdm09 virus hemagglutinins
Yang H , Chang JC , Guo Z , Carney PJ , Shore DA , Donis RO , Cox NJ , Villanueva JM , Klimov AI , Stevens J . J Virol 2014 88 (9) 4828-38 The non-covalent interactions that mediate trimerization of the influenza hemagglutinin (HA) are important determinants of its biological activities. Recent studies have demonstrated that mutations in the HA trimer interface affect the thermal and pH sensitivities of HA, suggesting a possible impact on vaccine stability (Farnsworth et al. 2011. Vaccine 29:: 1529-1533). We used size exclusion chromatography analysis of recombinant HA ectodomain to compare the differences among recombinant trimeric HA proteins from early 2009 pandemic H1N1 viruses, which dissociate to monomers, with those of more recent virus HAs that can be expressed as trimers. We analyzed differences amongst the HA sequences and identified inter-molecular interactions mediated by the residue at position 374 (HA0 numbering) of the HA2 sub-domain as critical for HA trimer stability. Crystallographic analyses of HA from the recent H1N1 virus A/Washington/5/2011 highlight the structural basis for this observed phenotype. It remains to be seen whether more recent viruses with this mutation will yield more stable vaccines in the future. IMPORTANCE: Hemagglutinins from the early 2009 H1N1 pandemic viruses are unable to maintain a trimeric complex when expressed in a recombinant system. However HAs from 2010 and 2011 strains are more stable and our work highlights the improvement in stability can be attributed to an E47K substitution in the HA2 subunit of the stalk that emerged naturally in the circulating viruses. |
Virulence difference between the prototypic Schu S4 strain (A1a) and Francisella tularensis A1a, A1b, A2 and type B strains in a murine model of infection
Molins CR , Delorey MJ , Yockey BM , Young JW , Belisle JT , Schriefer ME , Petersen JM . BMC Infect Dis 2014 14 67 BACKGROUND: The use of prototypic strains is common among laboratories studying infectious agents as it promotes consistency for data comparability among and between laboratories. Schu S4 is the prototypic virulent strain of Francisella tularensis and has been used extensively as such over the past six decades. Studies have demonstrated virulence differences among the two clinically relevant subspecies of F. tularensis, tularensis (type A) and holarctica (type B) and more recently between type A subpopulations (A1a, A1b and A2). Schu S4 belongs to the most virulent subspecies of F. tularensis, subspecies tularensis. METHODS: In this study, we investigated the relative virulence of Schu S4 in comparison to A1a, A1b, A2 and type B strains using a temperature-based murine model of infection. Mice were inoculated intradermally and a hypothermic drop point was used as a surrogate for death. Survival curves and the length of temperature phases were compared for all infections. Bacterial burdens were also compared between the most virulent type A subpopulation, A1b, and Schu S4 at drop point. RESULTS: Survival curve comparisons demonstrate that the Schu S4 strain used in this study resembles the virulence of type B strains, and is significantly less virulent than all other type A (A1a, A1b and A2) strains tested. Additionally, when bacterial burdens were compared between mice infected with Schu S4 or MA00-2987 (A1b) significantly higher burdens were present in the blood and spleen of mice infected with MA00-2987. CONCLUSIONS: The knowledge gained from using Schu S4 as a prototypic virulent strain has unquestionably advanced the field of tularemia research. The findings of this study, however, indicate that careful consideration of F. tularensis strain selection must occur when the overall virulence of the strain used could impact the outcome and interpretation of results. |
Liposome-antigen-nucleic acid complexes protect mice from lethal challenge with western and eastern equine encephalitis viruses
Phillips AT , Schountz T , Toth AM , Rico AB , Jarvis DL , Powers AM , Olson KE . J Virol 2014 88 (3) 1771-80 Alphaviruses are mosquito-borne viruses that cause significant disease in animals and humans. Western equine encephalitis virus (WEEV) and eastern equine encephalitis virus (EEEV), two New World alphaviruses, can cause fatal encephalitis, and EEEV is a select agent of concern in biodefense. However, we have no antiviral therapies against alphaviral disease, and current vaccine strategies target only a single alphavirus species. In an effort to develop new tools for a broader response to outbreaks, we designed and tested a novel alphavirus vaccine comprised of cationic lipid nucleic acid complexes (CLNCs) and the ectodomain of WEEV E1 protein (E1ecto). Interestingly, we found that the CLNC component, alone, had therapeutic efficacy, as it increased survival of CD-1 mice following lethal WEEV infection. Immunization with the CLNC-WEEV E1ecto mixture (lipid-antigen-nucleic acid complexes [LANACs]) using a prime-boost regimen provided 100% protection in mice challenged with WEEV subcutaneously, intranasally, or via mosquito. Mice immunized with LANACs mounted a strong humoral immune response but did not produce neutralizing antibodies. Passive transfer of serum from LANAC E1ecto-immunized mice to nonimmune CD-1 mice conferred protection against WEEV challenge, indicating that antibody is sufficient for protection. In addition, the LANAC E1ecto immunization protocol significantly increased survival of mice following intranasal or subcutaneous challenge with EEEV. In summary, our LANAC formulation has therapeutic potential and is an effective vaccine strategy that offers protection against two distinct species of alphavirus irrespective of the route of infection. We discuss plausible mechanisms as well the potential utility of our LANAC formulation as a pan-alphavirus vaccine. |
Albumin adsorption onto surfaces of urine collection and analysis containers
Robinson MK , Caudill SP , Koch DD , Ritchie J , Hortin G , Eckfeldt JH , Sandberg S , Williams D , Myers G , Miller WG . Clin Chim Acta 2014 431 40-5 BACKGROUND: Adsorption of albumin onto urine collection and analysis containers may cause falsely low concentrations. METHODS: We added 125I-labeled human serum albumin to urine and to phosphate buffered solutions, incubated them with 22 plastic container materials and measured adsorption by liquid scintillation counting. RESULTS: Adsorption of urine albumin (UA) at 5-6mg/l was <0.9%; and that at 90mg/l was <0.4%. Adsorption was generally less at pH8 than pH5 but only 3 cases had p<0.05. Adsorption from 11 unaltered urine samples with albumin 5-333mg/l was <0.8%. Albumin adsorption for the material with greatest binding was extrapolated to the surface areas of 100ml and 2l collection containers, and to instrument sample cups and showed <1% change in concentration at 5mg/l and <0.5% change at 20mg/l or higher concentrations. Adsorption of albumin from phosphate buffered solutions (2-28%) was larger than that from urine. CONCLUSIONS: Albumin adsorption differed among urine samples and plastic materials, but the total influence of adsorption was <1% for all materials and urine samples tested. Adsorption of albumin from phosphate buffered solutions was larger than that from urine and could be a limitation for preparations used as calibrators. |
Analytical considerations in the clinical laboratory assessment of metals
Wang RY , Caldwell KL , Jones RL . J Med Toxicol 2014 10 (2) 232-9 The presence of metals in the environment is ubiquitous and humans are constantly being exposed to them. As such, a general concern exists about potential health consequences that result from the exposure to metals. The continued efforts of environmental scientists to measure metals in clinical specimens are important for defining the extent of human exposure to these chemicals. Laboratory methods to measure the concentration of metals in human blood or urine are available, and they can be used to assess the extent of human exposure to these chemicals. However, several considerations should be reviewed when requesting a laboratory measurement of metals because some factors can affect the test result or its interpretation. These considerations are discussed in this article and include pre-analytical, analytical, and post-analytical factors. Clinicians with this knowledge will be able to request these laboratory tests for their patients with enhanced confidence. |
A chemical free, nanotechnology-based method for airborne bacterial inactivation using engineered water nanostructures
Pyrgiotakis G , McDevitt J , Bordini A , Diaz E , Molina R , Watson C , Deloid G , Lenard S , Fix N , Mizuyama Y , Yamauchi T , Brain J , Demokritou P . Environ Sci Nano 2014 1 (1) 15-26 Airborne pathogens are associated with the spread of infectious diseases and increased morbidity and mortality. Herein we present an emerging chemical free, nanotechnology-based method for airborne pathogen inactivation. This technique is based on transforming atmospheric water vapor into Engineered Water Nano-Structures (EWNS) via electrospray. The generated EWNS possess a unique set of physical, chemical, morphological and biological properties. Their average size is 25 nm and they contain reactive oxygen species (ROS) such as hydroxyl and superoxide radicals. In addition, EWNS are highly electrically charged (10 electrons per particle on average). A link between their electric charge and the reduction of their evaporation rate was illustrated resulting in an extended lifetime (over an hour) at room conditions. Furthermore, it was clearly demonstrated that the EWNS have the ability to interact with and inactivate airborne bacteria. Finally, inhaled EWNS were found to have minimal toxicological effects, as illustrated in an acute in-vivo inhalation study using a mouse model. In conclusion, this novel, chemical free, nanotechnology-based method has the potential to be used in the battle against airborne infectious diseases. |
Dispersion method for safety research on manufactured nanomaterials
Wu W , Ichihara G , Suzuki Y , Izuoka K , Oikawa-Tada S , Chang J , Sakai K , Miyazawa K , Porter D , Castranova V , Kawaguchi M , Ichihara S . Ind Health 2014 52 (1) 54-65 Nanomaterials tend to agglomerate in aqueous media, resulting in inaccurate safety assessment of the biological response to these substances. The present study searched for suitable dispersion methods for the preparation of nanomaterial suspensions. Titanium dioxide (TiO2) and zinc oxide (ZnO) nanoparticles were dispersed in a biocompatible dispersion medium by direct probe-type sonicator and indirect cup-type sonicator. Size characterization was completed using dynamic light scattering and transmission electron microscopy. A series of dispersion time and output power, as well as two different particle concentrations were tested. Microscopic contamination of metal titanium that broke away from the tip of the probe into the suspension was found. Size of agglomerated nanoparticles decreased with increase in sonication time or output power. Particle concentration did not show obvious effect on size distribution of TiO2 nanoparticles, while significant reduction of secondary diameter of ZnO was observed at higher concentration. A practicable protocol was then adopted and sizes of well-dispersed nanoparticles increased by less than 10% at 7 d after sonication. Multi-walled carbon nanotubes were also well dispersed by the same protocol. The cup-type sonicator might be a useful alternative to the traditional bath-type sonicator or probe-type sonicator based on its effective energy delivery and assurance of suspension purity. |
Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network
Schieve LA , Tian LH , Baio J , Rankin K , Rosenberg D , Wiggins L , Maenner MJ , Yeargin-Allsopp M , Durkin M , Rice C , King L , Kirby RS , Wingate MS , Devine O . Ann Epidemiol 2014 24 (4) 260-6 PURPOSE: Numerous studies establish associations between adverse perinatal outcomes/complications and autism spectrum disorder (ASD). There has been little assessment of population attributable fractions (PAFs). METHODS: We estimated average ASD PAFs for preterm birth (PTB), small for gestational age (SGA), and Cesarean delivery (CD) in a U.S. population. Average PAF methodology accounts for risk factor co-occurrence. ASD cases were singleton non-Hispanic white, non-Hispanic black, and Hispanic children born in 1994 (n = 703) or 2000 (n = 1339) who resided in 48 U.S. counties included within eight Autism and Developmental Disabilities Monitoring Network sites. Cases were matched on birth year, sex, and maternal county of residence, race-ethnicity, age, and education to 20 controls from U.S. natality files. RESULTS: For the 1994 cohort, average PAFs were 4.2%, 0.9%, and 7.9% for PTB, SGA, and CD, respectively. The summary PAF was 13.0% (1.7%-19.5%). For the 2000 cohort, average PAFs were 2.0%, 3.1%, and 6.7% for PTB, SGA, and CD, respectively, with a summary PAF of 11.8% (7.5%-15.9%). CONCLUSIONS: Three perinatal risk factors notably contribute to ASD risk in a U.S. population. Because each factor represents multiple etiologic pathways, PAF estimates are best interpreted as the proportion of ASD attributable to having a suboptimal perinatal environment resulting in PTB, SGA, and/or CD. |
The prospective association between sleep deprivation and depression among adolescents
Roberts RE , Duong HT . Sleep 2014 37 (2) 239-44 STUDY OBJECTIVES: To examine the prospective, reciprocal association between sleep deprivation and depression among adolescents. DESIGN: A community-based two-wave cohort study. SETTING: A metropolitan area with a population of over 4 million. PARTICIPANTS: 4,175 youths 11-17 at baseline, and 3,134 of these followed up a year later. MEASUREMENTS: Depression is measured using both symptoms of depression and DSM-IV major depression. Sleep deprivation is defined as ≤ 6 h of sleep per night. RESULTS: Sleep deprivation at baseline predicted both measures of depression at follow-up, controlling for depression at baseline. Examining the reciprocal association, major depression at baseline, but not symptoms predicted sleep deprivation at follow-up. CONCLUSION: These results are the first to document reciprocal effects for major depression and sleep deprivation among adolescents using prospective data. The data suggest reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep. |
Health-related quality of life and body mass index among US adolescents
Cui W , Zack MM , Wethington H . Qual Life Res 2014 23 (7) 2139-50 PURPOSE: To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents. METHODS: From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes-self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days-in four BMI categories-obese, overweight, normal weight, and underweight-of approximately 6,000 US adolescents aged 12-17 years. We also estimated the percentages for boys and girls separately. RESULTS: Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15-22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4-7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33-42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63-67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls. CONCLUSIONS: Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls. |
Contributors to excess infant mortality in the U.S. South
Hirai AH , Sappenfield WM , Kogan MD , Barfield WD , Goodman DA , Ghandour RM , Lu MC . Am J Prev Med 2014 46 (3) 219-27 BACKGROUND: Infant mortality rates (IMRs) are disproportionally high in the U.S. South; however, the proximate contributors that could inform regional action remain unclear. PURPOSE: To quantify the components of excess infant mortality in the U.S. South by maternal race/ethnicity, underlying cause of death, and gestational age. METHODS: U.S. Period Linked Birth/Infant Death Data Files 2007-2009 (analyzed in 2013) were used to compare IMRs between the South (U.S. Public Health Regions IV and VI) and all other regions combined. RESULTS: Compared to other regions, there were 1.18 excess infant deaths per 1000 live births in the South, representing about 1600 excess infant deaths annually. New Mexico and Texas did not have elevated IMRs relative to other regions; excess death rates among other states ranged from 0.62 per 1000 in Kentucky to 3.82 per 1000 in Mississippi. Racial/ethnic compositional differences, generally the greater proportion of non-Hispanic black births in the South, explained 59% of the overall regional difference; the remainder was mostly explained by higher IMRs among non-Hispanic whites. The leading causes of excess Southern infant mortality were sudden unexpected infant death (SUID; 36%, range=12% in Florida to 90% in Kentucky) and preterm-related death (22%, range= -71% in Kentucky to 51% in North Carolina). Higher rates of preterm birth, predominantly <34 weeks, accounted for most of the preterm contribution. CONCLUSIONS: To reduce excess Southern infant mortality, comprehensive strategies addressing SUID and preterm birth prevention for both non-Hispanic black and white births are needed, with state-level findings used to tailor state-specific efforts. |
Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study
Pietrzak RH , Feder A , Singh R , Schechter CB , Bromet EJ , Katz CL , Reissman DB , Ozbay F , Sharma V , Crane M , Harrison D , Herbert R , Levin SM , Luft BJ , Moline JM , Stellman JM , Udasin IG , Landrigan PJ , Southwick SM . Psychol Med 2014 44 (1) 205-19 BACKGROUND: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. METHOD: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. RESULTS: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. CONCLUSIONS: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities. |
Prevalence of obesity among U.S. workers and associations with occupational factors
Luckhaupt SE , Cohen MA , Li J , Calvert GM . Am J Prev Med 2014 46 (3) 237-48 BACKGROUND: Along with public health and clinical professionals, employers are taking note of rising obesity rates among their employees, as obesity is strongly related to chronic health problems and concomitant increased healthcare costs. Contributors to the obesity epidemic are complex and numerous, and may include several work characteristics. PURPOSE: To explore associations between occupational factors and obesity among U.S. workers. METHODS: Data from the 2010 National Health Interview Survey were utilized to calculate weighted prevalence rates and prevalence ratios (PRs) for obesity in relation to workweek length, work schedule, work arrangement, hostile work environment, job insecurity, work-family imbalance, and industry and occupation of employment. Data were collected in 2010 and analyzed in 2012-2013. RESULTS: Overall, 27.7% of U.S. workers met the BMI criterion for obesity. Among all workers, employment for more than 40 hours per week and exposure to a hostile work environment were significantly associated with an increased prevalence of obesity, although the differences were modest. Employment in health care and social assistance and public administration industries, as well as architecture and engineering, community and social service, protective service, and office and administrative support occupations was also associated with increased obesity prevalence. CONCLUSIONS: Work-related factors may contribute to the high prevalence of obesity in the U.S. working population. Public health professionals and employers should consider workplace interventions that target organization-level factors, such as scheduling and prevention of workplace hostility, along with individual-level factors such as diet and exercise. |
Profiling mild steel welding processes to reduce fume emissions and costs in the workplace
Keane MJ , Siert A , Chen BT , Stone SG . Ann Occup Hyg 2014 58 (4) 403-12 To provide quantitative information to choose the best welding processes for minimizing workplace emissions, nine gas metal arc welding (GMAW) processes for mild steel were assessed for fume generation rates, normalized fume generation rates (milligram fume per gram of electrode consumed), and normalized generation rates for elemental manganese, nickel, and iron. Shielded metal arc welding (SMAW) and flux-cored arc-welding (FCAW) processes were also profiled. The fumes were collected quantitatively in an American Welding Society-type fume chamber and weighed, recovered, homogenized, and analyzed by inductively coupled atomic emission spectroscopy for total metals. The processes included GMAW with short circuit, globular transfer, axial spray, pulsed spray, Surface Tension Transfer, Regulated Metal Deposition, and Cold Metal Transfer (CMT) modes. Flux-cored welding was gas shielded, and SMAW was a single rod type. Results indicate a wide range of fume emission factors for the process variations studied. Fume emission rates per gram of electrode consumed were highest for SMAW (~13mg fume g-1 electrode) and lowest for GMAW processes such as pulsed spray (~1.5mg g-1) and CMT (~1mg g-1). Manganese emission rates per gram of electrode consumed ranged from 0.45mg g-1 (SMAW) to 0.08mg g-1 (CMT). Nickel emission rates were generally low and ranged from ~0.09 (GMAW short circuit) to 0.004mg g-1 (CMT). Iron emission rates ranged from 3.7 (spray-mode GMAW) to 0.49mg g-1 (CMT). The processes studied have significantly different costs, and cost factors are presented based on a case study to allow comparisons between processes in specific cost categories. Costs per linear meter of weld were $31.07 (SMAW), $12.37 (GMAW short circuit), and $10.89 (FCAW). Although no single process is the best for minimizing fume emissions and costs while satisfying the weld requirements, there are several processes that can minimize emissions. This study provides information to aid in those choices. Suggestions for overcoming barriers to utilizing new and less hazardous welding processes are also discussed. |
Provisional recommended weight limits for manual lifting during pregnancy
Waters TR , MacDonald Leslie A , Hudock Stephen D , Goddard Donald E . Hum Factors 2014 56 (1) 203-214 OBJECTIVE: The National Institute for Occupational Safety and Health (NIOSH) Revised Lifting Equation (RNLE) was adapted to derive recommended weight limits (RWLs) for pregnant workers and to develop corresponding guidelines for clinicians. BACKGROUND: In the past three decades there has been a large increase in the number of women employed outside the home and remaining in the workforce during pregnancy. Practical authoritative guidelines based on accumulated evidence are needed to inform allowable work activity levels for healthy pregnant workers. METHOD: Empirically based lifting criteria established by NIOSH to reduce the risk of overexertion injuries in the general U.S. working population were evaluated for application to pregnant workers. Our evaluation included an extensive review of the literature linking occupational lifting to maternal and fetal health. Decision logic and supporting literature are presented, along with computational details. Results: Provisional RWLs for pregnant workers were derived from the RNLE, along with guidelines for clinicians. The guidelines advise against pregnant workers lifting below midshin and overhead. CONCLUSION: Based on our review of the available evidence, we present lifting thresholds that most pregnant workers with uncomplicated pregnancies should be able to perform without increased risk of adverse maternal and fetal health consequences. Except for restrictions involving lifting from the floor and overhead, the provisional guidelines presented are compatible with NIOSH lifting recommendations adopted in the early 1990s for the general working population. APPLICATION: Implementation of these provisional guidelines could protect millions of female workers in the workplace from fetal and maternal lifting-related health problems. |
First report of Dracunculus insignis in two naturally infected cats from the northeastern USA
Lucio-Forster A , Eberhard ML , Cama VA , Jenks MH , Jones C , Sanders SY , Pongratz JP , Bowman DD . J Feline Med Surg 2014 16 (2) 194-7 Dracunculiasis is rarely reported in cats, yet over the last few years we have identified two cats with filarioid-like spirurid infections. Case 1 was a 9-year-old cat with pituitary-dependent hyperadrenocorticism from New York state from which four adult dracunculoid nematodes were isolated from its torso. Based on morphometric characteristics and parasite geographic distribution, the specimens were identified as Dracunculus insignis females; at least one of the females was gravid, suggestive of patent infection. Species identification was confirmed through amplification and sequence analysis of nuclear and mitochondrial loci. Case 2 was a 14-year-old diabetic cat from Massachusetts. Formalin-fixed sections were obtained from a subcutaneous mass excised from the left foreleg. Histopathological examination revealed a large nematode with morphometrical characteristics of Dracunculus, surrounded by lymphocytes and sheets of eosinophils. These two cases appear to be the first published reports of dracunculiasis in domestic cats in the USA, and based on the findings from case 1, D insignis may be the species associated with both infections. |
State indoor tanning laws and adolescent indoor tanning
Guy GP Jr , Berkowitz Z , Jones SE , O'Malley Olsen E , Miyamoto JN , Michael SL , Saraiya M . Am J Public Health 2014 104 (4) e69-74 OBJECTIVES: Recently, several state indoor tanning laws, including age restrictions, were promulgated to reduce indoor tanning among minors. We examined the effects of these laws on adolescent indoor tanning. METHODS: We used nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys (n = 31 835). Using multivariable logistic regression, we examined the association between state indoor tanning laws and indoor tanning among US high school students. RESULTS: Female students in states with indoor tanning laws were less likely to engage in indoor tanning than those in states without any laws. We observed a stronger association among female students in states with systems access, parental permission, and age restriction laws than among those in states without any laws. We found no significant association among female students in states with only systems access and parental permission laws or among male students. CONCLUSIONS: Indoor tanning laws, particularly those including age restrictions, may be effective in reducing indoor tanning among female high school students, for whom rates are the highest. Such reductions have the potential to reduce the health and economic burden of skin cancer. |
The role of a state health agency in promoting cancer prevention at the community level: examples from New York State
Dacus HL , O'Sullivan GM , Major A , White DE . Am J Prev Med 2014 46 S81-6 Cancer is a major cause of morbidity and mortality in the U.S. and more work is needed to decrease the number of new cancer cases and the number of cancer cases diagnosed at a late stage. In New York State, about 106,000 people are diagnosed with cancer each year, 37% of which are diagnosed in adults aged 45-64 years and 55% in those aged ≥65 years. State health agencies are in a unique role to support implementation of cancer prevention strategies at the local level that may have a large impact on the burden of cancer by changing the context in which an individual makes health decisions. The New York State Department of Health, with support through the CDC, is implementing an 18-month cancer prevention demonstration project in two counties aimed at increasing access to nutritious foods, promoting exclusive breastfeeding and decreasing barriers to obtainment of cancer screening. The specific activities being used by the two counties are highlighted, and promising results after the first 6 months of the project are described. Lessons learned from these projects will be reported at regular intervals and used to inform development of larger, statewide initiatives aimed at reducing cancer incidence and death in New York State. |
Opportunities for cancer prevention during midlife: highlights from a meeting of experts
Holman DM , Grossman M , Jane Henley S , Peipins LA , Tison L , White MC . Am J Prev Med 2014 46 S73-80 This paper provides highlights from a CDC-hosted meeting on opportunities for cancer prevention during midlife (roughly ages 45-64 years). Positive changes during this phase of life have the potential to prevent cancer incidence later in life, making this phase an opportune time for targeted prevention efforts to facilitate healthy aging and increased longevity. Risk and protective factors discussed during the meeting included exposure to radiation from medical imaging procedures, circadian disruption, chemical exposures, dietary factors, alcohol consumption, obesity, physical activity, diabetes, and the human microbiome. Although many of these factors are well recognized as being related to cancer incidence, others are not as widely recognized or have emerged as growing areas of research. Meeting participants discussed promising strategies for cancer prevention targeting this age group. Just as there are multiple determinants of cancer risk, there are likely multiple solutions. Changes to social and physical environments may facilitate healthy behaviors and minimize harmful exposures. Information shared during the meeting about health disparities in the U.S. highlighted the need to go beyond traditional approaches to cancer prevention to truly reach vulnerable populations. Partnerships are also a key component to prevention efforts; community-based and nonprofit organizations, the healthcare system, research institutions, state health departments, and federal agencies were all noted as important partners in prevention efforts. Coordinated, multi-disciplinary efforts across multiple chronic diseases may provide opportunities for synergistic effects. Further, leveraging key partnerships and existing communication channels can maximize success and facilitate timely translation of research findings into public health practice. |
Tobacco control in a changing media landscape: how tobacco control programs use the internet
Emery S , Aly EH , Vera L , Alexander RL Jr . Am J Prev Med 2014 46 (3) 293-6 BACKGROUND: More than 80% of U.S. adults use the Internet, 65% of online adults use social media, and more than 60% use the Internet to find and share health information. PURPOSE: State tobacco control campaigns could effectively harness the powerful, inexpensive online messaging opportunities. Characterizing current Internet presence of state-sponsored tobacco control programs is an important first step toward informing such campaigns. METHODS: A research specialist searched the Internet for state-sponsored tobacco control resources and social media presence for each state in 2010 and 2011, to develop a resource inventory and observe change over 6 months. Data were analyzed and websites coded for interactivity and content between July and October 2011. RESULTS: Although all states have tobacco control websites, content and interactivity of those sites remain limited. State tobacco control program use of social media appears to be increasing over time. CONCLUSIONS: Information presented on the Internet by state-sponsored tobacco control programs remains modest and limited in interactivity, customization, and search engine optimization. These programs could take advantage of an important opportunity to communicate with the public about the health effects of tobacco use and available community cessation and prevention resources. |
Traditional and innovative promotional strategies of tobacco cessation services: a review of the literature
Momin B , Neri A , McCausland K , Duke J , Hansen H , Kahende J , Zhang L , Stewart SL . J Community Health 2014 39 (4) 800-9 An estimated 43.5 million American adults currently smoke cigarettes. Well-designed tobacco education campaigns with adequate reach increase cessation and reduce tobacco use. Smokers report great interest in quitting but few use effective treatments including quitlines (QLs). This review examined traditional (TV, radio, print ads) versus innovative tobacco cessation (internet, social media) promotions for QL services. Between November 2011 and January 2012, searches were conducted on EBSCO, PubMed, Wilson, OCLC, CQ Press, Google Scholar, Gale, LexisNexis, and JSTOR. Existing literature shows that the amount of radio and print advertising, and promotion of free cessation medications increases QL call volume. Television advertising volume seems to be the best predictor of QL service awareness. Much of the literature on Internet advertising compares the characteristics of participants recruited for studies through various channels. The majority of the papers indicated that Internet-recruited participants were younger; this was the only demographic characteristic with high agreement across studies. Traditional media was only studied within mass media campaigns with TV ads having a consistent impact on increasing calls to QLs, therefore, it is hard to distinguish the impact of traditional media as an independent QL promotion intervention. With innovative media, while many QL services have a presence on social media sites, there is no literature on evaluating the effectiveness of these channels for quitline promotion. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
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