Strategies to support self-management in osteoarthritis
Brady T . Am J Nurs 2012 112 S54-60 OVERVIEW: This overview of successful strategies for supporting self-management in patients with osteoarthritis (OA) defines the concepts of self-management, self-management support (SMS), and self-management education (SME); describes five categories of SMS interventions; identifies common elements across SMS categories; and provides evidence for and examples of self-management tools that are useful in OA. SMS categories include SME, other skill-building and behavior-change interventions, supportive provider interactions, ongoing supportive follow-up, and environmental changes. Where available, relevant OA-specific SMS strategies are used to illustrate these categories. |
Early renal function decline in type 2 diabetes
Pavkov ME , Knowler WC , Lemley KV , Mason CC , Myers BD , Nelson RG . Clin J Am Soc Nephrol 2012 7 (1) 78-84 BACKGROUND AND OBJECTIVES: Early decline in GFR may reflect progressive kidney disease in type 1 diabetes, but its predictive value in type 2 diabetes is uncertain. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this longitudinal study, GFR was measured serially over approximately 4.0 years in 195 Pima Indians with type 2 diabetes. Renal function decline (RFD) was defined during this initial period by an average GFR loss ≥3.3%/yr, as defined previously in type 1 diabetes. Subsequently, participants were followed for up to 17.8 years to ESRD onset, death, or December 31, 2010, whichever came first. RESULTS: RFD prevalence during the initial period was 32% in 68 participants with normal baseline albuminuria (albumin/creatinine ratio [ACR] < 30 mg/g), 42% in 88 with microalbuminuria (ACR 30 to <300 mg/g), and 74% in 39 with macroalbuminuria (ACR ≥300 mg/g; P<0.001). The cumulative incidence of ESRD 10 years after the initial period was 41% in those with RFD and 15% in those without (P<0.001); 41 of the 49 ESRD cases (83.7%) occurred in participants who had or developed macroalbuminuria during the initial period. When adjusted for age, sex, diabetes duration, and hemoglobin A1c, the ESRD hazard rate was 4.78 times (95% confidence interval, 2.39-9.58) as high in those with RFD as in those without; further adjustment for albuminuria attenuated this association (hazard ratio, 1.79; 95% confidence interval, 0.82-3.91). CONCLUSIONS: In type 2 diabetes, loss of GFR often occurs before the onset of macroalbuminuria, but a decline predictive of ESRD is strongly dependent on progression to macroalbuminuria. |
The impact of osteoarthritis in the United States: a population-health perspective
Murphy L , Helmick CG . Am J Nurs 2012 112 S13-9 OVERVIEW: Arthritis, of which osteoarthritis (OA) is the most common type, is the most frequent cause of disability among adults in the United States. The authors reviewed the epidemiologic literature to identify studies that describe the population-based burden of OA-that is, the burden in all adults in the community. They found that 27 million adults-more than 10% of the U.S. adult population-had clinical OA in 2005, and in 2009 OA was the fourth most common cause of hospitalization. OA is the leading indication for joint replacement surgery; 905,000 knee and hip replacements were performed in 2009 at a cost of $42.3 billion. Obesity is a strong risk factor for OA of the knee and hip. Nurses can improve the quality of life of people with OA by raising awareness among their patients and peers of the substantial OA burden and the strategies, such as physical activity, that can reduce it. |
Association of sleep duration and hypertension among US adults varies by age and sex
Fang J , Wheaton AG , Keenan NL , Greenlund KJ , Perry GS , Croft JB . Am J Hypertens 2012 25 (3) 335-41 BACKGROUND: While short sleep duration has been related to hypertension, the impact of age and sex on this association is less well known. We examined the association between hours of sleep and hypertension prevalence among US adults by age and sex. METHODS: The study was conducted using data from the 2007-2009 National Health Interview Surveys (NHISs). The association between self-reported hours of sleep and prevalence of hypertension was assessed after stratifying by age and sex. RESULTS: Among 71,455 participants, age-standardized hypertension prevalence rates (%) were 32.4, 25.5, 22.2, 23.2, 25.5, and 32.5 among adults reporting sleep of <6, 6, 7, 8, 9, and ≥10 h/day, respectively (P < 0.001). There was a "U"-shaped association of hours of sleep and hypertension prevalence among all age and sex subgroups. Logistic regression models, using 8 h sleep/day as the referent, showed a greater likelihood of hypertension among those who slept <7 or ≥10 h/day after adjusting for sociodemographic, behavior, and health characteristics. Further stratifying by age and sex, while adjusting for all other characteristics, revealed that among adults less than 45 years, short (<6 h for men and <8 h for women) and long (≥10 h for men) sleep were associated with higher likelihood of hypertension. For other age/sex groups, short sleep (<6 h) was associated with higher likelihood of hypertension among middle-aged men and older women, as was long sleep (≥10 h) among middle-aged women. CONCLUSIONS: This national sample study suggests that the association between hours of sleep and hypertension varies by age and sex. (American Journal of Hypertension (2012); doi:10.1038/ajh.2011.201.) |
Changes in femur neck bone density in US adults between 1988-1994 and 2005-2008: demographic patterns and possible determinants
Looker AC , Melton LJ 3rd , Borrud LG , Shepherd JA . Osteoporos Int 2012 23 (2) 771-80 SUMMARY: This analysis compares femur neck bone mineral density (FNBMD) and bone determinants in adults between National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 2005-2008. FNBMD was higher in NHANES 2005-2008 than in NHANES III, but between-survey differences varied by age, sex, and race/ethnicity. The likelihood that FNBMD has improved appears strongest for older white women. INTRODUCTION: Recent data on hip fracture incidence and femur neck osteoporosis suggest that the skeletal status of older US adults has improved since the 1990s, but the explanation for these changes remains uncertain. METHODS: The present study compares mean FNBMD of adults ages 20 years and older between the third (NHANES III, 1988-1994) and NHANES 2005-2008. Dual-energy X-ray absorptiometry systems (pencil beam in NHANES III, fan beam in NHANES 2005-2008) were used to measure hip BMD, and several bone determinants are compared between surveys to assess their potential role in explaining observed FNBMD differences. RESULTS: FNBMD was higher overall in NHANES 2005-2008 than in NHANES III, but between-survey differences varied by age, sex, and race/ethnicity. Although FNBMD differences in several groups were small enough (≤3%) to be attributable to use of different dual-energy X-ray absorptiometry (DXA) systems in the two surveys, variability in size and direction of the differences does not support artifactual differences in DXA methodology as the sole explanation. Several FNBMD determinants (body size, smoking, selected bone-active medications, self-reported health status, calcium intake, and caffeine consumption) changed in a bone-improving direction in older adults, but FNBMD in older non-Hispanic white women remained significantly higher in 2005-2008 even after adjusting for DXA methodology or for the selected bone determinants. CONCLUSION: The likelihood that FNBMD has improved appears strongest for older white women, but the reason for the improvement in this group remains unclear. |
Toward rubella elimination in Europe: an epidemiological assessment
Muscat M , Zimmerman L , Bacci S , Bang H , Glismann S , Molbak K , Reef S . Vaccine 2012 30 (11) 1999-2007 BACKGROUND: The elimination of rubella and prevention of congenital rubella syndrome (CRS) by 2015 are established goals for Europe. Our aim was to review the epidemiology of rubella in relation to this goal. MATERIAL AND METHODS: National surveillance institutions from 32 European countries provided information on rubella and CRS surveillance systems and data for 2000-08. We reported the number of notified rubella cases by year for countries with a national mandatory notification system for rubella covering total country population consistently throughout 2000-08 and analysed rubella surveillance data for 2008. RESULTS: Throughout 2000-08, 24 countries conducted passive routine surveillance based on mandatory reporting rubella covering total country population. Altogether these countries reported 526,751 rubella cases. The median incidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By 2008, the number of countries with mandatory notification systems for rubella increased to 28. These countries reported 21,475 rubella cases of which 1.5% (n=317) were laboratory-confirmed. Most cases (n=21,075; 98%) were reported from Poland, Italy and Romania. Ten countries reported zero rubella cases and five others reported an incidence of <1 per million inhabitants. In 2008, 20 CRS cases were reported from five countries. CONCLUSION: The overall decline in rubella incidence and increase in the number of countries conducting rubella surveillance through a mandatory notification system are notable achievements toward the goal of rubella elimination in Europe. However, in a few countries with high rubella incidence the risk for CRS still exists. Achievement and maintenance of the required high vaccination coverage and high-quality surveillance of rubella and CRS including laboratory testing of all suspected cases are fundamental to eliminate rubella and prevent CRS in Europe. |
Primary amebic meningoencephalitis: a case report and literature review
Lopez C , Budge P , Chen J , Bilyeu S , Mirza A , Custodio H , Irazuzta J , Visvesvara G , Sullivan KJ . Pediatr Emerg Care 2012 28 (3) 272-276 Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Cases of N. fowleri infection have been reported from many of the southern-tier states in the United States, with Florida and Texas disproportionately represented among them. Primary amebic meningoencephalitis presents clinically in a fashion that may be indistinguishable from bacterial and viral meningitis. Unfortunately, because the disease is so rare, PAM is often excluded from the differential diagnosis of children with meningitis resulting in delayed diagnostic and therapeutic efforts. Pediatric acute care practitioners in emergency departments, general pediatric wards, and critical care units, especially those practicing in the southern United States, should be familiar with the risk factors for acquisition of PAM, its clinical presentation, and the fact that common empiric treatment of bacterial meningitis will not treat N. fowleri. Herein, we present the case of an adolescent who died of PAM and review the (a) epidemiology, (b) pathophysiology, (c) available diagnostic modalities, (d) treatment options, and (e) outcomes of patients treated for N. fowleri infection of the central nervous system. |
Estimating the impact of newly arrived foreign-born persons on tuberculosis in the United States
Liu Y , Painter JA , Posey DL , Cain KP , Weinberg MS , Maloney SA , Ortega LS , Cetron MS . PLoS One 2012 7 (2) e32158 BACKGROUND: Among approximately 163.5 million foreign-born persons admitted to the United States annually, only 500,000 immigrants and refugees are required to undergo overseas tuberculosis (TB) screening. It is unclear what extent of the unscreened nonimmigrant visitors contributes to the burden of foreign-born TB in the United States. METHODOLOGY/PRINCIPAL FINDINGS: We defined foreign-born persons within 1 year after arrival in the United States as "newly arrived", and utilized data from U.S. Department of Homeland Security, U.S. Centers for Disease Control and Prevention, and World Health Organization to estimate the incidence of TB among newly arrived foreign-born persons in the United States. During 2001 through 2008, 11,500 TB incident cases, including 291 multidrug-resistant TB incident cases, were estimated to occur among 20,989,738 person-years for the 1,479,542,654 newly arrived foreign-born persons in the United States. Of the 11,500 estimated TB incident cases, 41.6% (4,783) occurred among immigrants and refugees, 36.6% (4,211) among students/exchange visitors and temporary workers, 13.8% (1,589) among tourists and business travelers, and 7.3% (834) among Canadian and Mexican nonimmigrant visitors without an I-94 form (e.g., arrival-departure record). The top 3 newly arrived foreign-born populations with the largest estimated TB incident cases per 100,000 admissions were immigrants and refugees from high-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of ≥100 cases/100,000 population/year; 235.8 cases/100,000 admissions, 95% confidence interval [CI], 228.3 to 243.3), students/exchange visitors and temporary workers from high-incidence countries (60.9 cases/100,000 admissions, 95% CI, 58.5 to 63.3), and immigrants and refugees from medium-incidence countries (e.g., 2008 WHO-estimated TB incidence rate of 15-99 cases/100,000 population/year; 55.2 cases/100,000 admissions, 95% CI, 51.6 to 58.8). CONCLUSIONS/SIGNIFICANCE: Newly arrived nonimmigrant visitors contribute substantially to the burden of foreign-born TB in the United States. To achieve the goals of TB elimination, direct investment in global TB control and strategies to target nonimmigrant visitors should be considered. |
Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity
Ott JJ , Stevens GA , Groeger J , Wiersma ST . Vaccine 2012 30 (12) 2212-9 OBJECTIVE: Chronic hepatitis B virus infection is one of the most serious infections and a major risk factor for deaths from cirrhosis and liver cancer. We estimate age-, sex- and region-specific prevalence of chronic HBV infection and calculate the absolute number of persons being chronically infected. METHODS: A systematic review of the literature for studies reporting HBV infection was conducted and worldwide HBsAg seroprevalence data was collected over a 27-year period (1980-2007). Based on observed data, age-specific prevalence and endemicity were estimated on a global level and for all world regions for 1990 and 2005 using an empirical Bayesian hierarchical model. FINDINGS: From 1990 to 2005, the prevalence of chronic HBV infection decreased in most regions. This was particularly evident in Central sub-Saharan Africa, Tropical and Central Latin America, South East Asia and Central Europe. Despite this decrease in prevalence, the absolute number of HBsAg positive persons increased from 223 million in 1990 to 240 million in 2005. Age-specific prevalence varied by geographical region with highest endemicity levels in sub-Saharan Africa and prevalence below 2% in regions such as Tropical and Central Latin America, North America and Western Europe. Asian regions showed distinct prevalence patterns with lower intermediate prevalence in South Asia, but up to 8.6% HBsAg prevalence in East Asia. Strong declines were seen in South East Asian children. CONCLUSION: Declines in HBV infection prevalence may be related to expanded immunization. The increasing overall number of individuals being chronically infected with HBV, and the widespread global differences in HBV prevalence call for targeted approaches to tackle HBV-related mortality and morbidity. HBV infection prevalence data are needed at country and sub-national level to estimate disease burden and guide health and vaccine policy. |
Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis
Edmond KM , Kortsalioudaki C , Scott S , Schrag SJ , Zaidi AK , Cousens S , Heath PT . Lancet 2012 379 (9815) 547-56 BACKGROUND: Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates. METHODS: We searched Medline, Embase, and Wholis databases for studies on invasive early-onset (day 0-6) and late-onset (day 7-89) group B streptococcal disease. Eligible studies were those that described incidence, deaths, or serotypes. We also reviewed reference lists and contacted experts to seek unpublished data and data missed by our search. Random effects meta-analysis was used to pool data. FINDINGS: 74 studies met the inclusion criteria; 56 studies reported incidence, 29 case fatality, and 19 serotype distribution. An additional search for studies that reported serotype distribution from Jan 1, 1980, yielded a total of 38 articles. Only five low-income countries were represented in the review and contributed 5% weight to the meta-analysis. 47 (69%) studies reported use of any intrapartum antibiotic prophylaxis. Substantial heterogeneity existed between studies. Mean incidence of group B streptococcus in infants aged 0-89 days was 0.53 per 1000 livebirths (95% CI 0.44-0.62) and the mean case fatality ratio was 9.6% (95% CI 7.5-11.8). Incidence of early-onset group B streptococcus (0.43 per 1000 livebirths [95% CI 0.37-0.49]) and case fatality (12.1%, [6.2-18.3]) were two-times higher than late-onset disease. Serotype III (48.9%) was the most frequently identified serotype in all regions with available data followed by serotypes Ia (22.9%), Ib (7.0%), II (6.2%), and V (9.1%). Studies that reported use of any intrapartum antibiotic prophylaxis were associated with lower incidence of early-onset group B streptococcus (0.23 per 1000 livebirths [95% CI 0.13-0.59]) than studies in which patients did not use prophylaxis (0.75 per 1000 livebirths [0.58-0.89]). INTERPRETATION: More high-quality studies are needed to accurately estimate the global burden of group B streptococcus, especially in low-income countries. A conjugate vaccine incorporating five serotypes (Ia, Ib, II, III, V) could prevent most global group B streptococcal disease. FUNDING: Child Epidemiology Reference Group (CHERG), WHO. |
Hepatitis E virus infection in HIV-infected persons
Crum-Cianflone NF , Curry J , Drobeniuc J , Weintrob A , Landrum M , Ganesan A , Bradley W , Agan BK , Kamili S . Emerg Infect Dis 2012 18 (3) 502-506 To determine whether hepatitis E virus (HEV) is a cause of hepatitis among HIV-infected persons, we evaluated 1985-2009 data for US military beneficiaries. Evidence of acute or prior HEV infection was detected for 7 (4%) and 5 (3%) of 194 HIV-infected persons, respectively. HEV might be a cause of acute hepatitis among HIV-infected persons. |
High prevalence of cryptococcal infection among HIV-infected patients hospitalized with pneumonia in Thailand
Harris JR , Lindsley MD , Henchaichon S , Poonwan N , Naorat S , Prapasiri P , Chantra S , Ruamcharoen F , Chang LS , Chittaganpitch M , Mehta N , Peruski L , Maloney SA , Park BJ , Baggett HC . Clin Infect Dis 2012 54 (5) e43-50 BACKGROUND: Cryptococcal meningitis (CM) is a major cause of death among HIV-infected patients. Cryptococcal antigenemia (CrAg+) in the absence of CM can represent early-stage cryptococcosis during which antifungal treatment might improve outcomes. However, patients without meningitis are rarely tested for cryptococcal infection. We evaluated Cryptococcus species as a cause of acute respiratory infection in hospitalized patients in Thailand and evaluated clinical characteristics associated with CrAg+. METHODS: We tested banked serum samples from 704 human immunodeficiency virus (HIV)-infected and 730 HIV-uninfected patients hospitalized with acute respiratory infection from 2004 through 2009 in 2 rural provinces in Thailand for the presence of CrAg+. Retrospective chart reviews were conducted for CrAg+ patients to distinguish meningeal and nonmeningeal cryptococcosis and to identify clinical characteristics associated with CrAg+ in patients with and without evidence of CM. RESULTS: CrAg+ was found in 92 HIV-infected patients (13.1%); only tuberculosis (19.3%) and rhinovirus (16.5%) were identified more frequently. No HIV-uninfected patients were CrAg+. Of 70 CrAg+ patients with medical charts available, 37 (52.9%) had no evidence of past or existing CM at hospitalization; 30 of those patients (42.9% of all CrAg+) had neither past nor existing CM, nor any alternate etiology of infection identified. Dyspnea was more frequent among CrAg+ patients without CM than among CrAg- patients (P = .0002). CONCLUSIONS: Cryptococcus species were the most common pathogens detected in HIV-infected patients hospitalized with acute respiratory infection in Thailand. Few clinical differences were found between antigenemic and nonantigenemic HIV-infected patients. Health care providers in Thailand should evaluate HIV-infected patients hospitalized with acute respiratory infection for cryptococcal antigenemia, even in the absence of meningitis. |
HIV prevention by oral preexposure prophylaxis
Heneine W , Kashuba A . Cold Spring Harb Perspect Med 2012 2 (3) a007419 The impressive advances in antiretroviral (ARV) therapy of chronic human immunodeficiency virus (HIV) infections during the last decade and the availability of potent ARV drugs have fueled interest in using chemoprophylaxis as a novel HIV prevention strategy. Preexposure prophylaxis (PrEP) refers to the use of ARV drugs in HIV-negative persons to prevent HIV infection. The rationale for PrEP builds on the success of ARV prophylaxis in preventing mother-to-child transmission of HIV and on a large body of animal studies that show the efficacy of PrEP against mucosal and parenteral infection. We focus on oral administration of ARV drugs for prevention of HIV infection. Identifying an effective prophylactic pill that individuals can take outside the setting of sexual intercourse precludes the necessity to disclose such use to their partners, thereby empowering those who might not be in a position to negotiate with their partners. Several human clinical trials evaluating the efficacy of daily regimens of the HIV reverse-transcriptase (RT) inhibitors tenofovir disoproxil fumarate (TDF) or Truvada (TDF and emtricitabine [FTC]) are under way among high-risk populations. The results of one trial among men who have sex with men showed that daily Truvada was safe and effective, providing the first support for oral PrEP as a prevention strategy. Here we outline the preclinical and clinical research on oral PrEP, pharmacologic considerations, and future directions and challenges. |
Antiviral resistance during the 2009 influenza A H1N1 pandemic: public health, laboratory, and clinical perspectives
Hurt AC , Chotpitayasunondh T , Cox NJ , Daniels R , Fry AM , Gubareva LV , Hayden FG , Hui DS , Hungnes O , Lackenby A , Lim W , Meijer A , Penn C , Tashiro M , Uyeki TM , Zambon M . Lancet Infect Dis 2012 12 (3) 240-248 Influenza A H1N1 2009 virus caused the first pandemic in an era when neuraminidase inhibitor antiviral drugs were available in many countries. The experiences of detecting and responding to resistance during the pandemic provided important lessons for public health, laboratory testing, and clinical management. We propose recommendations for antiviral susceptibility testing, reporting results, and management of patients infected with 2009 pandemic influenza A H1N1. Sustained global monitoring for antiviral resistance among circulating influenza viruses is crucial to inform public health and clinical recommendations for antiviral use, especially since community spread of oseltamivir-resistant A H1N1 2009 virus remains a concern. Further studies are needed to better understand influenza management in specific patient groups, such as severely immunocompromised hosts, including optimisation of antiviral treatment, rapid sample testing, and timely reporting of susceptibility results. |
Bartonella and Bartonella infections in China: from the clinic to the laboratory
Liu Q , Eremeeva ME , Li D . Comp Immunol Microbiol Infect Dis 2012 35 (2) 93-102 The current status of Bartonella studies in mainland China is reviewed including both laboratory and ecological data and limited clinical data. Detection and isolation of Bartonella species from arthropods, pets and small wild animals is commonplace; this includes a variety of known and emerging Bartonella pathogens. In contrast, the medical literature analyzed from 1980 to 2010 consists of 31 reports of only of cat scratch disease (CSD). Most cases are from the East and South-Eastern provinces, the most populated areas with best access to medical care. Disease typically is described as febrile illness with symptoms traditionally reported for CSD elsewhere in the world. Clinical observations and anamnesis are the primary bases for diagnosis, since specialized serologic and molecular diagnosis is not widely available. Seroprevalence of healthy populations determined using Bartonella henselae antigen varies from 9.6 to 19.6%. The apparent discordance postulated between possible environmental exposure to diverse Bartonella agents and restricted B. henselae case etiologies suggests a need to determine whether other Bartonella species may also be etiologic agents of human illness and emphasizes the importance of applying modern diagnostic tools widely in clinical practice in mainland China. |
Community-associated Clostridium difficile infections, Monroe County, New York, USA
Dumyati G , Stevens V , Hannett GE , Thompson AD , Long C , MacCannell D , Limbago B . Emerg Infect Dis 2012 18 (3) 392-400 We conducted active sentinel surveillance in Monroe County, New York, USA, to compare incidence of community-associated Clostridium difficile infections (CA-CDIs) with that of health care-associated infections (HA-CDIs) and identify exposure and strain type differences between CA and HA cases. Patients positive for C. difficile toxin and with no documented health care exposure in the previous 12 weeks were defined as possible CA case-patients. Patients with onset in a health care setting or recent health care exposure were defined as HA case-patients. Eighteen percent of CDIs were CA; 76% were in persons who reported antimicrobial drug use in the 12 weeks before CDI diagnosis. Strain type distribution was similar between CA and HA cases; North American pulsed-field 1 was the primary strain (31% CA, 42% HA; p = 0.34). CA-CDI is an emergent disease affecting patients recently exposed to antimicrobial drugs. Community strains are similar to those found in health care settings. |
Discordance in Mycobacterium tuberculosis rifampin susceptibility
Kalokhe AS , Shafiq M , Lee JC , Metchock B , Posey JE , Ray SM , Anderson A , Wang YF , Nguyen ML . Emerg Infect Dis 2012 18 (3) 537-9 TO THE EDITOR: Multidrug-resistant tuberculosis (MDR TB), i.e., TB resistant to at least the 2 most effective first-line antituberculous drugs (isoniazid [INH] and rifampin [RIF]), is increasing globally. World Health Organization estimations of 390,000-510,000 new MDR TB cases and 150,000 related deaths in 2008 highlight the need for timely drug susceptibility testing and improved therapies (1). Although novel rapid drug susceptibility testing tools are increasingly available, their clinical applicability is unsettled. We report a patient with pulmonary TB relapse with discordant genotypic and in vitro phenotypic drug susceptibility testing results associated with a mutation outside the RIF resistance determining region (RRDR) of the rpoB gene. |
Bangladeshi backyard poultry raisers' perceptions and practices related to zoonotic transmission of avian influenza
Sultana R , Rimi NA , Azad S , Islam MS , Khan MS , Gurley ES , Nahar N , Luby SP . J Infect Dev Ctries 2012 6 (2) 156-65 INTRODUCTION: Highly pathogenic avian influenza (H5N1) virus (known as "bird flu") is an important public health concern due to its potential to infect humans and cause a human pandemic. Bangladesh is a high-risk country for an influenza pandemic because of its dense human population, widespread backyard poultry raising, and endemic H5N1 infection in poultry. Understanding poultry raisers' perceived risks and identifying their risk exposures can help to develop interventions to reduce the risk of avian influenza transmission. This paper explores the perception of Bangladeshi backyard poultry raisers regarding poultry sickness and zoonotic disease transmission and relevant practices. METHODOLOGY: We conducted a qualitative study using social mapping (n=2), in-depth interviews (n=40), household mapping (n=40) and observation (n=16), in two backyard poultry-raising communities. RESULTS: The poultry raisers recognized various signs of poultry illness but they did not distinguish among diseases using biomedical classifications. They perceived disease transmission from poultry to poultry, but not from poultry to humans. They usually kept sick poultry under the bed. If the poultry did not recover, they were slaughtered and consumed or sold. The poultry raisers had close contact with sick birds while handling and slaughtering poultry. CONCLUSIONS: The poultry raisers are unlikely to follow instructions from health authorities to prevent "bird flu" transmission because many of the instructions ask low-income producers to change their existing practices and require time, money, and financial loss. Villagers are more likely to comply with interventions that help to protect their flocks and address their financial interest. |
Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building
Park JH , Kreiss K , Cox-Ganser JM . Indoor Air 2012 22 (5) 396-404 Mold exposure in damp buildings is associated with both nasal symptoms and asthma development, but progression of building-related (BR) rhinosinusitis symptoms to asthma is unstudied. We examined risk of developing BR-asthma symptoms in relation to prior BR-rhinosinusitis symptoms and microbial exposure among occupants of a damp building. We conducted four cross-sectional health and environmental surveys among occupants of a 20-story water-damaged office building. We defined BR-rhinosinusitis symptom (n=131) and comparison (n=361) groups from participants' first questionnaire responses. We compared the odds for development of BR-asthma symptoms between these two groups over the subsequent surveys, using logistic regression models adjusted for demographics, smoking, building tenure, and first survey exposures to fungi, endotoxin, and ergosterol. The BR-rhinosinusitis symptom group had higher odds for developing BR-asthma symptoms [odds ratio (OR)=2.2; 95% confidence interval (CI)=1.3-3.6] in any subsequent survey compared to those without BR-rhinosinusitis symptoms. The BR-rhinosinusitis symptom group with higher fungal exposure within the building had an OR of 7.4 (95% CI=2.8-19.9) for developing BR-asthma symptoms, compared to the lower fungal exposure group without BR-rhinosinusitis symptoms. Our findings suggest that rhinosinusitis associated with occupancy of water-damaged buildings may be a sentinel for increased risk for asthma onset in such buildings. ((c) 2012 John Wiley & Sons A/S.) |
Environmental transmission of norovirus gastroenteritis
Lopman B , Gastanaduy P , Park GW , Hall AJ , Parashar UD , Vinje J . Curr Opin Virol 2012 2 (1) 96-102 The advent of molecular techniques and their increasingly widespread use in public health laboratories and research studies has transformed the understanding of the burden of norovirus. Norovirus is the most common cause of community-acquired diarrheal disease across all ages, the most common cause of outbreaks of gastroenteritis, and the most common cause of foodborne disease in the United States. They are a diverse group of single-stranded RNA viruses that are highly infectious and stable in the environment; both symptomatic and asymptomatic infections are common. Through shedding in feces and vomit, norovirus can be transmitted directly through an array of routes: person-to-person, food or the environment. The relative importance of environmental transmission of virus is yet to be fully quantified but is likely to be substantial and is an important feature that complicates control. (2011 Elsevier B.V. All rights reserved.) |
Health impact assessment of the Atlanta BeltLine
Ross CL , Leone de Nie K , Dannenberg AL , Beck LF , Marcus MJ , Barringer J . Am J Prev Med 2012 42 (3) 203-13 BACKGROUND: Although a health impact assessment (HIA) is a tool that can provide decision makers with recommendations to promote positive health impacts and mitigate adverse health impacts of proposed projects and policies, it is not routinely conducted on most major projects or policies. PURPOSE: To make health a decision criterion for the Atlanta BeltLine, a multibillion-dollar transit, trails, parks, and redevelopment project. METHODS: An HIA was conducted in 2005-2007 to anticipate and influence the BeltLine's effect on health determinants. RESULTS: Changes in access and equity, environmental quality, safety, social capital, and physical activity were forecast, and steps to maximize health benefits and reduce negative effects were recommended. Key recommendations included giving priority to the construction of trails and greenspace rather than residential and retail construction, making health an explicit goal in project priority setting, adding a public health professional to decision-making boards, increasing the connectivity between the BeltLine and civic spaces, and ensuring that affordable housing is built. BeltLine project decision makers have incorporated most of the HIA recommendations into the planning process. The HIA was cited in the awarding of additional funds of $7,000,000 for brownfield clean-up and greenspace development. The project is expected to promote the health of local residents more than in the absence of the HIA. CONCLUSIONS: This report is one of the first HIAs to tie specific assessment findings to specific recommendations and to identifiable impacts from those recommendations. The lessons learned from this project may help others engaged in similar efforts. |
Using genotyping and geospatial scanning to estimate recent mycobacterium tuberculosis transmission, United States.
Moonan PK , Ghosh S , Oeltmann JE , Kammerer JS , Cowan LS , Navin TR . Emerg Infect Dis 2012 18 (3) 458-65 To determine the proportion of reported tuberculosis (TB) cases due to recent transmission in the United States, we conducted a cross-sectional study to examine culture-positive TB cases with complete genotype results (spoligotyping and 12-locus mycobacterial interspersed repetitive unit-variable-number tandem repeat typing) reported during January 2005-December 2009. Recently transmitted cases were defined as cases with matching results reported within statistically significant geospatial zones (identified by a spatial span statistic within a sliding 3-year window). Approximately 1 in 4 TB cases reported in the United States may be attributed to recent transmission. Groups at greatest risk for recent transmission appear to be men, persons born in the United States, members of a minority race or ethnic group, persons who abuse substances, and the homeless. Understanding transmission dynamics and establishing strategies for rapidly detecting recent transmission among these populations are essential for TB elimination in the United States. |
Minimum data elements for research reports on CFS
Jason LA , Unger ER , Dimitrakoff JD , Fagin AP , Houghton M , Cook DB , Marshall GD Jr , Klimas N , Snell C . Brain Behav Immun 2012 26 (3) 401-6 Chronic fatigue syndrome (CFS) is a debilitating condition that has received increasing attention from researchers in the past decade. However, it has become difficult to compare data collected in different laboratories due to the variability in basic information regarding descriptions of sampling methods, patient characteristics, and clinical assessments. The issue of variability in CFS research was recently highlighted at the NIH's 2011 State of the Knowledge of CFS meeting prompting researchers to consider the critical information that should be included in CFS research reports. To address this problem, we present our consensus on the minimum data elements that should be included in all CFS research reports, along with additional elements that are currently being evaluated in specific research studies that show promise as important patient descriptors for subgrouping of CFS. These recommendations are intended to improve the consistency of reported methods and the interpretability of reported results. Adherence to minimum standards and increased reporting consistency will allow for better comparisons among published CFS articles, provide guidance for future research and foster the generation of knowledge that can directly benefit the patient. |
Early detection of pandemic (H1N1) 2009, Bangladesh
Azziz-Baumgartner E , Rahman M , Al Mamun A , Haider MS , Zaman RU , Karmakar PC , Nasreen S , Muneer SM , Homaira N , Goswami DR , Ahmed BN , Husain MM , Jamil KM , Khatun S , Ahmed M , Chakraborty A , Fry A , Widdowson MA , Bresee J , Azim T , Alamgir AS , Brooks A , Hossain MJ , Klimov A , Rahman M , Luby SP . Emerg Infect Dis 2012 18 (1) 146-9 To explore Bangladesh's ability to detect novel influenza, we examined a series of laboratory-confirmed pandemic (H1N1) 2009 cases. During June-July 2009, event-based surveillance identified 30 case-patients (57% travelers); starting July 29, sentinel sites identified 252 case-patients (1% travelers). Surveillance facilitated response weeks before the spread of pandemic (H1N1) 2009 infection to the general population. |
Infectious disease surveillance and modelling across geographic frontiers and scientific specialties
Khan K , McNabb SJ , Memish ZA , Eckhardt R , Hu W , Kossowsky D , Sears J , Arino J , Johansson A , Barbeschi M , McCloskey B , Henry B , Cetron M , Brownstein JS . Lancet Infect Dis 2012 12 (3) 222-30 Infectious disease surveillance for mass gatherings (MGs) can be directed locally and globally; however, epidemic intelligence from these two levels is not well integrated. Modelling activities related to MGs have historically focused on crowd behaviours around MG focal points and their relation to the safety of attendees. The integration of developments in internet-based global infectious disease surveillance, transportation modelling of populations travelling to and from MGs, mobile phone technology for surveillance during MGs, metapopulation epidemic modelling, and crowd behaviour modelling is important for progress in MG health. Integration of surveillance across geographic frontiers and modelling across scientific specialties could produce the first real-time risk monitoring and assessment platform that could strengthen awareness of global infectious disease threats before, during, and immediately after MGs. An integrated platform of this kind could help identify infectious disease threats of international concern at the earliest stages possible; provide insights into which diseases are most likely to spread into the MG; help with anticipatory surveillance at the MG; enable mathematical modelling to predict the spread of infectious diseases to and from MGs; simulate the effect of public health interventions aimed at different local and global levels; serve as a foundation for scientific research and innovation in MG health; and strengthen engagement between the scientific community and stakeholders at local, national, and global levels. |
Commentary: Can mortality rates among adult antiretroviral therapy patients in Europe reach levels similar to those experienced in the general population?
Auld AF , Ellerbrock TV . Int J Epidemiol 2012 41 (2) 445-7 Since 1996, widespread availability of combination antiretroviral therapy (ART) has significantly improved survival of HIV-infected persons in industrialized countries.1,2 This has prompted researchers in Europe2,3 and North America1,2,4 to investigate whether mortality among HIV-infected persons receiving ART might reach levels similar to those in the general population. | In this paper by Lewden et al.,5 more than 80 000 patients from 31 European countries are included in an analysis to estimate crude ART patient mortality rates for persons ⩾18 years of age, who initiated ART during 1998–2008, had a known gender and date of birth, known baseline CD4+ T-cell (CD4) count, and ⩾1 follow-up visit. The standardized mortality ratio (SMR) is used to compare mortality between ART patients and the general population. The SMR is the ratio of the observed number of deaths in the ART cohorts to the expected number of deaths if ART cohorts had experienced general population country-, calendar-year-, gender-, and age-specific mortality. SMRs were estimated using random effects Poisson models, adjusted for age, gender, HIV transmission group and history of AIDS at ART start. | The overall ART patient mortality rate of 1.2 per 100 person years (PY) is similar to that recently reported for 13 cohorts from nine countries in Europe and North America (0.95/100 PY for the period 2001–2009)2 and 23 cohorts from 10 European countries, Australia and Canada (0.86/100 PY for the period 2004–2006),1 supporting previous estimates that average annual risk of death for ART patients has declined since 1996–2001, when estimates of about 3/100 PY were reported.1 |
Nonpasteurized dairy products, disease outbreaks, and state laws-United States, 1993-2006
Langer AJ , Ayers T , Grass J , Lynch M , Angulo FJ , Mahon BE . Emerg Infect Dis 2012 18 (3) 385-91 Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993-2006. We found 121 outbreaks for which the product's pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product-associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number ( approximately 150x greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered. |
Recommendations for group-based behavioral interventions to prevent adolescent pregnancy, human immunodeficiency virus, and other sexually transmitted infections: comprehensive risk reduction and abstinence education
Community Preventive Services Task Force , Sipe TA . Am J Prev Med 2012 42 (3) 304-7 The Community Preventive Services Task Force (Task Force) recommends group-based comprehensive risk reduction delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). The recommendation is based on sufficient evidence of effectiveness in: | • | reducing a number of self-reported risk behaviors, including engagement in any sexual activity, frequency of sexual activity, number of sex partners, and frequency of unprotected sexual activity; | • | increasing the self-reported use of protection against pregnancy and STIs; and | • | reducing the incidence of self-reported or clinically documented STIs. | | Direct evidence of effectiveness for reducing pregnancy and HIV is, however, limited. The Task Force finds insufficient evidence to determine the effectiveness of group-based abstinence education delivered to adolescents to prevent pregnancy, HIV, and other STIs. Evidence was considered insufficient because of inconsistent results across studies. |
Person-to-person interventions targeted to parents and other caregivers to improve adolescent health: a Community Guide systematic review
Burrus B , Leeks KD , Sipe TA , Dolina S , Soler R , Elder R , Barrios L , Greenspan A , Fishbein D , Lindegren ML , Achrekar A , Dittus P , Community Preventive Services Task Force . Am J Prev Med 2012 42 (3) 316-26 CONTEXT: Adolescence marks a time when many young people engage in risky behaviors with potential implications for long-term health. Interventions focused on adolescents' parents and other caregivers have the potential to affect adolescents across a variety of risk and health-outcome areas. EVIDENCE ACQUISITION: Community Guide methods were used to evaluate the effectiveness of caregiver-targeted interventions in addressing adolescent risk and protective behaviors and health outcomes. Sixteen studies published during the search period (1966-2007) met review requirements and were included in this review. EVIDENCE SYNTHESIS: Effectiveness was assessed based on changes in whether or not adolescents engaged in specified risk and protective behaviors; frequency of risk and protective behaviors, and health outcomes, also informed the results. Results from qualifying studies provided sufficient evidence that interventions delivered person-to-person (i.e., through some form of direct contact rather than through other forms of contact such as Internet or paper) and designed to modify parenting skills by targeting parents and other caregivers are effective in improving adolescent health. CONCLUSIONS: Interventions delivered to parents and other caregivers affect a cross-cutting array of adolescent risk and protective behaviors to yield improvements in adolescent health. Analysis from this review forms the basis of the recommendation by the Community Preventive Services Task Force presented elsewhere in this issue. |
Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial
Markham CM , Tortolero SR , Peskin MF , Shegog R , Thiel M , Baumler ER , Addy RC , Escobar-Chaves SL , Reininger B , Robin L . J Adolesc Health 2012 50 (3) 279-88 PURPOSE: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation. METHODS: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes. RESULTS: Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54-.77), among females (AOR: .43, 95% CI: .31-.60), and among African Americans (AOR: .38, 95% CI: .18-.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47-.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33-.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36-.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19-.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52-.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively affected psychosocial outcomes. CONCLUSIONS: The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth. |
Using intervention mapping to promote the receipt of clinical preventive services among women with physical disabilities
Suzuki R , Peterson JJ , Weatherby AV , Buckley DI , Walsh ES , Kailes JI , Krahn GL . Health Promot Pract 2012 13 (1) 106-115 This article describes the development of Promoting Access to Health Services (PATHS), an intervention to promote regular use of clinical preventive services by women with physical disabilities. The intervention was developed using intervention mapping (IM), a theory-based logical process that incorporates the six steps of assessment of need, preparation of matrices, selection of theoretical methods and strategies, program design, program implementation, and evaluation. The development process used methods and strategies aligned with the social cognitive theory and the health belief model. PATHS was adapted from the workbook Making Preventive Health Care Work for You, developed by a disability advocate, and was informed by participant input at five points: at inception through consultation by the workbook author, in conceptualization through a town hall meeting, in pilot testing with feedback, in revision of the curriculum through an advisory group, and in implementation by trainers with disabilities. The resulting PATHS program is a 90-min participatory small-group workshop, followed by structured telephone support for 6 months. ((PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract).) |
Using PCR-based detection and genotyping to trace Streptococcus salivarius meningitis outbreak strain to oral flora of radiology physician assistant.
Srinivasan V , Gertz RE Jr , Shewmaker PL , Patrick S , Chitnis AS , O'Connell H , Benowitz I , Patel P , Guh AY , Noble-Wang J , Turabelidze G , Beall B . PLoS One 2012 7 (2) e32169 We recently investigated three cases of bacterial meningitis that were reported from a midwestern radiology clinic where facemasks were not worn during spinal injection of contrast agent during myelography procedures. Using pulsed field gel electrophoresis we linked a case strain of S. salivarius to an oral specimen of a radiology physician assistant (RPA). We also used a real-time PCR assay to detect S. salivarius DNA within a culture-negative cerebrospinal fluid (CSF) specimen. Here we extend this investigation through using a nested PCR/sequencing strategy to link the culture-negative CSF specimen to the case strain. We also provide validation of the real-time PCR assay used, demonstrating that it is not solely specific for Streptococcus salivarius, but is also highly sensitive for detection of the closely related oral species Streptococcus vestibularis. Through using multilocus sequence typing and 16S rDNA sequencing we further strengthen the link between the CSF case isolate and the RPA carriage isolate. We also demonstrate that the newly characterized strains from this study are distinct from previously characterized S. salivarius strains associated with carriage and meningitis. |
Outbreak of bacterial meningitis among patients undergoing myelography at an outpatient radiology clinic
Chitnis AS , Guh AY , Benowitz I , Srinivasan V , Gertz RE Jr , Shewmaker PL , Beall BW , O'Connell H , Noble-Wang J , Gornet MF , Van Beneden C , Patrick SL , Turabelidze G , Patel PR . J Am Coll Radiol 2012 9 (3) 185-90 PURPOSE: To investigate an outbreak of bacterial meningitis at an outpatient radiology clinic (clinic A) and to determine the source and implement measures to prevent additional infections. METHODS: A case was defined as bacterial meningitis in a patient undergoing myelography at clinic A from October 11 to 25, 2010. Patients who underwent myelography and other procedures at clinic A during that period were interviewed, medical records were reviewed, and infection prevention practices were assessed. Case-patient cerebrospinal fluid (CSF) specimens, oral specimens from health care personnel (HCP), and opened iohexol vials were tested for bacteria. Bacterial isolates were compared using pulsed-field gel electrophoresis. A culture-negative CSF specimen was tested using a real-time polymerase chain reaction assay. RESULTS: Three cases were identified among 35 clinic A patients who underwent procedures from October 11 to 25, 2010. All case-patients required hospitalization, 2 in an intensive care unit. Case-patients had myelography performed by the same radiology physician assistant and technician on October 25; all patients who underwent myelography on October 25 were affected. HCP did not wear facemasks and reused single-dose iohexol vials for multiple patients. Streptococcus salivarius (a bacteria commonly found in oral flora) was detected in the CSF of 2 case-patients (1 by culture, 1 using real-time polymerase chain reaction) and in HCP oral specimens; 1 opened iohexol vial contained Staphylococcus epidermidis. Pulsed-field gel electrophoresis profiles from the case-patient S salivarius and the radiology physician assistant were indistinguishable. CONCLUSIONS: Bacterial meningitis likely occurred because HCP performing myelography did not wear facemasks; lapses in injection practices may have contributed to transmission. Targeted education regarding mask use and safe injection practices is needed among radiology HCP. |
Case-control study of hepatitis B and hepatitis C in older adults: Do healthcare exposures contribute to burden of new infections?
Perz JF , Grytdal S , Beck S , Fireteanu AM , Poissant T , Rizzo E , Bornschlegel K , Thomas A , Balter S , Miller J , Klevens M , Finelli L . Hepatology 2012 57 (3) 917-24 BACKGROUND: Reports of hepatitis B and hepatitis C virus transmission associated with unsafe medical practices have been increasing in the United States. However, the contribution of healthcare exposures to the burden of new infections is poorly understood outside of recognized outbreaks. METHODS: We conducted a case-control study at 3 health departments that perform enhanced viral hepatitis surveillance in New York and Oregon. Reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons aged ≥ 55 years from 2006-2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59 years, 60-69 years, and ≥70 years) and residential ZIP code. Data collection covered exposures within 6 months prior to symptom onset (cases) or date of interview (controls). RESULTS: Forty-eight (37 hepatitis B; 11 hepatitis C) case- and 159 control-patients were enrolled. Case-patients were more likely than controls to report one or more behavioral risk exposures, including sexual or household contact with an HBV or HCV patient, >1 sex partner, illicit drug use or incarceration (21% of cases vs 4% of controls exposed; matched Odds Ratio [mOR]=7.1; 95%CI 2.1, 24.1). Case-patients were more likely than controls to report hemodialysis (8% of cases; mOR=13.0; 95%CI 1.5, 115); injections in a healthcare setting (58%; mOR=2.7; 95%CI 1.3, 5.3); and surgery (33%; mOR=2.3; 95%CI 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR]=5.4, 95%CI 1.5, 19.0; 17% attributable risk), injections (aOR=2.7, 95%CI 1.3, 5.8; 37% attributable risk) and hemodialysis (aOR=11.5, 95%CI 1.2, 107; 8% attributable risk) were associated with case status. CONCLUSION: Healthcare exposures may represent an important source of new HBV and HCV infections among older adults. (HEPATOLOGY 2012.). |
Signal identification and evaluation for risk of febrile seizures in children following trivalent inactivated influenza vaccine in the Vaccine Safety Datalink Project, 2010-2011
Tse A , Tseng HF , Greene SK , Vellozzi C , Lee GM . Vaccine 2012 30 (11) 2024-2031 In fall 2010 in the southern hemisphere, an increased risk of febrile seizures was noted in young children in Australia in the 24h after receipt of trivalent inactivated influenza vaccine (TIV) manufactured by CSL Biotherapies. Although the CSL TIV vaccine was not recommended for use in young children in the US, during the 2010-2011 influenza season near real-time surveillance was conducted for febrile seizures in the 0-1 days following first dose TIV in a cohort of 206,174 vaccinated children ages 6 through 59 months in the Vaccine Safety Datalink Project. On a weekly basis, surveillance was conducted with the primary approach of a self-controlled risk interval design and the secondary approach of a current vs. historical vaccinee design. Sequential statistical methods were employed to account for repeated analyses of accumulating data. Signals for seizures based on computerized data were identified in mid November 2010 using a current vs. historical design and in late December 2010 using a self-controlled risk interval design. Further signal evaluation was conducted with chart-confirmed febrile seizure cases using only data from the primary approach (i.e. self-controlled risk interval design). The magnitude of the incidence rate ratio and risk difference comparing risk of seizures in the 0-1 days vs. 14-20 days following TIV differed by receipt of concomitant 13-valent pneumococcal conjugate vaccine (PCV13). Among children 6-59 months of age, the incidence rate ratio (IRR) for TIV adjusted for concomitant PCV13 was 2.4 (95% CI 1.2, 4.7) while the IRR for PCV13 adjusted for concomitant TIV was 2.5 (95% CI 1.3, 4.7). The IRR for concomitant TIV and PCV13 was 5.9 (95% CI 3.1, 11.3). Risk difference estimates varied by age due to the varying baseline risk for seizures in young children, with the highest estimates occurring at 16 months (12.5 per 100,000 doses for TIV without concomitant PCV13, 13.7 per 100,000 doses for PCV13 without concomitant TIV, and 44.9 per 100,000 doses for concomitant TIV and PCV13) and the lowest estimates occurring at 59 months (1.1 per 100,000 doses for TIV without concomitant PCV13, 1.2 per 100,000 doses for PCV13 without concomitant TIV, and 4.0 per 100,000 doses for concomitant TIV and PCV13). Incidence rate ratio and risk difference estimates were lower for children receiving TIV without concomitant PCV13 or PCV13 without concomitant TIV. Because of the importance of preventing influenza and pneumococcal infections and associated complications, our findings should be placed in a benefit-risk framework to ensure that population health benefits are maximized. |
Use of the emergency Incident Command System for school-located mass influenza vaccination clinics
Fishbane M , Kist A , Schieber RA . Pediatrics 2012 129 Suppl 2 S101-6 In Palm Beach County, Florida, the fall 2005 influenza vaccination season was interrupted by Hurricane Wilma, a particularly destructive storm that resulted in flooding, power outages, extensive property damage, and suspension of many routine community services. In its aftermath, all public health resources were immediately turned to the response and recovery process. School-located mass influenza vaccination (SLV) clinics were scheduled to begin in 1 week, but were necessarily postponed for a month. The juxtaposition of these 2 major public health events afforded the school district, health department, and other community services an opportunity to see their similarities and adopt the Incident Command System structure to manage the SLV clinics across West Palm Beach County, Florida, a geographically large county. Other lessons were learned during the hurricane concerning organizations and people, processes, and communications, and were applicable to school-located mass influenza vaccination programs, and vice versa. Those lessons are related here. |
Perspectives of allergists/immunologists on the 2009-2010 H1N1 vaccination effort
Clark SJ , Cowan AE , Wortley PM . J Asthma 2012 49 (2) 184-9 BACKGROUND: Persons with high-risk conditions such as asthma were a target group for national H1N1 vaccine recommendations. Allergists/immunologists (allergists) are a provider group that could vaccinate persons with asthma and other high-risk conditions. Their level of participation in and experiences with the 2009-2010 H1N1 vaccination campaign are unknown. OBJECTIVE: To describe the experiences of allergists related to the 2009-2010 H1N1 vaccination campaign. METHODS: A cross-sectional, mailed survey of a national sample of 1955 allergists providing outpatient care was conducted in June-September 2010. RESULTS: The overall response rate was 72%. Most allergists "strongly recommended" H1N1 vaccine for children, and most "recommended" or "strongly recommended" vaccine for adults. The majority (71%) agreed to participate in the H1N1 vaccine campaign and received vaccine. Vaccine supply was a significant challenge, but otherwise few major problems were experienced with administering H1N1 vaccine. The majority of respondents, particularly among those who participated in the 2009-2010 H1N1 vaccination campaign, felt they would be very likely to vaccinate in the event of future influenza pandemic. CONCLUSION: The experiences of allergists in the H1N1 vaccine campaign were generally positive. Most allergists are willing to serve as vaccinators in future influenza pandemics, which will help facilitate broad access to vaccine for patients with asthma and other high-risk conditions. |
Early experience conducting school-located vaccination programs for seasonal influenza
Schieber RA , Kennedy A , Kahn EB . Pediatrics 2012 129 Suppl 2 S68-74 OBJECTIVES: We determined program effectiveness, feasibility, and acceptance of school-located vaccination (SLV) clinics for seasonal influenza that took place before the 2008 universal influenza vaccination recommendations. METHODS: We surveyed program directors of 23 programs in the United States who conducted SLV clinics during the 2005 to 2006 and 2006 to 2007 influenza seasons. RESULTS: Of 391,423 children enrolled in schools with SLV clinics, 61,463 (15.7%) were vaccinated at 499 sites (schools) in 23 programs. Of these, 22 were small- and medium-sized programs that vaccinated 32,875 (24.1%) of the 136,151 children enrolled there, averaging 31.9% of students per site. One populous county vaccinated an additional 28,588 (11.2%) of its 255,272 enrolled children, averaging 13.9% per school. Children in grades K to 6 had consistently higher mean vaccination rates (21.5%) compared with middle school children (10.3%) or high school youth (5.8%). Program acceptability was high, and no program had to forego any key public health activities; 5 hired temporary help or paid overtime. The outlook for continuing such clinics was good in 7 programs, but depended on help with vaccine purchasing, funding, or additional personnel, with multiple responses allowed. CONCLUSIONS: These vaccination coverage rates provide a baseline for future performance of school-located mass vaccination clinics. Although the existence and conduct of these programs in our study was considered acceptable by leaders of public health departments and anecdotally by parents and school administrators, sustainability may require additional means to pay for vaccines or personnel beyond the usual available health department resources. |
Epilogue: School-located influenza vaccination during the 2009-2010 pandemic and beyond
Vogt TM , Wortley PM . Pediatrics 2012 129 Suppl 2 S107-9 As the preceding articles indicate, school-located vaccination (SLV) shows great promise as a method to quickly and efficiently vaccinate large numbers of school-aged children against influenza. This approach can both relieve health care providers who lack sufficient capacity to effectively vaccinate their patients annually, in accordance with the 2008 recommendations of Advisory Committee on Immunization Practices (ACIP),1 as well as provide a convenient option for parents and an opportunity for children without a medical home to be vaccinated. Importantly, SLV may be appropriate for routine vaccination against seasonal influenza, as well as during a public health emergency or pandemic. | The utility of SLV was demonstrated on a large scale in response to the 2009–2010 H1N1 influenza pandemic. In July 2009, intense efforts were underway to procure H1N1 vaccine and prepare for implementing a large-scale national vaccination program. At that time, the ACIP published recommendations that defined the highest-priority target groups to receive vaccine when it first became available, which included school-aged children.2 Accordingly, public health units, educational institutions, and others in local communities joined together to hold SLV clinics throughout the United States, with several states implementing SLV statewide. Based on a National Association of County and City Health Officials survey of local health department officials that was conducted in the summer of 2010, an estimated 85% of local health departments held at least 1 H1N1 influenza SLV clinic in their jurisdiction (National Association of County and City Health Officials, unpublished data). The Centers for Disease Control and Prevention’s (CDC) National 2009 H1N1 Flu Survey is a nationally representative telephone-based survey designed to collect vaccination coverage from US households.3 This survey indicated that 37% of school-aged children 5- to17-years-old received 2009 H1N1 influenza vaccination; approximately one-third of these children were vaccinated at school (CDC, unpublished data). |
Evolution of the pediatric influenza vaccination program in the United States
Neuzil KM , Fiore AE , Schieber RA . Pediatrics 2012 129 Suppl 2 S51-3 For many years, the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) focused its vaccination policy on persons at higher risk for influenza complications (eg, older adults, children and adults with certain high-risk conditions, pregnant women) and their contacts (eg, household contacts, health care personnel). Unfortunately, although vaccination coverage rates varied, they remained low for most adult and pediatric high-risk groups, other than persons aged ≥65 years.1 In conjunction with the recognition that influenza vaccination recommendations for high-risk target populations were not being optimally implemented, the adverse effects of influenza illness on all children was increasingly recognized. This led to the expansion of vaccination recommendations for children, beginning in 2002, when influenza vaccination was “encouraged” for children aged 6 through 23 months, and in 2004, when a full recommendation was issued for this age group.2,3 That recommendation was based largely on studies documenting that these young children had influenza-related hospitalization rates that were comparable to hospitalization rates in older persons with underlying risk conditions who were targeted to receive influenza vaccine.4,–6 Full recommendation was added for other groups who are at risk, such as adults and children with neuromuscular and other conditions that can compromise respiratory function or the handling of respiratory secretions, as data became available.7 |
Relevance, pathogenesis, and testing algorithm for mismatch repair-defective colorectal carcinomas: a report of the association for molecular pathology.
Funkhouser WK Jr , Lubin IM , Monzon FA , Zehnbauer BA , Evans JP , Ogino S , Nowak JA . J Mol Diagn 2012 14 (2) 91-103 Loss-of-function defects in DNA mismatch repair (MMR), which manifest as high levels of microsatellite instability (MSI), occur in approximately 15% of all colorectal carcinomas (CRCs). This molecular subset of CRC characterizes patients with better stage-specific prognoses who experience no benefit from 5-fluorouracil chemotherapy. Most MMR-deficient (dMMR) CRCs are sporadic, but 15% to 20% are due to inherited predisposition (Lynch syndrome). High penetrance of CRCs in germline MMR gene mutation carriers emphasizes the importance of accurate diagnosis of Lynch syndrome carriers. Family-based (Amsterdam), patient/family-based (Bethesda), morphology-based, microsatellite-based, and IHC-based screening criteria do not individually detect all germline mutation carriers. These limitations support the use of multiple concurrent tests and the screening of all patients with newly diagnosed CRC. This approach is resource intensive but would increase detection of inherited and de novo germline mutations to guide family screening. Although CRC prognosis and prediction of 5-fluorouracil response are similar in both the Lynch and sporadic dMMR subgroups, these subgroups differ significantly with regard to the implications for family members. We recommend that new CRCs should be classified into sporadic MMR-proficient, sporadic dMMR, or Lynch dMMR subgroups. The concurrent use of MSI testing, MMR protein IHC, and BRAF c.1799T>A mutation analysis would detect almost all dMMR CRCs, would classify 94% of all new CRCs into these MMR subgroups, and would guide secondary molecular testing of the remainder. |
Rapid HIV screening: missed opportunities for HIV diagnosis and prevention
Patel P , Bennett B , Sullivan T , Parker MM , Heffelfinger JD , Sullivan PS . J Clin Virol 2012 54 (1) 42-7 BACKGROUND: Although rapid HIV tests increase the number of persons who are aware of their HIV status, they may fail to detect early HIV infection. OBJECTIVES: To evaluate the sensitivity for early HIV infection of several rapid tests and third- and fourth-generation assays compared with nucleic acid amplification testing (NAAT). STUDY DESIGN: Sensitivity for early HIV infection was evaluated using 62 NAAT-positive/WB-negative or indeterminate specimens from the CDC Acute HIV Infection study. Specimens underwent third-generation testing with Genetic Systems 1/2+O((R)) and rapid testing with Multispot HIV-1/HIV-2. A subset was also tested with four FDA-approved rapid tests and Determine HIV-1 Antigen/Antibody Rapid Test((R)) and Architect HIV Antigen/Antibody Combo((R)), both fourth-generation tests. RESULTS: Of 99,111 specimens screened from April 2006 to March 2008, 62 met the definition for early HIV infection (60 NAAT-positive/seronegative and 2 NAAT-positive/Western blot indeterminate). Third-generation testing correctly detected antibody in 34 specimens (55%; 95% confidence interval (CI): 42-67); Multispot detected antibody in 16 (26%; 95% CI: 16-38). Of the 62 specimens, 33 (53%) had sufficient quantity for further testing. Rapid test sensitivities for early HIV infection ranged from 22-33% compared with 55-57% for the third-generation assay and 76-88% for the fourth-generation tests. CONCLUSIONS: Many rapid HIV tests failed to detect half of the early HIV infection cases in whom antibody was present. Programs that screen high-incidence populations with rapid tests should consider supplemental testing with NAAT or other antigen-based tests. These data support the need for more sensitive antigen-based point-of-care screening tests for early HIV infection. |
Rubella virus-like replicon particles: analysis of encapsidation determinants and non-structural roles of capsid protein in early post-entry replication
Claus C , Tzeng WP , Liebert UG , Frey TK . J Gen Virol 2012 93 516-25 Rubella virus (RUBV) contains a plus-strand RNA genome with two ORFs, one encoding the non-structural replicase proteins (NS-ORF) and the second encoding the virion structural proteins (SP-ORF). This study describes development and use of a trans-encapsidation system for the assembly of infectious RUBV-like replicon particles (VRPs) containing RUBV replicons (self replicating genomes with the SP-ORF replaced with a reporter gene). First, this system was used to map signals within the RUBV genome that mediate packaging of viral RNA. Mutations within a proposed packaging signal did not significantly affect relative packaging efficiency. The insertion of various fragments derived from the RUBV genome into Sindbis virus replicons revealed that there are several regions within the RUBV genome capable of enhancing encapsidation of heterologous replicon RNAs. Secondly, the trans-encapsidation system was used to analyse the effect of alterations within the capsid protein (CP) on release of VRPs and subsequent initiation of replication in newly infected cells. Deletion of the N-terminal eight amino acids of the CP reduced VRP titre significantly, which could be partially complemented by native CP provided in trans, indicating that this mutation affected an entry or post-entry event in the replication cycle. To test this hypothesis, the trans-encapsidation system was used to demonstrate the rescue of a lethal deletion within P150, one of the virus replicase proteins, by CP contained within the virus particle. This novel finding substantiated the functional role of CP in early post-entry replication. |
Safe and sustained vaginal delivery of pyrimidinedione HIV-1 inhibitors from polyurethane intravaginal rings
Johnson TJ , Srinivasan P , Albright TH , Watson-Buckheit K , Rabe L , Martin A , Pau CP , Hendry RM , Otten R , McNicholl J , Buckheit R Jr , Smith J , Kiser PF . Antimicrob Agents Chemother 2012 56 (3) 1291-9 The potent antiretroviral pyrimidinediones IQP-0528 (PYD1) and IQP-0532 (PYD2) were formulated in polyurethane intravaginal rings (IVRs) as prophylactic drug delivery systems to prevent the sexual transmission of HIV-1. To aid in the selection of a pyrimidinedione candidate and the optimal loading of the drug in the IVR delivery system, four pyrimidinedione IVR formulations (PYD1 at 0.5 wt% [PYD1(0.5wt%)], PYD1(1wt%), PYD2(4wt%), and PYD2(14wt%)) were evaluated in pigtail macaques over 28 days for safety and pyrimidinedione vaginal biodistribution. Kinetic analysis of vaginal proinflammatory cytokines, native microflora, and drug levels suggested that all formulations were safe, but only the high-loaded PYD2(14wt%) IVR demonstrated consistently high pyrimidinedione vaginal fluid and tissue levels over the 28-day study. This formulation delivered drug in excess of 10 mug/ml to vaginal fluid and 1 mug/g to vaginal tissue, a level over 1,000 times the in vitro 50% effective concentration. The in vitro release of PYD1 and PYD2 under nonsink conditions correlated well with in vivo release, both in amount and in kinetic profile, and therefore may serve as a more biologically relevant means of evaluating release in vitro than typically employed sink conditions. Lastly, the pyrimidinediones in the IVR formulation were chemically stable after 90 days of storage at elevated temperature, and the potent nanomolar-level antiviral activity of both molecules was retained after in vitro release. Altogether, these results point to the successful IVR formulation and vaginal biodistribution of the pyrimidinediones and demonstrate the usefulness of the pigtail macaque model in evaluating and screening antiretroviral IVR formulations prior to preclinical and clinical evaluation. |
Nonculture diagnostic tests for enteric diseases
Jones TF , Gerner-Smidt P . Emerg Infect Dis 2012 18 (3) 513-4 The diagnosis of acute gastroenteritis (AGE) has traditionally been based on culture results of feces from patients with diarrhea. Virtually everything we know about disease and the epidemiology of enteric pathogens, such as Salmonella spp., Shiga toxin-producing Escherichia coli (STEC), e.g., O157, and Campylobacter spp., has been generated from the study of patients with culture-confirmed infections. However, this pattern may be changing because AGE diagnostics are moving away from culture toward rapid nonculture methods. These infections are mainly foodborne and therefore preventable, and it is of paramount importance that public health surveillance for these infections is consistent and reliable. |
Influenza virus respiratory infection and transmission following ocular inoculation in ferrets
Belser JA , Gustin KM , Maines TR , Pantin-Jackwood MJ , Katz JM , Tumpey TM . PLoS Pathog 2012 8 (3) e1002569 While influenza viruses are a common respiratory pathogen, sporadic reports of conjunctivitis following human infection demonstrates the ability of this virus to cause disease outside of the respiratory tract. The ocular surface represents both a potential site of virus replication and a portal of entry for establishment of a respiratory infection. However, the properties which govern ocular tropism of influenza viruses, the mechanisms of virus spread from ocular to respiratory tissue, and the potential differences in respiratory disease initiated from different exposure routes are poorly understood. Here, we established a ferret model of ocular inoculation to explore the development of virus pathogenicity and transmissibility following influenza virus exposure by the ocular route. We found that multiple subtypes of human and avian influenza viruses mounted a productive virus infection in the upper respiratory tract of ferrets following ocular inoculation, and were additionally detected in ocular tissue during the acute phase of infection. H5N1 viruses maintained their ability for systemic spread and lethal infection following inoculation by the ocular route. Replication-independent deposition of virus inoculum from ocular to respiratory tissue was limited to the nares and upper trachea, unlike traditional intranasal inoculation which results in virus deposition in both upper and lower respiratory tract tissues. Despite high titers of replicating transmissible seasonal viruses in the upper respiratory tract of ferrets inoculated by the ocular route, virus transmissibility to naive contacts by respiratory droplets was reduced following ocular inoculation. These data improve our understanding of the mechanisms of virus spread following ocular exposure and highlight differences in the establishment of respiratory disease and virus transmissibility following use of different inoculation volumes and routes. |
Isothermal amplification using a chemical heating device for point-of-care detection of HIV-1
Curtis KA , Rudolph DL , Nejad I , Singleton J , Beddoe A , Weigl B , Labarre P , Owen SM . PLoS One 2012 7 (2) e31432 BACKGROUND: To date, the use of traditional nucleic acid amplification tests (NAAT) for detection of HIV-1 DNA or RNA has been restricted to laboratory settings due to time, equipment, and technical expertise requirements. The availability of a rapid NAAT with applicability for resource-limited or point-of-care (POC) settings would fill a great need in HIV diagnostics, allowing for timely diagnosis or confirmation of infection status, as well as facilitating the diagnosis of acute infection, screening and evaluation of infants born to HIV-infected mothers. Isothermal amplification methods, such as reverse-transcription, loop-mediated isothermal amplification (RT-LAMP), exhibit characteristics that are ideal for POC settings, since they are typically quicker, easier to perform, and allow for integration into low-tech, portable heating devices. METHODOLOGY/SIGNIFICANT FINDINGS: In this study, we evaluated the HIV-1 RT-LAMP assay using portable, non-instrumented nucleic acid amplification (NINA) heating devices that generate heat from the exothermic reaction of calcium oxide and water. The NINA heating devices exhibited stable temperatures throughout the amplification reaction and consistent amplification results between three separate devices and a thermalcycler. The performance of the NINA heaters was validated using whole blood specimens from HIV-1 infected patients. CONCLUSION: The RT-LAMP isothermal amplification method used in conjunction with a chemical heating device provides a portable, rapid and robust NAAT platform that has the potential to facilitate HIV-1 testing in resource-limited settings and POC. |
Acoustic testing facilities at the Office of Mine Safety and Health Research
Peterson JS , Yantek D , Smith AK . Noise Control Eng J 2012 60 (1) 85-96 The National Institute for Occupational Safety and Health (NIOSH) Office of Mine Safety and Health Research (OMSHR) maintains a noise control program as part of its Hearing Loss Prevention Branch (HLPB). This program utilizes two large acoustic laboratories-a reverberation chamber and a hemi-anechoic chamber-to assist OMSHR engineers with the development and evaluation of noise controls. This paper discusses the design, instrumentation, and use of the NIOSH acoustics laboratories and the important role they play in noise control development and evaluation. The NIOSH reverberation chamber meets the absorption, reverberation time, and test room broadband qualification requirements specified in the ISO 3741/ANSI S12.51 acoustics standard for precision method sound power testing. As part of a qualification testing program, NIOSH conducted an uncertainty estimate for sound power level testing in the chamber. For an overall sound power measurement, this uncertainty estimate was 0.4 dB. The NIOSH hemi-anechoic chamber, which uses Eckel Industries SuperSoft Panels on the walls and ceiling, is used primarily for noise source identification to determine significant noise sources on equipment. Testing was completed to ensure that the chamber functions as a free-field. The SuperSoft panels met NIOSH requirements and the chamber was verified as a free-field per the test room qualification criteria set forth in ISO 3745. ((C) 2012 Institute of Noise Control Engineering.) |
Bioaerosol exposure assessment in the workplace: the past, present and recent advances
Eduard W , Heederik D , Duchaine C , Green BJ . J Environ Monit 2012 14 (2) 334-9 Louis Pasteur described the first measurements of airborne microorganisms in 1861. A century later, the inhalation of spores from thermophilic microorganisms was shown to induce attacks of farmers' lung in patients with this disease, while endotoxins originating from Gram-negative bacteria were identified as causal agents for byssinosis in cotton workers. Further epidemiological and toxicological studies have demonstrated inflammatory, respiratory, and pathogenic effects following exposure to bioaerosols. Exposure assessment is often confounded by the diversity of bioaerosol agents in the environment. Microorganisms represent a highly diverse group that may vary in toxicity. Fungi and bacteria are mainly quantified as broad groups using a variety of viable and nonviable assessment methods. Endotoxins and beta(1 --> 3)-glucans are mainly measured by their activity in the Limulus amebocyte lysate assay, enzymes by immuno-chemical methods and mycotoxins by liquid chromatography-mass spectrometry. Few health-based occupational exposure limits (OELs) are available for risk assessment. For endotoxins, a health-based OEL of 90 endotoxin units m(-3) has been proposed in the Netherlands. A criteria document for fungal spores recently proposed a lowest observed effect level of 100,000 spores m(-3) for non-pathogenic and non-mycotoxin producing species based on inflammatory respiratory effects. Recent developments in bioaerosol assessment were presented at the Organic Dust Tromso Symposium including molecular biological methods for infectious agents and organisms that are difficult to cultivate; studies of submicronic and hyphal fragments from fungi; the effect of biodiversity of microorganisms in asthma studies; and new/improved measurement methods for fungal antigens, enzymes and allergens. Although exposure assessment of bioaerosol agents is complex and limited by the availability of methods and criteria, the field is rapidly evolving. |
De novo subtype and strain identification of botulinum neurotoxin type B through toxin proteomics
Kalb SR , Baudys J , Rees JC , Smith TJ , Smith LA , Helma CH , Hill K , Kull S , Kirchner S , Dorner MB , Dorner BG , Pirkle JL , Barr JR . Anal Bioanal Chem 2012 403 (1) 215-26 Botulinum neurotoxins (BoNTs) cause the disease botulism, which can be lethal if untreated. There are seven known serotypes of BoNT, A-G, defined by their response to antisera. Many serotypes are distinguished into differing subtypes based on amino acid sequence, and many subtypes are further differentiated into toxin variants. Previous work in our laboratory described the use of a proteomics approach to distinguish subtype BoNT/A1 from BoNT/A2 where BoNT identities were confirmed after searching data against a database containing protein sequences of all known BoNT/A subtypes. We now describe here a similar approach to differentiate subtypes BoNT/B1, /B2, /B3, /B4, and /B5. Additionally, to identify new subtypes or hitherto unpublished amino acid substitutions, we created an amino acid substitution database covering every possible amino acid change. We used this database to differentiate multiple toxin variants within subtypes of BoNT/B1 and B2. More importantly, with our amino acid substitution database, we were able to identify a novel BoNT/B subtype, designated here as BoNT/B7. These techniques allow for subtype and strain level identification of both known and unknown BoNT/B rapidly with no DNA required. |
Parental occupational exposures and autism spectrum disorder
McCanlies EC , Fekedulegn D , Mnatsakanova A , Burchfiel CM , Sanderson WT , Charles LE , Hertz-Picciotto I . J Autism Dev Disord 2012 42 (11) 2323-34 Both self-report and industrial hygienist (IH) assessed parental occupational information were used in this pilot study in which 174 families (93 children with ASD and 81 unaffected children) enrolled in the Childhood Autism Risks from Genetics and Environment study participated. IH results indicated exposures to lacquer, varnish, and xylene occurred more often in the parents of children with ASD compared to the parents of unaffected children. Parents of children with ASD were more likely to report exposures to asphalt and solvents compared to parents of unaffected children. This study was limited by the small sample size, but results suggest that workplace exposures to some chemicals may be important in the etiology of ASD and deserve further investigation. |
Fixed FEV1/FVC ratio <0.7 for identifying airflow limitation: not a good idea in occupational settings
Hnizdo E , Petsonk EL . Occup Environ Med 2012 69 (3) 227 Dr Søyseth and colleagues recently reported an increased prevalence of airflow limitation in workers employed in the Norwegian smelting industry and significant associations with workplace dust exposures.1 The prevalence of airflow limitation was assessed using prebronchodilator spirometry and two measures of airflow limitation: FEV1/FVC ratio <0.7 and FEV1/FVC ratio <lower limit of normal (LLN). When compared across age categories (<35, 35–44, ≥45 years), the prevalence of airflow limitation based on the ratio <0.7 versus LLN was approximately doubled in the ≥45 years age categories across all levels of exposure duration (overall ≈17.6 vs ≈8.8%). The rate of FEV1 decline was increased for prevalent and incident cases of airflow limitation defined by both criteria, but it would be of interest to see the rates of decline for workers with FEV1/FVC <0.7 compared with those where the ratio is <LLN and ≥LLN. | The authors recommended that ‘in occupational healthcare settings, FEV1/FVC ratio <0.7 should be the preferred index for airflow limitation’. | Although we find the associations between airflow obstruction and occupational exposure to be convincing, we believe that the authors' recommendation regarding the preferred index of airflow limitation is not substantiated by their results (as well as others). The proportionate increase in the presence of obstruction comparing exposed and unexposed smelter workers was consistently greater using the FEV1/FVC ratio <LLN compared with the ratio <0.7 (table 21). Workers showed a highly significant effect of a 1 mg/m3 geometric mean dust exposure when using the ratio <LLN (p=0.01), but not the ratio <0.7 (p>0.05). Similarly, the effect of a 1 mg/m3 exposure to dusts of SiMn, FeMn and FeCr was highly significant using the ratio <LLN (p=0.005) but not the ratio <0.7 (p>0.05, table 41). |
Focused actions to protect carbon nanotube workers
Schulte PA , Kuempel ED , Zumwalde RD , Geraci CL , Schubauer-Berigan MK , Castranova V , Hodson L , Murashov V , Dahm MM , Ellenbecker M . Am J Ind Med 2012 55 (5) 395-411 There is still uncertainty about the potential health hazards of carbon nanotubes (CNTs) particularly involving carcinogenicity. However, the evidence is growing that some types of CNTs and nanofibers may have carcinogenic properties. The critical question is that while the carcinogenic potential of CNTs is being further investigated, what steps should be taken to protect workers who face exposure to CNTs, current and future, if CNTs are ultimately found to be carcinogenic? This paper addresses five areas to help focus action to protect workers: (i) review of the current evidence on the carcinogenic potential of CNTs; (ii) role of physical and chemical properties related to cancer development; (iii) CNT doses associated with genotoxicity in vitro and in vivo; (iv) workplace exposures to CNT; and (v) specific risk management actions needed to protect workers. (Am. J. Ind. Med. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Comparison of speech intelligibility measures for an electronic amplifying earmuff and an identical passive attenuation device
Byrne DC , Palmer CV . Audiol Res 2012 2 (1) 17-24 The purpose of this study was to identify any differences between speech intelligibility measures obtained with MineEars electronic earmuffs (ProEars, Westcliffe, CO, USA) and the Bilsom model 847 (Sperian Hearing Protection, San Diego, CA, USA), which is a conventional passive-attenuation earmuff. These two devices are closely related, since the MineEars device consisted of a Bilsom 847 earmuff with the addition of electronic amplification circuits. Intelligibility scores were obtained by conducting listening tests with 15 normalhearing human subject volunteers wearing the earmuffs. The primary research objective was to determine whether speech understanding differs between the passive earmuffs and the electronic earmuffs (with the volume control set at three different positions) in a background of 90 dB(A) continuous noise. As expected, results showed that speech intelligibility increased with higher speech-to-noise ratios; however, the electronic earmuff with the volume control set at full-on performed worse than when it was set to off or the lowest on setting. This finding suggests that the maximum volume control setting for these electronic earmuffs may not provide any benefits in terms of increased speech intelligibility in the background noise condition that was tested. Other volume control settings would need to be evaluated for their ability to produce higher speech intelligibility scores. Additionally, since an extensive electro-acoustic evaluation of the electronic earmuff was not performed as a part of this study, the exact cause of the reduced intelligibility scores at full volume remains unknown. | |
A consensus method for updating psychosocial measures used in NIOSH Health Hazard Evaluations
Wiegand DM , Chen PY , Hurrell JJ Jr , Jex S , Nakata A , Nigam JA , Robertson M , Tetrick LE . J Occup Environ Med 2012 54 (3) 350-5 OBJECTIVE: An expert panel was convened to select practical, valid psychosocial measures for use during National Institute for Occupational Safety and Health field investigations. METHODS: A taxonomy of psychosocial constructs was developed using existing taxonomies and criteria regarding the malleability, actionability, and validity of constructs. Panel members identified measures for each construct based on their expertise and experience. Measures were selected on the basis of the following criteria: practicality, brevity, validity, availability of existing data, and lack of confounds between psychosocial constructs and outcomes. RESULTS: The panel came to a consensus in recommending 24 measures representing 22 constructs. CONCLUSIONS: It is important that the National Institute for Occupational Safety and Health regularly evaluates its methodologies to ensure it is in line with current best practices. The measures identified will be used modularly in the National Institute for Occupational Safety and Health fieldwork depending on the nature of the evaluation request, industry type, and worker population. |
The Diesel Exhaust in Miners Study: A cohort mortality study with emphasis on lung cancer
Attfield MD , Schleiff PL , Lubin JH , Blair A , Stewart PA , Vermeulen R , Coble JB , Silverman DT . J Natl Cancer Inst 2012 104 (11) 869-83 BACKGROUND: Current information points to an association between diesel exhaust exposure and lung cancer and other mortality outcomes, but uncertainties remain. METHODS: We undertook a cohort mortality study of 12,315 workers exposed to diesel exhaust at eight US non-metal mining facilities. Historical measurements and surrogate exposure data, along with study industrial hygiene measurements, were used to derive retrospective quantitative estimates of respirable elemental carbon (REC) exposure for each worker. Standardized mortality ratios and internally adjusted Cox proportional hazard models were used to evaluate REC exposure-associated risk. Analyses were both unlagged and lagged to exclude recent exposure such as that occurring in the 15 years directly before the date of death. RESULTS: Standardized mortality ratios for lung cancer (1.26, 95% confidence interval [CI] = 1.09 to 1.44), esophageal cancer (1.83, 95% CI = 1.16 to 2.75), and pneumoconiosis (12.20, 95% CI = 6.82 to 20.12) were elevated in the complete cohort compared with state-based mortality rates, but all-cause, bladder cancer, heart disease, and chronic obstructive pulmonary disease mortality were not. Differences in risk by worker location (ever-underground vs surface only) initially obscured a positive diesel exhaust exposure-response relationship with lung cancer in the complete cohort, although it became apparent after adjustment for worker location. The hazard ratios (HRs) for lung cancer mortality increased with increasing 15-year lagged cumulative REC exposure for ever-underground workers with 5 or more years of tenure to a maximum in the 640 to less than 1280 mcg/m(3)-y category compared with the reference category (0 to <20 mcg/m(3)-y; 30 deaths compared with eight deaths of the total of 93; HR = 5.01, 95% CI = 1.97 to 12.76) but declined at higher exposures. Average REC intensity hazard ratios rose to a plateau around 32 mcg/m(3). Elevated hazard ratios and evidence of exposure-response were also seen for surface workers. The association between diesel exhaust exposure and lung cancer risk remained after inclusion of other work-related potentially confounding exposures in the models and were robust to alternative approaches to exposure derivation. CONCLUSIONS: The study findings provide further evidence that exposure to diesel exhaust increases risk of mortality from lung cancer and have important public health implications. |
The Diesel Exhaust in Miners Study: A nested case-control study of lung cancer and diesel exhaust
Silverman DT , Samanic CM , Lubin JH , Blair AE , Stewart PA , Vermeulen R , Coble JB , Rothman N , Schleiff PL , Travis WD , Ziegler RG , Wacholder S , Attfield MD . J Natl Cancer Inst 2012 104 (11) 855-68 BACKGROUND: Most studies of the association between diesel exhaust exposure and lung cancer suggest a modest, but consistent, increased risk. However, to our knowledge, no study to date has had quantitative data on historical diesel exposure coupled with adequate sample size to evaluate the exposure-response relationship between diesel exhaust and lung cancer. Our purpose was to evaluate the relationship between quantitative estimates of exposure to diesel exhaust and lung cancer mortality after adjustment for smoking and other potential confounders. METHODS: We conducted a nested case-control study in a cohort of 12,315 workers in eight non-metal mining facilities, which included 198 lung cancer deaths and 562 incidence density-sampled control subjects. For each case subject, we selected up to four control subjects, individually matched on mining facility, sex, race/ethnicity, and birth year (within 5 years), from all workers who were alive before the day the case subject died. We estimated diesel exhaust exposure, represented by respirable elemental carbon (REC), by job and year, for each subject, based on an extensive retrospective exposure assessment at each mining facility. We conducted both categorical and continuous regression analyses adjusted for cigarette smoking and other potential confounding variables (eg, history of employment in high-risk occupations for lung cancer and a history of respiratory disease) to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Analyses were both unlagged and lagged to exclude recent exposure such as that occurring in the 15 years directly before the date of death (case subjects)/reference date (control subjects). All statistical tests were two-sided. RESULTS: We observed statistically significant increasing trends in lung cancer risk with increasing cumulative REC and average REC intensity. Cumulative REC, lagged 15 years, yielded a statistically significant positive gradient in lung cancer risk overall (P(trend) = .001); among heavily exposed workers (ie, above the median of the top quartile [REC ≥ 1005 mcg/m(3)-y]), risk was approximately three times greater (OR = 3.20, 95% CI = 1.33 to 7.69) than that among workers in the lowest quartile of exposure. Among never smokers, odd ratios were 1.0, 1.47 (95% CI = 0.29 to 7.50), and 7.30 (95% CI = 1.46 to 36.57) for workers with 15-year lagged cumulative REC tertiles of less than 8, 8 to less than 304, and 304 mcg/m(3)-y or more, respectively. We also observed an interaction between smoking and 15-year lagged cumulative REC (P(interaction) = .086) such that the effect of each of these exposures was attenuated in the presence of high levels of the other. CONCLUSION: Our findings provide further evidence that diesel exhaust exposure may cause lung cancer in humans and may represent a potential public health burden. |
The Diesel Exhaust in Miners Study: V. Evaluation of the exposure assessment methods
Stewart PA , Vermeulen R , Coble JB , Blair A , Schleiff P , Lubin JH , Attfield M , Silverman DT . Ann Occup Hyg 2012 56 (4) 389-400 Exposure to respirable elemental carbon (REC), a component of diesel exhaust (DE), was assessed for an epidemiologic study investigating the association between DE and mortality, particularly from lung cancer, among miners at eight mining facilities from the date of dieselization (1947-1967) through 1997. To provide insight into the quality of the estimates for use in the epidemiologic analyses, several approaches were taken to evaluate the exposure assessment process and the quality of the estimates. An analysis of variance was conducted to evaluate the variability of 1998-2001 REC measurements within and between exposure groups of underground jobs. Estimates for the surface exposure groups were evaluated to determine if the arithmetic means (AMs) of the REC measurements increased with increased proximity to, or use of, diesel-powered equipment, which was the basis on which the surface groups were formed. Estimates of carbon monoxide (CO) (another component of DE) air concentrations in 1976-1977, derived from models developed to predict estimated historical exposures, were compared to 1976-1977 CO measurement data that had not been used in the model development. Alternative sets of estimates were developed to investigate the robustness of various model assumptions. These estimates were based on prediction models using: (i) REC medians rather AMs, (ii) a different CO:REC proportionality than a 1:1 relation, and (iii) 5-year averages of historical CO measurements rather than modeled historical CO measurements and DE-related determinants. The analysis of variance found that in three of the facilities, most of the between-group variability in the underground measurements was explained by the use of job titles. There was relatively little between-group variability in the other facilities. The estimated REC AMs for the surface exposure groups rose overall from 1 to 5 mcg/m(3) as proximity to, and use of, diesel equipment increased. The alternative estimates overall were highly correlated (~0.9) with the primary set of estimates. The median of the relative differences between the 1976-1977 CO measurement means and the 1976-1977 estimates for six facilities was 29%. Comparison of estimated CO air concentrations from the facility-specific prediction models with historical CO measurement data found an overall agreement similar to that observed in other epidemiologic studies. Other evaluations of components of the exposure assessment process found moderate to excellent agreement. Thus, the overall evidence suggests that the estimates were likely accurate representations of historical personal exposure levels to DE and are useful for epidemiologic analyses. |
Seroprevalence of antibodies against Taenia solium cysticerci among refugees resettled in United States
O'Neal SE , Townes JM , Wilkins PP , Noh JC , Lee D , Rodriguez S , Garcia HH , Stauffer WM . Emerg Infect Dis 2012 18 (3) 431-8 Neurocysticercosis (NCC) is a disease caused by central nervous system infection by the larval stage of the pork tapeworm, Taenia solium. In developing countries, NCC is a leading cause of adult-onset epilepsy. Case reports of NCC are increasing among refugees resettled to the United States and other nations, but the underlying prevalence among refugee groups is unknown. We tested stored serum samples from the Centers for Disease Control and Prevention Migrant Serum Bank for antibodies against T. solium cysts by using the enzyme-linked immunoelectrotransfer blot. Seroprevalence was high among all 4 populations tested: refugees from Burma (23.2%), Lao People's Democratic Republic (18.3%), Bhutan (22.8%), and Burundi (25.8%). Clinicians caring for refugee populations should suspect NCC in patients with seizure, chronic headache, or unexplained neurologic manifestations. Improved understanding of the prevalence of epilepsy and other associated diseases among refugees could guide recommendations for their evaluation and treatment before, during, and after resettlement. |
Targeting of intermittent preventive treatment for malaria
Steketee RW , Slutsker L . Lancet Infect Dis 2012 12 (3) 168-9 Common sense dictates that African children surviving hospital admittance for severe malaria and anaemia likely remain at high risk of malaria reinfection and should be followed up closely in the months after discharge. In The Lancet Infectious Diseases, Kamija Phiri and colleagues1 report a randomised placebo-controlled trial showing that, for such children admitted to hospital and requiring blood transfusion, initial (during hospital stay) and then repeated treatment with artemether–lumefantrine at 1 month and 2 months after discharge provides substantial short-term benefit by lowering the likelihood of death, hospital admittance, and recurrence of severe anaemia compared with placebo (protective efficacy in 1–6 months after discharge was 31%, 95% CI 5–50; p=0·02). | For malaria control, this approach represents a potential new intermittent preventive treatment (IPT) strategy and builds on the use of such strategies in areas of high malaria transmission during pregnancy,2 infancy,3 and in children living in areas of highly seasonal malaria transmission.4 Because malaria treatment programmes include IPT, examination of its basis and the context in which it has value is important, especially because of the substantial reduction in malaria transmission in some African countries. |
Multilevel measurement of dimensions of collaborative functioning in a network of collaboratives that promote child and family well-being
Barile JP , Darnell AJ , Erickson SW , Weaver SR . Am J Community Psychol 2012 49 270-82 Evaluating collaboration between community partners presents a series of methodological challenges (Roussos and Fawcett in Annu Rev Public Health 21:369-402, 2000; Yin and Kaftarian 1997), one of which is selection of the appropriate level of analysis. When data are collected from multiple members of multiple settings, multilevel analysis techniques should be used. Multilevel confirmatory factor analysis (MCFA) is an analytic approach that incorporates the advantages of latent variable measurement modeling and multilevel modeling for nested data. This study utilizes MCFA on data obtained from an evaluation survey of collaborative functioning provided to members of 157 community collaboratives in Georgia. This study presents a well-fitting measurement model that includes five dimensions of collaborative functioning, and a structural component with individual- and collaborative-level covariates. Findings suggest that members' role and meeting attendance significantly predicted their assessment of collaboration at the individual level, and that tenure of collaborative leaders predicted the overall functioning of the collaborative at the collaborative level. Dimensionality of collaborative functioning and implications of potentially substantial measurement biases associated with selection of respondents are addressed. |
Public health department accreditation: setting the research agenda
Riley WJ , Lownik EM , Scutchfield FD , Mays GP , Corso LC , Beitsch LM . Am J Prev Med 2012 42 (3) 263-71 Health department accreditation is one of the most important initiatives in the field of public health today. The Public Health Accreditation Board (PHAB) is establishing a voluntary accreditation system for more than 3000 state, tribal, territorial, and local health departments using domains, standards, and measures with which to evaluate public health department performance. In addition, public health department accreditation has a focus on continuous quality improvement to enhance capacity and performance of health departments in order to advance the health of the population. In the accreditation effort, a practice-based research agenda is essential to build the scientific base and advance public health department accreditation as well as health department effectiveness. This paper provides an overview of public health accreditation and identifies the research questions raised by this accreditation initiative, including how the research agenda will contribute to better understanding of processes underlying the delivery of services by public health departments and how voluntary accreditation may help improve performance of public health departments. |
Characteristics, services, and infection control practices of New York City assisted living facilities, 2010
Stachel AG , Bornschlegel K , Balter S . J Am Geriatr Soc 2012 60 (2) 284-9 OBJECTIVES: To describe New York City (NYC) assisted living facility (ALF) characteristics, services offered, and infection control practices and to identify infection control barriers and unmet needs. DESIGN: Cross-sectional. SETTING: ALFs licensed or applying to be licensed in NYC. PARTICIPANTS: Seventy ALFs; 70 of 77 eligible facilities participated (91% participation rate). MEASUREMENTS: Telephone interview questions assessed ALF characteristics, services offered, and infection control practices, including glucometry practices. RESULTS: ALFs provided a broad range of services, such as vaccination (90%), assistance with taking medication (75%), bathing and showering (33%), and blood glucose monitoring (90%). Ninety percent of the facilities had nurses on site (directly employed or through a contract agency). Five facilities reported that residents sometimes shared glucometers, and one reported that fingerstick devices were sometimes shared. The majority of facilities wanted educational materials for staff (83%) and residents (77%) on topics including influenza, respiratory illness, norovirus, standard precautions, and general infection control. ALFs had a range of sick leave policies and infection control training requirements. Eighty-nine percent of the facilities reported having designated staff responsible for infection control, although 50% had nonclinical job titles. CONCLUSION: NYC ALFs were varied in terms of nursing services offered, characteristics, and residents' needs; therefore, public health agencies may need to be flexible in their assistance. Public health agencies should consider strengthening relationships with ALFs to identify unmet needs and gaps in services. |
Aging in the United States: opportunities and challenges for public health
Anderson LA , Goodman RA , Holtzman D , Posner SF , Northridge ME . Am J Public Health 2012 102 (3) 393-395 Never before has the global population included as many older adults as it does today. Over the past century in the United States alone, the proportion of persons aged 65 years or older increased more than threefold, from 4.1% to 12.9%.1 This issue of the Journal devoted to “Healthy Aging” opens a dialogue for examining innovative roles for public health and the health care system in relation to a broad spectrum of priorities involving the aging population. Despite the acknowledged challenges of limited resources and economic uncertainty, as this issue's articles suggest, opportunities abound to improve the health and functioning of older adults and enhance intergenerational programs and policies that enrich all of society. Additional articles for this series will be published in subsequent Journal issues over the coming years. |
The bar sinister: does handlebar level damage the pelvic floor in female cyclists?
Partin SN , Connell KA , Schrader S , Lacombe J , Lowe B , Sweeney A , Reutman S , Wang A , Toennis C , Melman A , Mikhail M , Guess MK . J Sex Med 2012 9 (5) 1367-73 INTRODUCTION: Cycling is associated with genital neuropathies and erectile dysfunction in males. Women riders also have decreased genital sensation; however, sparse information exists addressing the effects of modifiable risks on neurological injuries in females. AIM: This study assesses the effects of bicycle setup and cyclists' attributes on GS and saddle pressures among female cyclists. METHODS: Previously, we compared genital sensation in competitive female cyclists (N = 48) to that of female runners (N = 22). The current study is a subanalysis of the 48 cyclists from the original study group. Nonpregnant, premenopausal women who rode at least 10 miles per week, 4 weeks per month were eligible for participation. MAIN OUTCOME MEASURES: Genital sensation was measured in microns using biosthesiometry measures of vibratory thresholds (VTs). Perineal and total saddle pressures were determined using a specialized pressure map and recorded in kilopascals (kPA). RESULTS: Handlebars positioned lower than the saddle correlated with increased perineum saddle pressures and decreased anterior vaginal and left labial genital sensation (P < 0.05, P < 0.02, P < 0.03, respectively). Low handlebars were not associated with total saddle pressures or altered genital sensation in other areas. After adjusting for age and saddle type, low handlebars were associated with a 3.47-kPA increase in mean perineum saddle pressures (P < 0.04) and a 0.86-micron increase in anterior vagina VT (P < 0.01). CONCLUSION: Handlebars positioned lower than the saddle were significantly associated with increased perineum saddle pressures and decreased genital sensation in female cyclists. Modifying bicycle setup may help alleviate neuropathies in females. Additional research is warranted to further assess the extent of the associations. |
Organizational attraction toward a company that adopts a smoke-free policy
Park HS , Dalsey E , Kang YF , Hong S , Lee SA . Asia Pac J Manag 2012 29 (1) 169-189 The current study investigated Korean smokers' and non-smokers' evaluations of an organization implementing a policy which either mandated or recommended that employees quit smoking. Undergraduates (n = 268) were randomly assigned to one of 2 (high vs. low severity of smoke-free policy implementation) x 2 (high vs. low organizational assistance) conditions and indicated their attraction to a hypothetical organization, posing as job applicants. The findings showed that non-smoking individuals' perception of organizational support was more strongly and positively related to organizational attraction when they were more likely to endorse employers' right to control employee smoking behaviors. Ex-smokers indicated greater attraction toward the organization when it was described as implementing a high severity policy than a low severity policy. Non-smokers indicated greater attraction toward the organization when it was described as offering a high level of assistance than a low level of assistance for smokers' cessation efforts. These and other findings concerning individuals' perception of severity, perception of organizational support, smoking sensitivity, and employer control are presented in detail, and the implications thereof are discussed. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Health Behavior and Risk
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Laboratory Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Program Evaluation
- Public Health Leadership and Management
- Public Health, General
- Reproductive Health
- Social and Behavioral Sciences
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:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure