A national public health agenda for osteoarthritis 2010
Lubar D , White PH , Callahan LF , Chang RW , Helmick CG , Lappin DR , Melnick A , Moskowitz RW , Odom E , Sacks J , Toal SB , Waterman MB . Semin Arthritis Rheum 2010 39 (5) 323-6 Arthritis is the most common cause of disability, and osteoarthritis is our nation's most common form of arthritis. This serious, painful and potentially life-altering joint disease places severe limits on daily activity and quality of life for over 27 million Americans. Affecting mainly hands, knees and hips, osteoarthritis (OA) often causes weakness and disability, interferes with work productivity, results in joint replacement and generates inordinate socioeconomic costs. In view of the fact that the U.S. population is aging and obesity is on the rise, the prevalence, health impact and economic consequences of OA are expected to increase dramatically. | Now is the time for bold and innovative action to reduce the burden of this growing public health issue. The National Public Health Agenda for Osteoarthritis sets the stage for a collaborative and focused initiative to achieve three overall goals over the next three to five years: | • | Ensure the availability of evidence-based intervention strategies—such as self management education, physical activity, injury prevention, and weight management and healthy nutrition—to all Americans with OA | • | Establish supportive policies, communication initiatives and strategic alliances for OA prevention and management | • | Initiate needed research to better understand the burden of OA, its risk factors and effective strategies for intervention. | | Leadership from the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation (AF) initiated a collaboration to address ways to reduce the public health burden of osteoarthritis. This collaboration led to the creation of The National Public Health Agenda for Osteoarthritis. This document is an executive summary of the report; the complete report can be found on our journal's website (http://semarthritisrheumatism.com), the AF's website (http://www.arthritis.org/osteoarthritis-agenda.php), and the CDC's website (www.cdc.gov/arthritis/docs/OAagenda.pdf). |
Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States
Crews DC , Plantinga LC , Miller 3rd ER , Saran R , Hedgeman E , Saydah SH , Williams DE , Powe NR . Hypertension 2010 55 (5) 1102-9 Hypertension is both a cause and a consequence of chronic kidney disease, but the prevalence of chronic kidney disease throughout the diagnostic spectrum of blood pressure has not been established. We determined the prevalence of chronic kidney disease within blood pressure categories in 17 794 adults surveyed by the National Health and Nutrition Examination Survey during 1999-2006. Diagnosed hypertension was defined as self-reported provider diagnosis (n=5832); undiagnosed hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, without report of provider diagnosis (n=3046); prehypertension was defined as systolic blood pressure ≥120 and <140 mm Hg or diastolic blood pressure ≥80 and <90 mm Hg (n=3719); and normal was defined as systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg (n=5197). Chronic kidney disease was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2) or urinary albumin:creatinine ratio >30 mg/g. Prevalences of chronic kidney disease among those with prehypertension and undiagnosed hypertension were 17.3% and 22.0%, respectively, compared with 27.5% with diagnosed hypertension and 13.4% with normal blood pressure, after adjustment for age, sex, and race in multivariable logistic regression. This pattern persisted with varying definitions of kidney disease; macroalbuminuria (urinary albumin:creatinine ratio >300 mg/g) had the strongest association with increasing blood pressure category (odds ratio: 2.37 [95% CI: 2.00 to 2.81]). Chronic kidney disease is prevalent in undiagnosed and prehypertension. Earlier identification and treatment of both these conditions may prevent or delay morbidity and mortality from chronic kidney disease. |
Cost-effectiveness of aspirin use among persons with newly diagnosed type 2 diabetes
Li R , Zhang P , Barker L , Hoerger TJ . Diabetes Care 2010 33 (6) 1193-9 OBJECTIVE: To assess the long-term cost-effectiveness of aspirin use among adults ≥ 40 years of age with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS: We used a validated cost-effectiveness model of type 2 diabetes to assess the lifetime health and cost consequences of use or non-use of aspirin. The model simulates the progression of diabetes and accompanying complications for a cohort of persons with type 2 diabetes. The model predicts the outcomes of type 2 diabetes along five disease paths (nephropathy, neuropathy, retinopathy, coronary heart disease, and stroke) from the time of diagnosis until age 94 years or until death. RESULTS: Over a lifetime, aspirin users gained 0.31 life years (LYs) or 0.19 quality-adjusted life years (QALYs) over non-aspirin users at an incremental cost of $1,700; the incremental cost-effectiveness ratio (ICER) of aspirin use was $5,428 per LY gained or $8,801 per QALY gained. In probabilistic sensitivity analyses, the ICER was less than $30,000 per QALY in all of 2,000 realizations in two scenarios. CONCLUSIONS: Regular use of aspirin among persons with newly diagnosed diabetes is cost-effective. |
Results of a program to test women for rectal chlamydia and gonorrhea
Barry PM , Kent CK , Philip SS , Klausner JD . Obstet Gynecol 2010 115 (4) 753-9 OBJECTIVE: To analyze whether rectal testing among women increased chlamydia and gonorrhea case-finding and whether reported receptive anal intercourse was a risk factor for rectal infection. METHODS: From March 2007 to August 2008, women receiving pelvic examinations at the San Francisco sexually transmitted disease clinic were tested for rectal gonorrhea and chlamydia by using a transcription-mediated amplification assay. Results of testing and clinical and demographic data were analyzed using a cross-sectional study design. RESULTS: Of 1,308 women with both rectal and vaginal tests, test results were positive for 79 patients (6.0%) for rectal chlamydia or gonorrhea and 88 patients (6.7%) for genital chlamydia or gonorrhea. Test results were positive for 13 patients (1.0%) at the rectum only, increasing detection from 88 to 101 patients (14.8%; 95% confidence interval 8.1-23.9). No correlation existed between reported anal sex and rectal chlamydia (P=.74); however, 50% of women with rectal gonorrhea reported anal sex compared with 21% of women without rectal gonorrhea (P=.002). CONCLUSION: Sexually transmitted disease clinics might improve chlamydia and gonorrhea case-finding through rectal testing of women, but more study is needed to determine the effects of finding and treating such infections. Reporting anal intercourse did not predict rectal chlamydial infection among women tested at both the rectum and the vagina. LEVEL OF EVIDENCE: II. |
Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women
Creanga AA , Johnson TF , Graitcer SB , Hartman LK , Al-Samarrai T , Schwarz AG , Chu SY , Sackoff JE , Jamieson DJ , Fine AD , Shapiro-Mendoza CK , Jones LE , Uyeki TM , Balter S , Bish CL , Finelli L , Honein MA . Obstet Gynecol 2010 115 (4) 717-726 OBJECTIVE: To examine 2009 H1N1 influenza illness severity and the effect of antiviral treatment on the severity of illness among pregnant women. METHODS: We abstracted medical records from hospitalized pregnant (n=62) and nonpregnant (n=74) women with laboratory-confirmed 2009 H1N1 influenza in New York City, May through June 2009. We compared characteristics of pregnant and nonpregnant women and of severe and moderate influenza illness among pregnant women, with severe defined as illness resulting in intensive care admission or death. RESULTS: The 2009 H1N1 hospitalization rate was significantly higher among pregnant than nonpregnant women (55.3 compared with 7.7 per 100,000 population). Eight pregnant (including two deaths) and 16 nonpregnant (including four deaths) cases were severe. Pregnant women represented 6.4% of hospitalized cases and 4.3% of deaths caused by 2009 H1N1 influenza. Only 1 in 30 (3.3%) pregnant women who received oseltamivir treatment within 2 days of symptom onset had severe illness compared with 3 of 14 (21.4%) and four of nine (44.4%) pregnant women who started treatment 3-4 days and 5 days or more after symptom onset, respectively (P=.002 for trend). Severe and moderate 2009 H1N1 influenza illness occurred in all pregnancy trimesters, but most women (54.8%) were in the third trimester. Twenty-two women delivered during their influenza hospitalization, and severe neonatal outcomes (neonatal intensive care unit admission or death) occurred among five of six (83.3%) women with severe illness compared with 2 of 16 (12.5%) women with moderate illness (P=.004). CONCLUSION: Our findings highlight the potential for severe illness and adverse neonatal outcomes among pregnant 2009 H1N1 influenza-infected women and suggest the benefit of early oseltamivir treatment. LEVEL OF EVIDENCE: II. |
Surveillance and molecular characterization of rotavirus strains circulating in Manipur, north-eastern India: increasing prevalence of emerging G12 strains
Mukherjee A , Chattopadhyay S , Bagchi P , Dutta D , Singh NB , Arora R , Parashar UD , Gentsch JR , Chawla-Sarkar M . Infect Genet Evol 2010 10 (2) 311-20 To determine the frequency and genotypes of rotavirus strains, samples were collected from children hospitalized with acute diarrhea at the Regional Institute of Medical Sciences, Manipur. The globally common genotypes G1P[8] and G2P[4] constituted 58% of the total positive strains, while 3% and 8% strains were emerging genotypes, G9P[6] and G12P[6]. This is the first report of genotype G12 in Manipur. The G12 strains clustered with lineage III strains and had >98% identity with corresponding rotaviruses from Bangladesh, Thailand and the USA. Other uncommon G-P combinations including G4P[4], G4P[6], G10P[6] and G9P[19], along with a few strains that could not be typed were also found. The VP7 genes of G4 and G10 strains clustered with porcine and bovine strains, indicating possible zoonotic transmission. High frequency (36-62%) of rotavirus infection and predominance of G1P[8] and G2P[4] among children with acute diarrhea emphasized the need for implementation of currently available vaccines to reduce the burden of rotavirus induced diarrhea in India. |
Tuberculosis among persons born in the Philippines and living in the United States, 2000-2007
Manangan LP , Salibay CJ , Wallace RM , Kammerer S , Pratt R , McAllister L , Robison V . Am J Public Health 2010 101 (1) 101-11 OBJECTIVES: We examined demographic, clinical, and treatment outcome characteristics of Filipinos with tuberculosis (TB) in the United States. METHODS: We calculated TB case rates from US Census Bureau population estimates and National Tuberculosis Surveillance System data for US-born non-Hispanic Whites and for US residents born in the Philippines, India, China, Cambodia, Vietnam, Pakistan, and Korea- countries that are major contributors to the TB burden in the United States. We compared Filipinos with the other groups through univariate and multivariate analyses. RESULTS: Of 45504 TB patients, 15.5% were Filipinos; 43.0% were other Asian/Pacific Islander groups; and 41.6% were Whites. Per 100000 persons in 2007, the TB rate was 73.5 among Cambodians, 54.0 among Vietnamese, 52.1 among Filipinos, and 0.9 among Whites. Filipinos were more likely than other groups to be employed as health care workers and to have used private health care providers but less likely to be HIV positive and to be offered HIV testing. CONCLUSIONS: The relatively high TB rate among Filipinos indicates that TB control strategies should target this population. Providers should be encouraged to offer HIV testing to all TB patients. |
Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease
Morgan OW , Bramley A , Fowlkes A , Freedman DS , Taylor TH , Gargiullo P , Belay B , Jain S , Cox C , Kamimoto L , Fiore A , Finelli L , Olsen SJ , Fry AM . PLoS One 2010 5 (3) e9694 BACKGROUND: Severe illness due to 2009 pandemic A(H1N1) infection has been reported among persons who are obese or morbidly obese. We assessed whether obesity is a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1), independent of chronic medical conditions considered by the Advisory Committee on Immunization Practices (ACIP) to increase the risk of influenza-related complications. METHODOLOGY/PRINCIPAL FINDINGS: We used a case-cohort design to compare cases of hospitalizations and deaths from 2009 pandemic A(H1N1) influenza occurring between April-July, 2009, with a cohort of the U.S. population estimated from the 2003-2006 National Health and Nutrition Examination Survey (NHANES); pregnant women and children <2 years old were excluded. For hospitalizations, we defined categories of relative weight by body mass index (BMI, kg/m(2)); for deaths, obesity or morbid obesity was recorded on medical charts, and death certificates. Odds ratio (OR) of being in each BMI category was determined; normal weight was the reference category. Overall, 361 hospitalizations and 233 deaths included information to determine BMI category and presence of ACIP-recognized medical conditions. Among >or=20 year olds, hospitalization was associated with being morbidly obese (BMI>or=40) for individuals with ACIP-recognized chronic conditions (OR = 4.9, 95% CI 2.4-9.9) and without ACIP-recognized chronic conditions (OR = 4.7, 95%CI 1.3-17.2). Among 2-19 year olds, hospitalization was associated with being underweight (BMI<or=5(th) percentile) among those with (OR = 12.5, 95%CI 3.4-45.5) and without (OR = 5.5, 95%CI 1.3-22.5) ACIP-recognized chronic conditions. Death was not associated with BMI category among individuals 2-19 years old. Among individuals aged >or=20 years without ACIP-recognized chronic medical conditions death was associated with obesity (OR = 3.1, 95%CI: 1.5-6.6) and morbid obesity (OR = 7.6, 95%CI 2.1-27.9). CONCLUSIONS/SIGNIFICANCE: Our findings support observations that morbid obesity may be associated with hospitalization and possibly death due to 2009 pandemic H1N1 infection. These complications could be prevented by early antiviral therapy and vaccination. |
Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay
Freeman AH , Katz KA , Pandori MW , Rauch LM , Kohn RP , Liska S , Bernstein KT , Klausner JD . Sex Transm Dis 2010 37 (3) 165-8 We describe the epidemiology of Trichomonas vaginalis (TV) among San Francisco County Jail inmates using APTIMA TV analyte-specific reagents on remnant urine. We detected TV in 15/713 (2.1%) men and 95/297 (32.0%) women. Among women, increased age was significantly associated with TV. The benefits of TV screening should be determined. |
Case-control study to evaluate risk factors for acute hepatitis B virus infection in Egypt
Talaat M , Radwan E , El-Sayed N , Ismael T , Hajjeh R , Mahoney FJ . East Mediterr Health J 2010 16 (1) 4-9 Hepatitis B virus (HBV) infection is a significant health problem in Egypt. To better define risk factors associated with HBV transmission, we conducted a case-control study among patients admitted with acute hepatitis to an infectious disease hospital in Cairo. A total of 60 cases and 120 controls were interviewed about various exposures within 6 months prior to admission. Univariate analysis revealed HBV case-patients were more likely to report providing injections to relatives or friends, injecting drug use, exposure to a household contact with hepatitis, exposure to invasive medical procedures and being in the military. Efforts should be made to implement strict infection control standards in Egypt. |
Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)
Cohen SH , Gerding DN , Johnson S , Kelly CP , Loo VG , McDonald LC , Pepin J , Wilcox MH . Infect Control Hosp Epidemiol 2010 31 (5) 431-55 Since publication of the Society for Healthcare Epidemiology of America position paper on Clostridium difficile infection in 1995, significant changes have occurred in the epidemiology and treatment of this infection. C. difficile remains the most important cause of healthcare-associated diarrhea and is increasingly important as a community pathogen. A more virulent strain of C. difficile has been identified and has been responsible for more-severe cases of disease worldwide. Data reporting the decreased effectiveness of metronidazole in the treatment of severe disease have been published. Despite the increasing quantity of data available, areas of controversy still exist. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, and infection control and environmental management. |
Difficulties in the diagnosis and management of a US servicemember presenting with possible chronic Q fever
Ake JA , Massung RF , Whitman TJ , Gleeson TD . J Infect 2010 60 (2) 175-7 A 34 year old corpsman developed acute Q fever upon return from Iraq. Subsequent testing demonstrated trace mitral regurgitation and widely discrepant serologic testing results between commercial and reference laboratories. We discuss the dilemma of isolated minor echocardiographic abnormalities and propose caution in the interpretation of Q fever serologic tests. |
Drug-resistant tuberculosis in sub-Saharan Africa
Hafkin J , Gammino VM , Amon JJ . Curr Infect Dis Rep 2010 12 (1) 36-45 Drug-resistant tuberculosis (DRTB) is an emerging infectious disease threat to sub-Saharan Africa (SSA), particularly in the regions hit hardest by the HIV epidemic. Numerous challenges face clinicians and public health officials tasked with combating DRTB in SSA. These include difficulties providing effective diagnosis, treatment, and prevention of this illness. Furthermore, combating DRTB requires addressing various legal and ethical complexities. A sustained commitment to investigating as well as implementing new diagnostic, therapeutic, and preventative interventions is essential to defeating this threat. copyright 2010 Springer Science+Business Media, LLC. |
Decreases in smoking prevalence in Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) project
Liao Y , Tsoh JY , Chen R , Foo MA , Garvin CC , Grigg-Saito D , Liang S , McPhee S , Nguyen TT , Tran JH , Giles WH . Am J Public Health 2010 100 (5) 853-60 OBJECTIVES: We examined trends in smoking prevalence from 2002 through 2006 in 4 Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) intervention. METHODS: Annual survey data from 2002 through 2006 were gathered in 4 REACH Asian communities. Trends in the age-standardized prevalence of current smoking for men in 2 Vietnamese communities, 1 Cambodian community, and 1 Asian American/Pacific Islander (API) community were examined and compared with nationwide US and state-specific data from the Behavioral Risk Factor Surveillance System. RESULTS: Prevalence of current smoking decreased dramatically among men in REACH communities. The reduction rate was significantly greater than that observed in the general US or API male population, and it was greater than reduction rates observed in the states in which REACH communities were located. There was little change in the quit ratio of men at the state and national levels, but there was a significant increase in quit ratios in the REACH communities, indicating increases in the proportions of smokers who had quit smoking. CONCLUSIONS: Smoking prevalence decreased in Asian communities served by the REACH project, and these decreases were larger than nationwide decreases in smoking prevalence observed for the same period. However, disparities in smoking prevalence remain a concern among Cambodian men and non-English-speaking Vietnamese men; these subgroups continue to smoke at a higher rate than do men nationwide. |
Does the composition of urine change when collected from disposable diapers and other absorbent materials?
Ye X , Zhou X , Bishop AM , Needham LL , Calafat AM . J Expo Sci Environ Epidemiol 2010 20 (7) 644-9 The free and conjugated urinary species of non-persistent environmental chemicals or their breakdown products are valid human exposure biomarkers. For convenience, disposable diapers and other absorbent materials are widely used to collect urine specimens from infants and young toddlers. However, the extent to which the different urinary species of the target analytes and other components are recovered after the urine is extracted from these absorbent materials is unknown. In this proof-of-concept study, we investigated the extraction recovery from disposable diapers, cotton pads, and gauzes of the free versus glucuronidated urinary species of three example chemicals: bisphenol A, triclosan, and 4-methylumbelliferone. Although the glucuronides were almost fully recovered, the free species were not. Our results suggest that, in addition to other sampling considerations, the binding affinity and extraction recovery of the target biomarkers to the material used to collect the urine should be considered. Alternative collection approaches that do not require such an extraction (e.g., urine bags routinely used in hospitals) may be worth exploring. Despite its shortcomings, having urinary concentrations for biomonitoring considerably strengthens the exposure assessment, particularly for infants and young toddlers, and the benefits of including biomonitoring data outweigh their potential limitations.Journal of Exposure Science and Environmental Epidemiology advance online publication, 24 March 2010; doi:10.1038/jes.2010.16. |
Biomonitoring for environmental exposures to arsenic
Orloff K , Mistry K , Metcalf S . J Toxicol Environ Health B Crit Rev 2009 12 (7) 509-24 Arsenic (As) is a widely occurring environmental contaminant. To assess human exposures to As, public health officials and researchers often conduct biomonitoring. Samples of urine, hair, nails, or blood are collected from potentially exposed people and are analyzed for As compounds and their metabolites. When analyzing for As exposure, it is useful to distinguish between As species, since they differ in their origin and toxicity. Urine is the most frequently used biological medium for biomonitoring. Measuring the urinary concentration of As is useful in assessing recent exposure to As, and high-quality reference ranges are available for urinary As concentrations in the U.S. population. Biomonitoring for As in hair and nails has been used in many studies and is particularly useful in evaluating chronic exposures to As. Interpreting the health implications of As concentrations in biological samples is limited by the small number of studies that provide information on the correlation and dose-response relationship between biomonitoring test results and adverse health effects. This study discusses the advantages and limitations of biomonitoring for As in biological samples and provides illustrative case studies. |
Outbreak of Carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel Carbapenemase variant
Gregory CJ , Llata E , Stine N , Gould C , Santiago LM , Vazquez GJ , Robledo IE , Srinivasan A , Goering RV , Tomashek KM . Infect Control Hosp Epidemiol 2010 31 (5) 476-84 BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality. OBJECTIVE: To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak. DESIGN: Two case-control studies. SETTINGS: A 328-bed tertiary care teaching hospital. PATIENTS:Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period. METHODS: We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla(KPC) gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis. RESULTS: In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak. CONCLUSIONS: Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak. |
Prevalence of insufficient, borderline, and optimal hours of sleep among high school students - United States, 2007
Eaton DK , McKnight-Eily LR , Lowry R , Perry GS , Presley-Cantrell L , Croft JB . J Adolesc Health 2010 46 (4) 399-401 We describe the prevalence of insufficient, borderline, and optimal sleep hours among U.S. high school students on an average school night. Most students (68.9%) reported insufficient sleep, whereas few (7.6%) reported optimal sleep. The prevalence of insufficient sleep was highest among female and black students, and students in grades 11 and 12. |
Fruits and vegetables intake and physical activity among hypertensive adults in the United States: Behavioral Risk Factor Surveillance System, 2003 and 2007
Fang J , Keenan NL , Ayala C , Dai S , Valderrama AL . Am J Hypertens 2010 23 (7) 762-6 BACKGROUND: Consuming enough fruits and vegetables and engaging in regular physical activity are believed to be two important components of several lifestyle modifications for people with hypertension. The purpose of this study was to measure the degree to which US adults with hypertension achieved recommended intakes of fruits and vegetables and engaged in recommended levels of physical activity in 2003 and 2007. METHODS: Using the Behavioral Risk Factor Surveillance System (BRFSS) data conducted in 2003 (N = 264,178) and 2007 (N = 430,082), we determined the changes in the prevalence of eating ≥5 servings of fruits and vegetables and of obtaining Healthy People 2010 recommended level of physical activity among adults with hypertension during the period. RESULTS: In 2003 and 2007, among individuals with hypertension, age-adjusted prevalences of eating ≥5 servings of fruits and vegetables were 23.8 and 24.4% (P = 0.394) and meeting a recommended physical activity level were 38.2 and 40.3% (P < 0.001). With 2003 as the reference, odds ratios (95% confidence interval) of eating ≥5 servings of fruits and vegetables and meeting a recommended physical activity for 2007 were 1.02 (0.97-1.08) and 1.06 (1.01-1.10), respectively, after adjusting for relevant factors. CONCLUSIONS: Among hypertensives, less than a quarter are eating five or more servings of fruits and vegetables per day, and less than half are meeting recommended physical activity. In 4 years, there was no statistically significant improvement in intake of fruits and vegetables and just a slight, albeit statistically significant, improvement in physical activity among US adults. American Journal of Hypertension 2010; doi:10.1038/ajh.2010.46. |
Diabetes risk reduction behaviors among U.S. adults with prediabetes
Geiss LS , James C , Gregg EW , Albright A , Williamson DF , Cowie CC . Am J Prev Med 2010 38 (4) 403-9 BACKGROUND: Diabetes can be prevented or delayed in high-risk adults through lifestyle modifications, including dietary changes, moderate-intensity exercise, and modest weight loss. However, the extent to which U.S. adults with prediabetes are making lifestyle changes consistent with reducing risk is unknown. PURPOSE: This study aimed to study lifestyle changes consistent with reducing diabetes risk and factors associated with their adoption among adults with prediabetes. METHODS: In 2009, data were analyzed from 1402 adults aged ≥20 years without diabetes who participated in the 2005-2006 National Health and Nutrition Examination Survey and had valid fasting plasma glucose and oral glucose tolerance tests. The extent to which adults with prediabetes report that in the past year they tried to control or lose weight, reduced the amount of fat or calories in their diet, or increased physical activity or exercise was estimated and factors associated with the adoption of these behaviors were examined. RESULTS: Almost 30% of the U.S. adult population had prediabetes in 2005-2006, but only 7.3% (95% CI=5.5%, 9.2%) were aware they had it. About half of adults with prediabetes reported performing diabetes risk reduction behaviors in the past year, but only about one third of adults with prediabetes had received healthcare provider advice about these behaviors in the past year. In multivariate analyses, provider advice, female gender, and being overweight or obese were positively associated with all three risk reduction behaviors. CONCLUSIONS: Adoption of risk reduction behaviors among U.S. adults with prediabetes is suboptimal. Efforts to improve awareness of prediabetes, increase promotion of healthy behaviors, and improve availability of evidence-based lifestyle programs are needed to slow the growth in new cases of diabetes. |
Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008
Kallen AJ , Hidron AI , Patel J , Srinivasan A . Infect Control Hosp Epidemiol 2010 31 (5) 528-31 We evaluated isolates of Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii that were reported to the National Healthcare Safety Network from January 2006 through December 2008 to determine the proportion that represented multidrug-resistant phenotypes. The pooled mean percentage of resistance varied by the definition used; however, multidrug resistance was relatively common and widespread. |
Hospitalization earlier than 1 year prior to admission as an additional risk factor for methicillin-resistant Staphylococcus aureus colonization
McAllister L , Gaynes RP , Rimland D , McGowan Jr JE . Infect Control Hosp Epidemiol 2010 31 (5) 538-40 Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk. |
Analyzing national health reform strategies with a dynamic simulation model
Milstein B , Homer J , Hirsch G . Am J Public Health 2010 100 (5) 811-9 Proposals to improve the US health system are commonly supported by models that have only a few variables and overlook certain processes that may delay, dilute, or defeat intervention effects. We use an evidence-based dynamic simulation model with a broad national scope to analyze 5 policy proposals. Our results suggest that expanding insurance coverage and improving health care quality would likely improve health status but would also raise costs and worsen health inequity, whereas a strategy that also strengthens primary care capacity and emphasizes health protection would improve health status, reduce inequities, and lower costs. A software interface allows diverse stakeholders to interact with the model through a policy simulation game called HealthBound. |
Child maltreatment fatalities in children under 5: findings from the National Violence Death Reporting System
Klevens J , Leeb RT . Child Abuse Negl 2010 34 (4) 262-6 OBJECTIVE: To describe the distribution of child maltreatment fatalities of children under 5 by age, sex, race/ethnicity, type of maltreatment, and relationship to alleged perpetrator using data from the National Violent Death Reporting System (NVDRS). STUDY DESIGN: Two independent coders reviewed information from death certificates, medical examiner and police reports corresponding to all deaths in children less than 5 years of age reported to NVDRS in 16 states. RESULTS: Of the 1,374 deaths for children under 5 reported to NVDRS, 600 were considered attributable to child maltreatment. Over a half of the 600 victims of child maltreatment in this age group were under 1 year old, 59% were male, 42% non-Hispanic Whites, and 38% were non-Hispanic Blacks. Two thirds of child maltreatment fatalities in children under 5 were classified as being due to abusive head trauma (AHT), 27.5% as other types of physical abuse, and 10% as neglect. Based on these data, fathers or their substitutes were significantly more likely than mothers to be identified as alleged perpetrators for AHT and other types of physical abuse, while mothers were more likely to be assigned responsibility for neglect. CONCLUSIONS: Among children under 5 years, children under 1 are the main age group contributing to child maltreatment fatalities in the NVDRS. AHT is the main cause of death in these data. These findings are limited by underascertainment of cases and fair inter-rater reliability of coding. PRACTICE IMPLICATIONS: The findings suggest the need to develop and evaluate interventions targeting AHT to reduce the overall number of child maltreatment deaths in young children. These interventions should make special efforts to include fathers and their substitutes. |
A selective TrkB agonist with potent neurotrophic activities by 7,8-dihydroxyflavone
Jang SW , Liu X , Yepes M , Shepherd KR , Miller GW , Liu Y , Wilson WD , Xiao G , Blanchi B , Sun YE , Ye K . Proc Natl Acad Sci U S A 2010 107 (6) 2687-92 Brain-derived neurotrophic factor (BDNF), a cognate ligand for the tyrosine kinase receptor B (TrkB) receptor, mediates neuronal survival, differentiation, synaptic plasticity, and neurogenesis. However, BDNF has a poor pharmacokinetic profile that limits its therapeutic potential. Here we report the identification of 7,8-dihydroxyflavone as a bioactive high-affinity TrkB agonist that provokes receptor dimerization and autophosphorylation and activation of downstream signaling. 7,8-Dihydroxyflavone protected wild-type, but not TrkB-deficient, neurons from apoptosis. Administration of 7,8-dihydroxyflavone to mice activated TrkB in the brain, inhibited kainic acid-induced toxicity, decreased infarct volumes in stroke in a TrkB-dependent manner, and was neuroprotective in an animal model of Parkinson disease. Thus, 7,8-dihydroxyflavone imitates BDNF and acts as a robust TrkB agonist, providing a powerful therapeutic tool for the treatment of various neurological diseases. |
Standardization of testosterone measurements in humans
Vesper HW , Botelho JC . J Steroid Biochem Mol Biol 2010 121 513-519 Testosterone levels are used primarily for the diagnosis of hypogonadism in men and androgen excess in women. Current studies suggest that serum testosterone measurements may be indicated in a wide range of diseases and conditions. Translation of testosterone levels outside of the reference ranges into clinical treatment, appropriate cut offs for clinical guidelines and epidemiological studies with public health impact pose challenges due to the measurement variability among assays and in assay sensitivity. While introducing mass spectrometry technology can overcome some of these challenges and help to improve measurements, it faces variability issues similar to those observed with immunoassays that need to be addressed. To overcome these problems in testosterone testing, the Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences (CDC/NCEH/DLS) started a steroid hormone standardization project. Their objective was to create testosterone measurement results that are traceable to one accuracy basis, thus allowing measurements to be comparable across methods, time, and location. CDC/NCEH/DLS conducts activities to standardize and improve testosterone assays and laboratory measurements by establishing metrological traceability to a higher order reference method and material. In addition, the standardization effort includes pre- and post-analytical challenges, such as test selection, interpretation, and establishing reference ranges to improve the translation of standardized results into clinical guidelines and public health assessments. CDC is conducting these standardization activities in collaboration with the clinical, laboratory, and research communities. |
Taenia crassiceps cysticerci: characterization of the 14-kDa glycoprotein with homologies to antigens from Taenia solium cysticerci
Peralta RH , Espindola NM , Pardini AX , Iha AH , Moura H , Barr JR , Vaz AJ , Peralta JM . Exp Parasitol 2010 124 (3) 295-300 Glycoproteins from the total vesicular fluid of Taenia crassiceps (VF-Tc) were prepared using three different purification methods, consisting of ConA-lectin affinity chromatography (ConA-Tc), preparative electrophoresis (SDS-PAGE) (14 gp-Tc), and monoclonal antibody immunoaffinity chromatography (18/14-Tc). The complex composition represented by the VF-Tc and ConA-Tc antigens revealed peptides ranging from 101- to 14-kDa and from 92- to 12-kDa, respectively. Immunoblotting using lectins confirmed glucose/mannose (glc/man) residues in the 18- and 14-kDa peptides, which are considered specific and immunodominant for the diagnosis of cysticercosis, and indicated that these fractions are glycoproteins. Serum antibodies from a patient with neurocysticercosis that reacted to the 14 gp band from T. crassiceps (Tc) were eluted from immunoblotting membranes and showed reactivity to 14 gp from Taenia solium. In order to determine the similar peptide sequence, the N-terminal amino acid was determined and analyzed with sequences available in public databases. This sequence revealed partial homology between T. crassiceps and T. solium peptides. In addition, mass spectrometry along with theoretical M(r) and pI of the 14 gp-Tc point suggested a close relationship to some peptides of a 150-kDa protein complex of the T. solium previously described. The identification of these common immunogenic sites will contribute to future efforts to develop recombinant antigens and synthetic peptides for immunological assays. |
Nucleic acid amplification tests for the diagnosis of neisseria gonorrhoeae and chlamydia trachomatis rectal infections
Bachmann LH , Johnson RE , Cheng H , Markowitz L , Papp JR , Palella FJ Jr , Hook 3rd EW . J Clin Microbiol 2010 48 (5) 1827-32 Optimal methods for the diagnosis of rectal gonococcal and chlamydial infection are uncertain. This study evaluated performance of culture and nucleic acid amplification tests (NAATs) for rectal chlamydial and gonococcal diagnosis. From July 2003 until February 2007, 441 rectal test sets were collected from individuals attending a sexually transmitted disease clinic and 3 HIV clinics who gave a history of anal intercourse or were women at high risk for N. gonorrhoeae or C. trachomatis infections. Rectal swab specimens were tested using culture and commercial NAATs employing Transcription Mediated Amplification (TMA), Strand Displacement Amplification (SDA), and Polymerase Chain Reaction (PCR) Amplification. Test performance was evaluated using a rotating standard by which patients were classified infected if either two or three comparator tests were positive. Test sensitivities for the detection of N. gonorrhoeae ranged from 66.7% to 71.9% for culture to 100% for TMA. Specificities were 99.7% to 100% for culture and greater than 95.5% for all 3 NAATs. Test sensitivities for C. trachomatis ranged from 36.1% to 45.7% for culture and among NAATS from 91.4% to 95.8% for PCR to 100% for TMA. Specificities of the NAATs ranged from 95.6% to 98.5% (2 of 3 standard) and from 88.8% to 91.8% (3 of 3 standard). Over 60% and 80% of gonococcal and chlamydial infections among men who have sex with men and over 20% of chlamydial infections in women, respectively, would have been missed if the rectal site had not been tested. Currently available NAATs are more sensitive than culture for detection of chlamydial and gonococcal infection at the rectal site. |
Experimental inoculation of pigs with pandemic H1N1 2009 virus and HI cross-reactivity with contemporary swine influenza virus antisera
Vincent AL , Lager KM , Faaberg KS , Harland M , Zanella EL , Ciacci-Zanella JR , Kehrli ME Jr , Janke BH , Klimov A . Influenza Other Respir Viruses 2010 4 (2) 53-60 BACKGROUND: A novel A/H1N1 was identified in the human population in North America in April 2009. The gene constellation of the virus was a combination from swine influenza A viruses (SIV) of North American and Eurasian lineages that had never before been identified in swine or other species. OBJECTIVES: The objectives were to (i) evaluate the clinical response of swine following experimental inoculation with pandemic H1N1 2009; (ii) assess serologic cross-reactivity between H1N1 2009 and contemporary SIV antisera; and (iii) develop a molecular assay to differentiate North American-lineage SIV from H1N1 2009. METHODS: Experiment 1: Weaned pigs were experimentally infected with A/California/04/2009 (H1N1). Experiment 2: The cross-reactivity of a panel of US SIV H1N1 or H1N2 antisera with three isolates of pandemic A/H1N1 was evaluated. Experiment 3: A polymerase chain reaction (PCR)-based diagnostic test was developed and validated on samples from experimentally infected pigs. RESULTS AND CONCLUSIONS: In experiment 1, all inoculated pigs demonstrated clinical signs and lesions similar to those induced by endemic SIV. Viable virus and antigen were only detected in the respiratory tract. In experiment 2, serologic cross-reactivity was limited against H1N1 2009 isolates, notably among virus antisera from the same HA phylogenetic cluster. The limited cross-reactivity suggests North American pigs may not be fully protected against H1N1 2009 from previous exposure or vaccination and novel tests are needed to rapidly diagnose the introduction of H1N1 2009. In experiment 3, an RT-PCR test that discriminates between H1N1 2009 and endemic North American SIV was developed and validated on clinical samples. |
An improved high-performance liquid chromatography-tandem mass spectrometric method to measure atrazine and its metabolites in human urine
Panuwet P , Restrepo PA , Magsumbol M , Jung KY , Montesano MA , Needham LL , Barr DB . J Chromatogr B Analyt Technol Biomed Life Sci 2010 878 957-62 We report an improved solid-phase extraction-high-performance liquid chromatography-tandem mass spectrometry method with isotope dilution quantification to measure seven atrazine metabolites in urine. The metabolites measured were hydroxyatrazine (HA), diaminochloroatrazine (DACT), desisopropylatrazine (DIA), desethylatrazine (DEA), desethylatrazine mercapturate (DEAM), atrazine mercapturate (ATZM), and atrazine (ATZ). Using offline mixed-mode reversed-phase/cation-exchange solid-phase extraction dramatically increased recovery and sensitivity by reducing the influence of matrix components during separation and analysis. DACT extraction recovery improved to greater than 80% while the other analytes had similar extraction efficiencies as previously observed. Limits of detection were lower than our previous method (0.05-0.19ng/mL) with relative standard deviations less than 10%. The total runtime was shorter (18min) than the previous on-line method, thus it is suitable for large-scale sample analyses. We increased the throughput of our method twofold by using the newer extraction technique. |
An interlaboratory comparison of three multiplexed bead-based immunoassays for measuring serum antibodies to pneumococcal polysaccharides
Whaley MJ , Rose C , Martinez J , Laher G , Sammons DL , Smith JP , Snawder JE , Borrow R , Biagini RE , Plikaytis B , Carlone GM , Romero-Steiner S . Clin Vaccine Immunol 2010 17 (5) 862-9 Serotype-specific IgG, as quantified by a standardized WHO ELISA, is a serologic end-point used to evaluate pneumococcal polysaccharide-based vaccine immunogenicity. Antibodies to each vaccine polysaccharide in licensed multivalent vaccines are quantified separately; this is laborious and consumes serum. We compared three bead-based immunoassays, a commercial assay (xMAP(R)Pneumo14, Luminex) and two in-house assays (Health Protection Agency [HPA] and Centers for Disease Control and Prevention [CDC]) using WHO recommended standard reference and reference sera (n=11) from vaccinated adults. Multiple comparisons of the IgG concentrations for seven conjugate vaccine serotypes were performed by sample (percent error), serotype (equivalency testing), and laboratory (concordance correlation coefficient [CCC]). When comparing concentrations by sample, bead-based immunoassays generally yielded higher antibody concentrations than ELISA and had higher variability for serotypes 6B, 18C, and 23F. None of the three assays met the current WHO recommendation of 75% of sera falling within +/-40% of the assigned antibody concentrations for all seven serotypes. When compared by serotype, CDC and HPA were equivalent for 5 of 7 serotypes, whereas Luminex was equivalent for 4 of 7 serotypes. When overall mean IgG concentrations were compared by laboratories, a higher level of agreement, CCC close to 1, was found among bead-based immunoassays than between the assays and WHO assignments. When compared to WHO assignments, the HPA assay out performed (r = 0.920, rc = 0.894, Ca = 0.972) the other assays. Additional testing with sera from immunogenicity studies should demonstrate the applicability of this methodology for vaccine evaluation. |
Detection of West Nile viral RNA from field-collected mosquitoes in tropical regions by conventional and real-time RT-PCR
Gonzalez-Reiche AS , Monzon-Pineda Mde L , Johnson BW , Morales-Betoulle ME . Methods Mol Biol 2010 630 109-24 West Nile virus (WNV) is an emerging mosquito-borne flavivirus, which has rapidly spread and is currently widely distributed. Therefore, efforts for WNV early detection and ecological surveillance of this disease agent have been increased around the world. Although virus isolation is known to be the standard method for detection and identification of viruses, the use of RT-PCR assays as routine laboratory tests provides a rapid alterative suitable for the detection of viral RNA on field-collected samples. A method for WNV RNA genome detection in field-collected mosquitoes is presented in this chapter. This method has been designed for virus surveillance in tropical regions endemic for other flaviviruses. Reverse Transcriptase-PCR (RT-PCR) assays, both standard and real time, to detect WNV and other flaviviruses are described. A first screening for flavivirus RNA detection is performed using a conventional RT-PCR with two different sets of flavivirus consensus primers. Mosquito samples are then tested for WNV RNA by a real-time (TaqMan) RT-PCR assay. Sample preparation and RNA extraction procedures are also described. |
Recent trends in cesarean delivery in the United States
Menacker F , Hamilton BE . NCHS Data Brief 2010 (35) 1-8 KEY FINDINGS: Data from the Natality Data File, National Vital Statistics System The cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States. From 1996 to 2007, the cesarean rate increased for mothers in all age and racial and Hispanic origin groups. The pace of the increase accelerated from 2000 to 2007. Cesarean rates also increased for infants at all gestational ages; from 1996 to 2006 preterm infants had the highest rates. Cesarean rates increased for births to mothers in all U.S. states, and by more than 70% in six states from 1996 to 2007. |
Perinatal outcomes for Asian, Native Hawaiian, and other Pacific Islander mothers of single and multiple race/ethnicity: California and Hawaii, 2003-2005
Schempf AH , Mendola P , Hamilton BE , Hayes DK , Makuc DM . Am J Public Health 2010 100 (5) 877-87 OBJECTIVES: We examined characteristics and birth outcomes of Asian/Pacific Islander (API) mothers to determine whether differences in outcomes existed between mothers of single race/ethnicity and multiple race/ethnicity. METHODS: We used data from California and Hawaii birth certificates from 2003 through 2005 to describe variation in birth outcomes for API subgroups by self-reported maternal race/ethnicity (single versus multiple race or API subgroup), and we also compared these outcomes to those of non-Hispanic White women. RESULTS: Low birthweight (LBW) and preterm birth (PTB) varied more among API subgroups than between mothers of single versus multiple race/ethnicity. After adjustment for sociodemographic and behavioral risk factors, API mothers of multiple race/ethnicity had outcomes similar to mothers of single race/ethnicity, with exceptions for multiple race/ethnicity-Chinese (higher PTB), Filipino (lower LBW and PTB), and Thai (higher LBW) subgroups. Compared with single-race non-Hispanic Whites, adverse outcomes were elevated for most API subgroups: only single-race/ethnicity Korean mothers had lower rates of both LBW (3.4%) and PTB (5.6%); single-race/ethnicity Cambodian, Laotian, and Marshallese mothers had the highest rates of both LBW (8.8%, 9.2%, and 8.4%, respectively) and PTB (14.0%, 13.7%, and 18.8%, respectively). CONCLUSIONS: Strategies to improve birth outcomes for API mothers should consider variations in risk by API subgroup and multiple race/ethnicity. |
Assessment of the Institute of Medicine recommendations for weight gain during pregnancy: Florida, 2004-2007
Park S , Sappenfield WM , Bish C , Salihu H , Goodman D , Bensyl DM . Matern Child Health J 2010 15 (3) 289-301 We investigated the association between 2009 IOM recommendations and adverse infant outcomes by maternal prepregnancy body mass index (BMI). Birth outcomes for 570,672 women aged 18-40 years with a singleton full-term live-birth were assessed using 2004-2007 Florida live-birth certificates. Outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA). Associations between gestational weight change and outcomes were assessed for 10 BMI groups by calculating proportions, and logistic regression modeling was used to produce adjusted odds ratios (aORs) to account for the effect of confounders. We created comparison categories below and above recommendations using 2009 IOM recommendations as a reference. Of importance, 41.6% of women began pregnancy as overweight and obese and 51.2% gained weight excessively during pregnancy on the basis of 2009 IOM recommendations. Proportions of LGA were higher among obese women and increased with higher weight gain. Compared with recommended weight gain, aORs for LGA were lower with less than recommended gain (aOR range: 0.27-0.77) and higher with more than recommended gain (aOR range: 1.27-5.99). However, SGA was less prevalent among obese women, and the proportion of SGA by BMI was similar with higher weight gain. Gain less than recommended was associated with increased odds of SGA (aOR range: 1.11-2.97), and gain greater than recommended was associated with decreased odds of SGA (aOR range: 0.38-0.83). Gestational weight gain influenced the risk for LGA and SGA in opposite directions. Minimal weight gain or weight loss lowered risk for LGA among obese women. Compared with 1990 IOM recommendations, 2009 recommendations include weight gain ranges that are associated with lower risk of LGA and higher risk of SGA. Awareness of these tradeoffs may assist with clinical implementation of the 2009 IOM gestational weight gain recommendations. However, our results did not consider other maternal and infant outcomes related to gestational weight gain; therefore, the findings should be interpreted with caution. |
Prediction of porosity and permeability of caved zone in longwall gobs
Karacan CO . Transp Porous Media 2010 82 (2) 413-439 The porosity and permeability of the caved zone (gob) in a longwall operation impact many ventilation and methane control related issues, such as air leakage into the gob, the onset of spontaneous combustion, methane and air flow patterns in the gob, and the interaction of gob gas ventholes with the mining environment. Despite its importance, the gob is typically inaccessible for performing direct measurements of porosity and permeability. Thus, there has always been debate on the likely values of porosity and permeability of the caved zone and how these values can be predicted. This study demonstrates a predictive approach that combines fractal scaling in porous medium with principles of fluid flow. The approach allows the calculation of porosity and permeability from the size distribution of broken rock material in the gob, which can be determined from image analyzes of gob material using the theories on a completely fragmented porous medium. The virtual fragmented fractal porous medium so generated is exposed to various uniaxial stresses to simulate gob compaction and porosity and permeability changes during this process. The results suggest that the gob porosity and permeability values can be predicted by this approach and the presented models are capable to produce values close to values documented by other researchers. |
Occupational and recreational noise exposures at stock car racing circuits: an exploratory survey of three professional race tracks
Kardous CA , Morata TC . Noise Control Eng J 2010 58 (1) 54-61 Noise in stock car racing is accepted as a normal occurrence but the exposure levels associated with the sport have not been adequately characterized. Researchers from the National Institute for Occupational Safety and Health (NIOSH) conducted an exploratory assessment of noise exposures to drivers, racing team members, and spectators at three stock car racing events. Sound level measurements were conducted using sound level meters, personal noise dosimeters, and a digital audio tape recorder that made sound recordings for later laboratory analysis. Area sound level measurements were made during race preparation, practice, qualification, and competition. Personal dosimetry measurements were conducted on drivers, team members, and spectators. Findings showed time-weighted averages (TWA) that ranged from A-weighted 96 decibels (dBA) for a spectator in the stands during a race to 114 dBA for a driver inside a car during practice. Peak sound pressure levels exceeded the maximum allowable limit of 140 dB during race competitions. Personal exposure measurements exceeded the NIOSH recommended exposure limit of 85 dBA as an 8-hr TWA in less than a minute for one driver during practice, within several minutes for team members, and less than one hour for spectators during the race. Hearing protection use was variable and intermittent among team members and spectators. Among drivers and team members, there was greater concern for communication performance than for hearing protection. |
Challenges and strategies in applying performance measurement to federal public health programs
Degroff A , Schooley M , Chapel T , Poister TH . Eval Program Plann 2010 33 (4) 365-72 Performance measurement is widely accepted in public health as an important management tool supporting program improvement and accountability. However, several challenges impede developing and implementing performance measurement systems at the federal level, including the complexity of public health problems that reflect multiple determinants and involve outcomes that may take years to achieve, the decentralized and networked nature of public health program implementation, and the lack of reliable and consistent data sources and other issues related to measurement. All three of these challenges hinder the ability to attribute program results to specific public health program efforts. The purpose of this paper is to explore these issues in detail and offer potential solutions that support the development of robust and practical performance measures to meet the needs for program improvement and accountability. Adapting performance measurement to public health programs is both an evolving science and art. Through the strategies presented here, appropriate systems can be developed and monitored to support the production of meaningful data that will inform effective decision making at multiple levels. |
Utilization of health services in physician offices and outpatient clinics by adolescents and young women in the United States: implications for improving access to reproductive health services
Hoover KW , Tao G , Berman S , Kent CK . J Adolesc Health 2010 46 (4) 324-30 PURPOSE: We examined utilization patterns of adolescents and young women as they seek general and reproductive health services in physician offices and hospital outpatient clinics. METHODS: We analyzed physician office visits in the 2003-2006 National Ambulatory Medical Care Surveys, and hospital outpatient clinic visits in the National Hospital Ambulatory Medical Care Surveys, to examine utilization patterns of females aged 9-26 years by 2-year age intervals and other characteristics such as physician specialty or clinic type. RESULTS: The number of visits to primary care physician offices increased with age, from 4.9 million for ages 9-10 years to 9.0 million for ages 25-26 years. The proportion of visits made to obstetrician-gynecologists and family practitioners increased with age, and by ages 15-16 years fewer than half of all visits to primary care providers were made to pediatricians. The proportion of visits to family practitioners increased from 25% at ages 9-10 years to 30% at ages 25-26 years. By ages 17-18 years, a larger proportion of visits were made to obstetrician-gynecologists (33% of 7.0 million visits) and to family practitioners (34%) than to pediatricians (23%). The proportion of visits for reproductive health services peaked at 53% of 7.5 million physician visits at ages 20-21 years. Similar utilization patterns were observed for the 11.0 million hospital outpatient visits to primary care providers. CONCLUSIONS: Because adolescents and young women most commonly utilize healthcare services provided by obstetrician-gynecologists and family practitioners, these specialties should be priority targets for interventions to improve the quality and availability of reproductive health services. |
Condoms for dual protection: patterns of use with highly effective contraceptive methods
Pazol K , Kramer MR , Hogue CJ . Public Health Rep 2010 125 (2) 208-17 OBJECTIVES: U.S. women experience high rates of unplanned pregnancy and sexually transmitted infections (STIs), yet they seldom combine condoms with highly effective contraceptives for optimal protection. Because oral contraceptives (OCs) have been the predominant form of highly effective contraception in the U.S., it is unknown whether condom use is similarly low with increasingly promoted user-independent methods. METHODS: We used weighted data from the National Survey of Family Growth to assess condom use odds among women relying on OCs vs. user-independent methods (i.e., injectibles, intrauterine devices, and implants). We also estimated the expected reduction in unplanned pregnancies and abortions if half or all of the women currently using a single highly effective method also used condoms. RESULTS: Across every demographic subgroup based on age, partner status, race/ethnicity, household income, and education, condom use prevalence was lower for women relying on user-independent methods vs. OCs. Multivariable models for adult women also revealed a significant reduction within most demographic subgroups in the odds of condom use among women relying on user-independent methods vs. OCs. Population estimates suggested that if half of all women using highly effective methods alone also used condoms, approximately 40% of unplanned pregnancies and abortions among these women could be prevented, for an annual reduction of 393,000 unplanned pregnancies and nearly 76,000 abortions. If all highly effective method users also used condoms, approximately 80% of unplanned pregnancies and abortions among these women could be prevented, for an annual reduction of 786,000 unplanned pregnancies and nearly 152,000 abortions. CONCLUSIONS: Adding condoms to other methods should be considered seriously as the first line of defense against unplanned pregnancy and STls. This analysis can serve to target interventions where dual-method promotion is needed most. |
Thermodynamic and differential entropy under a change of variables
Hnizdo V , Gilson MK . Entropy (Basel) 2010 12 (3) 578-590 The differential Shannon entropy of information theory can change under a change of variables (coordinates), but the thermodynamic entropy of a physical system must be invariant under such a change. This difference is puzzling, because the Shannon and Gibbs entropies have the same functional form. We show that a canonical change of variables can, indeed, alter the spatial component of the thermodynamic entropy just as it alters the differential Shannon entropy. However, there is also a momentum part of the entropy, which turns out to undergo an equal and opposite change when the coordinates are transformed, so that the total thermodynamic entropy remains invariant. We furthermore show how one may correctly write the change in total entropy for an isothermal physical process in any set of spatial coordinates. |
Homozygous triplicate mutations in three 16S rRNA genes: responsible for high-level aminoglycoside resistance in Nocardia farcinica clinically isolated in the Canada-wide bovine mastitis epizootic
Kogure T , Shimada R , Ishikawa J , Yazawa K , Brown JM , Mikami Y , Gonoi T . Antimicrob Agents Chemother 2010 54 (6) 2385-90 Nocardia farcinica strains showing high-level resistance to amikacin were isolated from clinical cases in a Canada-wide bovine mastitis epizootic. Shotgun cloning of the resistance genes in the amikacin-resistant mastitis isolate N. farcinica IFM 10580 (= W6220, CDC) using a multicopy vector system revealed that the 16S rRNA gene with an A to G single-point mutation at position 1408 (in E. coli numbering) conferred "moderate" cross-resistance to amikacin and other aminoglycosides to an originally susceptible N. farcinica strain IFM 10152. Subsequent DNA sequence analyses revealed that, in contrast to the susceptible strain, all three chromosomal 16S rRNA genes of IFM 10580, the epizootic clinical strain, contained the same A1408G point mutations. Mutant colonies showing high-level aminoglycoside resistance were obtained when the susceptible strain N. farcinica IFM 10152 was transformed with a multicopy plasmid carrying the A1408G mutant 16S rRNA gene and was cultured in the presence of aminoglycosides for 3-5 days. Of these transformants, at least two of the three chromosomal 16S rRNA genes contained A1408G mutations. A triple mutant was easily obtained from a strain carrying the two chromosomal A1408G mutant genes and one wild-type gene, even in the absence of the plasmid. The triple mutant showed the highest-level of resistance to aminoglycosides, even in the absence of the plasmid carrying the mutant 16S rRNA gene. These results suggest that the homozygous mutations in the three 16S rRNA genes are responsible for the high-level aminoglycoside resistance found in N. farcinica isolates of the bovine mastitis epizootic. |
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