The United States National Health and Nutrition Examination Survey and the epidemiology of ankylosing spondylitis in the United States
Dillon CF , Hirsch R . Am J Med Sci 2011 341 (4) 281-3 Currently available U.S. population-based data for ankylosing spondylitis (AS), spondyloarthritis and inflammatory back pain (IBP) from the nationally representative U.S. National Health and Nutrition Examination Survey (NHANES) include both NHANES I (1971-1975) and NHANES II (1976-1980) surveys. The pelvic radiographs obtained in NHANES I provided U.S. prevalence estimates for radiographic sacroiliitis, an important component of the AS case definition. AS and spondyloarthritis prevalences cannot readily be calculated from NHANES I survey data; however, IBP prevalence (Rudwaleit et al Criteria 7b) can be estimated from NHANES II. The NHANES II estimate for IBP is 0.8% of the adult population ages 25 to 49 years. The prevalence of IBP in the subset of persons with a history of a back pain episode lasting 2 or more weeks was 6.7%. The 2009-2010 NHANES U.S. Inflammatory Back Pain/Spondyloarthritis survey is currently fielded. |
Vulnerable populations and the association between periodontal and chronic kidney disease
Grubbs V , Plantinga LC , Crews DC , Bibbins-Domingo K , Saran R , Heung M , Patel PR , Burrows NR , Ernst KL , Powe NR . Clin J Am Soc Nephrol 2011 6 (4) 711-7 BACKGROUND AND OBJECTIVES: Recent studies suggest an overall association between chronic kidney disease (CKD) and periodontal disease, but it is unknown whether this association is similar across various subpopulations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study was a cross-sectional analysis of 2001 to 2004 National Health and Nutrition Examination Survey data. CKD was defined as a urinary albumin-to-creatinine ratio ≤30 mg/g or estimated GFR of 15 to 59 ml/min per 1.73 m(2). Adjusted odds ratios were calculated using multivariable logistic regression with U.S. population-based weighting. RESULTS: These analyses included 6199 dentate adult participants (aged 21 to 75 years) with periodontal exams. The estimated prevalences of moderate/severe periodontal disease and CKD were 5.3% and 10.6%, respectively. Periodontal disease was associated with >2-fold higher risk of CKD that was moderately attenuated after adjustment for age, gender, race/ethnicity, tobacco use, hypertension, diabetes, educational attainment, poverty index ratio, and dental care use. There were no statistically significant interactions between periodontal disease and race/ethnicity, educational attainment, or poverty status. Less-than-recommended dental care use was associated with periodontal disease and CKD and was increasingly prevalent among nonwhites, lower educational attainment, and lower poverty status. CONCLUSIONS: The association between periodontal disease and CKD is not significantly different among subgroups. However, because nonwhites, those with a lower educational level, and the poor less frequently report use of recommended dental care, the association between periodontal disease and kidney function over time may become stronger among these groups and warrants further investigation. |
The Colorectal Cancer Control Program: partnering to increase population level screening
Joseph DA , Degroff AS , Hayes NS , Wong FL , Plescia M . Gastrointest Endosc 2011 73 (3) 429-34 Colorectal cancer (CRC) is the second leading cause of | cancer deaths in the United States, killing more nonsmokers than any other cancer.1 In 2006, more than 139,000 | people were diagnosed with CRC and more than 53,000 | died of the disease.2 Screening can effectively decrease | CRC incidence and mortality in 2 ways: first, unlike most | cancers, screening offers the opportunity to prevent cancer by removing premalignant polyps; second, screening | can detect CRC early when treatment is more effective.3,4 If | CRC is diagnosed at early stages, the 5-year survival rate is | more than 88%.5 In a modeling study to assess deaths | prevented through increased use of clinical preventive | services, Farley et al6 estimated that 1900 deaths could be | prevented for every 10% increase in CRC screening with a | colonoscopy. |
Conceptual framework of the Controlling Asthma in American Cities Project
Herman EJ . J Urban Health 2011 88 Suppl 1 7-15 The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need. |
Peramivir: another tool for influenza treatment?
Jain S , Fry AM . Clin Infect Dis 2011 52 (6) 707-9 During the 2009 influenza A (H1N1) (pH1N1) pandemic, young persons and groups with certain health conditions, including pregnant women, were disproportionately affected, although illnesses and influenza-related complications were seen in all age groups [1, 2]. Vaccine was not available until after the peak of the fall pH1N1 wave in the Northern Hemisphere, after the peak of pH1N1 circulation in the Southern Hemisphere, and not until early 2010 in many developing countries [3]. Thus, influenza antiviral drugs were the primary influenza-specific pharmacologic tools available to minimize severe illness and death, and there were limited treatment options for severely ill persons, especially those receiving mechanical ventilation. One year after the pandemic and as the annual influenza season looms for the Northern Hemisphere, this is a salient time to think about the tools at hand and in development to mitigate severe illness from influenza infection. |
Gonococcal resistance: are cephalosporins next?
Kirkcaldy RD , Ballard RC , Dowell D . Curr Infect Dis Rep 2011 13 (2) 196-204 The development of resistance to multiple antibiotics has limited treatment options for gonorrhea in many countries. Currently, the Centers for Disease Control and Prevention only recommend cephalosporin antibiotics for treatment of uncomplicated gonorrhea. Although the cephalosporins remain effective, the demonstrated ability of Neisseria gonorrhoeae to develop resistance has raised concerns about the possibility of multidrug-resistant N. gonorrhoeae strains, which include cephalosporin resistance. This article provides a review of global trends in cephalosporin susceptibility among gonococcal isolates, recent findings that deepen our understanding of genetic mechanisms of resistance, and the public health and clinical implications of the potential emergence of cephalosporin-resistant gonorrhea. |
Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda
Butler LM , Were WA , Balinandi S , Downing R , Dollard S , Neilands TB , Gupta S , Rutherford GW , Mermin J . J Infect Dis 2011 203 (5) 625-34 BACKGROUND: Human herpesvirus 8 (HHV-8) infection is endemic in sub-Saharan Africa. We examined sociodemographic, behavioral, and biological factors associated with HHV-8 infection in children and adults to determine HHV-8 seroprevalence and potential routes of transmission. METHODS: Participants were 1383 children and 1477 adults from a population-based sample in a rural community in Uganda. Serum samples were tested for HHV-8 antibodies with use of an enzyme immunoassay against K8.1. RESULTS: HHV-8 seroprevalence increased from 16% among children aged 1.5-2 years to 32% among children aged 10-13 years (P <.001) and from 37% among participants aged 14-19 years to 49% among adults aged ≥ 50 years (P <.05). HHV-8 seropositivity in children was independently associated with residing with a seropositive parent (P < .001) and residing with ≥ 1 other seropositive child aged <14 years (P < .001). History of sharing food and/or sauce plates was marginally associated with HHV-8 infection in children (P = .05). Among 1404 participants aged ≥ 15 years , there was no association between correlates of sexual behavior (eg, number of lifetime sex partners and HIV infection) and HHV-8 seropositivity (P > .10). CONCLUSIONS: Our data suggest that HHV-8 is acquired primarily through horizontal transmission in childhood from intrafamilial contacts and that transmission continues into adulthood potentially through nonsexual routes. |
The Blood Xenotropic Murine Leukemia Virus-Related Virus Scientific Research Working Group: mission, progress, and plans
Simmons G , Glynn SA , Holmberg JA , Coffin JM , Hewlett IK , Lo SC , Mikovits JA , Switzer WM , Linnen JM , Busch MP . Transfusion 2011 51 (3) 643-53 Recently, there have been studies that indicate that Xenotropic Murine Leukemia Virus (MLV)-related Virus (XMRV), a newly described human gammaretrovirus, and other related viruses, may be associated with both prostate cancer and myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS)1–4. It has also been suggested that these viruses have the potential to be transmitted by blood transfusion5. However, a number of studies have failed to support these associations, or indeed detect significant evidence of XMRV in the human population6–9. Currently, there is insufficient information to determine whether or not XMRV and related viruses are a threat to blood safety. Accordingly, the Department of Health and Human Services (HHS) has established a Scientific Research Working Group (SRWG) to explore the following questions: What is the prevalence of XMRV in the donor population? Is XMRV transmissible by blood transfusion? And if XMRV is transmissible by transfusion, are there any pathologic consequences for the infected recipient? As a starting point, the SRWG has focused on standardizing the various tests used to detect XMRV in blood samples and has facilitated the sharing of clinical samples between laboratories. This commentary discusses background information relating to blood safety and XMRV and related viruses and outlines the specific actions that the SRWG has taken and plans to take. |
Protecting the public from H1N1 through Points of Dispensing (PODs)
Rinchiuso-Hasselmann A , McKay RL , Williams CA , Starr DT , Morgenthau BM , Zucker JR , Raphael M . Biosecur Bioterror 2011 9 (1) 13-21 In fall 2009, the New York City Department of Health and Mental Hygiene (DOHMH) operated 58 points of dispensing (PODs) over 5 weekends to provide influenza A (H1N1) 2009 monovalent vaccination to New Yorkers. Up to 7 sites were opened each day across the 5 boroughs, with almost 50,000 New Yorkers being vaccinated. The policies and protocols used were based on those developed for New York City's POD Plan, the cornerstone of the city's mass prophylaxis planning. Before the H1N1 experience, NYC had not opened more than 5 PODs simultaneously and had only experienced the higher patient volume seen with the H1N1 PODs on 1 prior occasion. Therefore, DOHMH identified factors that contributed to the success of POD operations, as well as areas for improvement to inform future mass prophylaxis planning and response. Though this was a relatively small-scale, preplanned operation, during which a maximum of 7 PODs were operated on a given day, the findings have implications for larger-scale mass prophylaxis planning for emergencies. |
Family and home asthma services across the Controlling Asthma in American Cities Project
Brown AS , Disler S , Burns L , Carlson A , Davis A , Kurian C , Weems D Jr , Wilson K . J Urban Health 2011 88 Suppl 1 100-12 Asthma is among the most common chronic childhood diseases, affecting 6.8 million children nationwide. The highest rates of morbidity and mortality associated with the disease occur among those living in the inner city. Because asthma is a complex disease affected by physiological, social, environmental, and behavioral factors, interventions to reduce its morbidity burden need to address multiple determinants of health. In response to this need, the Centers for Disease Control and Prevention developed a multisite cooperative agreement for the Controlling Asthma in American Cities Project (CAAC), with the primary goal of developing innovative, effective community-based interventions. All CAAC sites found a need for family and home asthma services (FHAS) and developed multicomponent (e.g., asthma self-management, social services, coordinated care) and multitrigger environmental interventions. This paper presents a synthesis of key program variables and process indicators for six CAAC FHAS interventions for consideration by communities, coalitions, or programs planning to implement similar activities. |
Assessing community-based approaches to asthma control: the Controlling Asthma in American Cities Project
Herman EJ , Garbe PL , McGeehin MA . J Urban Health 2011 88 Suppl 1 1-6 More than 30 million people in the USA have been diagnosed with asthma during their lifetime. Of the 20 million US residents who currently have asthma, 12 million have had an asthma episode or attack during the past year. Asthma affects people of all races, both sexes, and all ages, and in every region of the USA. However, asthma occurs more often among children, women and girls, African Americans, Puerto Ricans, people in the Northeast, those living below the federal poverty level, and those with particular work-related exposures. Asthma death rates rose between 1980 and 1996 among both sexes and most age and ethnic groups, but have declined since 2000. Women and girls account for nearly 64% of asthma deaths overall, although, among children, more boys than girls die each year. Many of the 4,000 asthma-related deaths that occur annually could be avoided with proper treatment and care.1 | The burden of asthma in the USA has increased greatly over the last 25 years and affects our nation and health system in more ways than limited and lost lives. Asthma leads to almost 13 million outpatient physician visits and two million emergency department visits each year. Asthma is a leading cause of school absenteeism with children missing almost 14 million school days per year due to asthma.2 Asthma is the fourth leading cause of work absenteeism and diminished work productivity among adults, resulting in nearly 12 million missed or less productive workdays each year.2 The estimated annual cost of asthma for 2006 was over $32 billion, including nearly $28 billion in direct health care costs and $4.5 billion for indirect costs such as lost earnings due to illness or death.3 |
An acarologic survey and Amblyomma americanum distribution map with implications for tularemia risk in Missouri
Brown HE , Yates KF , Dietrich G , Macmillan K , Graham CB , Reese SM , Helterbrand WS , Nicholson WL , Blount K , Mead PS , Patrick SL , Eisen RJ . Am J Trop Med Hyg 2011 84 (3) 411-419 In the United States, tickborne diseases occur focally. Missouri represents a major focus of several tickborne diseases that includes spotted fever rickettsiosis, tularemia, and ehrlichiosis. Our study sought to determine the potential risk of human exposure to human-biting vector ticks in this area. We collected ticks in 79 sites in southern Missouri during June 7-10, 2009, which yielded 1,047 adult and 3,585 nymphal Amblyomma americanum, 5 adult Amblyomma maculatum, 19 adult Dermacentor variabilis, and 5 nymphal Ixodes brunneus. Logistic regression analysis showed that areas posing an elevated risk of exposure to A. americanum nymphs or adults were more likely to be classified as forested than grassland, and the probability of being classified as elevated risk increased with increasing relative humidity during the month of June (30-year average). Overall accuracy of each of the two models was greater than 70% and showed that 20% and 30% of the state were classified as elevated risk for human exposure to nymphs and adults, respectively. We also found a significant positive association between heightened acarologic risk and counties reporting tularemia cases. Our study provides an updated distribution map for A. americanum in Missouri and suggests a wide-spread risk of human exposure to A. americanum and their associated pathogens in this region. |
Landscape and residential variables associated with plague-endemic villages in the West Nile region of Uganda
MacMillan K , Enscore RE , Ogen-Odoi A , Borchert JN , Babi N , Amatre G , Atiku LA , Mead PS , Gage KL , Eisen RJ . Am J Trop Med Hyg 2011 84 (3) 435-42 Plague, caused by the bacteria Yersinia pestis, is a severe, often fatal disease. This study focuses on the plague-endemic West Nile region of Uganda, where limited information is available regarding environmental and behavioral risk factors associated with plague infection. We conducted observational surveys of 10 randomly selected huts within historically classified case and control villages (four each) two times during the dry season of 2006 (N = 78 case huts and N = 80 control huts), which immediately preceded a large plague outbreak. By coupling a previously published landscape-level statistical model of plague risk with this observational survey, we were able to identify potential residence-based risk factors for plague associated with huts within historic case or control villages (e.g., distance to neighboring homestead and presence of pigs near the home) and huts within areas previously predicted as elevated risk or low risk (e.g., corn and other annual crops grown near the home, water storage in the home, and processed commercial foods stored in the home). The identified variables are consistent with current ecologic theories on plague transmission dynamics. This preliminary study serves as a foundation for future case control studies in the area. |
Genome Medicine: past, present and future.
Auffray C , Caulfield T , Khoury MJ , Lupski JR , Schwab M , Veenstra T . Genome Med 2011 3 (1) 6 The field of genomic medicine continues to expand, driven by the efforts of numerous researchers around the world. To celebrate Genome Medicine's 2nd anniversary, we asked our Section Editors what they felt were the most exciting breakthroughs in research in the past 2 years and what the future of genomic medicine might hold. |
Computational analysis suggests that lyssavirus glycoprotein gene plays a minor role in viral adaptation.
Tang K , Wu X . Int J Evol Biol 2011 2011 143498 The Lyssavirus glycoprotein (G) is a membrane protein responsible for virus entry and protective immune responses. To explore possible roles of the glycoprotein in host shift or adaptation of Lyssavirus, we retrieved 53 full-length glycoprotein gene sequences from NCBI GenBank. The sequences were from different host isolates over a period of 70 years in 21 countries. Computational analyses detected 1 recombinant (AY987478, a dog isolate of CHAND03, genotype 1 in India) with incongruent phylogenetic support. No recombination was detected when AY98748 was excluded in the analyses. We applied different selection models to identify selection pressure on the glycoprotein gene. One codon at amino acid residual 483 was found to be under weak positive selection with marginal probability of 95% by using the maximum likelihood method. We found no significant evidence of positive selection on any site of the glycoprotein gene when the putative recombinant AY987478 was excluded. The computational analyses suggest that the G gene has been under purifying selection and that the evolution of the G gene may not play a significant role in Lyssavirus adaptation. |
Differences between African-American adolescent females with and without human papillomavirus infection
Seth P , Wingood GM , Diclemente RJ , Crosby RA , Salazar LF , Rose ES , Sales JM . Sex Health 2011 8 (1) (1) 125-127 BACKGROUND: An important policy question is whether high-risk populations can be identified and prioritised for human papillomavirus (HPV) immunisation. METHODS: Data collection included an audio computer-assisted survey interview and testing of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and HPV among 295 African-American adolescent females. RESULTS: The results indicated that 43.1% tested positive for HPV. Logistic regression analyses indicated that HPV prevalence was not associated with other sexually transmissible infections (prevalence ratio (PR)=0.85, 95% confidence interval (CI)=0.51-1.41), unprotected vaginal sex (PR=1.04, 95% CI=0.56-1.92), having sex with an older male partner (PR=1.12, 95% CI=0.64-1.96), and having a casual partner (PR=0.89, 95% CI=0.54-1.48). Additionally, t-tests indicated that HPV prevalence was not associated with frequency of vaginal sex (t=0.17, P=0.87), protected sex (t=0.16, P=0.87), number of recent (t=0.40, P=0.69) or lifetime (t=1.45, P=0.15) sexual partners. However, those testing positive for HPV were younger (t=1.97, P=0.05) and reported current use of birth control pills (PR=2.38, 95% CI=1.00-5.63). CONCLUSIONS: It may not be possible to identify those with elevated risk of HPV acquisition. Thus, HPV vaccination, regardless of risk indicators, may be the most efficacious public health strategy. CSIRO 2011. |
Meaningful measure of performance: a foundation built on valid, reproducible findings from surveillance of health care-associated infections
Fridkin SK , Olmsted RN . Am J Infect Control 2011 39 (2) 87-90 A tenet of public health practice is that surveillance systems must be able to evolve in response to ever changing needs of the communities and society they serve. In the case of health care-associated infection (HAI) surveillance, the needs of patients, providers, other consumers, and payers of health care have become drivers of recent evolution, although sometimes they appear to generate movement in different directions. A leading example is the apparent tension between comprehensive public reporting of facility-specific HAI data intended to meet mounting consumer and payer demands for a broad set of comparative quality measures and the more focused, traditional surveillance of select HAIs developed to satisfy the needs of providers for data to identify internal HAI prevention priorities and measure the impact of interventions within their institutions. In the past, if infections that met HAI surveillance criteria were deemed nonpreventable by clinicians, the consequences were limited to debates within the facility and internal decisions about how best to use the data. However, the advent of state-based mandates for HAI reporting and public release of facility-specific HAI data, coupled with a new federal HAI reporting requirement, have cast a spotlight on certain operational methods and definitional criteria used. Methods and criteria considered sufficient for HAI surveillance within facilities have elicited criticism when proposed as a means to measure performance. |
Health care-associated infections studies project: case 4
Wright MO , Hebden JN , Allen-Bridson K , Morrell GC , Horan T . Am J Infect Control 2011 39 (1) 64-65 Welcome to the fourth publication of a joint effort between the American Journal of Infection Control and the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). This collaboration is a series of case studies representing surveillance scenarios faced everyday by infection preventionists (IPs) using NHSN definitions. | With each case, a link to an online survey will be provided, where you may answer the questions posed and receive immediate feedback in the form of answers and explanations. All individual participant answers will remain confidential, although it is the authors’ hope to share a summary of the findings at a later date. The content development was a partnership between the listed authors, and all cases, answers, and explanations have been reviewed and approved by the NHSN. |
Donor-derived Strongyloides stercoralis infections in renal transplant recipients
Hamilton KW , Abt PL , Rosenbach MA , Bleicher MB , Levine MS , Mehta J , Montgomery SP , Hasz RD , Bono BR , Tetzlaff MT , Mildiner-Early S , Introcaso CE , Blumberg EA . Transplantation 2011 91 (9) 1019-24 BACKGROUND: Donor-derived Strongyloides stercoralis infection occurs rarely after transplantation, and the risk factors are not well understood. We present cases of two renal allograft recipients who developed Strongyloides hyperinfection syndrome after receipt of organs from a common deceased donor who received high-dose steroids as part of a preconditioning regimen. METHODS: The two renal transplant patients who developed Strongyloides hyperinfection syndrome are reported in case study format with review of the literature. RESULTS: Microscopic examination of stool from one renal transplant patient and of tracheal and gastric aspirates from the other transplant patient revealed evidence of S.stercoralis larvae. Retrospective testing of serum from the deceased donor for Strongyloides antibodies by enzyme-linked immunosorbent assay was positive at 11.7 U/mL (Centers for Disease Control reference >1.7 U/mL positive). One patient was treated successfully with oral ivermectin. The other patient also had complete resolution of strongyloidiasis, but required a course of parenteral ivermectin because of malabsorption from severe gastrointestinal strongyloidiasis. CONCLUSIONS: These case studies provide some of the best evidence of transmission of S.stercoralis by renal transplantation. Because of the high risk of hyperinfection syndrome and its associated morbidity and mortality, high-risk donors and recipients should be screened for Strongyloides infection, so that appropriate treatment can be initiated before the development of disease. This study indicates that parenteral ivermectin can be used safely and effectively in patients in whom severe malabsorption would preclude the effective use of oral formulation. These cases also suggest that reconsideration should be given for the safety of steroids in donor-preconditioning regimens. |
Predictors of hepatitis A vaccination among young children in the United States
Byrd KK , Santibanez TA , Chaves SS . Vaccine 2011 29 (17) 3254-9 We analysed data from the 2009 National Immunization Survey to determine potential predictors of hepatitis A vaccination coverage among children aged 19-35 months. Overall national coverage was 75% for ≥1 dose. Residence in a state with hepatitis A vaccination recommendations prior to 2006, or in a metropolitan statistical area within such state, or being a minority child were among the variables independently associated with higher vaccination coverage. While hepatitis A vaccination coverage has improved since nationwide routine childhood vaccination began in 2006, coverage remains lower than that for other recommended childhood vaccines. |
Comment on the contribution by Souayah et al., "Guillain-Barre syndrome after Gardasil vaccination: data from Vaccine Adverse Event Reporting System 2006-2009"
Slade BA , Gee J , Broder KR , Vellozzi C . Vaccine 2011 29 (5) 865-6 Souayah et al. recently [1] described reports of Guillain–Barré syndrome (GBS) following the quadrivalent human papillomavirus vaccine (HPV4 or Gardasil®) received by the United States Vaccine Adverse Event Reporting System (VAERS) during 2006–2009. The authors accessed the publically available VAERS dataset (http://vaers.hhs.gov), and supplemented it with data from the Food and Drug Administration (FDA) under the Freedom of Information Act, but did not fully account for some of the limitations of VAERS in their interpretation of the data. | As a spontaneous reporting system that is national in scope, VAERS is an important signal-detection system that can generate hypotheses to be tested more rigorously using other data sources [2], [3]. Since reporting is voluntary, VAERS data are subject to reporting biases, such as under-reporting and stimulated reporting (e.g., after the introduction of a new vaccine or when there is publicity around a vaccine). The temporal association of an adverse event with vaccination alone does not prove a causal relationship and VAERS cannot usually assess causality [2], [4]. Furthermore, the information provided on the VAERS report is often incomplete and, without additional review of medical records, it is difficult to verify the reported diagnoses. In a review of HPV4-related VAERS reports through 2008 [5], there were 42 reports of GBS. Of the 21 cases with adequate medical records, only 12 cases (57%) met the Brighton Collaboration case definition of GBS [6]. Although VAERS is a critical frontline system, the Centers for Disease Control and Prevention (CDC) relies on other systems such as the Vaccine Safety Datalink (VSD) to assess any potential associations between vaccination and adverse events, including GBS [7]. |
Multiplex immunoassay for Lyme disease using VlsE1-IgG and pepC10-IgM antibodies: improving test performance through bioinformatics
Porwancher RB , Hagerty CG , Fan J , Landsberg L , Johnson BJ , Kopnitsky M , Steere AC , Kulas K , Wong SJ . Clin Vaccine Immunol 2011 18 (5) 851-9 The Centers for Disease Control and Prevention currently recommends a 2-tier serologic approach to Lyme disease laboratory diagnosis, comprised of an initial serum enzyme immunoassay (EIA) for antibody to Borrelia burgdorferi followed by supplementary IgG and IgM Western blotting of EIA-positive or -equivocal samples. Western blot accuracy is limited by subjective interpretation of weak-positive bands, false-positive IgM immunoblots, and low sensitivity for early disease. We developed an objective alternative second-tier immunoassay using a multiplex microsphere system that measures VlsE1-IgG and pepC10-IgM antibodies simultaneously from the same sample. Our study population was comprised of 79 patients with early acute Lyme disease, 82 with early convalescent, 47 with stages II or III disease, 34 post-antibiotic treatment patients, and 794 controls. A bioinformatic technique called partial receiver-operating characteristic (ROC) regression was used to combine individual antibody levels into a single diagnostic score with a single cutoff; this technique enhances test performance when high specificity is required (e.g. ≥95%). Compared to the Western blot, the multiplex assay was equally specific (95.6%), but 20.7% more sensitive for early convalescent disease (89.0% versus 68.3%, respectively; 95% CI of difference: 12.1% to 30.9%) and 12.5% more sensitive overall (75.0% versus 62.5%, respectively; 95% CI of difference: 8.1% to 17.1%). When used as a second-tier test, a multiplex assay for VlsE1-IgG and pepC10-IgM antibodies performed as well as or better than the Western blot for Lyme disease diagnosis. Prospective validation studies appear to be warranted. |
Comparison of global- and local-scale pansharpening for rapid assessment of humanitarian emergencies
Kim M , Holt JB , Madden M . Photogramm Eng Remote Sensing 2011 77 (1) 51-63 We compared global-scale pansharpening of full- or large-scene QuickBird satellite imagery with local-scale pansharpening of a subset of these scenes by using modified intensity-hue-saturation (mills), principal component analysis (PGA), multiplicative (MP), and high pass filter (tiff) methods. The spectral properties of all pansharpened images were evaluated by using quantitative indices such as erreur relative globale adimensionnelle de synthese (ERGAs), correlation coefficient (cc), relative difference to mean (RDm), and relative difference to standard deviation (RDs). This study discovered that local-scale pansharpening was generally lower and higher than the global-scale approach in terms of ERGAS and cc, respectively. In particular, local-scale HPF produced pansharpening results very close to the original multispectral image with less than 0.18 percent and 0.07 percent of RDM and RDS, respectively. Local-scale fusion results with PCA and MP were similar to those of the global-scale approach. Local-scale pansharpening that uses very high spatial resolution imagery could lead to the rapid assessment of the magnitude and severity of humanitarian situations by producing a color image of high spatial resolution with reduced processing time. |
Intimate partner violence perpetration by court-ordered men: distinctions and intersections among physical violence, sexual violence, psychological abuse, and stalking
Basile KC , Hall JE . J Interpers Violence 2011 26 (2) 230-53 This study assessed the construct validity of two different measurement models of male partners' perpetration of physical violence, sexual violence, psychological abuse, and stalking against intimate partners. Data were obtained from a sample of 340 men arrested for physical assault of a female spouse or partner and court ordered into batterer intervention programs. Men were surveyed before starting the intervention. Confirmatory factor analysis (CFA) was used to compare the construct validity of a four-factor measurement model of intimate partner violence (IPV) perpetration to a three-factor measurement model that combined psychological abuse with stalking; overlap in the perpetration of the various forms of IPV was also examined. CFA results supported the superiority of a four-factor measurement model. There were 96.8% of participants who reported perpetration of all four types of violence; most men perpetrated multiple types of violence. Future studies should determine whether there are distinct risk factors associated with each of the four types of IPV perpetration. |
Quality assurance for Duchenne and Becker muscular dystrophy genetic testing: development of a genomic DNA reference material panel.
Kalman L , Leonard J , Gerry N , Tarleton J , Bridges C , Gastier-Foster JM , Pyatt RE , Stonerock E , Johnson MA , Richards CS , Schrijver I , Ma T , Miller VR , Adadevoh Y , Furlong P , Beiswanger C , Toji L . J Mol Diagn 2011 13 (2) 167-74 Duchenne and Becker muscular dystrophies (DMD/BMD) are allelic X-linked recessive disorders that affect approximately 1 in 3500 and 1 in 20,000 male individuals, respectively. Approximately 65% of patients with DMD have deletions, 7% to 10% have duplications, and 25% to 30% have point mutations in one or more of the 79 exons of the dystrophin gene. Most clinical genetics laboratories test for deletions, and some use technologies that can detect smaller mutations and duplications. Reference and quality control materials for DMD/BMD diagnostic and carrier genetic testing are not commercially available. To help address this need, the Centers for Disease Control and Prevention-based Genetic Testing Reference Material Coordination Program, in collaboration with members of the genetic testing and the DMD/BMD patient communities and the Coriell Cell Repositories, have characterized new and existing cell lines to create a comprehensive DMD/BMD reference material panel. Samples from 31 Coriell DMD cell lines from male probands and female carriers were analyzed using the Affymetrix SNP Array 6.0 and Multiplex Ligation-Dependent Probe Amplification (MRC-Holland BV, Amsterdam, the Netherlands), a multiplex PCR assay, and DNA sequence analysis. Identified were 16 cell lines with deletions, 9 with duplications, and 4 with point mutations distributed throughout the dystrophin gene. There were no discordant results within assay limitations. These samples are publicly available from Coriell Institute for Medical Research (Camden, NJ) and can be used for quality assurance, proficiency testing, test development, and research, and should help improve the accuracy of DMD testing. |
Diagnosis of influenza from respiratory autopsy tissues: detection of virus by real-time reverse transcription-PCR in 222 cases.
Denison AM , Blau DM , Jost HA , Jones T , Rollin D , Gao R , Liu L , Bhatnagar J , Deleon-Carnes M , Shieh WJ , Paddock CD , Drew C , Adem P , Emery SL , Shu B , Wu KH , Batten B , Greer PW , Smith CS , Bartlett J , Montague JL , Patel M , Xu X , Lindstrom S , Klimov AI , Zaki SR . J Mol Diagn 2011 13 (2) 123-8 The recent influenza pandemic, caused by a novel H1N1 influenza A virus, as well as the seasonal influenza outbreaks caused by varieties of influenza A and B viruses, are responsible for hundreds of thousands of deaths worldwide. Few studies have evaluated the utility of real-time reverse transcription-PCR to detect influenza virus RNA from formalin-fixed, paraffin-embedded tissues obtained at autopsy. In this work, respiratory autopsy tissues from 442 suspect influenza cases were tested by real-time reverse transcription-PCR for seasonal influenza A and B and 2009 pandemic influenza A (H1N1) viruses and the results were compared to those obtained by immunohistochemistry. In total, 222 cases were positive by real-time reverse transcription-PCR, and of 218 real-time, reverse transcription-PCR-positive cases also tested by immunohistochemistry, only 107 were positive. Although formalin-fixed, paraffin-embedded tissues can be used for diagnosis, frozen tissues offer the best chance to make a postmortem diagnosis of influenza because these tissues possess nucleic acids that are less degraded and, as a consequence, provide longer sequence information than that obtained from fixed tissues. We also determined that testing of all available respiratory tissues is critical for optimal detection of influenza virus in postmortem tissues. |
Zoster sine herpete: virologic verification by detection of anti-VZV IgG antibody in CSF
Blumenthal DT , Shacham-Shmueli E , Bokstein F , Schmid DS , Cohrs RJ , Nagel MA , Mahalingam R , Gilden D . Neurology 2011 76 (5) 484-5 Classic zoster sine herpete (ZSH) is defined clinically as dermatomal distribution pain without rash. ZSH was designated as a nosologic entity based on virologic confirmation in 3 men over age 60 with chronic thoracic-distribution radicular pain, with amplifiable varicella zoster virus (VZV) DNA found in CSF of the first 2 patients1 and in blood mononuclear cells (MNCs) in the third patient.2 Herein, we describe a patient who developed radicular pain without rash in the same dermatome as his initial cervical-distribution zoster episode, but with a remarkably prolonged interval between episodes, and in whom ZSH was virologically confirmed by the detection of anti-VZV immunoglobulin G (IgG) antibody in CSF with serum/CSF ratios indicative of intrathecal antibody synthesis. |
Pre-sampling contamination of filters used in measurements of airborne (1 → 3)-β-D-glucan based on glucan-specific Limulus amebocyte lysate assay
Shogren ES , Park JH . J Environ Monit 2011 13 (4) 1082-7 Air sampling for (1 --> 3)-beta-D-glucan may be a good method for assessing inhalation exposure to airborne fungi. Pre-sampling contamination of filter media used for sampling (1 --> 3)-beta-D-glucan may lead to substantial exposure measurement errors. Using the Limulus amebocyte lysate assay, we tested for pre-sampling levels of (1 --> 3)-beta-D-glucan on three types of filters-mixed cellulose ester (MCE)[1 brand], glass fiber (GF)[1 brand], and polycarbonate (PC)[5 brands]. Levels of (1 --> 3)-beta-D-glucan on MCE filters exceeded 4586.1 pg per filter. Levels on GF filters averaged 135.3 (+/-28.9) pg per filter (range = 94.8-160.4 pg per filter) and levels on PC filters averaged 152.4 (+/-236.1) pg per filter (range = non-detectable-1760.7 pg per filter). Efforts to clean MCE and GF filters were unfeasible or unsuccessful. Sonicating PC filters for two hours in ethanol, followed by a wash in pyrogen-free water, effectively eliminated measured levels of (1 --> 3)-beta-D-glucan on four brands of PC filters, as compared to untreated PC filters. This pretreatment process did not appear to physically damage the PC filters. Air sampling results highlighted the potentially problematic contamination of untreated PC filters. Ensuring that sampling media are free of (1 --> 3)-beta-D-glucan before sampling is crucial to accurately measure levels of (1 --> 3)-beta-D-glucan exposure, especially in environments where levels of (1 --> 3)-beta-D-glucan are low. |
Quantitative mid-infrared diffuse reflection of occupational wood dust exposures
Chirila MM , Lee T , Flemmer MM , Slaven JE , Harper M . Appl Spectrosc 2011 65 (3) 243-9 Occupational exposure to airborne wood dust has been implicated in the development of several symptoms and diseases, including nasal carcinoma. However, the assessment of occupational wood dust exposure is usually performed by gravimetric analysis, which is non-specific. In this study, a mid-infrared (mid-IR) diffuse reflection method was adapted for direct on-filter determination of wood dust mass. The cup from the diffuse reflection unit was replaced with a horizontal translational stage and a filter with wood dust was set thereon. Diffuse reflection (DR) spectra were collected from filters with six different diameters in order to average the signal from the most filter surface. Two absorption bands around 1595 and 1510 cm(-1), attributed to lignin, were monitored for quantitative analysis. Calibration curves were constructed for standard extrathoracic red oak and yellow pine (aerodynamic particle diameters between 10 and 100 mum). Calibration of DR intensity versus known wood dust mass on the filter using the Kubelka-Munk function showed a nonlinear dependence for mass of less than 10 mg of wood dust. The experimental data and small-thickness samples indicate that Kubelka-Munk conditions are not obeyed. Alternatively, the pseudo-absorption function log(1/R), for which R is the relative reflectance, while still giving nonlinear dependence against mass, is closer to a linear dependence and has been preferred by other researchers. Therefore, we consider the use of the log(1/R) function for mid-infrared DR analysis of neat, small-thickness wood dust samples. Furthermore, we suggest the use of a silver metal membrane filter for direct on-filter analysis of wood dust rather than the glass fiber filters that have been used previously. |
Identification of cytokeratin-18 as a biomarker of mouse and human hepatosplenic schistosomiasis
Manivannan B , Rawson P , Jordan TW , Karanja DM , Mwinzi PN , Secor WE , La Flamme AC . Infect Immun 2011 79 (5) 2051-8 Previously, we demonstrated unique protein expression patterns in 20-week Schistosoma mansoni-infected CBA/J mice with moderate splenomegaly syndrome (MSS) or hypersplemomegaly syndrome (HSS). To better understand development of severe pathology, we compared the 2D-DIGE (two-dimensional differential in gel electrophoresis) proteomic signatures of livers from uninfected mice and mice infected for 6, 8, 12, or 20-weeks and found significant changes in collagen isoforms, IL-2, cytokeratin 18, hydroxyproline, S. mansoni-phosphoenolpyruvate carboxykinase, major urinary protein isoforms and peroxiredoxin 6. Cytokeratin 18, hydroxyproline, and connective tissue growth factor (CTGF) were chosen for analysis in mouse and human sera using targeted biochemical assays. Consistent with the liver analysis, cytokeratin 18, CTGF and hydroxyproline were significantly elevated in HSS mouse serum compared to uninfected or MSS mice. Moreover, cytokeratin 18 and CTGF were found to be markers for hepatosplenic and intestinal schistosomiasis subjects, respectively, while serum hydroxyproline was a strong indicator of fibrosis for severe HS. These findings indicate that schistosome-associated changes to the liver can be detected in the serum and reveal the potential for cytokeratin-18 to be used as a diagnostic marker for early detection of hepatosplenic schistosomiasis. |
International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients
Schijman AG , Bisio M , Orellana L , Sued M , Duffy T , Mejia Jaramillo AM , Cura C , Auter F , Veron V , Qvarnstrom Y , Deborggraeve S , Hijar G , Zulantay I , Lucero RH , Velazquez E , Tellez T , Sanchez Leon Z , Galvao L , Nolder D , Monje Rumi M , Levi JE , Ramirez JD , Zorrilla P , Flores M , Jercic MI , Crisante G , Anez N , De Castro AM , Gonzalez CI , Acosta Viana K , Yachelini P , Torrico F , Robello C , Diosque P , Triana Chavez O , Aznar C , Russomando G , Buscher P , Assal A , Guhl F , Sosa Estani S , DaSilva A , Britto C , Luquetti A , Ladzins J . PLoS Negl Trop Dis 2011 5 (1) e931 BACKGROUND: A century after its discovery, Chagas disease still represents a major neglected tropical threat. Accurate diagnostics tools as well as surrogate markers of parasitological response to treatment are research priorities in the field. The purpose of this study was to evaluate the performance of PCR methods in detection of Trypanosoma cruzi DNA by an external quality evaluation. METHODOLOGY/FINDINGS: An international collaborative study was launched by expert PCR laboratories from 16 countries. Currently used strategies were challenged against serial dilutions of purified DNA from stocks representing T. cruzi discrete typing units (DTU) I, IV and VI (set A), human blood spiked with parasite cells (set B) and Guanidine Hidrochloride-EDTA blood samples from 32 seropositive and 10 seronegative patients from Southern Cone countries (set C). Forty eight PCR tests were reported for set A and 44 for sets B and C; 28 targeted minicircle DNA (kDNA), 13 satellite DNA (Sat-DNA) and the remainder low copy number sequences. In set A, commercial master mixes and Sat-DNA Real Time PCR showed better specificity, but kDNA-PCR was more sensitive to detect DTU I DNA. In set B, commercial DNA extraction kits presented better specificity than solvent extraction protocols. Sat-DNA PCR tests had higher specificity, with sensitivities of 0.05-0.5 parasites/mL whereas specific kDNA tests detected 5.10(-3) par/mL. Sixteen specific and coherent methods had a Good Performance in both sets A and B (10 fg/microl of DNA from all stocks, 5 par/mL spiked blood). The median values of sensitivities, specificities and accuracies obtained in testing the Set C samples with the 16 tests determined to be good performing by analyzing Sets A and B samples varied considerably. Out of them, four methods depicted the best performing parameters in all three sets of samples, detecting at least 10 fg/microl for each DNA stock, 0.5 par/mL and a sensitivity between 83.3-94.4%, specificity of 85-95%, accuracy of 86.8-89.5% and kappa index of 0.7-0.8 compared to consensus PCR reports of the 16 good performing tests and 63-69%, 100%, 71.4-76.2% and 0.4-0.5, respectively compared to serodiagnosis. Method LbD2 used solvent extraction followed by Sybr-Green based Real time PCR targeted to Sat-DNA; method LbD3 used solvent DNA extraction followed by conventional PCR targeted to Sat-DNA. The third method (LbF1) used glass fiber column based DNA extraction followed by TaqMan Real Time PCR targeted to Sat-DNA (cruzi 1/cruzi 2 and cruzi 3 TaqMan probe) and the fourth method (LbQ) used solvent DNA extraction followed by conventional hot-start PCR targeted to kDNA (primer pairs 121/122). These four methods were further evaluated at the coordinating laboratory in a subset of human blood samples, confirming the performance obtained by the participating laboratories. CONCLUSION/SIGNIFICANCE: This study represents a first crucial step towards international validation of PCR procedures for detection of T. cruzi in human blood samples. |
Amino acid changes within the E protein hinge region that affect dengue virus type 2 infectivity and fusion
Butrapet S , Childers T , Moss KJ , Erb SM , Luy BE , Calvert AE , Blair CD , Roehrig JT , Huang CY . Virology 2011 413 (1) 118-27 Fifteen mutant dengue viruses were engineered and used to identify AAs in the molecular hinge of the envelope protein that are critical to viral infection. Substitutions at Q52, A54, or E133 reduced infectivity in mammalian cells and altered the pH threshold of fusion. Mutations at F193, G266, I270, or G281 affected viral replication in mammalian and mosquito cells, but only I270W had reduced fusion activity. T280Y affected the pH threshold for fusion and reduced replication in C6/36 cells. Three different mutations at L135 were lethal in mammalian cells. Among them, L135G abrogated fusion and reduced replication in C6/36 cells, but only slightly reduced the mosquito infection rate. Conversely, L135W replicated well in C6/36 cells, but had the lowest mosquito infection rate. Possible interactions between hinge residues 52 and 277, or among 53, 135, 170, 186, 265, and 276 required for hinge function were discovered by sequence analysis to identify compensatory mutations. |
Development and evaluation of novel one-step TaqMan realtime RT-PCR assays for the detection and direct genotyping of genogroup I and II noroviruses
Schultz AC , Vega E , Dalsgaard A , Christensen LS , Norrung B , Hoorfar J , Vinje J . J Clin Virol 2011 50 (3) 230-4 BACKGROUND: Current detection and genotyping methods of genogroup (G) I and II noroviruses (NoVs) consist of a 2-step approach including detection of viral RNA by TaqMan realtime RT-PCR (RT-qPCR) followed by conventional RT-PCR and sequencing of partial regions of ORF1 or ORF2. OBJECTIVE: To develop novel long-template one-step TaqMan assays (L-RT-qPCR) for the rapid detection and direct genotyping of GI and GII NoVs and to evaluate the sensitivity and specificity of the assays. STUDY DESIGN: GI and GII-specific broadly reactive L-RT-qPCR assays were developed by combining existing NoV primers and probes targeting the open reading frame (ORF)1-ORF2 junction as well as region C at the 5'-ORF2. The assays were validated using GI and GII RNA transcripts and a coded panel of 75 stool samples containing NoV strains representing 9 GI genotypes and 12 GII genotypes, as well as sapoviruses, astroviruses, polioviruses, and rotaviruses. L-RT-qPCR products were typed by sequencing. RESULTS: The novel GI and GII L-RT-qPCR assays detected and typed all but one of the NoV positive panel samples. As few as 5-500 RNA copies could be accurately typed by sequencing of amplicons. CONCLUSIONS: We developed novel one-step TaqMan RT-qPCR assays for the sensitive detection and direct genotyping of GI and GII NoVs from clinical and environmental matrices. |
Maternal smoking and congenital heart defects in the Baltimore-Washington Infant Study
Alverson CJ , Strickland MJ , Gilboa SM , Correa A . Pediatrics 2011 127 (3) e647-53 OBJECTIVE: We investigated associations between maternal cigarette smoking during the first trimester and the risk of congenital heart defects (CHDs) among the infants. METHODS: The Baltimore-Washington Infant Study was the first population-based case-control study of CHDs conducted in the United States. Case and control infants were enrolled during the period 1981-1989. We excluded mothers with overt pregestational diabetes and case mothers whose infants had noncardiac anomalies (with the exception of atrioventricular septal defects with Down syndrome) from the analysis, which resulted in 2525 case and 3435 control infants. Self-reported first-trimester maternal cigarette consumption was ascertained via an in-person interview after delivery. Associations for 26 different groups of CHDs with maternal cigarette consumption were estimated by using logistic regression models. Odds ratios (ORs) corresponded to a 20-cigarette-per-day increase in consumption. RESULTS: We observed statistically significant positive associations between self-reported first-trimester maternal cigarette consumption and the risk of secundum-type atrial septal defects (OR: 1.36 [95% confidence interval (CI): 1.04-1.78]), right ventricular outflow tract defects (OR: 1.32 [95% CI: 1.06-1.65]), pulmonary valve stenosis (OR: 1.35 [95% CI: 1.05-1.74]), truncus arteriosus (OR: 1.90 [95% CI: 1.04-3.45]), and levo-transposition of the great arteries (OR: 1.79 [95% CI: 1.04-3.10]). A suggestive association was observed for atrioventricular septal defects among infants without Down syndrome (OR: 1.50 [95% CI: 0.99-2.29]). CONCLUSIONS: These findings add to the existing body of evidence that implicates first-trimester maternal cigarette smoking as a modest risk factor for select CHD phenotypes. |
Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006: a report from the Autism and Developmental Disabilities Monitoring Network
Kirby RS , Wingate MS , Van Naarden Braun K , Doernberg NS , Arneson CL , Benedict RE , Mulvihill B , Durkin MS , Fitzgerald RT , Maenner MJ , Patz JA , Yeargin-Allsopp M . Res Dev Disabil 2011 32 (2) 462-9 AIM: To estimate the prevalence of cerebral palsy (CP) and the frequency of co-occurring developmental disabilities (DDs), gross motor function (GMF), and walking ability using the largest surveillance DD database in the US. METHODS: We conducted population-based surveillance of 8-year-old children in 2006 (N=142,338), in areas of Alabama, Georgia, Wisconsin, and Missouri. This multi-site collaboration involved retrospective record review at multiple sources. We reported CP subtype, co-occurring DDs, Gross Motor Function Classification System (GMFCS) level, and walking ability as well as CP period prevalence by race/ethnicity and sex. RESULTS: CP prevalence was 3.3 (95% confidence interval [CI]: 3.1-3.7) per 1000 and varied by site, ranging from 2.9 (Wisconsin) to 3.8 (Georgia) per 1000, 8-year olds (p<0.02). Approximately 81% had spastic CP. Among children with CP, 8% had an autism spectrum disorder and 35% had epilepsy. Using the GMFCS, 38.1% functioned at the highest level (I), with 17.1% at the lowest level (V). Fifty-six percent were able to walk independently and 33% had limited or no walking ability. INTERPRETATION: Surveillance data are enhanced when factors such as functioning and co-occurring conditions known to affect clinical service needs, quality of life, and health care are also considered. |
Prevalence at birth of cleft lip with or without cleft palate: data from the International Perinatal Database of Typical Oral Clefts (IPDTOC)
IPDTOC Working Group , Correa Adolfo , Siffel Csaba . Cleft Palate Craniofac J 2011 48 (1) 66-81 As part of a collaborative project on the epidemiology of craniofacial anomalies, funded by the National Institutes for Dental and Craniofacial Research and channeled through the Human Genetics Programme of the World Health Organization, the International Perinatal Database of Typical Orofacial Clefts (IPDTOC) was established in 2003. IPDTOC is collecting case-by-case information on cleft lip with or without cleft palate and on cleft palate alone from birth defects registries contributing to at least one of three collaborative organizations: European Surveillance Systems of Congenital Anomalies (EUROCAT) in Europe, National Birth Defects Prevention Network (NBDPN) in the United States, and International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) worldwide. Analysis of the collected information is performed centrally at the ICBDSR Centre in Rome, Italy, to maximize the comparability of results. The present paper, the first of a series, reports data on the prevalence of cleft lip with or without cleft palate from 54 registries in 30 countries over at least 1 complete year during the period 2000 to 2005. Thus, the denominator comprises more than 7.5 million births. A total of 7704 cases of cleft lip with or without cleft palate (7141 livebirths, 237 stillbirths, 301 terminations of pregnancy, and 25 with pregnancy outcome unknown) were available. The overall prevalence of cleft lip with or without cleft palate was 9.92 per 10,000. The prevalence of cleft lip was 3.28 per 10,000, and that of cleft lip and palate was 6.64 per 10,000. There were 5918 cases (76.8%) that were isolated, 1224 (15.9%) had malformations in other systems, and 562 (7.3%) occurred as part of recognized syndromes. Cases with greater dysmorphological severity of cleft lip with or without cleft palate were more likely to include malformations of other systems. |
Relationship between comfort and attenuation measurements for two types of earplugs
Byrne DC , Davis RR , Shaw PB , Specht BM , Holland AN . Noise Health 2011 13 (51) 86-92 Noise-induced hearing loss is almost always preventable if properly fitted hearing protectors are worn to reduce exposure. Many individuals choose not to wear hearing protection because it may interfere with effective communication in the workplace or it may be uncomfortable. Hearing protector comfort has not received the same amount of attention as noise reduction capability. The present study was conducted to evaluate the comfort level of two different types of insert earplugs as well as the attenuation levels achieved by the earplugs. Attenuation levels were obtained with a commercially available earplug fit-test system, and the comfort ratings were obtained by questionnaire. The primary research objective was to determine whether hearing protector comfort was related to measured attenuation values. A linear mixed effects model provided evidence for an inverse relationship between comfort and attenuation. |
Rotating shift work and menstrual cycle characteristics
Lawson CC , Whelan EA , Lividoti Hibert EN , Spiegelman D , Schernhammer ES , Rich-Edwards JW . Epidemiology 2011 22 (3) 305-12 BACKGROUND: Shift workers who experience sleep disturbances and exposure to light at night could be at increased risk for alterations in physiologic functions that are circadian in nature. METHODS: We investigated rotating shift work and menstrual cycle patterns in the Nurses' Health Study II using cross-sectional data collected in 1993 from 71,077 nurses aged 28-45 years who were having menstrual periods and were not using oral contraceptives. Log-binomial regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Eight percent of participants reported working rotating night shifts for 1-9 months, 4% for 10-19 months, and 7% for 20+ months during the previous 2 years. Irregular cycles (>7 days variability) were reported by 10% of participants. Seventy percent of women reported menstrual cycles of 26-31 days, 1% less than 21 days, 16% 21-25 days, 11% 32-39 days, and 1% 40+ days. Women with 20+ months of rotating shift work were more likely to have irregular cycles (adjusted RR = 1.23 [CI = 1.14-1.33]); they were also more likely to have cycle length <21 days (1.27 [0.99-1.62]) or 40+ days (1.49 [1.19-1.87]) (both compared with 26-31 days). For irregular patterns and for 40+ day cycles, there was evidence of a dose response with increasing months of rotating shift work. Moderately short (21-25 days) or long (32-39 days) cycle lengths were not associated with rotating shift work. CONCLUSIONS: Shift work was modestly associated with menstrual function, with possible implications for fertility and other cycle-related aspects of women's health. |
Noise-induced hearing loss in agriculture: creating partnerships to overcome barriers and educate the community on prevention
Ehlers JJ , Graydon PS . Noise Health 2011 13 (51) 142-6 Noise-induced hearing loss (NIHL) is a common and preventable injury for farmers. Farmers are frequently exposed to excessive noise, ranking among the top three occupations and industries with the highest risk for hearing loss. Use of hearing protection among farmers is not common. Although the age when NIHL begins among farmers is unknown, its prevalence is higher among male adolescents who live and work on farms. The purpose of this paper is to describe how NIOSH created partnerships to promote hearing conservation for this hard-to-reach population. Partnerships included organizations and individuals who were trusted sources of information for the target population, young farmers 14-35 years of age and their families, and those who had linkages in rural communities. NIOSH engaged partners through exhibits and train-the-trainer workshops at state or national conventions. NIOSH workshops included basic information on NIHL as well as information on free or low-lost resources that participants could use in training others at schools and community events. People with hearing conservation expertise have an important role and many opportunities to improve the knowledge and implementation of hearing conservation among those in agriculture. |
Effects of training on hearing protector attenuation
Murphy WJ , Stephenson MR , Byrne DC , Witt B , Duran J . Noise Health 2011 13 (51) 132-41 The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session specific to the product, or as a one-on-one training session was evaluated using four hearing protection devices with eight groups of subjects. Naive subjects were recruited and tested using three different forms of training: written, video, and individual training. The group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter-trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRS A ) and the associated confidence intervals were calculated for the 80 th and 20 th percentiles of protection. Across subject groups for each protector, the differences between NRS A ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented. |
Hearing loss prevention for carpenters: part 1 - using health communication and health promotion models to develop training that works
Stephenson CM , Stephenson MR . Noise Health 2011 13 (51) 113-21 In phase 1 of a large multiyear effort, health communication and health promotion models were used to develop a comprehensive hearing loss prevention training program for carpenters. Additionally, a survey was designed to be used as an evaluation instrument. The models informed an iterative research process in which the authors used key informant interviews, focus groups, and early versions of the survey tool to identify critical issues expected to be relevant to the success of the hearing loss prevention training. Commonly held attitudes and beliefs associated with occupational noise exposure and hearing losses, as well as issues associated with the use or non-use of hearing protectors, were identified. The training program was then specifically constructed to positively shape attitudes, beliefs, and behavioral intentions associated with healthy hearing behaviors - especially those associated with appropriate hearing protector use. The goal was to directly address the key issues and overcome the barriers identified during the formative research phase. The survey was finalized using factor analysis methods and repeated pilot testing. It was designed to be used with the training as an evaluation tool and thus could indicate changes over time in attitudes, beliefs, and behavioral intentions regarding hearing loss prevention. Finally, the training program was fine tuned with industry participation so that its delivery would integrate seamlessly into the existing health and safety training provided to apprentice carpenters. In phase 2, reported elsewhere in this volume, the training program and the survey were tested through a demonstration project at two sites. |
Hearing loss prevention for carpenters: part 2 - demonstration projects using individualized and group training
Stephenson MR , Shaw PB , Stephenson CM , Graydon PS . Noise Health 2011 13 (51) 122-31 Two demonstration projects were conducted to evaluate the effectiveness of a comprehensive training program for carpenters. This training was paired with audiometry and counseling and a survey of attitudes and beliefs in hearing loss prevention. All participants received hearing tests, multimedia instruction on occupational noise exposure/hearing loss, and instruction and practice in using a diverse selection of hearing protection devices (HPDs). A total of 103 apprentice carpenters participated in the Year 1 training, were given a large supply of these HPDs, and instructions on how to get additional free supplies if they ran out during the 1-year interval between initial and follow-up training. Forty-two participants responded to the survey a second time a year later and completed the Year 2 training. Significant test-retest differences were found between the pre-training and the post-training survey scores. Both forms of instruction (individual versus group) produced equivalent outcomes. The results indicated that training was able to bring all apprentice participants up to the same desired level with regard to attitudes, beliefs, and behavioral intentions to use hearing protection properly. It was concluded that the health communication models used to develop the educational and training materials for this effort were extremely effective. |
Heat and humidity buildup under earmuff-type hearing protectors
Davis RR , Shaw PB . Noise Health 2011 13 (51) 93-8 A major barrier to effective wear of hearing protection is comfort. This study examined several comfort indicators in the earmuff-type hearing protectors. Twenty subjects wore hearing protectors instrumented with two different temperature/humidity measurement systems (Omega and iButton) while walking a corridor for about 25 min. The instruments recorded the temperature and humidity every 10 s and their results were compared. In addition, skin surface pH was measured at the ear canal entrance before and after the task. Finally, the subject indicated earmuff comfort at the beginning and end of the session. Earmuff comfort decreased significantly over the course of the walking task. Ear canal pH became slightly less acidic, but the change was not statistically significant. The two temperature/humidity systems provided comparable results. Heat increased at about 0.3 degrees F while humidity built up at about 0.5%/min. However, the study found some limitations on the instrumentation. The complexity of the electrical connections and equipment in the Omega probe system led to loss of three subject's data. The iButton device was more robust, but provided only 256 gradations of temperature and relative humidity. Even with its limitations, the iButton device would be a valuable tool for field studies. The present study showed that the buildup of heat and humidity can be modeled using linear equations. The present study demonstrates that relatively inexpensive tools and a low-exertion task can provide important information about the under-earmuff environment, which can inform assumptions about comfort during use. |
Introduction to the special issue: Hearing protection state of the art
Davis RR . Noise Health 2011 13 (51) 85 It appears that the hearing protection device (HPD) will be a fixture of hearing loss prevention programs for the foreseeable future. The perception in industry is that it is more cost-effective to place workers in hearing loss prevention programs wearing hearing protection devices than to quiet the environment to safe levels. This issue describes the state of the art for research in hearing protection devices and hearing loss prevention programs. | The barriers to workers accepting and wearing hearing protection include comfort and communication. Byrne et al. describe a simple study where subjects wearing a foam plug in one ear and a wax plug in the other report on comfort. Davis and Shaw characterize heat and humidity buildup under an earmuff both in terms of physical and comfort measures. Another barrier is the ability to hear safety signals. Alali and Casali report some new research on detection and localization of backup alarms while wearing different types of hearing protection. | Training workers to more effectively use their hearing protection is fundamental to the hearing loss prevention program. Two companion papers by Stephenson et al. demonstrate how health communication can significantly influence attitudes, beliefs, and behavioral intentions about hearing protector use. Murphy et al. provide information on the effectiveness of video training versus professional training of HPD insertion techniques for workers. Their results seem to indicate that human contact is still needed for good hearing protection device placement. Ehlers and Graydon present a case study of their work on "training the trainers" to propagate the hearing loss prevention message to the agricultural community - an underserved population. | The goal of hearing protector use is to reduce exposure of the ear to noise and thus hearing loss. A number of tools are emerging to help the hearing loss professional with that task, including individual fit-testing and under-the-protector monitoring. |
The business cycle and the incidence of workplace injuries: evidence from the U.S.A
Asfaw A , Pana-Cryan R , Rosa R . J Safety Res 2011 42 (1) 1-8 The current study explored the association between the business cycle and the incidence of workplace injuries to identify cyclically sensitive industries and the relative contribution of physical capital and labor utilization within industries. METHOD: Bureau of Labor Statistics nonfatal injury rates from 1976 through 2007 were examined across five industry sectors with respect to several macroeconomic indicators. Within industries, injury associations with utilization of labor and physical capital over time were tested using time series regression methods. RESULTS: Pro-cyclical associations between business cycle indicators and injury incidence were observed in mining, construction, and manufacturing but not in agriculture or trade. Physical capital utilization was the highest potential contributor to injuries in mining while labor utilization was the highest potential contributor in construction. In manufacturing each effect had a similar association with injuries. CONCLUSION: The incidence of workplace injury is associated with the business cycle. However, the degree of association and the mechanisms through with the business cycle affects the incidence of workplace injuries was not the same across industries.Impact on Industry The results suggest that firms in the construction, manufacturing, and mining industries should take additional precautionary safety measures during cyclical upturns. Potential differences among industries in the mechanisms through which the business cycle affects injury incidence suggest different protective strategies for those industries. For example, in construction, additional efforts might be undertaken to ensure workers are adequately trained and not excessively fatigued, while safety procedures continue to be followed even during boom times. |
Controlling diesel exhaust exposure inside firehouses
Baldwin TN , Hales TR , Niemeier MT . Fire Eng 2011 164 (2) 63-74 Diesel exhaust in firehouses has been and continues to be a problem for many firefighters. A diesel-powered apparatus generates exhaust whenever it leaves or returns to a station. If not properly captured, this exhaust will enter not only the apparatus bay but also the firefighters’ living quarters. As a result, firefighters can be exposed to diesel exhaust for a significant portion of their shifts. Scientific evidence suggests an association between lung cancer and occupational exposure to diesel exhaust emissions. Safety and health professionals at the National Institute for Occupational Safety and Health (NIOSH) have evaluated several fire stations for diesel exhaust through its Health Hazard Evaluation (HHE) program. We address the health effects of diesel exhaust, the amount of diesel exhaust typically found in fire stations, and the controls and work practices that can reduce firefighters’ exposure. |
Associations between peripheral Plasmodium falciparum malaria parasitemia, human immunodeficiency virus, and concurrent helminthic infection among pregnant women in Malawi
Thigpen MC , Filler SJ , Kazembe PN , Parise ME , Macheso A , Campbell CH , Newman RD , Steketee RW , Hamel M . Am J Trop Med Hyg 2011 84 (3) 379-85 Approximately 2 billion persons worldwide are infected with schistosomiasis and soil-transmitted helminthes (STH), many in areas where endemic malaria transmission coexists. Few data exist on associations between these infections. Nested within a larger clinical trial, primigravid and secundigravid women provided blood samples for human immunodeficiency virus (HIV) testing and peripheral malaria films and stool and urine for evaluation of STH and Schistosoma spp. during their initial antenatal clinic visit. The most common parasitic infections were malaria (37.6%), S. haematobium (32.3%), and hookworm (14.4%); 14.2% of women were HIV-infected. S. haematobium infection was associated with lower malarial parasite densities (344 versus 557 parasites/muL blood; P < 0.05). In multivariate analysis, HIV and hookworm infection were independently associated with malaria infection (adjusted odds ratio = 1.9 and 95% confidence interval = 1.2-3.0 for HIV; adjusted odds ratio = 1.9 and 95% confidence interval = 1.03-3.5 for hookworm). Concurrent helminthic infection had both positive and negative effects on malaria parasitemia among pregnant women in Malawi. |
A model-driven approach to qualitatively assessing the added value of community coalitions
Herman EJ , Keller A , Davis A , Ehrensberger R , Telleen S , Kurz R , Nesvold JH , Findley S , Bryant-Stephens T , Benson M , Fierro L . J Urban Health 2011 88 Suppl 1 130-43 Community-based coalitions are commonly formed to plan and to carry out public health interventions. The literature includes evaluations of coalition structure, composition, and functioning; evaluations of community-level changes achieved through coalition activities; and the association between coalition characteristics and various indicators of success. Little information is available on the comparative advantage or "added value" of conducting public health interventions through coalitions as opposed to less structured collaborative mechanisms. This paper describes a qualitative, iterative process carried out with site representatives of the Controlling Asthma in American Cities Project (CAACP) to identify outcomes directly attributable to coalitions. The process yielded 2 complementary sets of results. The first were criteria that articulated and limited the concept of "added value of coalitions". The criteria included consensus definitions, an organizing figure, a logic model, and inclusion/exclusion criteria. The second set of results identified site-specific activities that met the definitional criteria and were, by agreement, examples of CAACP coalitions' added value. Beyond the specific findings relevant to the added value of coalitions in this project, the use of a social ecological model to identify the components of added value and the placement of those components within a logic model specific to coalitions should provide useful tools for those planning and assessing coalition-based projects. |
Evaluation of HIV incidence surveillance in New York City, 2006
Nair HP , Torian LV , Forgione L , Begier EM . Public Health Rep 2011 126 (1) 28-38 In 2005, the New York City (NYC) Department of Health and Mental Hygiene implemented a standardized human immunodeficiency virus (HIV) incidence surveillance protocol based on the serologic testing algorithm for recent HIV seroconversion deployed nationwide by the Centers for Disease Control and Prevention (CDC). We evaluated four key attributes of NYC's HIV incidence surveillance system-simplicity, data quality, timeliness, and acceptability--using CDC's guidelines for surveillance system evaluation. The evaluation revealed that the system could potentially provide HIV incidence estimates stratified by borough and major demographic groups at about nine months after the period of interest. The system strengths include its relative simplicity and integration with routine HIV/acquired immunodeficiency syndrome surveillance. Weaknesses include lack of completeness of testing history information, a critical component of incidence estimation. Continued improvements in data completeness and timeliness will improve the currently available information to inform personnel who develop HIV-prevention programs and policy initiatives in NYC and nationally. |
Tobacco use, exposure to secondhand smoke, and cessation counseling training of dental students around the world
Warren CW , Sinha DN , Lee J , Lea V , Jones N , Asma S . J Dent Educ 2011 75 (3) 385-405 The Global Health Professions Student Survey (GHPSS) has been conducted among third-year dental students in schools in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called "sites" in this article). In more than half the sites, over 20 percent of the students currently smoked cigarettes, with males having higher rates than females in thirty sites. Over 60 percent of students reported having been exposed to secondhand smoke in public places in thirty-seven of forty-eight sites. The majority of students recognized that they are role models in society and believed they should receive training on counseling patients to quit using tobacco, but few reported receiving formal training. Tobacco control efforts must discourage tobacco use among dentists, promote smoke-free workplaces, and implement programs that train dentists in effective cessation-counseling techniques. |
The International Union for Circumpolar Health - an important actor in circumpolar health
Bruce M . Int J Circumpolar Health 2011 70 (1) 3-5 The International Union for CircumpolarHealth (IUCH) was established in 1981 as aninternational non-governmental organization, with members, adhering bodies and affiliatesthroughout the circumpolar regions to addressa long-standing need for the exchange of scientific, medical and public health research dataof concern to the circumpolar regions. Thehealth and wellness of circumpolar peoples arethe focus of the IUCH, the only organization(dedicated to health in the Arctic and Antarctic)which formally brings together members ofthe national circumpolar societies from all theArctic countries. For more information, pleasevisit www.iuch.net. |
A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial
Chaffin M , Funderburk B , Bard D , Valle LA , Gurwitch R . J Consult Clin Psychol 2011 79 (1) 84-95 OBJECTIVE: A package of parent-child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects. METHOD: Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 x 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home. RESULTS: A significant orientation condition by parenting condition interaction favoring the SM + PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later. CONCLUSIONS: Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized. |
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