Leptospira seropositivity as a risk factor for Mesoamerican Nephropathy
Riefkohl A , Ramirez-Rubio O , Laws RL , McClean MD , Weiner DE , Kaufman JS , Galloway RL , Shadomy SV , Guerra M , Amador JJ , Sanchez JM , Lopez-Pilarte D , Parikh CR , Leibler JH , Brooks DR . Int J Occup Environ Health 2017 23 (1) 1-10 BACKGROUND: Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. OBJECTIVES: Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. METHODS: In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). RESULTS: Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. CONCLUSIONS: Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Additional studies may help establish whether Leptospira infection plays any role in MeN among Central American workers. |
The Managing Epilepsy Well Network: Advancing epilepsy self-management
Sajatovic M , Jobst BC , Shegog R , Bamps YA , Begley CE , Fraser RT , Johnson EK , Pandey DK , Quarells RC , Scal P , Spruill TM , Thompson NJ , Kobau R . Am J Prev Med 2017 52 S241-s245 Epilepsy, a complex spectrum of disorders, affects about 2.9 million people in the U.S. Similar to other chronic disorders, people with epilepsy face challenges related to management of the disorder, its treatment, co-occurring depression, disability, social disadvantages, and stigma. Two national conferences on public health and epilepsy (1997, 2003) and a 2012 IOM report on the public health dimensions of epilepsy highlighted important knowledge gaps and emphasized the need for evidence-based, scalable epilepsy self-management programs. The Centers for Disease Control and Prevention translated recommendations on self-management research and dissemination into an applied research program through the Prevention Research Centers Managing Epilepsy Well (MEW) Network. MEW Network objectives are to advance epilepsy self-management research by developing effective interventions that can be broadly disseminated for use in people's homes, healthcare providers' offices, or in community settings. The aim of this report is to provide an update on the MEW Network research pipeline, which spans efficacy, effectiveness, and dissemination. Many of the interventions use e-health strategies to eliminate barriers to care (e.g., lack of transportation, functional limitations, and stigma). Strengths of this mature research network are the culture of collaboration, community-based partnerships, e-health methods, and its portfolio of prevention activities, which range from efficacy studies engaging hard-to-reach groups, to initiatives focused on provider training and knowledge translation. The MEW Network works with organizations across the country to expand its capacity, help leverage funding and other resources, and enhance the development, dissemination, and sustainability of MEW Network programs and tools. Guided by national initiatives targeting chronic disease or epilepsy burden since 2007, the MEW Network has been responsible for more than 43 scientific journal articles, two study reports, seven book chapters, and 62 presentations and posters. To date, two programs have been adopted and disseminated by the national Epilepsy Foundation, state Epilepsy Foundation affiliates, and other stakeholders. Recent expansion of the MEW Network membership will help to extend future reach and public health impact. |
Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50
Wheeler SB , Kuo TM , Meyer AM , Martens CE , Hassmiller Lich KM , Tangka FK , Richardson LC , Hall IJ , Smith JL , Mayorga ME , Brown P , Crutchfield TM , Pignone MP . Prev Med Rep 2017 6 9-16 Understanding multilevel predictors of colorectal cancer (CRC) screening test modality can help inform screening program design and implementation. We used North Carolina Medicare, Medicaid, and private, commercially available, health plan insurance claims data from 2003 to 2008 to ascertain CRC test modality among people who received CRC screening around their 50th birthday, when guidelines recommend that screening should commence for normal risk individuals. We ascertained receipt of colonoscopy, fecal occult blood test (FOBT) and fecal immunochemical test (FIT) from billing codes. Person-level and county-level contextual variables were included in multilevel random intercepts models to understand predictors of CRC test modality, stratified by insurance type. Of 12,570 publicly-insured persons turning 50 during the study period who received CRC testing, 57% received colonoscopy, whereas 43% received FOBT/FIT, with significant regional variation. In multivariable models, females with public insurance had lower odds of colonoscopy than males (odds ratio [OR] = 0.68; p < 0.05). Of 56,151 privately-insured persons turning 50 years old who received CRC testing, 42% received colonoscopy, whereas 58% received FOBT/FIT, with significant regional variation. In multivariable models, females with private insurance had lower odds of colonoscopy than males (OR = 0.43; p < 0.05). People living 10-15 miles away from endoscopy facilities also had lower odds of colonoscopy than those living within 5 miles (OR = 0.91; p < 0.05). Both colonoscopy and FOBT/FIT are widely used in North Carolina among insured persons newly age-eligible for screening. The high level of FOBT/FIT use among privately insured persons and women suggests that renewed emphasis on FOBT/FIT as a viable screening alternative to colonoscopy may be important. |
Prostate cancer screening decision-making in three states: 2013 Behavioral Risk Factor Surveillance System analysis
Li J , Hall IJ , Zhao G . Cancer Causes Control 2017 28 (3) 235-240 INTRODUCTION: Given the discordant prostate cancer screening recommendations in the United States, shared decision-making (SDM) has become increasingly important. The objectives of this study were to determine who made the final decision to obtain prostate-specific antigen (PSA)-based screening and identify factors associated with the screening decision made by both patients and their health care providers. METHODS: Using the 2013 Behavioral Risk Factor Surveillance System data from Delaware, Hawaii, and Massachusetts, we calculated weighted percentages of SDM. Associations between the SDM and sociodemographic, lifestyle, access to care, and PSA testing-related factors were assessed using multivariate logistic regression. RESULTS: There were 2,248 men aged 40 years or older who ever had a PSA-based screening in these three states. Only 36% of them made their prostate cancer screening decision jointly with their health care provider. Multivariate analyses showed that men who were married/living together or had a college degree and above were more likely to report having SDM than men who were never married or had less than high school education (P = 0.02 and 0.002). Moreover, men whose most recent PSA test occurred within the past year were more likely to report SDM than men who had the test done more than 2 years ago (P = 0.02). CONCLUSIONS: The majority of screening decisions were made by the patient or health care provider alone in these three states, not jointly, as recommended. Our study points to the need to promote SDM among patients and their health care providers before PSA testing. |
Epilepsy by the numbers: Epilepsy deaths by age, race/ethnicity, and gender in the United States significantly increased from 2005 to 2014
Greenlund SF , Croft JB , Kobau R . Epilepsy Behav 2017 69 28-30 To inform public health efforts to prevent epilepsy-related deaths, we used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER; Wonder.cdc.gov) to examine any-listed epilepsy deaths for the period 2005-2014 by age groups (≤24, 25-44, 45-64, 65-84, ≥85years), sex, and race/ethnicity (non-Hispanic White, non-Hispanic African American, Hispanic, Asian/Pacific Islander, or American Indian/Alaska Native). Epilepsy deaths were defined by the International Classification of Diseases, Tenth Revision (ICD-10) codes G40.0-G40.9. The total number of deaths per year with epilepsy as any listed cause ranged from 1760 in 2005 to 2962 in 2014. Epilepsy was listed as the underlying cause of death for about 54% of all deaths with any mention of epilepsy in 2005 and for 43% of such deaths in 2014. Age-adjusted epilepsy mortality rates (as any-listed cause of death) per 100,000 significantly increased from 0.58 in 2005 to 0.85 in 2014 (47% increase). In 2014, deaths among the non-Hispanic Black population (1.42 deaths per 100,000) were higher than among non-Hispanic White (0.86 deaths per 100,000) and Hispanic populations (0.70 deaths per 100,000). Males had a higher mortality rate than females (1.01 per 100,000 versus 0.74 per 100,000 in 2014), and those aged 85years or older had the highest mortality among age groups. Results highlight the need for heightened action to prevent and monitor epilepsy-associated mortality. |
Food insecurity, CKD, and subsequent ESRD in US adults
Banerjee T , Crews DC , Wesson DE , Dharmarajan S , Saran R , Rios Burrows N , Saydah S , Powe NR . Am J Kidney Dis 2017 70 (1) 38-47 BACKGROUND: Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD. STUDY DESIGN: Longitudinal cohort study. SETTING & PARTICIPANTS: 2,320 adults (aged ≥ 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income ≤ 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years. PREDICTOR: Food insecurity, defined as an affirmative response to the food-insecurity screening question. OUTCOME: Development of ESRD. MEASUREMENTS: Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates. RESULTS: 4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P<0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P=0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49). LIMITATIONS: Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago. CONCLUSIONS: Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes. |
Highlights from the 2016 HIV diagnostics conference: The new landscape of HIV testing in laboratories, public health programs and clinical practice.
Wesolowski LG , Parker MM , Delaney KP , Owen SM . J Clin Virol 2017 91 63-68 The 2016 HIV Diagnostics Conference, held in Atlanta, Georgia, was attended by public health officials, laboratorians, HIV testing program managers, surveillance coordinators and industry representatives. The conference addressed test performance data, the implementation of new testing algorithms, quality assurance, and the application of new tests in a variety of settings. With regard to the recommended Centers for Disease Control and Prevention/Association of Public Health Laboratories HIV laboratory testing algorithm, the conference featured performance data, implementation challenges such as a lack of test options for the second and third steps, as well as data needs for new tests that may be used as part of the algorithm. There are delays when nucleic acid testing is needed with the algorithm. Novel tests such as point of care nucleic acid tests are needed on the U.S. market to readily identify acute infection. Multiplex tests are being developed which allow for the simultaneous detection of multiple pathogens. CDC staff highlighted new guidance for testing in non-clinical settings. Innovative approaches to linking testing and care in some settings have led to identification of early infections, improved receipt of test results and expedited initiation of therapy. Work continues to optimize testing so that infections are accurately identified as early as possible and time to treatment is minimized to improve health outcomes and prevent transmission. |
Risk factors for death during a resurgence of influenza-A (H1N1) pdm09 in Punjab State in 2013
Kumar T , Bhatia D , Maha Lakshmi PV , Laserson KF , Narain JP , Kumar R . Indian J Public Health 2017 61 (1) 9-13 BACKGROUND: In 2013, high mortality from influenza-A (H1N1) pdm09 (pH1N1) was observed in Punjab, India. OBJECTIVES: To describe cases and deaths of 2013 pH1N1 positives, to evaluate the high case fatality ratio and risk factors for pH1N1-associated mortality among the hospitalized cases in Punjab for 2013. METHODS: A case-control study was conducted and compared those who died from confirmed pH1N1 with those who survived in the hospital between January 1, 2013, and April 30, 2013. Sociodemographic and clinical details were extracted from hospital records and from telephone interviews with controls and next of kin of cases using pretested questionnaires. Logistic regression analysis was performed. RESULTS: A total of 182 laboratory-confirmed pH1N1 cases (99 males and 83 females) were hospitalized in 30 hospitals in Punjab; 42 (23%) patients died. Those who died were significantly more likely to be younger than 50 years of age (adjusted odds ratio [AOR] =10.6, 95% confidence interval [CI] =1.8-21.1), be obese (AOR = 16.7, 95% CI = 1.6-170.7), and have visited more than two health-care facilities before laboratory confirmation (AOR = 25.8, 95% CI = 5.4-121.6). CONCLUSIONS: The health-care community should have a high index of suspicion for influenza, and general community should be sensitized about risk factors and to seek medical advice early in the illness. |
Levels of intracellular phosphorylated tenofovir and emtricitabine correlate with natural substrate concentrations in peripheral blood mononuclear cells of persons prescribed daily oral TruvadaTM for HIV pre-exposure prophylaxis
Haaland RE , Holder A , Pau CP , Swaims-Kohlmeier A , Dawson C , Smith DK , Segolodi TM , Thigpen MC , Paxton LA , Parsons TL , Hendrix CW , Hart CE . J Acquir Immune Defic Syndr 2017 75 (3) e86-e88 Successful clinical trials of antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV infection have been reported in heterosexual men and women, men who have sex with men (MSM), and injection drug users1. A daily oral drug regimen containing nucleoside reverse transcriptase inhibitors (NRTIs) tenofovir disoproxil fumarate (TDF) alone or in combination with emtricitabine (FTC) have been effective when participant adherence is high1. Analysis of PrEP dosing patterns estimate taking at least four TDF doses per week provides 96% protection from HIV infection and at least two doses per week provides 76% protection in MSM and transgender women2, though some estimate more frequent dosing in heterosexual women may be needed3. TDF and FTC require phosphorylation in HIV target cells to tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) to provide PrEP protection as competitive analogs of naturally occurring deoxyadenosine triphosphate (dATP) and deoxycytidine triphosphate (dCTP), respectively. However, it is unclear if physiological conditions that increase dNTP concentrations can affect pharmacokinetics (PK) and pharmacodynamics (PD) of NRTIs. This may be particularly relevant when cellular deoxynucleoside triphosphate (dNTP) pools in HIV target cells increase in response to immune activation. Decreased ratios of phosphorylated NRTIs to their respective dNTPs have been associated with cell activation in vitro and in nonhuman primate studies4,5, yet this observation remains unexplored in PK and PD studies that measured intracellular drug6-8. The study presented here compared dATP and dCTP concentrations to TFV-DP and FTC-TP in peripheral blood mononuclear cell (PBMCs) of persons using daily oral Truvada™ during a successful HIV PrEP study. We further examined if variations among intracellular drug:dNTP ratios were related to lymphocyte activation. |
Prevalence of internalized HIV-related stigma among HIV-infected adults in care, United States, 2011-2013
Baugher AR , Beer L , Fagan JL , Mattson CL , Freedman M , Skarbinski J , Shouse RL . AIDS Behav 2017 21 (9) 2600-2608 HIV-infected U.S. adults have reported internalized HIV-related stigma; however, the national prevalence of stigma is unknown. We sought to determine HIV-related stigma prevalence among adults in care, describe which socio-demographic groups bear the greatest stigma burden, and assess the association between stigma and sustained HIV viral suppression. The Medical Monitoring Project measures characteristics of U.S. HIV-infected adults receiving care using a national probability sample. We used weighted data collected from June 2011 to May 2014 and assessed self-reported internalized stigma based on agreement with six statements. Overall, 79.1% endorsed ≥1 HIV-related stigma statements (n = 13,841). The average stigma score was 2.4 (out of a possible high score of six). White males had the lowest stigma scores while Hispanic/Latina females and transgender persons who were multiracial or other race had the highest. Although stigma was associated with viral suppression, it was no longer associated after adjusting for age. Stigma was common among HIV-infected adults in care. Results suggest individual and community stigma interventions may be needed, particularly among those who are <50 years old or Hispanic/Latino. Stigma was not independently associated with viral suppression; however, this sample was limited to adults in care. Examining HIV-infected persons not in care may elucidate stigma's association with viral suppression. |
Efficacy of the Young Women's CoOp: An HIV risk-reduction intervention for substance-using African-American female adolescents in the south
Wechsberg WM , Browne FA , Zule WA , Novak SP , Doherty IA , Kline TL , Carry MG , Raiford JL , Herbst JH . J Child Adolesc Subst Abuse 2017 26 (3) 205-218 HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women's CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths. |
Evaluation of a field test for antibodies against Chlamydia trachomatis during trachoma surveillance in Nepal
Sun MJ , Zambrano AI , Dize L , Munoz B , Gwyn S , Mishra S , Martin DL , Sharma S , West SK . Diagn Microbiol Infect Dis 2017 88 (1) 3-6 PURPOSE: Testing for antibodies to Chlamydia trachomatis has potential as a surveillance tool. Our evaluation compares lateral flow assays (LFAs) during surveillance surveys in Nepal with Multiplex bead array (MBA). Fifty children were randomly sampled from each of 15 random clusters in two districts of Nepal. Finger prick blood samples were collected from 1509 children and tested onsite for anti-Pgp3 antibodies by LFA. The LFA was read at 30min as negative, positive, or invalid. Tests results were also rated as difficult to read ("equivocal"). Blood was processed at Johns Hopkins University using the MBA. RESULTS: The LFA had agreement of 40.0% for MBA-positive samples and 99.3% for MBA-negative samples. Inter-reader reliability was kappa=0.65 (95% CI=0.56-0.74). If the equivocal results (7%) could be decreased, reliability could be improved. CONCLUSIONS: Further optimization and testing of the LFA test are needed to improve agreement with MBA and the interpretation of the results. |
Hepatitis C virus and HIV co-infection among pregnant women in Rwanda
Mutagoma M , Balisanga H , Sebuhoro D , Mbituyumuremyi A , Remera E , Malamba SS , Riedel DJ , Nsanzimana S . BMC Infect Dis 2017 17 (1) 167 BACKGROUND: Hepatitis C virus (HCV) infection is a pandemic causing disease; more than 185 million people are infected worldwide. An HCV antibody (Ab) prevalence of 6.0% was estimated in Central African countries. The study aimed at providing HCV prevalence estimates among pregnant women in Rwanda. METHODS: HCV surveillance through antibody screening test among pregnant women attending antenatal clinics was performed in 30 HIV sentinel surveillance sites in Rwanda. RESULTS: Among 12,903 pregnant women tested at antenatal clinics, 335 (2.6% [95% Confidence Interval 2.32-2.87]) tested positive for HCV Ab. The prevalence of HCV Ab in women aged 25-49 years was 2.8% compared to 2.4% in women aged 15-24 years (aOR = 1.3; [1.05-1.59]); This proportion was 2.7% [2.37-2.94] in pregnant women in engaged in non-salaried employment compared to 1.2% [0.24-2.14] in those engaged in salaried employment (aOR = 3.2; [1.60-6.58]). The proportion of HCV Ab-positive co-infected with HIV was estimated at 3.9% (13 cases). Women in urban residence were more likely to be associated with HCV-infection (OR = 1.3; 95%CI [1.0-1.6]) compared to those living in rural setting. CONCLUSION: HCV is a public health problem in pregnant women in Rwanda. Few pregnant women were co-infected with HCV and HIV. Living in urban setting was more likely to associate pregnant women with HCV infection. |
Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs
Cranmer LM , Langat A , Ronen K , McGrath CJ , LaCourse S , Pintye J , Odeny B , Singa B , Katana A , Nganga L , Kinuthia J , John-Stewart G . Int J Tuberc Lung Dis 2017 21 (3) 256-262 BACKGROUND: Tuberculosis (TB) screening in Prevention of Mother-To-Child Transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. METHODS: As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high human immunodeficiency virus (HIV) prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers, and associations with infant cofactors were determined. RESULTS: Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (P = 0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (P = 0.02) and non-specific TB symptoms, including cough (P = 0.003), fever (P = 0.05), and difficulty breathing (P = 0.01). TB exposure was reported by 11% of the women, and 15% of the TB-exposed women received isoniazid preventive therapy. CONCLUSIONS: Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes. |
The 17th International Congress on Infectious Diseases Workshop on Developing Infection Prevention and Control Resources for Low to Middle Income Countries
Sastry S , Masroor N , Bearman G , Hajjeh R , Holmes A , Memish Z , Lassmann B , Pittet D , Macnab F , Kamau R , Wesangula E , Pokharel P , Brown P , Daily F , Amer F , Torres J , O'Ryan M , Gunturu R , Bulabula A , Mehtar S . Int J Infect Dis 2017 57 138-143 Hospital acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks including MERS (Middle East Respiratory Syndrome) coronavirus and Ebola have highlighted the importance of infection control. Further, HAIs especially with multi-drug resistant gram negative rods (MDRO-GNRs) have become a top global priority. Though adequate approaches and guidelines have been in existence for many years and have sometimes proven effective in some countries, the implementation of such approaches in low and middle income countries (LMICs) is often restricted due to limited resources and underdeveloped infrastructure. While evidence based infection control principles and practices are universal, studies are needed to evaluate simplified approaches that can be better adapted to LMIC needs, in order to practically guide IPC practices. A group of experts from around the world attended a workshop held at the 17th International Congress on Infectious Diseases conference in Hyderabad, India, to discuss the existing IPC practices in LMICs, and how these can be best improved within the local context. |
Acute respiratory infections among returning Hajj pilgrims-Jordan, 2014
Al-Abdallat MM , Rha B , Alqasrawi S , Payne DC , Iblan I , Binder AM , Haddadin A , Nsour MA , Alsanouri T , Mofleh J , Whitaker B , Lindstrom SL , Tong S , Ali SS , Dahl RM , Berman L , Zhang J , Erdman DD , Gerber SI . J Clin Virol 2017 89 34-37 BACKGROUND: The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) has prompted enhanced surveillance for respiratory infections among pilgrims returning from the Hajj, one of the largest annual mass gatherings in the world. OBJECTIVES: To describe the epidemiology and etiologies of respiratory illnesses among pilgrims returning to Jordan after the 2014 Hajj. STUDY DESIGN: Surveillance for respiratory illness among pilgrims returning to Jordan after the 2014 Hajj was conducted at sentinel health care facilities using epidemiologic surveys and molecular diagnostic testing of upper respiratory specimens for multiple respiratory pathogens, including MERS-CoV. RESULTS: Among the 125 subjects, 58% tested positive for at least one virus; 47% tested positive for rhino/enterovirus. No cases of MERS-CoV were detected. CONCLUSIONS: The majority of pilgrims returning to Jordan from the 2014 Hajj with respiratory illness were determined to have a viral etiology, but none were due to MERS-CoV. A greater understanding of the epidemiology of acute respiratory infections among returning travelers to other countries after Hajj should help optimize surveillance systems and inform public health response practices. |
Perspectives on West Africa Ebola virus disease outbreak, 2013-2016
Spengler JR , Ervin ED , Towner JS , Rollin PE , Nichol ST . Emerg Infect Dis 2016 22 (6) 956-63 The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013-2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community's insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research. |
effects of antiretroviral therapy on the survival of human immunodeficiency virus-positive adult patients in Andhra Pradesh, India: A retrospective cohort study, 2007-2013
Bajpai R , Chaturvedi H , Jayaseelan L , Harvey P , Seguy N , Chavan L , Raj P , Pandey A . J Prev Med Public Health 2016 49 (6) 394-405 OBJECTIVES: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS: The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mm3 vs. >350 cells/mm3), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients. |
As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men
Stenger MR , Baral S , Stahlman S , Wohlfeiler D , Barton JE , Peterman T . Sex Health 2016 14 (1) 18-27 The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM. |
Isolation and characterization of a unique strain of Rickettsia parkeri associated with the hard tick Dermacentor parumapertus Neumann in the western United States.
Paddock CD , Allerdice ME , Karpathy SE , Nicholson WL , Levin ML , Smith TC , Becker T , Delph RJ , Knight RN , Ritter JM , Sanders JH , Goddard J . Appl Environ Microbiol 2017 83 (9) In 1953, investigators at the Rocky Mountain Laboratories in Hamilton, Montana, described the isolation of a spotted fever group Rickettsia (SFGR) species from Dermacentor parumapertus collected from black-tailed jackrabbits (Lepus californicus) in northern Nevada. Several decades later, investigators characterized this SFGR by using mouse serotyping methods and determined that it represented a distinct rickettsial serotype, related closely to Rickettsia parkeri; nonetheless, the parumapertus agent was not further characterized or studied. No extant isolates of the parumapertus agent remain in any rickettsial culture collection around the world which precludes contemporary phylogenetic placement of this enigmatic SFGR. To rediscover the parumapertus agent, adult-stage D. parumapertus ticks were collected from black-tailed jackrabbits shot or encountered as road-kills in Arizona, Utah, or Texas during 2011-2016. A total of 339 ticks were collected and evaluated for infection with Rickettsia species. From 112 D. parumapertus collected in south Texas, 16 (14.3%) contained partial ompA sequences with closest identity (99.6%) to Rickettsia sp. Atlantic rainforest, a recently identified pathogenic SFGR that causes a mild rickettsiosis in several states of Brazil. A pure isolate, designated strain Black Gap, was cultivated in Vero E6 cells and sequence analysis of the rrs, gltA, sca0, sca5 and sca4 genes also revealed closest genetic identity to Rickettsia sp. Atlantic rainforest. Phylogenetic analysis of the five concatenated rickettsial genes place Rickettsia sp. Black Gap and Rickettsia sp. Atlantic rainforest with R. parkeri in a distinct and well-supported clade.Importance. We suggest that Rickettsia sp. Black Gap and Rickettsia sp. Atlantic rainforest represent nearly identical strains of R. parkeri, and that Rickettsia sp. Black Gap, or a very similar strain of R. parkeri, represents the parumapertus agent. Close genetic relatedness among these taxa, as well as the response of guinea pigs infected with Black Gap strain, suggest that R. parkeri Black Gap could cause disease in humans. The identification of this organism could also account, at least in part, for remarkable differences in severity ascribed to RMSF among various regions of the American West during the early 20th century. We suggest that wide variation in case-fatality rates attributed to RMSF could have occurred by the inadvertent inclusion of cases of milder disease caused by R. parkeri Black Gap. |
Risk factors for Anopheles mosquitoes in rural and urban areas of Blantyre District, southern Malawi
Mzilahowa T , Luka-Banda M , Uzalili V , Mathanga DP , Campbell CH Jr , Mukaka M , Gimnig JE . Malawi Med J 2016 28 (4) 151-158 Background Although urban malaria transmission is low and seasonal, it remains a major public health problem. This study aimed at demonstrating the presence of Anopheles mosquitoes and their potential to transmit malaria in urban settings. Methods Two cross-sectional surveys were carried out in Blantyre District, Malawi, during the dry and wet seasons of 2008 and 2010, respectively. A map of Blantyre was divided into a grid of 400 cells, of which 60 cells were randomly selected. Five households located within 100 m from the centre of each selected cell were enrolled, a standard questionnaire was administered, and indoor resting mosquitoes were sampled. Results In 2008 and 2010, a total of 960 and 1045 mosquitoes were collected, respectively. Anophelesfunestus comprised 9.9% (n = 95) and 10.3% (n = 108) during the two surveys, respectively. Anophelesgambiae sensu lato (s.l.) was rarely detected during the second survey (n = 6; 0.6%). Molecular identification was performed on samples collected during the first survey, and An. funestus sensu stricto (s.s.) was the only sibling species detected. All the Anopheles mosquitoes were collected from households located in rural areas of Blantyre and none from urban areas. In univariate analysis, the presence of open eaves was associated with increased Anopheles prevalence, both during the dry (incidence rate ratio, IRR = 4.3; 95% CI 2.4-7.6) and wet (IRR = 2.47; 95% CI 1.7-3.59) seasons. Chances of detecting Anopheles spp. decreased with increasing altitude (IRR = 0.996; 95% CI 0.995-0.997) and during the dry season, but increased during the wet season (IRR = 1.0017; 95% CI 1.0012-1.0023). These factors remained significant following a multiple Poisson regression analysis. No association was found between insecticide-treated bednet ownership and the number of Anopheles mosquitoes detected. Conclusions The presence of An. funestus s.s and An. gambiae s.l. in the periphery of Blantyre city was an indication that malaria transmission was potentially taking place in these areas. |
Summary of the Workshop on the Safe Handling of Hazardous Drugs cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical Oncology
Connor TH , Celano P , Frame JN , Zon RT . J Oncol Pract 2017 13 (3) Jop2016017384 The National Institute for Occupational Safety and Health (NIOSH) and ASCO cohosted the Workshop on the Safe Handling of Hazardous Drugs on November 13, 2015, in Alexandria, Virginia. NIOSH is the US federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. ASCO is a national organization representing nearly 40,000 physicians and other health care professionals specializing in cancer treatment, diagnosis, and prevention. | The Workshop focused on the history of guidance development for safe handling of hazardous drugs and challenges in development of guidance for worker safety. The goal was to promote information sharing and collaboration among stakeholders, including experts in occupational health, drug management and safety, cancer care, and research. | Thomas Connor, PhD, from NIOSH and Robin Zon, MD, Chair of ASCO’s Task Force on Safe Handling of Chemotherapy, served as Workshop co-chairs. Participating organizations included the American Nurses Association, American Society of Health-System Pharmacists, ASCO, NIOSH/Centers for Disease Control and Prevention, Hematology Oncology Pharmacy Association, Oncology Nursing Society (ONS), Occupational Safety and Health Administration, US Pharmacopeial Convention, and the Department of Veterans Affairs. A full list of Workshop participants is included in the Appendix (online only). |
Private well groundwater quality in West Virginia, USA - 2010
Law RK , Murphy MW , Choudhary E . Sci Total Environ 2017 586 559-565 The Centers for Disease Control and Prevention (CDC), in collaboration with the West Virginia Bureau of Public Health (BPH), initiated an investigation to characterize private well water quality in West Virginia. The objective was to better characterize private well water across various aquifer geologies by testing household drinking water samples and comparing them to EPA's National Primary Drinking Water Standards. The BPH selected ten counties representing three regions to capture geologically diverse areas that represent varying aquifer geology. We collected well-water samples from participating households and analyzed all water samples for 20 constituents currently monitored in public drinking-water systems. We calculated geometric means for each constituent and compared metal concentrations to EPA maximum and secondary contaminant levels by the geologic age of the rock surrounding the aquifer where the sample was obtained. All participating households (n=139) provided a water sample. We detected arsenic at levels higher than the EPA maximum contaminant level in 10 (7.2%) samples. We detected elevated radon-222 in 48 (34.5%) samples. Geologic age of the region was indicative of whether arsenic and radon-222 were present at levels that exceeded current EPA drinking water standards. We found arsenic and radon concentrations were higher in Permian aquifers compared to those of other geologic ages. Homeowners with private wells in areas with Permian aged aquifers could benefit from targeted public health messaging about potentially harmful constituent concentrations in the well water. This may help ensure proper testing and maintenance of private wells and reduce exposure to these constituents. |
Integrating health and transportation in Nashville, Tennessee, USA: From policy to projects
Meehan LA , Whitfield GP . J Transp Health 2017 4 325-33 The Nashville Area Metropolitan Planning Organization (MPO) is among the first MPOs in the United States to recognize the interplay of transportation and public health, particularly regarding physical activity, air pollution, and traffic crashes. The Nashville MPO has taken a multifaceted approach to simultaneously improve the transportation system, quality of life, and health status of the region's population. The purpose of this paper is to describe the multiple programs and projects that the MPO has undertaken to this end, so that other cities might learn from Nashville's example.The MPO's strategy comprised six processes. First, the MPO conducted the Regional Bicycle and Pedestrian Study in 2009 and 2014 that established priority issues to be addressed by bicycle and pedestrian projects in Regional Transportation Plans. Second, the MPO responded to public opinion by adopting new transportation policies in the 2035 and 2040 Regional Transportation Plans, including increasing bicycle and pedestrian options and expanding public transit. Third, the MPO created scoring criteria for proposed roadway projects that prioritized health impacts. Fourth, the MPO reserved funding for projects selected under the new criteria and established a new funding program, the Active Transportation Program. Fifth, the MPO conducted the Middle Tennessee Transportation and Health Study, one of the first regional studies in the nation linking transportation and health. Finally, the MPO implemented the Integrated Transport and Health Impact Model which predicts and monetizes population-level health impacts of shifting the population towards active transportation modes.Recent inventories of bicycle and pedestrian infrastructure suggest these interrelated processes are increasing opportunities for walking, bicycling, and public transit use in the region. Further, each of these projects has contributed to a growing appreciation in the region of the links between transportation and health, and continued evaluation efforts can determine if transportation behaviors and health outcomes are changing. |
Assessing adaptation strategies for extreme heat: A public health evaluation of cooling centers in Maricopa County, Arizona
Berisha V , Hondula D , Roach M , White JR , McKinney B , Bentz D , Mohamed A , Uebelherr J , Goodin K . Weather Clim Soc 2017 9 (1) 71-80 Preventing heat-associated morbidity and mortality is a public health priority in Maricopa County, Arizona (United States). The objective of this project was to evaluate Maricopa County cooling centers and gain insight into their capacity to provide relief for the public during extreme heat events. During the summer of 2014, 53 cooling centers were evaluated to assess facility and visitor characteristics. Maricopa County staff collected data by directly observing daily operations and by surveying managers and visitors. The cooling centers in Maricopa County were often housed within community, senior, or religious centers, which offered various services for at least 1500 individuals daily. Many visitors were unemployed and/or homeless. Many learned about a cooling center by word of mouth or by having seen the cooling center's location. The cooling centers provide a valuable service and reach some of the region's most vulnerable populations. This project is among the first to systematically evaluate cooling centers from a public health perspective and provides helpful insight to community leaders who are implementing or improving their own network of cooling centers. |
Blood cadmium by race/Hispanic origin: The role of smoking
Aoki Y , Yee J , Mortensen ME . Environ Res 2017 155 193-198 BACKGROUND: There have been increasing concerns over health effects of low level exposure to cadmium, especially those on bones and kidneys. OBJECTIVE: To explore how age-adjusted geometric means of blood cadmium in adults varied by race/Hispanic origin, sex, and smoking status among U.S. adults and the extent to which the difference in blood cadmium by race/Hispanic origin and sex may be explained by intensity of smoking, a known major source of cadmium exposure. METHODS: Our sample included 7,368 adults from National Health and Nutrition Examination Survey (NHANES) 2011-2014. With direct age adjustment, geometric means of blood cadmium and number of cigarettes smoked per day were estimated for subgroups defined by race/Hispanic origin, smoking status, and sex using interval regression, which allows mean estimation in the presence of left- and right-censoring. RESULTS: Among never and former smoking men and women, blood cadmium tended to be higher for non-Hispanic Asian adults than adults of other race/Hispanic origin. Among current smokers, who generally had higher blood cadmium than never and former smokers, non-Hispanic white, black, and Asian adults had similarly elevated blood cadmium compared to Hispanic adults. A separate analysis revealed that non-Hispanic white adults tended to have the highest smoking intensity regardless of sex, than adults of the other race/Hispanic origin groups. CONCLUSIONS: The observed pattern provided evidence for smoking as a major source of cadmium exposure, yet factors other than smoking also appeared to contribute to higher blood cadmium of non-Hispanic Asian adults. |
Near Real-Time Surveillance of U.S. Norovirus Outbreaks by the Norovirus Sentinel Testing and Tracking Network - United States, August 2009-July 2015.
Shah MP , Wikswo ME , Barclay L , Kambhampati A , Shioda K , Parashar UD , Vinje J , Hall AJ . MMWR Morb Mortal Wkly Rep 2017 66 (7) 185-189 Norovirus is the leading cause of endemic and epidemic acute gastroenteritis in the United States. New variant strains of norovirus GII.4 emerge every 2-4 years and are often associated with increased disease and health care visits. Since 2009, CDC has obtained epidemiologic data on norovirus outbreaks from state health departments through the National Outbreak Reporting System (NORS) and laboratory data through CaliciNet. NORS is a web-based platform for reporting waterborne, foodborne, and enteric disease outbreaks of all etiologies, including norovirus, to CDC. CaliciNet, a nationwide electronic surveillance system of local and state public health and regulatory agency laboratories, collects genetic sequences of norovirus strains associated with gastroenteritis outbreaks. Because these two independent reporting systems contain complementary data, integration of NORS and CaliciNet records could provide valuable public health information about norovirus outbreaks. However, reporting lags and inconsistent identification codes in NORS and CaliciNet records have been an obstacle to developing an integrated surveillance system. |
Surveillance for health care access and health services use, adults aged 18-64 years - Behavioral Risk Factor Surveillance System, United States, 2014
Okoro CA , Zhao G , Fox JB , Eke PI , Greenlund KJ , Town M . MMWR Surveill Summ 2017 66 (7) 1-42 PROBLEM/CONDITION: As a result of the 2010 Patient Protection and Affordable Care Act, millions of U.S. adults attained health insurance coverage. However, millions of adults remain uninsured or underinsured. Compared with adults without barriers to health care, adults who lack health insurance coverage, have coverage gaps, or skip or delay care because of limited personal finances might face increased risk for poor physical and mental health and premature mortality. PERIOD COVERED: 2014. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18-64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. RESULTS: In 2014, health insurance coverage and other health care access measures varied substantially by state, state Medicaid expansion status, expanded geographic region (i.e., states categorized geographically into nine regions), and FPL category. The following proportions refer to the range of estimated prevalence for health insurance and other health care access measures by examined geographical unit (unless otherwise specified), as reported by respondents. Among adults with health insurance coverage, the range was 70.8%-94.5% for states, 78.8%-94.5% for Medicaid expansion states, 70.8%-89.1% for nonexpansion states, 73.3%-91.0% for expanded geographic regions, and 64.2%-95.8% for FPL categories. Among adults who had a usual source of health care, the range was 57.2%-86.6% for states, 57.2%-86.6% for Medicaid expansion states, 61.8%-83.9% for nonexpansion states, 64.4%-83.6% for expanded geographic regions, and 61.0%-81.6% for FPL categories. Among adults who received a routine checkup, the range was 52.1%-75.5% for states, 56.0%-75.5% for Medicaid expansion states, 52.1%-71.1% for nonexpansion states, 56.8%-70.2% for expanded geographic regions, and 59.9%-69.2% for FPL categories. Among adults who had unmet health care need because of cost, the range was 8.0%-23.1% for states, 8.0%-21.9% for Medicaid expansion states, 11.9%-23.1% for nonexpansion states, 11.6%-20.3% for expanded geographic regions, and 5.3%-32.9% for FPL categories. Estimated prevalence of cancer screenings, influenza vaccination, and having ever been tested for human immunodeficiency virus also varied by state, state Medicaid expansion status, expanded geographic region, and FPL category. The prevalence of insurance coverage varied by approximately 25 percentage points among racial/ethnic groups (range: 63.9% among Hispanics to 88.4% among non-Hispanic Asians) and by approximately 32 percentage points by FPL category (range: 64.2% among adults with household income <100% of FPL to 95.8% among adults with household income >400% of FPL). The prevalence of unmet health care need because of cost varied by nearly 14 percentage points among racial/ethnic groups (range: 11.3% among non-Hispanic Asians to 25.0% among Hispanics), by approximately 17 percentage points among adults with and without disabilities (30.8% versus 13.7%), and by approximately 28 percentage points by FPL category (range: 5.3% among adults with household income >400% of FPL to 32.9% among adults with household income <100% of FPL). Among the 43 states that included questions from the optional module, a majority of adults reported private health insurance coverage (63.4%), followed by public health plan coverage (19.4%) and no primary source of insurance (17.1%). Financial barriers to health care (unmet health care need because of cost, unmet prescribed medication need because of cost, and medical bills being paid off over time [medical debt]) were typically lower among adults in Medicaid expansion states than those in nonexpansion states regardless of source of insurance. Approximately 75.6% of adults reported being continuously insured during the preceding 12 months, 12.9% reported a gap in coverage, and 11.5% reported being uninsured during the preceding 12 months. The largest proportion of adults reported ≥3 visits to a health care professional during the preceding 12 months (47.3%), followed by 1-2 visits (37.1%), and no health care visits (15.6%). Adults in expansion and nonexpansion states reported similar levels of satisfaction with received health care by primary source of health insurance coverage and by continuity of health insurance coverage during the preceding 12 months. INTERPRETATION: This report presents for the first time estimates of population-based health care access and use of CPS among adults aged 18-64 years. The findings in this report indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS by state, state Medicaid expansion status, expanded geographic region, and FPL category. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. These disparities might be due to larger differences to begin with, decreased disparities in Medicaid expansion states versus nonexpansion states, or increased disparities in nonexpansion states. PUBLIC HEALTH ACTION: BRFSS data from 2014 can be used as a baseline by which to assess and monitor changes that might occur after 2014 resulting from programs and policies designed to increase access to health care, reduce health disparities, and improve the health of the adult population. Post-2014 changes in health care access, such as source of health insurance coverage, attainment and continuity of coverage, financial barriers, preventive care services, and health outcomes, can be monitored using these baseline estimates. |
Genome Sequence of a Genotype 2 Hepatitis E Virus World Health Organization Reference Strain.
Kaiser M , Kamili S , Hayden T , Blumel J , Baylis SA . Genome Announc 2017 5 (7) We report here the sequence of a genotype 2a reference strain of hepatitis E virus (HEV), developed on behalf of the World Health Organization. The HEV reference strain is intended for use in assays based on nucleic acid amplification for the validation of HEV RNA detection. |
Genetic Assessment of African Swine Fever Isolates Involved in Outbreaks in the Democratic Republic of Congo between 2005 and 2012 Reveals Co-Circulation of p72 Genotypes I, IX and XIV, Including 19 Variants.
Mulumba-Mfumu LK , Achenbach JE , Mauldin MR , Dixon LK , Tshilenge CG , Thiry E , Moreno N , Blanco E , Saegerman C , Lamien CE , Diallo A . Viruses 2017 9 (2) African swine fever (ASF) is a devastating disease of domestic pigs. It is a socioeconomically important disease, initially described from Kenya, but subsequently reported in most Sub-Saharan countries. ASF spread to Europe, South America and the Caribbean through multiple introductions which were initially eradicated-except for Sardinia-followed by reintroduction into Europe in 2007. In this study of ASF within the Democratic Republic of the Congo, 62 domestic pig samples, collected between 2005-2012, were examined for viral DNA and sequencing at multiple loci: C-terminus of the B646L gene (p72 protein), central hypervariable region (CVR) of the B602L gene, and the E183L gene (p54 protein). Phylogenetic analyses identified three circulating genotypes: I (64.5% of samples), IX (32.3%), and XIV (3.2%). This is the first evidence of genotypes IX and XIV within this country. Examination of the CVR revealed high levels of intra-genotypic variation, with 19 identified variants. |
Evolutionary relationships of macaca fascicularis fascicularis (Raffles 1821) (primates: Cercopithecidae) from Singapore revealed by Bayesian analysis of mitochondrial DNA sequences
Schillaci MA , Klegarth AR , Switzer WM , Shattuck MR , Lee BPYH , Hollocher H . Raffles Bull Zool 2017 65 3-19 Long-tailed macaques (Macaca fascicularis) have a wide geographic distribution across mainland and insular Southeast Asia. The evolutionary history of long-tailed macaques has been examined extensively through comparison of phenotypic variation and by phylogenetic analyses of molecular genetic data. Nonetheless, the complex evolutionary history of M. fascicularis throughout Southeast Asia is not fully understood. For the present study, we performed a Bayesian phylogenetic analysis of M. fascicularis mitochondrial 12S/tRNA-val/16S sequences to examine the evolutionary relationships of the long-tailed macaques from Singapore. More generally, we hoped to gain a better understanding of the evolutionary history of long-tailed macaques throughout Southeast Asia. We used previously archived sequences in GenBank and new sequences from Singapore (n=34) and Bali, Indonesia (n=2) in a Bayesian phylogenetic framework to co-infer evolutionary histories and divergence dates. Our results revealed two large clades, one composed of haplotypes primarily from Sundaic islands populations, and the second primarily from continental populations. These two larger clades comprise four primary regional clades. All three haplotypes from Singapore form a well-supported subclade within a larger peninsular clade. A medianjoining network of haplotypes mirrored the results from the phylogenetic analyses. We found divergence dates that were largely consistent with previous studies using complete mitochondrial genomes. Based on an assessment of phylogenetic relationships, the pattern of estimated divergence dates, and the available fossil record, we suggest that the evolutionary history of M. fascicularis likely included multiple dispersal events. |
Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014
Zhao G , Okoro CA , Dhingra SS , Xu F , Zack M . Public Health 2017 146 108-117 Objective To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18–64 years) in 50 states and the District of Columbia (DC). Study design Cross-sectional surveys. Methods We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18–64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993–2010 and 2011–2014 due to methodologic changes in the BRFSS. Results From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0–24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2–10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. Conclusions The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18–64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population. |
Cost-effectiveness analysis of four simulated colorectal cancer screening interventions, North Carolina
Hassmiller Lich K , Cornejo DA , Mayorga ME , Pignone M , Tangka FK , Richardson LC , Kuo TM , Meyer AM , Hall IJ , Smith JL , Durham TA , Chall SA , Crutchfield TM , Wheeler SB . Prev Chronic Dis 2017 14 E18 INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population's health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina. METHODS: We used individual-based modeling to simulate and compare intervention costs and results under 4 evidence-based and stakeholder-informed intervention scenarios for a 10-year intervention window, from January 1, 2014, through December 31, 2023. We compared the proportion of people living in North Carolina who were aged 50 to 75 years at some point during the window (that is, age-eligible for screening) who were up to date with CRC screening recommendations across intervention scenarios, both overall and among groups with documented disparities in receipt of screening. RESULTS: We estimated that the costs of the 4 intervention scenarios considered would range from $1.6 million to $3.75 million. Our model showed that mailed reminders for Medicaid enrollees, mass media campaigns targeting African Americans, and colonoscopy vouchers for the uninsured reduced disparities in receipt of screening by 2023, but produced only small increases in overall screening rates (0.2-0.5 percentage-point increases in the percentage of age-eligible adults who were up to date with CRC screening recommendations). Increased screenings ranged from 41,709 additional life-years up to date with screening for the voucher intervention to 145,821 for the mass media intervention. Reminders mailed to Medicaid enrollees and the mass media campaign for African Americans were the most cost-effective interventions, with costs per additional life-year up to date with screening of $25 or less. The intervention expanding the number of endoscopy facilities cost more than the other 3 interventions and was less effective in increasing CRC screening. CONCLUSION: Cost-effective CRC screening interventions targeting observed disparities are available, but substantial investment (more than $3.75 million) and additional approaches beyond those considered here are required to realize greater increases population-wide. |
Cost-effectiveness of the 2014 U.S. Preventive Services Task Force (USPSTF) Recommendations for Intensive Behavioral Counseling Interventions for Adults With Cardiovascular Risk Factors
Lin J , Zhuo X , Bardenheier B , Rolka DB , Gregg WE , Hong Y , Wang G , Albright A , Zhang P . Diabetes Care 2017 40 (5) 640-646 OBJECTIVE: In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended behavioral counseling interventions for overweight or obese adults with the following known cardiovascular disease risk factors: impaired fasting glucose (IFG), hypertension, dyslipidemia, or metabolic syndrome. We assessed the long-term cost-effectiveness (CE) of implementing the recommended interventions in the U.S. RESEARCH DESIGN AND METHODS: We used a disease progression model to simulate the 25-year CE of the USPSTF recommendation for eligible U.S. adults and subgroups defined by a combination of the risk factors. The baseline population was estimated using 2005-2012 National Health and Nutrition Examination Surveys. The cost and effectiveness of the intervention were obtained from systematic reviews. Incremental CE ratios (ICERs), measured in cost/quality-adjusted life year (QALY), were used to assess the CE of the intervention compared with no intervention. Future QALYs and costs (reported in 2014 U.S. dollars) were discounted at 3%. RESULTS: We estimated that approximately 98 million U.S. adults (44%) would be eligible for the recommended intervention. Compared with no intervention, the ICER of the intervention would be $13,900/QALY. CE varied widely among subgroups, ranging from a cost saving of $302 per capita for those who were obese with IFG, hypertension, and dyslipidemia to a cost of $103,200/QALY in overweight people without these conditions. CONCLUSIONS: The recommended intervention is cost effective based on the conventional CE threshold. Considerable variation in CE across the recommended subpopulations suggests that prioritization based on risk level would yield larger total health gains per dollar spent. |
Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States
Zheng Z , Han X , Guy GP Jr , Davidoff AJ , Li C , Banegas MP , Ekwueme DU , Yabroff KR , Jemal A . Cancer 2017 123 (8) 1453-1463 BACKGROUND: There is limited evidence from nationally representative samples about changes in prescription drug use for financial reasons among cancer survivors in the United States. METHODS: The 2011 to 2014 National Health Interview Survey was used to identify adults who reported ever having been told they had cancer (cancer survivors; n = 8931) and individuals without a cancer history (n = 126,287). Measures of changes in prescription drug use for financial reasons included: 1) skipping medication doses, 2) taking less medicine, 3) delaying filling a prescription, 4) asking a doctor for lower cost medication, 5) buying prescription drugs from another country, and 6) using alternative therapies. Multivariable logistic regression analyses were controlled for demographic characteristics, number of comorbid conditions, interactions between cancer history and number of comorbid conditions, and health insurance coverage. Main analyses were stratified by age (nonelderly, ages 18-64 years; elderly, ages ≥65 years) and time since diagnosis (recently diagnosed, <2 years; previously diagnosed, ≥2 years). RESULTS: Among nonelderly individuals, both recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors were more likely to report any change in prescription drug use for financial reasons than those without a cancer history (21.4%), with the excess percentage changes for individual measures ranging from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01). Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons. CONCLUSIONS: Nonelderly cancer survivors are particularly vulnerable to changes in prescription drug use for financial reasons, suggesting that targeted efforts are needed. Cancer 2017. |
Zimbabwe's Human Resources for health Information System (ZHRIS) - an assessment in the context of establishing a global standard
Waters KP , Zuber A , Simbini T , Bangani Z , Krishnamurthy RS . Int J Med Inform 2017 100 121-128 Introduction There have been numerous global calls to action to utilize human resources information systems (HRIS) to improve the availability and quality of data for strengthening the regulation and deployment of health workers. However, with no normative guidance in existence, the development of HRIS has been inconsistent and lacking in standardization, hindering the availability and use of data for health workforce planning and decision making (Riley et al., 2012). CDC and WHO partnered with the Ministry of Health in several countries to conduct HRIS functional requirements analyses and establish a Minimum Data Set (MDS) of elements essential for a global standard HRIS. As a next step, CDC advanced a study to examine the alignment of one of the HRIS it supports (in Zimbabwe) against this MDS. Method For this study, we created a new data collection and analysis tool to assess the extent to which Zimbabwe's CDC-supported HRIS was aligned with the WHO MDS. We performed systematic "gap analyses" in order to make prioritized recommendations for addressing the gaps, with the aim of improving the availability and quality of data on Zimbabwe's health workforce. Results The majority of the data elements outlined in the WHO MDS were present in the ZHRIS databases, though they were found to be missing various applicable elements. The lack of certain elements could impede functions such as health worker credential verification or equitable in-service training allocation. While the HRIS MDS treats all elements equally, our assessment revealed that not all the elements have equal significance when it comes to data utilization. Further, some of the HRIS MDS elements exceeded the current needs of regulatory bodies and the Ministry of Health and Child Care (MOHCC) in Zimbabwe. The preliminary findings of this study helped inspire the development of a more recent HRH Registry MDS subset, which is a shorter list of priority data elements recommended as a global standard for HRIS. Conclusion The field-tested assessment methodology presented here, with suggested improvements to the tool, can be used to identify absent or unaligned elements in either an HRH Registry or a full HRIS. Addressing the prioritized gaps will increase the availability of critical data in the ZHRIS and can empower the MOHCC and councils to conduct more strategic analyses, improving health workforce planning and ultimately public health outcomes in the country. |
Cross-disciplinary consultancy to enhance predictions of asthma exacerbation risk in Boston
Reid M , Gunn J , Shah S , Donovan M , Eggo R , Babin S , Stajner I , Rogers E , Ensor KB , Raun L , Levy JI , Painter I , Phipatanakul W , Yip F , Nath A , Streichert LC , Tong C , Burkom H . Online J Public Health Inform 2016 8 (3) e199 This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement. |
Linkage of traffic crash and hospitalization records with limited identifiers for enhanced public health surveillance
Conderino S , Fung L , Sedlar S , Norton JM . Accid Anal Prev 2017 101 117-123 BACKGROUND: Motor vehicle traffic (MVT) crashes kill or seriously injure approximately 4250 people in New York City (NYC) each year. Traditionally, NYC surveillance practices use hospitalization and crash data separately to monitor trends in MVT-related injuries, but key information linking crash circumstances to health outcomes is lost when analyzing these data sources in isolation. Our objective was to match crash reports to hospitalization records to create a traffic injury surveillance dataset that can be used to describe crash circumstances and related injury outcomes. The linkage of the two systems presents a unique challenge since the system tracking crashes and the system tracking hospitalizations and emergency department (ED) visits lack key identifying data such as names and dates of birth. METHODS: NYC Department of Transportation provided electronic records based on reports of motor vehicle crashes submitted to the New York State Department of Motor Vehicles for all crashes occurring in NYC from 2009 to 2013. New York Statewide Planning and Research Cooperative System (SPARCS) ED and hospitalization administrative data from NYC hospitals were used to identify unintentional MVT-related injuries using external cause of injury codes. Since the two systems do not share unique individual identifiers, probabilistic record linkage was conducted using LinkSolv9.0. Sensitivity/specificity calculations and chi-square analyses of linkage rates were conducted to assess linkage results. RESULTS: From 2009-2013, there were 1,054,344 individuals involved in MVT crashes in NYC and 280,340 ED visits and hospitalizations from MVT-related injuries. There were 145,003 linked pairs, giving a linkage rate of 52% of the total MVT-related hospital records. This linkage had a sensitivity of 74% and a specificity of 93%. Linkage rates were comparable by age, sex, crash role, collision type, hospital county, injury location, hospital type, and hospital status, indicating no apparent biases in the match by these variables. CONCLUSIONS: Performing a probabilistic linkage between MVT crash reports and hospitalization records is possible with a limited set of identifying variables. These linked data will inform traffic safety policies by providing new information on how crash circumstances translate to health outcomes. |
Immunogenicity and Cross Protection in Mice Afforded by Pandemic H1N1 Live Attenuated Influenza Vaccine Containing Wild-Type Nucleoprotein.
Rekstin A , Isakova-Sivak I , Petukhova G , Korenkov D , Losev I , Smolonogina T , Tretiak T , Donina S , Shcherbik S , Bousse T , Rudenko L . Biomed Res Int 2017 2017 9359276 Since conserved viral proteins of influenza virus, such as nucleoprotein (NP) and matrix 1 protein, are the main targets for virus-specific CD8+ cytotoxic T-lymphocytes (CTLs), we hypothesized that introduction of the NP gene of wild-type virus into the genome of vaccine reassortants could lead to better immunogenicity and afford better protection. This paper describes in vitro and in vivo preclinical studies of two new reassortants of pandemic H1N1 live attenuated influenza vaccine (LAIV) candidates. One had the hemagglutinin (HA) and neuraminidase (NA) genes from A/South Africa/3626/2013 H1N1 wild-type virus on the A/Leningrad/134/17/57 master donor virus backbone (6 : 2 formulation) while the second had the HA, NA, and NP genes of the wild-type virus on the same backbone (5 : 3 formulation). Although both LAIVs induced similar antibody immune responses, the 5 : 3 LAIV provoked greater production of virus-specific CTLs than the 6 : 2 variant. Furthermore, the 5 : 3 LAIV-induced CTLs had higher in vivo cytotoxic activity, compared to 6 : 2 LAIV. Finally, the 5 : 3 LAIV candidate afforded greater protection against infection and severe illness than the 6 : 2 LAIV. Inclusion in LAIV of the NP gene from wild-type influenza virus is a new approach to inducing cross-reactive cell-mediated immune responses and cross protection against pandemic influenza. |
Engineering Botulinum Neurotoxin C1 as a Molecular Vehicle for Intra-Neuronal Drug Delivery.
Vazquez-Cintron EJ , Beske PH , Tenezaca L , Tran BQ , Oyler JM , Glotfelty EJ , Angeles CA , Syngkon A , Mukherjee J , Kalb SR , Band PA , McNutt PM , Shoemaker CB , Ichtchenko K . Sci Rep 2017 7 42923 Botulinum neurotoxin (BoNT) binds to and internalizes its light chain into presynaptic compartments with exquisite specificity. While the native toxin is extremely lethal, bioengineering of BoNT has the potential to eliminate toxicity without disrupting neuron-specific targeting, thereby creating a molecular vehicle capable of delivering therapeutic cargo into the neuronal cytosol. Building upon previous work, we have developed an atoxic derivative (ad) of BoNT/C1 through rationally designed amino acid substitutions in the metalloprotease domain of wild type (wt) BoNT/C1. To test if BoNT/C1 ad retains neuron-specific targeting without concomitant toxic host responses, we evaluated the localization, activity, and toxicity of BoNT/C1 ad in vitro and in vivo. In neuronal cultures, BoNT/C1 ad light chain is rapidly internalized into presynaptic compartments, but does not cleave SNARE proteins nor impair spontaneous neurotransmitter release. In mice, systemic administration resulted in the specific co-localization of BoNT/C1 ad with diaphragmatic motor nerve terminals. The mouse LD50 of BoNT/C1 ad is 5 mg/kg, with transient neurological symptoms emerging at sub-lethal doses. Given the low toxicity and highly specific neuron-targeting properties of BoNT/C1 ad, these data suggest that BoNT/C1 ad can be useful as a molecular vehicle for drug delivery to the neuronal cytoplasm. |
Safe recombinant outer membrane vesicles that display M2e elicit heterologous influenza protection
Watkins HC , Rappazzo CG , Higgins JS , Sun X , Brock N , Chau A , Misra A , Cannizzo JP , King MR , Maines TR , Leifer CA , Whittaker GR , DeLisa MP , Putnam D . Mol Ther 2017 25 (4) 989-1002 Recombinant, Escherichia coli-derived outer membrane vesicles (rOMVs), which display heterologous protein subunits, have potential as a vaccine adjuvant platform. One drawback to rOMVs is their lipopolysaccharide (LPS) content, limiting their translatability to the clinic due to potential adverse effects. Here, we explore a unique rOMV construct with structurally remodeled lipids containing only the lipid IVa portion of LPS, which does not stimulate human TLR4. The rOMVs are derived from a genetically engineered B strain of E. coli, ClearColi, which produces lipid IVa, and which was further engineered in our laboratory to hypervesiculate and make rOMVs. We report that rOMVs derived from this lipid IVa strain have substantially attenuated pyrogenicity yet retain high levels of immunogenicity, promote dendritic cell maturation, and generate a balanced Th1/Th2 humoral response. Additionally, an influenza A virus matrix 2 protein-based antigen displayed on these rOMVs resulted in 100% survival against a lethal challenge with two influenza A virus strains (H1N1 and H3N2) in mice with different genetic backgrounds (BALB/c, C57BL/6, and DBA/2J). Additionally, a two-log reduction of lung viral titer was achieved in a ferret model of influenza infection with human pandemic H1N1. The rOMVs reported herein represent a potentially safe and simple subunit vaccine delivery platform. |
Serum-borne bioactivity caused by pulmonary multiwalled carbon nanotubes induces neuroinflammation via blood-brain barrier impairment
Aragon MJ , Topper L , Tyler CR , Sanchez B , Zychowski K , Young T , Herbert G , Hall P , Erdely A , Eye T , Bishop L , Saunders SA , Muldoon PP , Ottens AK , Campen MJ . Proc Natl Acad Sci U S A 2017 114 (10) E1968-E1976 Pulmonary exposure to multiwalled carbon nanotubes (MWCNTs) causes indirect systemic inflammation through unknown pathways. MWCNTs translocate only minimally from the lungs into the systemic circulation, suggesting that extrapulmonary toxicity may be caused indirectly by lung-derived factors entering the circulation. To assess a role for MWCNT-induced circulating factors in driving neuroinflammatory outcomes, mice were acutely exposed to MWCNTs (10 or 40 microg/mouse) via oropharyngeal aspiration. At 4 h after MWCNT exposure, broad disruption of the blood-brain barrier (BBB) was observed across the capillary bed with the small molecule fluorescein, concomitant with reactive astrocytosis. However, pronounced BBB permeation was noted, with frank albumin leakage around larger vessels (>10 microm), overlain by a dose-dependent astroglial scar-like formation and recruitment of phagocytic microglia. As affirmed by elevated inflammatory marker transcription, MWCNT-induced BBB disruption and neuroinflammation were abrogated by pretreatment with the rho kinase inhibitor fasudil. Serum from MWCNT-exposed mice induced expression of adhesion molecules in primary murine cerebrovascular endothelial cells and, in a wound-healing in vitro assay, impaired cell motility and cytokinesis. Serum thrombospondin-1 level was significantly increased after MWCNT exposure, and mice lacking the endogenous receptor CD36 were protected from the neuroinflammatory and BBB permeability effects of MWCNTs. In conclusion, acute pulmonary exposure to MWCNTs causes neuroinflammatory responses that are dependent on the disruption of BBB integrity. |
High-confidence qualitative identification of organophosphorus nerve agent adducts to human butyrylcholinesterase
Mathews TP , Carter MD , Johnson D , Isenberg SL , Graham LA , Thomas JD , Johnson RC . Anal Chem 2017 89 (3) 1955-1964 In this study, a data-dependent, high-resolution tandem mass spectrometry (ddHRMS/MS) method capable of detecting all organophosphorus nerve agent (OPNA) adducts to human butyrylcholinesterase (BChE) was developed. After an exposure event, immunoprecipitation from blood with a BChE-specific antibody and digestion with pepsin produces a nine amino acid peptide containing the OPNA adduct. Signature product ions of this peptic BChE nonapeptide (FGES*AGAAS) offer a route to broadly screen for OPNA exposure. Taking this approach on an HRMS instrument identifies biomarkers, including unknowns, with high mass accuracy. Using a set of pooled human sera exposed to OPNAs as quality control (QC) materials, the developed method successfully identified precursor ions with <1 ppm and tied them to signature product ions with <5 ppm deviation from their chemical formulas. This high mass accuracy data from precursor and product ions, collected over 23 independent immunoprecipitation preparations, established method operating limits. QC data and experiments with 14 synthetic reference peptides indicated that reliable qualitative identification of biomarkers was possible for analytes >15 ng/mL. The developed method was applied to a convenience set of 96 unexposed serum samples and a blinded set of 80 samples treated with OPNAs. OPNA biomarkers were not observed in convenience set samples and no false positive or negative identifications were observed in blinded samples. All biomarkers in the blinded serum set >15 ng/mL were correctly identified. For the first time, this study reports a ddHRMS/MS method capable of complementing existing quantitative methodologies and suitable for identifying exposure to unknown organophosphorus agents. |
AOAC SMPR 2016.009: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Brucella suis in field-deployable, Department of Defense aerosol collection devices
Roberto F , Arce J , Beck LC , Blank TR , Cahall R , Damer K , Ficht T , Foster J , Kiss K , Nikolich M , Olsen S , Ozanich R , Rozak D , Schaefer F , Sozhamannan S , Tiller R , Coates SG . J AOAC Int 2017 100 (1) 255-260 Intended Use: Field-deployed use for analysis of | aerosol collection filters and/or liquids | 1 Applicability | Detection of Brucella suis in collection buffers from aerosol | collection devices. Field-deployable assays are preferred. | 2 Analytical Technique | Molecular detection of nucleic acid. | 3 Definitions | Acceptable minimum detection level (AMDL).— | Predetermined minimum level of an analyte, as specified by | an expert committee which must be detected by the candidate | method at a specified probability of detection (POD). | Exclusivity.—Study involving pure nontarget strains, which | are potentially cross-reactive, that shall not be detected or | enumerated by the candidate method. | Inclusivity.—Study involving pure target strains that shall be | detected or enumerated by the candidate method. | Maximum time-to-result.—Maximum time to complete an | analysis starting from the collection buffer to assay result. | Probability of detection (POD).—Proportion of positive | analytical outcomes for a qualitative method for a given matrix | at a specified analyte level or concentration with a ≥0.95 | confidence interval. | System false-negative rate.—Proportion of test results that | are negative contained within a population of known positives. | System false-positive rate.—Proportion of test results that are | positive contained within a population of known negatives. | 4 Method Performance Requirements | See Table 1. | 5 System Suitability Tests and/or Analytical Quality control | The controls listed in Table 2 shall be embedded in assays as | appropriate. Manufacturer must provide written justification if | controls are not embedded in the assay |
AOAC SMPR 2016.010: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Burkholderia pseudomallei in field-deployable, Department of Defense aerosol collection devices
Gee J , Arce J , Beck LC , Blank TR , Blyn L , Cahall R , Clark AJ , Currie B , Damer K , Davenport M , DeShazer D , Johns M , Keim PS , Kiss K , Lesho M , Lin N , Morse SA , Naraghi-Arani P , Ozanich R , Roberto F , Rozak D , Sahl J , Schaefer F , Schutzer S , Schweizer HP , Sozhamannan S , Tuanyok A , Coates S . J AOAC Int 2017 100 (1) 261-265 Intended Use: Field-deployed use for analysis of | aerosol collection filters and/or liquids | 1 Applicability | Detection of Burkholderia pseudomallei in collection buffers | from aerosol collection devices. Field-deployable assays are | preferred. | 2 Analytical Technique | Molecular detection of nucleic acid. | 3 Definitions | Acceptable minimum detection level (AMDL).— | Predetermined minimum level of an analyte, as specified by | an expert committee which must be detected by the candidate | method at a specified probability of detection (POD). | Exclusivity.—Study involving pure nontarget strains, which | are potentially cross-reactive, that shall not be detected or | enumerated by the candidate method. | Inclusivity.—Study involving pure target strains that shall be | detected or enumerated by the candidate method. | Maximum time-to-result.—Maximum time to complete an | analysis starting from the collection buffer to assay result. | Probability of detection (POD).—Proportion of positive | analytical outcomes for a qualitative method for a given matrix | at a specified analyte level or concentration with a ≥0.95 | confidence interval. | System false-negative rate.—Proportion of test results that | are negative contained within a population of known positives. | System false-positive rate.—Proportion of test results that are | positive contained within a population of known negatives. | 4 Method Performance Requirements | See Table 1. | 5 System Suitability Tests and/or Analytical Quality Control | The controls listed in Table 2 shall be embedded in assays as | appropriate. Manufacturer must provide written justification if | controls are not embedded in the assay. |
AOAC SMPR 2016.012: Standard Method Performance Requirements (SMPRs) for detection and identification of Variola virus
Olson V , Arce J , Beck LC , Blyn L , Cahall R , Clark AJ , Damer K , Ibrahim MS , Jackson PJ , Kiss K , Meyer H , Naraghi-Arani P , Pettit D , Schaefer F , Scheckelhoff M , Sozhamannan S , Vitalis E , Coates SG . J AOAC Int 2017 100 (1) 270-275 Intended Use: Laboratory use by trained technicians | 1 Applicability | Detection of Variola virus DNA in collection buffers from | aerosol collection devices for DoD applications. | Note: Method developers are advised to check the AOAC | website for the most up to date version of this SMPR before | initiating a validation. | 2 Analytical Technique | Polymerase chain reaction (PCR) methods | 3 Definitions | Acceptable minimum detection level (AMDL).— | Predetermined minimum level of an analyte, as specified by an | expert committee that must be detected by the candidate method | at a specified probability of detection (POD). The AMDL | is dependent on the intended use. (Draft EN ISO/CD 16140- | 1: Microbiology of food and animal feeding stuffs—Method | validation—Part 1: Terminology of method validation, vs 17- | 03-2011) | Exclusivity.—Study involving pure nontarget strains that | are potentially cross-reactive that shall not be detected or | enumerated by the tested method. (Draft EN ISO/CD 16140- | 1: Microbiology of food and animal feeding stuffs—Method | validation—Part 1: Terminology of method validation, vs 17- | 03-2011) | Inclusivity.—Study involving pure target strains that shall be | detected or enumerated by the alternative method. (Draft EN | ISO/CD 16140-1: Microbiology of food and animal feeding | stuffs—Method validation—Part 1: Terminology of method | validation, vs 17-03-2011) | Maximum time-to-assay result.—Maximum time to complete | an analysis starting from the collection buffer to assay result. | Probability of detection (POD).—Proportion of positive | analytical outcomes for a qualitative method for a given | matrix at a specified analyte level or concentration with | a ≥0.95 confidence interval [Appendix H: Probability of | Detection (POD) as a Statistical Model for the Validation of | Qualitative Methods, Official Methods of Analysis of AOAC | INTERNATIONAL, 20th Ed., 2016]. | System false-negative rate.—Proportion of test results that | are negative contained within a population of known positives. | System false-positive rate.—Proportion of test results that are | positive contained within a population of known negatives. | Variola virus.—A member of the genus Orthopoxvirus and | the causative agent of smallpox. |
Chemical characterization of mainstream smoke from SPECTRUM VARIABLE NICOTINE RESEARCH CIGARETTES
Ding YS , Richter P , Hearn B , Zhang L , Bravo R , Yan X , Perez JJ , Chan M , Hughes J , Chen P , Chen W , Wong J , Holmberg S , Smith S , Larango M , Valentin-Blasini L , Watson CH . Tob Regul Sci 2017 3 (1) 81-94 OBJECTIVE: Our objective was to characterize mainstream smoke constituent deliveries from SPECTRUM variable nicotine research cigarettes under 2 machine smoking regimens. SPECTRUM cigarettes are manufactured by the 22nd Century company for the National Institute on Drug Abuse, National Institutes of Health to contain varying (including reduced) levels of nicotine. METHODS: Mainstream smoke constituent deliveries of "tar," nicotine, carbon monoxide, tobacco-specific nitrosamines (N'-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)), benzo[a]pyrene, aromatic amines, and carbonyls were analyzed in 23 varieties of SPECTRUM cigarettes using ISO 17025 accredited methods. RESULTS: Data are presented as means and standard deviations of 5 replicates for all analytes. CONCLUSIONS: Under the ISO smoking regimen, mean levels of many smoke emissions for SPECTRUM varieties were comparable to the 3R4F research cigarette. Calculated SPECTRUM elasticity ranged from 1.6 to 4.0. Accordingly, under intense machine smoking conditions differences in emissions of SPECTRUM cigarettes were apparent. In addition, NNN increased with smoke nicotine while the same rate of change was not seen for NNK. It is important to monitor levels of chemicals of public health concern and regulatory interest as technologies emerge to reduce levels of nicotine or other targeted chemicals in tobacco products. |
The combined effects of 3,4-methylenedioxymethamphetamine (MDMA) and selected substituted methcathinones on measures of neurotoxicity
Miner NB , O'Callaghan JP , Phillips TJ , Janowsky A . Neurotoxicol Teratol 2017 61 74-81 The rise in popularity of substituted methcathinones (aka "bath salts") has increased the focus on their neurotoxic effects. Two commonly abused methcathinones, 3,4-methylenedioxymethcathinone (methylone, MDMC) and 3,4-methylenedioxypyrovalerone (MDPV), are often concomitantly ingested with the illicit drug 3,4-methylenedioxymethamphetamine (MDMA). To examine potential neurotoxic effects of these drug combinations, C57BL/6J mice were administered 4 i.p. injection of the drugs, at 2h intervals, either singularly: MDMA 15 or 30mg/kg, methylone 20mg/kg, MDPV 1mg/kg; or in combination: methylone/MDMA 20/15mg/kg, MDPV/MDMA 1/15mg/kg. Drug effects on thermoregulation were characterized and striatal tissue analyzed after 2 or 7days for dopamine (DA) and tyrosine hydroxylase (TH) levels, as well as glial fibrillary acidic protein (GFAP) expression. Two days following drug administration, DA and TH were decreased only in the MDMA 30mg/kg group, whereas GFAP expression was dose-dependently increased by MDMA alone. While the combination of the methcathinones with the lower MDMA dose did not affect DA or TH levels, both blocked the MDMA-induced increase in GFAP expression. Seven days following drug administration, there were no significant differences in DA, TH, or GFAP for any treatment group, indicating that changes in DA, TH, and GFAP were transient. Five of the six drug groups exhibited acute hypothermia followed by gradually increasing temperatures. Animals treated with MDPV did not exhibit these biphasic temperature changes, and resembled the saline group. These results indicate that specific effects of both methylone and MDPV on DA depletion or astrocyte activation in the striatum are not additive with effects of MDMA, but block astrogliosis caused by MDMA alone. Additionally, MDPV modulates thermoregulation through a different mechanism than methylone or MDMA. |
Comparison between the triglycerides standardization of routine methods used in Japan and the chromotropic acid reference measurement procedure used by the CDC Lipid Standardization Programme
Nakamura M , Iso H , Kitamura A , Imano H , Noda H , Kiyama M , Sato S , Yamagishi K , Nishimura K , Nakai M , Vesper HW , Teramoto T , Miyamoto Y . Ann Clin Biochem 2016 53 (6) 632-639 Background The US Centers for Disease Control and Prevention ensured adequate performance of the routine triglycerides methods used in Japan by a chromotropic acid reference measurement procedure used by the Centers for Disease Control and Prevention lipid standardization programme as a reference point. We examined standardized data to clarify the performance of routine triglycerides methods. Methods The two routine triglycerides methods were the fluorometric method of Kessler and Lederer and the enzymatic method. The methods were standardized using 495 Centers for Disease Control and Prevention reference pools with 98 different concentrations ranging between 0.37 and 5.15 mmol/L in 141 survey runs. The triglycerides criteria for laboratories which perform triglycerides analyses are used: accuracy, as bias ≤5% from the Centers for Disease Control and Prevention reference value and precision, as measured by CV, ≤5%. Results The correlation of the bias of both methods to the Centers for Disease Control and Prevention reference method was: y (%bias) = 0.516 x (Centers for Disease Control and Prevention reference value) -1.292 ( n = 495, R2 = 0.018). Triglycerides bias at medical decision points of 1.13, 1.69 and 2.26 mmol/L was -0.71%, -0.42% and -0.13%, respectively. For the combined precision, the equation y (CV) = -0.398 x (triglycerides value) + 1.797 ( n = 495, R2 = 0.081) was used. Precision was 1.35%, 1.12% and 0.90%, respectively. It was shown that triglycerides measurements at Osaka were stable for 36 years. Conclusions The epidemiologic laboratory in Japan met acceptable accuracy goals for 88.7% of all samples, and met acceptable precision goals for 97.8% of all samples measured through the Centers for Disease Control and Prevention lipid standardization programme and demonstrated stable results for an extended period of time. |
The Sudden Death in the Young Case Registry: Collaborating to Understand and Reduce Mortality.
Burns KM , Bienemann L , Camperlengo L , Cottengim C , Covington TM , Dykstra H , Faulkner M , Kobau R , Erck Lambert AB , MacLeod H , Parks SE , Rosenberg E , Russell MW , Shapiro-Mendoza CK , Shaw E , Tian N , Whittemore V , Kaltman JR . Pediatrics 2017 139 (3) Knowledge gaps persist about the incidence of and risk factors for sudden death in the young (SDY). The SDY Case Registry is a collaborative effort between the National Institutes of Health, the Centers for Disease Control and Prevention, and the Michigan Public Health Institute. Its goals are to: (1) describe the incidence of SDY in the United States by using population-based surveillance; (2) compile data from SDY cases to create a resource of information and DNA samples for research; (3) encourage standardized approaches to investigation, autopsy, and categorization of SDY cases; (4) develop partnerships between local, state, and federal stakeholders toward a common goal of understanding and preventing SDY; and (5) support families who have lost loved ones to SDY by providing resources on bereavement and medical evaluation of surviving family members. Built on existing Child Death Review programs and as an expansion of the Sudden Unexpected Infant Death Case Registry, the SDY Case Registry achieves its goals by identifying SDY cases, providing guidance to medical examiners/coroners in conducting comprehensive autopsies, evaluating cases through child death review and an advanced review by clinical specialists, and classifying cases according to a standardized algorithm. The SDY Case Registry also includes a process to obtain informed consent from next-of-kin to save DNA for research, banking, and, in some cases, diagnostic genetic testing. The SDY Case Registry will provide valuable incidence data and will enhance understanding of the characteristics of SDY cases to inform the development of targeted prevention efforts. |
Trends in anthropometric measures among US children 6 to 23 months, 1976-2014
Akinbami LJ , Kit BK , Carroll MD , Fakhouri TH , Ogden CL . Pediatrics 2017 139 (3) BACKGROUND AND OBJECTIVES: The surveillance of children's growth reflects a population's nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months. METHODS: We analyzed NHANES data from 1976-1980, 1988-1994, 1999-2002, 2003-2006, 2007-2010, and 2011-2014. We estimated z scores < -2 (low) and ≥+2 (high) in comparison with World Health Organization growth standards for each indicator. Weight gain (relative to sex-age-specific medians) from birth until survey participation was estimated. Trends were assessed by low birth weight status and race/Hispanic origin. Race/Hispanic origin trends were assessed from 1988-1994 to 2011-2014. RESULTS: In 2011-2014, the prevalence of low and high length-for-age was 3.3% (SE, 0.8) and 3.7% (SE, 0.8); weight-for-age was 0.6% (SE, 0.3) and 7.0% (SE, 1.1); and weight-for-length was 1.0% (SE, 0.4) and 7.7% (SE, 1.2). The only significant trend was a decrease in high length-for-age (5.5% in 1976-1980 vs 3.7% in 2011-2014; P = .04). Relative weight gain between birth and survey participation did not differ over time, although trends differed by race/Hispanic origin. Non-Hispanic black children gained more weight between birth and survey participation in 2011-2014 versus 1988-1994, versus no change among other groups. CONCLUSIONS: Between 1976-1980 and 2011-2014, there were no significant trends in low or high weight-for-age and weight-for-length among 6- to 23-month-old children whereas the percent with high length-for-age decreased. A significant trend in relative weight gain between birth and survey participation was observed among non-Hispanic black children. |
Hearing loss in children with asymptomatic congenital cytomegalovirus infection
Lanzieri TM , Chung W , Flores M , Blum P , Caviness AC , Bialek SR , Grosse SD , Miller JA , Demmler-Harrison G . Pediatrics 2017 139 (3) OBJECTIVES: To assess the prevalence, characteristics, and risk of sensorineural hearing loss (SNHL) in children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected children. METHODS: We included 92 case-patients and 51 controls assessed by using auditory brainstem response and behavioral audiometry. We used Kaplan-Meier survival analysis to estimate the prevalence of SNHL, defined as ≥25 dB hearing level at any frequency and Cox proportional hazards regression analyses to compare SNHL risk between groups. RESULTS: At age 18 years, SNHL prevalence was 25% (95% confidence interval [CI]: 17%-36%) among case-patients and 8% (95% CI: 3%-22%) in controls (hazard ratio [HR]: 4.0; 95% CI: 1.2-14.5; P = .02). Among children without SNHL by age 5 years, the risk of delayed-onset SNHL was not significantly greater for case-patients than for controls (HR: 1.6; 95% CI: 0.4-6.1; P = .5). Among case-patients, the risk of delayed-onset SNHL was significantly greater among those with unilateral congenital/early-onset hearing loss than those without (HR: 6.9; 95% CI: 2.5-19.1; P < .01). The prevalence of severe to profound bilateral SNHL among case-patients was 2% (95% CI: 1%-9%). CONCLUSIONS: Delayed-onset and progression of SNHL among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. However, the risk of developing SNHL after age 5 years among case-patients was not different than in uninfected children. Overall, 2% of case-patients developed SNHL that was severe enough for them to be candidates for cochlear implantation. |
Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trial
Budd N , Jeffries JK , Jones-Smith J , Kharmats A , McDermott AY , Gittelsohn J . Public Health Nutr 2017 20 (18) 1-11 OBJECTIVE: Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. DESIGN: Factorial design randomized controlled trial. SETTING: Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. SUBJECTS: Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. RESULTS: All interventions showed significantly increased stock of promoted foods v. CONTROL: There was a significant treatment effect for daily unit sales of healthy snacks (beta=6.4, 95 % CI 0.9, 11.9) and prices of healthy staple foods (beta=-0.49, 95 % CI -0.90, -0.03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. CONCLUSIONS: All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand. |
Development of a roof bolter canopy air curtain for respirable dust control
Reed WR , Joy GJ , Kendall B , Bailey A , Zheng Y . Min Eng 2017 69 (1) 33-39 Testing of the roof bolter canopy air curtain (CAC) designed by the U.S. National Institute for Occupational Safety and Health (NIOSH) has gone through many iterations, demonstrating successful dust control performance under controlled laboratory conditions. J.H. Fletcher & Co., an original equipment manufacturer of mining equipment, further developed the concept by incorporating it into the design of its roof bolting machines. In the present work, laboratory testing was conducted, showing dust control efficiencies ranging from 17.2 to 24.5 percent. Subsequent computational fluid dynamics (CFD) analysis revealed limitations in the design, and a potential improvement was analyzed and recommended. As a result, a new CAC design is being developed, incorporating the results of the testing and CFD analysis. |
Assessment of lymphatic filariasis prior to re-starting mass drug administration campaigns in coastal Kenya
Njenga SM , Kanyi HM , Mutungi FM , Okoyo C , Matendechero HS , Pullan RL , Halliday KE , Brooker SJ , Wamae CN , Onsongo JK , Won KY . Parasit Vectors 2017 10 (1) 99 BACKGROUND: Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and is one of a diverse group of diseases referred to as neglected tropical diseases (NTDs) which mainly occur among the poorest populations. In line with global recommendations to eliminate LF, Kenya launched its LF elimination programme in 2002 with the aim to implement annual mass drug administration (MDA) in order to interrupt LF transmission. However, the programme faced financial and administrative challenges over the years such that sustained annual MDA was not possible. Recently, there has been renewed interest to eliminate LF and the Kenyan Ministry of Health, through support from World Health Organization (WHO), restarted annual MDA in 2015. The objective of this study was to evaluate the current status of LF infection in the endemic coastal region of Kenya before MDA campaigns were restarted. RESULTS: Ten sentinel sites in Kwale, Kilifi, Tana River, Lamu, and Taita-Taveta counties in coastal Kenya were selected for participation in a cross-sectional survey of LF infection prevalence. At least 300 individuals in each sentinel village were sampled through random house-to-house visits. During the day, the point-of-care immunochromatographic test (ICT) was used to detect the presence of Wuchereria bancrofti circulating filarial antigen in finger prick blood samples collected from residents of the selected sentinel villages. Those individuals who tested positive with the ICT test were requested to provide a night-time blood sample for microfilariae (MF) examination. The overall prevalence of filarial antigenaemia was 1.3% (95% CI: 0.9-1.8%). Ndau Island in Lamu County had the highest prevalence (6.3%; 95% CI: 4.1-9.7%), whereas sites in Kilifi and Kwale counties had prevalences < 1.7%. Mean microfilarial density was also higher in Ndau Island (234 MF/ml) compared to sentinel sites in Kwale and Kilifi counties (< 25 MF/ml). No LF infection was detected in Tana River and Taita-Taveta counties. Overall, more than 88% of the study participants reported to have used a bed net the previous night. CONCLUSIONS: Prevalence of LF infection is generally very low in coastal Kenya, but there remain areas that require further rounds of MDA if the disease is to be eliminated as a public health problem in line with the ongoing global elimination efforts. However, areas where there was no evidence of LF transmission should be considered for WHO-recommended transmission assessment surveys in view of stopping MDA. |
The impact of the Physical Activity Policy Research Network
Manteiga AM , Eyler AA , Valko C , Brownson RC , Evenson KR , Schmid T . Am J Prev Med 2017 52 S224-s227 INTRODUCTION: Lack of physical activity is one of the greatest challenges of the 21st century. The Physical Activity Policy Research Network (PAPRN) is a thematic network established in 2004 to identify determinants, implementation, and outcomes of policies that are effective in increasing physical activity. The purpose of this study is to describe the products of PAPRN and make recommendations for future research and best practices. METHODS: A mixed methods approach was used to obtain both quantitative and qualitative data on the network. First, in 2014, PAPRN's dissemination products from 2004 to 2014 were extracted and reviewed, including 57 publications and 56 presentations. Next, semi-structured qualitative interviews were conducted with 25 key network participants from 17 locations around the U.S. The transcripts were transcribed and coded. RESULTS: The results of the interviews indicated that the research network addressed several components of its mission, including the identification of physical activity policies, determinants of these policies, and the process of policy implementation. However, research focusing on physical activity policy outcomes was limited. Best practices included collaboration between researchers and practitioners and involvement of practitioners in research design, data collection, and dissemination of results. CONCLUSIONS: PAPRN is an example of a productive research network and has contributed to both the process and content of physical activity policy research over the past decade. Future research should emphasize physical activity policy outcomes. Additionally, increased partnerships with practitioners for collaborative, cross-sectoral physical activity policy research should be developed. |
The Prevention Research Centers directors: Reflections covering two decades of leadership
Harris JR , Riley PL , Kreuter M , Simoes EJ . Am J Prev Med 2017 52 S211-s213 Between 1992 and 2011, the Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRC) Program had a series of five directors. In the following Commentary, four of these five directors offer their reflections on the program during their periods of leadership. |
Prevention Research Centers: Perspective for the future
Massoudi MS , Marcelin RA , Young BR , Bish CL , Henry D , Hurley S , Greenlund KJ , Giles WH . Am J Prev Med 2017 52 S218-s223 The Prevention Research Centers (PRC) Program began in 1984, when Congress authorized the DHHS to create a network of academic health centers to conduct applied public health prevention research.1 In 1986, the Centers for Disease Control and Prevention (CDC) was selected to provide leadership, technical assistance, and oversight for this network of PRCs. | The PRCs are university-based research centers that undertake research-to-practice projects in health promotion and disease prevention. Their work demonstrates the use of new and innovative research in public health approaches that improve the health of the population, particularly those experiencing health disparities. PRCs partner with local, state, and national organizations on a variety of topics, including obesity, diabetes, heart attack and stroke, cancer, physical activity, nutrition, injury prevention, adolescent health, disability prevention among older Americans, and HIV/AIDS. PRCs tap into the expertise of diverse disciplines across their universities and beyond to address health issues and employ diverse methods appropriate to their research questions. A timeline of significant PRC milestones is depicted in the Appendix (available online) and PRC funding appropriations are depicted in Figure 1. |
The Guest editors' introduction to the special issue: Prevention Research Centers Program's 30th anniversary celebration
Massoudi MS , Ammerman AS , Brownson RC , Harris JR . Am J Prev Med 2017 52 S207-s208 The 30th anniversary of the founding of the Prevention Research Centers (PRC) Network is an appropriate time to reflect on our progress as well as look to the future. Applied prevention research with a focus on understanding health disparities and promoting health equity has never been more important than now. With innovative leadership and a commitment to promoting health for all, the PRC Network has made great strides in developing, testing, and disseminating programs and policies that have had broad and sustained impact. | The PRC Program supports research that identifies unique public health solutions for those who are experiencing health disparities. PRCs conduct community-engaged research that supports the mission of the PRC Program by: | 1 | serving as the hub for conducting high-impact and innovative applied public health prevention research; | 2 | conducting Centers for Disease Control and Prevention (CDC)-supported PRC research focusing on ways to maximize public health resources and reduce healthcare costs, with an emphasis on the leading causes of disease and disability; | 3 | serving as a leader in the field of prevention research for conducting, disseminating, and implementing quality research; | 4 | investing in PRCs and thus supporting their infrastructure and core resources, strengthening centers’ ability to leverage outside resources and expand their reach and impact; | 5 | engaging local communities and serving a resource for public health partners; | 6 | capitalizing on the collaboration and partnership with health departments and other public health partners to translate promising research findings into practical, cost-effective prevention programs relevant to the needs of the communities; and | 7 | collaborating with many partners to train and prepare the public health workforce to assess and evaluate existing health programs or policies. |
Incorporating One Health into medical education
Rabinowitz PM , Natterson-Horowitz BJ , Kahn LH , Kock R , Pappaioanou M . BMC Med Educ 2017 17 (1) 45 One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers. |
Removing barriers to contraception through use of criteria to assess pregnancy risk
Tepper NK , Curtis KM , Jatlaoui TC , Whiteman MK . Contraception 2017 95 (4) 323-325 Safe initiation of many contraceptive methods requires an accurate assessment of whether a woman may already be pregnant. Upon initial thought, routine administration of pregnancy tests would seem to be the easiest way to assess pregnancy status. However, pregnancy tests may not be available in every setting, are associated with some cost and have limitations in detection, particularly for very early or recent pregnancies. The US Centers for Disease Control and Prevention (CDC) developed contraceptive guidance, adapted from that of the World Health Organization, which is intended to provide evidence-based guidance on contraceptive provision and reduce barriers to access and use of contraception. According to the US Selected Practice Recommendations for Contraceptive Use (US SPR), health care providers can evaluate certain criteria related to pregnancy risk before initiating contraception [1]. These criteria are easy to assess, are likely already administered in routine practice and are highly accurate for excluding pregnancy [2]. The US SPR was first issued in 2013 and recently updated in 2016. While no changes were made to the criteria for excluding pregnancy, there may be challenges in interpretation and implementation. The intent of this commentary is to explain the rationale underpinning the current US SPR recommendations [1] and contribute to the dialog on removing barriers to immediate contraception initiation [3], [4]. |
Being committed: Conceptualizations of romantic relationship commitment among low-income African American adolescents
Barton AW , Hurt TR , Futris TG , Sheats KF , McElroy SE , Landor AM . J Black Psychol 2017 43 (2) 111-134 Few studies have examined adolescents’ understanding of romantic relationship commitment, particularly among African American youth. Using three waves of semistructured interviews, the present descriptive study addresses this topic by exploring the ways in which 20 African American adolescents (age range 13-19 years) from low-income backgrounds conceptualize and describe commitment in romantic relationships. Qualitative analyses revealed three main themes related to defining commitment, indicating that which commitment provides, and describing the nature of commitment in different relationship contexts. Findings inform psychological research and practice relating to commitment and romantic relationships among African American adolescents. |
Expanding veterinary biosurveillance in Washington, DC: The creation and utilization of an electronic-based online veterinary surveillance system
Hennenfent A , DelVento V , Davies-Cole J , Johnson-Clarke F . Prev Vet Med 2017 138 70-78 Objectives To enhance the early detection of emerging infectious diseases and bioterrorism events using companion animal-based surveillance. Methods Washington, DC, small animal veterinary facilities (n = 17) were surveyed to determine interest in conducting infectious disease surveillance. Using these results, an electronic-based online reporting system was developed and launched in August 2015 to monitor rates of canine influenza, canine leptospirosis, antibiotic resistant infections, canine parvovirus, and syndromic disease trends. Results Nine of the 10 facilities that responded expressed interest conducting surveillance. In September 2015, 17 canine parvovirus cases were reported. In response, a campaign encouraging regular veterinary preventative care was launched and featured on local media platforms. Additionally, during the system's first year of operation it detected 5 canine leptospirosis cases and 2 antibiotic resistant infections. No canine influenza cases were reported and syndromic surveillance compliance varied, peaking during National Special Security Events. Conclusions Small animal veterinarians and the general public are interested in companion animal disease surveillance. The system described can serve as a model for establishing similar systems to monitor disease trends of public health importance in pet populations and enhance biosurveillance capabilities. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Economics
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Physical Activity
- Public Health Leadership and Management
- Reproductive Health
- Social and Behavioral Sciences
- Veterinary Medicine
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