Published norms underestimate the health-related quality of life among persons with type 2 diabetes
Norris SL , McNally TK , Zhang X , Burda B , Chan B , Chowdhury FM , Zhang P , Patrick D . J Clin Epidemiol 2011 64 (4) 358-65 OBJECTIVE: To assess health-related quality of life (HRQL) among adults with type 2 diabetes using the Short Form (SF)-36 and to obtain pooled estimates of HRQL for subpopulations defined by demographic characteristics, diabetes-related complications, and comorbidities. STUDY DESIGN AND METHODS: We conducted computerized searches of multiple electronic bibliographic databases, and studies in any language were selected in which HRQL was reported among adults with type 2 diabetes using the SF-36. Estimates were combined using a random-effects model. RESULTS: One hundred eighteen studies fulfilled the inclusion criteria. HRQL was lower in persons with type 2 diabetes, as measured by all the eight component scores of the SF-36 when compared with the existing U.S. population norms and with previously published type 2 diabetes norms. SF-36 component and summary scores were extremely heterogeneous, and subpopulation data were sparse; this precluded obtaining meaningful pooled scores for most populations of interest and made comparisons among subpopulations difficult. CONCLUSION: Our data suggest that previously published norms may underestimate the effect of diabetes on HRQL, and diabetes populations are extremely heterogeneous, making broad population "norms" for HRQL in type 2 diabetes of limited use. Additional research with important subpopulations and individual-level data are needed to further explore the effect of diabetes on HRQL. |
Canadian adolescents and young adults with cancer: opportunity to improve coordination and level of care
De P , Ellison LF , Barr RD , Semenciw R , Marrett LD , Weir HK , Dryer D , Grunfeld E . CMAJ 2011 183 (3) (3) E187-E194 Cancers in adolescents and young adults (aged 15–29 years) represent a transition between the nonepithelial types, especially acute leukemias and embryonal tumours, that are common during childhood and the epithelial types (i.e., carcinomas) that account for most cancers in older adults. The embryonal tumours that are common in children, such as neuroblastoma, Wilms tumour, retinoblastoma, medulloblastoma and hepatoblastoma, are rare among adolescents and young adults. Similarly, the most common carcinomas in older adults, such as lung, breast, prostate and colorectal cancers, have a much lower incidence among young people. The differences relative to other age groups is such that the classification system used to report cancer incidence in adolescents and young adults is a blend of those used for cancers in childhood and adult life.1 | Adolescents and young adults account for about 2% of all patients with a new diagnosis of invasive cancer in Canada.2 Although the annual number of cases is small relative to those in older adults, a diagnosis of cancer during adolescence or young adulthood can have a major impact on future quality of life and life expectancy, as well as disrupting normal trajectories of development (e.g., physical, psychological and social) and life goals related to family and careers.3 Self-image among young cancer patients can be compromised by the adverse effects of therapy (e.g., loss of hair, gain or loss of weight, impairment of sexuality, mutilating surgery). Social relationships are also challenged by the strain caused by a diagnosis of cancer and subsequent therapy. Medical professionals are often ill-equipped to deal with the psychosocial challenges faced by young people with cancer. |
Risk factors for severe illness with 2009 pandemic influenza A (H1N1) virus infection in China
Yu H , Feng Z , Uyeki TM , Liao Q , Zhou L , Feng L , Ye M , Xiang N , Huai Y , Yuan Y , Jiang H , Zheng Y , Gargiullo P , Peng Z , Feng Y , Zheng J , Xu C , Zhang Y , Shu Y , Gao Z , Yang W , Wang Y . Clin Infect Dis 2011 52 (4) 457-65 BACKGROUND: Data on risk factors for severe outcomes from 2009 pandemic influenza A (H1N1) virus infection are limited outside of developed countries. METHODS: We reviewed medical charts to collect data from patients hospitalized with laboratory-confirmed 2009 H1N1 infection who were identified across China during the period from September 2009 through February 2010, and we analyzed potential risk factors associated with severe illness (defined as illness requiring intensive care unit admission or resulting in death). RESULTS: Among 9966 case patients, the prevalence of chronic medical conditions (33% vs 14%), pregnancy (15% vs 7%), or obesity (19% vs 14%) was significantly higher in those patients with severe illness than it was in those with less severe disease. In multivariable analyses, among nonpregnant case patients aged ≥ 2 years, having a chronic medical condition significantly increased the risk of severe outcome among all age groups, and obesity was a risk factor among those <60 years of age. The risk of severe illness among pregnant case patients was significantly higher for those in the second and third trimesters. The risk of severe illness was increased when oseltamivir treatment was initiated ≥ 5 days after illness onset (odds ratio, 1.42; 95% confidence interval, 1.20-1.67). For persons <60 years of age, the prevalence of obesity among case patients with severe illness was significantly greater than it was among those without severe illness or among the general population. CONCLUSIONS: Risk factors for severe 2009 H1N1 illness in China were similar to those observed in developed countries, but there was a lower prevalence of chronic medical conditions and a lower prevalence of obesity. Obesity was a risk factor among case patients < 60 years of age. Early initiation of oseltamivir treatment was most beneficial, and there was an increased risk of severe disease when treatment was started ≥ 5 days after illness onset. |
Robert Koch
Schultz MG . Emerg Infect Dis 2011 17 (3) 547-9 This is a photograph of Heinrich Hermann Robert Koch (1843-1910). Koch in Germany and Louis Pasteur in France were the 2 main founders of the science of bacteriology. Koch is best known for his discovery of Mycobacterium tuberculosis, the organism that causes tuberculosis. For this discovery, Koch was awarded the Nobel Prize in Physiology or Medicine in 1905. |
Sequential Rift Valley fever outbreaks in eastern Africa caused by multiple lineages of the virus
Nderitu L , Lee JS , Omolo J , Omulo S , O'Guinn ML , Hightower A , Mosha F , Mohamed M , Munyua P , Nganga Z , Hiett K , Seal B , Feikin DR , Breiman RF , Njenga MK . J Infect Dis 2011 203 (5) 655-65 BACKGROUND: During the Rift Valley fever (RVF) epidemic of 2006-2007 in eastern Africa, spatial mapping of the outbreaks across Kenya, Somalia, and Tanzania was performed and the RVF viruses were isolated and genetically characterized. METHODS: Following confirmation of the RVF epidemic in Kenya on 19 December 2006 and in Tanzania on 2 February 2007, teams were sent to the field for case finding. Human, livestock, and mosquito specimens were collected and viruses isolated. The World Health Organization response team in Kenya worked with the WHO's polio surveillance team inside Somalia to collect information and specimens from Somalia. RESULTS: Seven geographical foci that reported hundreds of livestock and >25 cases in humans between December 2006 and June 2007 were identified. The onset of RVF cases in each epidemic focus was preceded by heavy rainfall and flooding for at least 10 days. Full-length genome analysis of 16 RVF virus isolates recovered from humans, livestock, and mosquitoes in 5 of the 7 outbreak foci revealed 3 distinct lineages of the viruses within and across outbreak foci. CONCLUSION: The findings indicate that the sequential RVF epidemics in the region were caused by multiple lineages of the RVF virus, sometimes independently activated or introduced in distinct outbreak foci. |
Surveillance for invasive meningococcal disease in children, US-Mexico Border, 2005-2008
Chacon-Cruz E , Sugerman DE , Ginsberg MM , Hopkins J , Hurtado-Montalvo JA , Lopez-Viera JL , Lara-Munoz CA , Rivas-Landeros RM , Volker ML , Leake JA . Emerg Infect Dis 2011 17 (3) 543-6 We reviewed confirmed cases of pediatric invasive meningococcal disease in Tijuana, Mexico, and San Diego County, California, USA, during 2005-2008. The overall incidence and fatality rate observed in Tijuana were similar to those found in the US, and serogroup distribution suggests that most cases in Tijuana are vaccine preventable. |
Targeted drug-resistance testing strategy for multidrug-resistant tuberculosis detection, Lima, Peru, 2005-2008
Velasquez GE , Yagui M , Cegielski JP , Asencios L , Bayona J , Bonilla C , Jave HO , Yale G , Susrez C , Atwood S , Contreras CC , Shin SS . Emerg Infect Dis 2011 17 (3) 432-440 The Peruvian National Tuberculosis Control Program issued guidelines in 2006 specifying criteria for culture and drug-susceptibility testing (DST), including district-level rapid DST. All patients referred for culture and DST in 2 districts of Lima, Peru, during January 2005-November 2008 were monitored prospectively. Of 1,846 patients, 1,241 (67.2%) had complete DST results for isoniazid and rifampin; 419 (33.8%) patients had multidrug-resistant (MDR) TB at the time of referral. Among patients with new smear-positive TB, household contact and suspected category I failure were associated with MDR TB, compared with concurrent regional surveillance data. Among previously treated patients with smear-positive TB, adult household contact, suspected category II failure, early relapse after category I, and multiple previous TB treatments were associated with MDR TB, compared with concurrent regional surveillance data. The proportion of MDR TB detected by using guidelines was higher than that detected by a concurrent national drug-resistance survey, indicating that the strategy effectively identified patients for DST. |
Tuberculosis outbreak investigations in the United States, 2002-2008
Mitruka K , Oeltmann JE , Ijaz K , Haddad MB . Emerg Infect Dis 2011 17 (3) 425-31 To understand circumstances of tuberculosis transmission that strain public health resources, we systematically reviewed Centers for Disease Control and Prevention (CDC) staff reports of US outbreaks in which CDC participated during 2002-2008 that involved ≥3 culture-confirmed tuberculosis cases linked by genotype and epidemiology. Twenty-seven outbreaks, representing 398 patients, were reviewed. Twenty-four of the 27 outbreaks involved primarily US-born patients; substance abuse was another predominant feature of outbreaks. Prolonged infectiousness because of provider- and patient-related factors was common. In 17 outbreaks, a drug house was a notable contributing factor. The most frequently documented intervention to control the outbreak was prioritizing contacts according to risk for infection and disease progression to ensure that the highest risk contacts were completely evaluated. US-born persons with reported substance abuse most strongly characterized the tuberculosis outbreaks in this review. Substance abuse remains one of the greatest challenges to controlling tuberculosis transmission in the United States. |
Vaccinia virus infections in martial arts gym, Maryland, USA, 2008
Hughes CM , Blythe D , Li Y , Reddy R , Jordan C , Edwards C , Adams C , Conners H , Rasa C , Wilby S , Russell J , Russo KS , Somsel P , Wiedbrauk DL , Dougherty C , Allen C , Frace M , Emerson G , Olson VA , Smith SK , Braden Z , Abel J , Davidson W , Reynolds M , Damon IK . Emerg Infect Dis 2011 17 (4) 730-3 Vaccinia virus is an orthopoxvirus used in the live vaccine against smallpox. Vaccinia virus infections can be transmissible and can cause severe complications in those with weakened immune systems. We report on a cluster of 4 cases of vaccinia virus infection in Maryland, USA, likely acquired at a martial arts gym. |
Mycobacterium tuberculosis cluster with developing drug resistance, New York, New York, USA, 2003-2009
Perri BR , Proops D , Moonan PK , Munsiff SS , Kreiswirth BN , Goranson C , Ahuja SD . Emerg Infect Dis 2011 17 (3) 372-8 In 2004, identification of patients infected with the same Mycobacterium tuberculosis strain in New York, New York, USA, resulted in an outbreak investigation. The investigation involved data collection and analysis, establishing links between patients, and forming transmission hypotheses. Fifty-four geographically clustered cases were identified during 2003-2009. Initially, the M. tuberculosis strain was drug susceptible. However, in 2006, isoniazid resistance emerged, resulting in isoniazid-resistant M. tuberculosis among 17 (31%) patients. Compared with patients with drug-susceptible M. tuberculosis, a greater proportion of patients with isoniazid-resistant M. tuberculosis were US born and had a history of illegal drug use. No patients named one another as contacts. We used patient photographs to identify links between patients. Three links were associated with drug use among patients infected with isoniazid-resistant M. tuberculosis. The photographic method would have been more successful if used earlier in the investigation. Name-based contact investigation might not identify all contacts, particularly when illegal drug use is involved. |
Outbreak of type 2 vaccine-derived poliovirus in Nigeria: emergence and widespread circulation in an underimmunized population
Wassilak S , Pate MA , Wannemuehler K , Jenks J , Burns C , Chenoweth P , Abanida EA , Adu F , Baba M , Gasasira A , Iber J , Mkanda P , Williams AJ , Shaw J , Pallansch M , Kew O . J Infect Dis 2011 203 (7) 898-909 Wild poliovirus has remained endemic in northern Nigeria because of low coverage achieved in the routine immunization program and in supplementary immunization activities (SIAs). An outbreak of infection involving 315 cases of type 2 circulating vaccine-derived poliovirus (cVDPV2; >1% divergent from Sabin 2) occurred during July 2005-June 2010, a period when 23 of 34 SIAs used monovalent or bivalent oral poliovirus vaccine (OPV) lacking Sabin 2. In addition, 21 "pre-VDPV2" (0.5%-1.0% divergent) cases occurred during this period. Both cVDPV and pre-VDPV cases were clinically indistinguishable from cases due to wild poliovirus. The monthly incidence of cases increased sharply in early 2009, as more children aged without trivalent OPV SIAs. Cumulative state incidence of pre-VDPV2/cVDPV2 was correlated with low childhood immunization against poliovirus type 2 assessed by various means. Strengthened routine immunization programs in countries with suboptimal coverage and balanced use of OPV formulations in SIAs are necessary to minimize risks of VDPV emergence and circulation. |
Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus
Marks SM , Magee E , Robison V . Int J Tuberc Lung Dis 2011 15 (4) 465-70 OBJECTIVES: To describe trends and risk factors for tuberculosis (TB) mortality. DESIGN: We calculated trends, identified patient characteristics associated with TB diagnosis at death or death during TB treatment, and described diagnostic procedures using the United States National TB Surveillance System for 1997-2005. RESULTS: Human immunodeficiency virus (HIV) infected TB patients had an adjusted odds ratio (aOR) of 4-11 for TB diagnosis at death (foreign-born non-Whites, aOR = 11) and of 3-19 for death during TB treatment vs. non-HIV-infected patients. Odds increased by age. Hispanic males had an aOR of 2 for TB diagnosis at death compared with female non-Hispanics. Multidrug-resistant TB (MDR-TB) patients had a three times greater aOR of death during treatment than non-MDR patients. American Indians, Black females, residents in long-term care facilities, US-born patients, and non-HIV-infected homeless persons aged 25-44 years each had an aOR of 2 for mortality during treatment; 86% of pulmonary patients diagnosed at death had a chest radiograph, but 34% had no sputum smear or culture reported. CONCLUSION: During 1997-2005, controlling for age, HIV remained the characteristic with the greatest aOR for TB diagnosis at death or death during TB therapy. Race/ethnicity, country of birth and homelessness further increased the adjusted odds of death. Results show possible missed opportunities for TB diagnosis prior to death. |
Elephant-to-human transmission of tuberculosis, 2009
Murphree R , Warkentin JV , Dunn JR , Schaffner W , Jones TF . Emerg Infect Dis 2011 17 (3) 366-71 In 2009, the Tennessee Department of Health received reports of 5 tuberculin skin test (TST) conversions among employees of an elephant refuge and isolation of Mycobacterium tuberculosis from a resident elephant. To determine the extent of the outbreak and identify risk factors for TST conversion, we conducted a cohort study and onsite assessment. Risk for conversion was increased for elephant caregivers and administrative employees working in the barn housing the M. tuberculosis-infected elephant or in offices connected to the barn (risk ratio 20.3, 95% confidence interval 2.8-146.7). Indirect exposure to aerosolized M. tuberculosis and delayed or inadequate infection control practices likely contributed to transmission. The following factors are needed to reduce risk for M. tuberculosis transmission in the captive elephant industry: increased knowledge about M. tuberculosis infection in elephants, improved infection control practices, and specific occupational health programs. |
HIV mono-infection is associated with FIB-4 - a noninvasive index of liver fibrosis - in women
Blackard JT , Welge JA , Taylor LE , Mayer KH , Klein RS , Celentano DD , Jamieson DJ , Gardner L , Sherman KE . Clin Infect Dis 2011 52 (5) 674-80 BACKGROUND: FIB-4 represents a noninvasive, composite index that is a validated measure of hepatic fibrosis, which is an important indicator of liver disease. To date, there are limited data regarding hepatic fibrosis in women. METHODS: FIB-4 was evaluated in a cohort of 1227 women, and associations were evaluated in univariate and multivariate regression models among 4 groups of subjects classified by their human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection status. RESULTS: The median FIB-4 scores were 0.60 in HIV-/HCV- women, 0.83 in HIV-/HCV+ women, 0.86 in HIV+/HCV- women, and 1.30 in HIV+/HCV+ women. In the HIV/HCV co-infected group, multivariate analysis showed that CD4(+) cell count and albumin level were negatively associated with FIB-4 (P <.0001), whereas antiretroviral therapy (ART) was positively associated with FIB-4 score (P =.0008). For the HIV mono-infected group, multivariate analysis showed that CD4(+) cell count (P <.0001) and albumin level (P =.0019) were negatively correlated with FIB-4 score, ART was positively associated with FIB-4 score (P =.0008), and plasma HIV RNA level was marginally associated with FIB-4 score (P =.080). In 72 HIV mono-infected women who were also hepatitis B surface antigen negative, ART naive, and reported no recent alcohol intake, plasma HIV RNA level was associated with increased FIB-4 score (P =.030). CONCLUSIONS: HIV RNA level was associated with increased FIB-4 score in the absence of hepatitis B, hepatitis C, ART, or alcohol use, suggesting a potential relationship between HIV infection and hepatic fibrosis in vivo. A better understanding of the various demographic and virologic variables that contribute to hepatic fibrosis may lead to more effective treatment of HIV infection and its co-morbid conditions. |
Increased rates of bone fracture among HIV-infected persons in the HIV outpatient study (HOPS) compared with the US general population, 2000-2006
Young B , Dao CN , Buchacz K , Baker R , Brooks JT . Clin Infect Dis 2011 52 (8) 1061-8 BACKGROUND: Among persons with HIV infection, low bone mineral density is common and has raised concerns about increased risk of fracture. METHODS: We analyzed data from the HIV Outpatient Study (HOPS), an open prospective cohort study of HIV-infected adults who were followed up at 10 US HIV clinics. We assessed rates of first fractures at any anatomic site during the period 2000-2008. We indirectly standardized the rates of fracture in the HOPS to the general population by age and sex, using data from outpatients in the National Hospital Ambulatory Medical Care Survey (NHAMCS-OPD). We examined factors associated with fractures using Cox proportional hazards modeling. RESULTS: Among 5826 active HOPS patients whose data were analyzed (median baseline age, 40 years; male sex, 79%; white race, 52%; exposure to antiretroviral therapy, 73%), 233 patients had incident fractures (crude annual rates, 59.6-93.5 fractures per 10,000 persons). Age-standardized fracture rates increased from 2000 to 2002 (P = .01) and stabilized thereafter. Among persons aged 25-54 years, both fracture rates and relative proportion of fragility fractures were higher among HOPS patients than among patients in the NHAMCS-OPD. In addition to older age and substance abuse, nadir CD4+ cell count <200 cells/mm(3) (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.11-2.31), hepatitis C infection (aHR, 1.61; 95% CI, 1.13-2.29) and diabetes (aHR, 1.62; 95% CI, 1.00-2.64) were associated with incident fractures. CONCLUSIONS: Age-adjusted fracture rates among HOPS patients were higher than rates in the general US population during the period 2000-2006. Clinicians should regularly assess HIV-infected persons for fracture risk, especially those with low nadir CD4+ cell counts or other established risk factors for fracture. |
Isoniazid-resistant tuberculous meningitis, United States, 1993-2005
Vinnard C , Winston CA , Wileyto EP , Macgregor RR , Bisson GP . Emerg Infect Dis 2011 17 (3) 539-42 To determine patient characteristics associated with isoniazid resistance in cases of tuberculous meningitis, we conducted a cross-sectional study by using data from the US National Tuberculosis Surveillance System during 1993-2005. Foreign-born patients were more likely to be infected with an isoniazid-resistant strain. |
Bridging implementation, knowledge, and ambition gaps to eliminate tuberculosis in the United States and globally
Castro KG , Lobue P . Emerg Infect Dis 2011 17 (3) 337-42 We reflect on remarkable accomplishments in global tuberculosis (TB) control and identify persistent obstacles to the successful elimination of TB from the United States and globally. One hundred and twenty nine years after Koch's discovery of the etiologic agent of TB, this health scourge continues to account for 9.4 million cases and 1.7 million deaths annually worldwide. Implementation of the Directly Observed Treatment Short-course strategy from 1995 through 2009 has saved 6 million lives. TB control is increasingly being achieved in countries with high-income economies, yet TB continues to plague persons living in countries with low-income and lower-middle-income economies. To accelerate progress against the global effects of disease caused by TB and achieve its elimination, we must bridge 3 key gaps in implementation, knowledge, and ambition. |
Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children
Liu C , Bayer A , Cosgrove SE , Daum RS , Fridkin SK , Gorwitz RJ , Kaplan SL , Karchmer AW , Levine DP , Murray BE , JRybak M , Talan DA , Chambers HF . Clin Infect Dis 2011 52 (3) e18-55 Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures. |
Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary
Liu C , Bayer A , Cosgrove SE , Daum RS , Fridkin SK , Gorwitz RJ , Kaplan SL , Karchmer AW , Levine DP , Murray BE , JRybak M , Talan DA , Chambers HF . Clin Infect Dis 2011 52 (3) 285-92 Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures. |
Using geographic information systems and decision support systems for the prediction, prevention, and control of vector-borne diseases
Eisen L , Eisen RJ . Annu Rev Entomol 2011 56 41-61 Emerging and resurging vector-borne diseases cause significant morbidity and mortality, especially in the developing world. We focus on how advances in mapping, Geographic Information System, and Decision Support System technologies, and progress in spatial and space-time modeling, can be harnessed to prevent and control these diseases. Major themes, which are addressed using examples from tick-borne Lyme borreliosis; flea-borne plague; and mosquito-borne dengue, malaria, and West Nile virus disease, include (a) selection of spatial and space-time modeling techniques, (b) importance of using high-quality and biologically or epidemiologically relevant data, (c) incorporation of new technologies into operational vector and disease control programs, (d) transfer of map-based information to stakeholders, and (e) adaptation of technology solutions for use in resource-poor environments. We see great potential for the use of new technologies and approaches to more effectively target limited surveillance, prevention, and control resources and to reduce vector-borne and other infectious diseases. |
Time to change the paradigm--from "potentially inappropriate" to real patient harms
Shehab N , Budnitz DS . Arch Intern Med 2011 171 (5) 473-4 The recent study by Mattison et al1 demonstrated a statistically significant reduction in potentially inappropriate (Beers criteria) medication (PIM) orders for hospitalized older patients after the introduction of a computerized provider order entry (CPOE) warning system; however, the authors provided no evidence that patient harms were reduced or outcomes were improved as a result of PIM warnings. Thus, we disagree with their conclusions that a reduction from 12 to 10 PIM orders per day is clinically significant, and we caution against overreliance on CPOE warnings of PIM use as a “tool for improving the safety of hospitalized older adults.”1(p1336) | Potentially inappropriate medication use is a poor metric for monitoring safe medication use and a weak trigger for patient safety interventions. Steinman et al2 demonstrated that algorithmic identification of PIM hospital orders failed to accurately identify problematic prescribing when compared with individualized clinical record review. Published evidence that PIM prescribing leads to poor patient outcomes is mixed at best. Page et al,3 after adjustment for covariates, found no significant correlation between PIMs and adverse events, length of stay, discharge to higher levels of care, or in-hospital mortality. Schamder et al4 reduced PIM use among hospitalized patients, but this reduction did not result in fewer adverse reactions. |
Variability of urinary concentrations of bisphenol A in spot samples, first-morning voids, and 24-hour collections
Ye X , Wong LY , Bishop AM , Calafat AM . Environ Health Perspect 2011 119 (7) 983-8 BACKGROUND: Human exposure to bisphenol A (BPA) is widespread. After exposure, BPA is rapidly metabolized and eliminated in urine. Therefore, there is considerable within- and between-person variability of BPA concentrations in spot urine samples. However, no information exists on the within-day variability of urinary BPA concentrations. OBJECTIVES: We examined the between- and within-person and between- and within-day variability in the urinary BPA concentrations of eight adults who collected all voids for 1 week to investigate the impact of sampling strategy in the exposure assessment of BPA using spot, first morning, or 24-hour urine collections. METHODS: We determined the urinary concentrations of BPA using on-line solid-phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. RESULTS: The between-day/within-person variability was the primary contributor to the total variance both for first-morning voids (77 %) and 24-hr urine collections (88 %). For the spot collections, we observed considerable within-day variance (70 %), which outweighed the between-person (9 %) and between-day/within-person (21 %) variances. CONCLUSIONS: Regardless of the type of void (spot, first morning, 24-hour collections), urinary BPA concentrations for a given adult changed considerably-both within a day and among the 7 days of the study period. Single 24 hour urine collections accurately reflect daily exposure, but can misrepresent variability in daily exposures over time. Of interest, when the population investigated is sufficiently large and samples are randomly collected relative to meal ingestion times and bladder emptying times, the single spot sampling approach may adequately reflect the population's average exposure to BPA. |
Lead poisoning among Burmese refugee children--Indiana, 2009
Ritchey MD , Sucosky MS , Jefferies T , McCormick D , Hesting A , Blanton C , Duwve J , Bruner R , Daley WR , Jarrett J , Brown MJ . Clin Pediatr (Phila) 2011 50 (7) 648-56 Recent routine screening revealed multiple cases of unexplained lead poisoning among children of Burmese refugees living in Fort Wayne, Indiana. A cross-sectional study was conducted to determine (a) the prevalence of elevated blood lead levels (BLLs) among Burmese children and (b) potential sources of lead exposure. A case was defined as an elevated venous BLL (≥10 mug/dL); prevalence was compared with all Indiana children screened during 2008. Environmental and product samples were tested for lead. In all, 14 of 197 (7.1%) children had elevated BLLs (prevalence ratio: 10.7) that ranged from 10.2 to 29.0 mug/dL. Six cases were newly identified; 4 were among US-born children. Laboratory testing identified a traditional ethnic digestive remedy, Daw Tway, containing a median 520 ppm lead. A multilevel linear regression model identified daily use of thanakha, an ethnic cosmetic, and Daw Tway use were related to elevated BLLs (P < .05). Routine monitoring of BLLs among this population should remain a priority. |
Assessment of Beta particle flux from surface contamination as a relative indicator for radionuclide distribution on external surfaces of a multistory building in Pripyat
Farfan EB , Gaschak SP , Maksymenko AM , Jannik GT , Marra JC , Bondarkov MD , Donnelly EH . Health Phys 2011 100 (2) 221-7 Several issues should be considered when assessing the feasibility of remediation following the detonation of a radiological dispersion device (e.g., dirty bomb) or improvised nuclear device in a large city. These issues include the levels and characteristics of the radioactive contamination, the availability of resources required for decontamination, and the planned future use of the city's structures and buildings. Presently, little is known about the distribution, redistribution, and migration of radionuclides in an urban environment. However, Pripyat, a city substantially contaminated by the Chernobyl Nuclear Power Plant accident in April 1986, may provide some answers. The main objective of this study was to determine the radionuclide distribution on a Pripyat multistory building that had not been decontaminated and, therefore, could reflect the initial fallout and its further natural redistribution on external surfaces over 23 y. The seven-story building selected was surveyed from the ground floor to the roof on horizontal and vertical surfaces along seven ground-to-roof transections. Some results from this study indicate that the upper floors of the building had higher contamination levels than the lower floors. Consequently, the authors recommend that thorough decontamination should be considered for all the floors of tall buildings (not just lower floors). |
Genome sequence based molecular epidemiology of unusual US Rotavirus A G9 strains isolated from Omaha, USA between 1997 and 2000.
Mijatovic-Rustempasic S , Banyai K , Esona MD , Foytich K , Bowen MD , Gentsch JR . Infect Genet Evol 2011 11 (2) 522-7 After discovery in the early 1980s, Rotavirus A serotype G9 was detected infrequently for almost a decade. Since the mid-1990s, however, serotype G9 has emerged to become a globally common strain linked to the introduction of a single, new genetic variant of G9 VP7 gene. Studies have demonstrated that genetically divergent G9 strains co-circulated at low frequency with the emerging variants. Examples include unique U.S. G9 strains Om46/Hu/USA/1998 and Om67/Hu/USA/1998, isolated in Omaha during the 1997-1998 rotavirus season, that are more closely related phylogenetically to reference strains from the 1980s than to most emerging G9 strains from the U.S. and globally. Here, we sequenced the VP7 full open reading frame for all available G9 strains (n=12) identified in Omaha during 1996-2000 seasons to investigate their epidemiology and evolution. In addition, the full or partial length open reading frames of the remaining 10 genes for five divergent Om46-like strains and one modern G9 variant were sequenced to evaluate their potential origin. Our findings suggest that Om46-like G9 strains may have been introduced into humans recently, perhaps in 1997-1998 when it was first detected, and the presumed original host of this VP7 gene variant may have been an animal species based on the unexpected detection of porcine rotavirus related NSP2 gene in the genome. The relatively high fitness of Om46-like strains during the 1997-1998 rotavirus season, 1 year after the globally important G9 variant was documented to be already spreading in the study area and other sites of the United States, appears to parallel findings on seasonal replacement of various genetic and antigenic variants of other common human rotavirus antigen specificities. |
Tracking deaths related to Hurricane Ike, Texas, 2008
Zane DF , Bayleyegn TM , Hellsten J , Beal R , Beasley C , Haywood T , Wiltz-Beckham D , Wolkin AF . Disaster Med Public Health Prep 2011 5 (1) 23-28 BACKGROUND: On September 13, 2008, Hurricane Ike, a category 2 storm with maximum sustained winds of 110 mph, made landfall near Galveston, Texas. Ike produced a damaging, destructive, and deadly storm surge across the upper Texas and southwestern Louisiana coasts. Thirty-four Texas counties were declared disaster areas by the Federal Emergency Management Agency; 15 counties were under mandatory evacuation orders. To describe causes of death associated with this hurricane and identify prevention strategies during the response and recovery phases, the Texas Department of State Health Services (DSHS) monitored mortality data in 44 counties throughout the state. This report summarizes Ike-related deaths reported by Texas medical examiners, justices of the peace (coroners), forensic centers, public health officials, and hospitals. METHODS: Based on the Centers for Disease Control and Prevention (CDC) disaster-related mortality surveillance form, DSHS developed a state-specific 1-page form and collected (optimally daily) data on demographic, date and place of death, and cause and circumstance of deaths. A case was defined as any death that was directly or indirectly related to Ike among evacuees, residents, nonresidents, or rescue personnel in the declared disaster counties, counties along the Texas Gulf coast or counties known to have evacuation shelters occurring September 8, 2008, through October 13, 2008. Analyzed data were shared with the state emergency operation center and the CDC on a daily basis. RESULTS: The surveillance identified 74 deaths in Texas as directly (10 [14%]), indirectly (49 [66%]), or possibly (15 [20%]) related to Ike. The majority of deaths (n = 57) were reported by medical examiners. Deaths occurred in 16 counties of the 44 counties covered by the surveillance. The majority of deaths occurred in Harris and Galveston (28 [38%] and 17 [23%]), respectively. The deceased ranged in age from younger than 1 year to 85 years, with an average age of 46 years (median 50 years); 70% were male. Of the 74 deaths, 47 (64%) resulted from injuries, 23 (31%) from illnesses, and 4 (5%) were undetermined. Among the injuries, carbon monoxide poisoning (13 [18%]) and drowning (8 [11%]) were the leading causes of injury-related deaths. Cardiovascular failure (12 [16%]) was the leading cause of illness-related deaths. CONCLUSIONS: Defining the relation of death to hurricane using an active mortality surveillance system is possible. The active mortality surveillance form used in Ike provided valuable daily information to DSHS, state emergency management officials, and the CDC regarding the characteristics of deaths in the state. Most of the Ike-related deaths were caused by injury (direct and indirectly related) such as carbon monoxide poisonings and drowning and may have been preventable by educating the public. |
Estimating HIV incidence among adults in Kenya and Uganda: a systematic comparison of multiple methods
Kim AA , Hallett T , Stover J , Gouws E , Musinguzi J , Mureithi PK , Bunnell R , Hargrove J , Mermin J , Kaiser RK , Barsigo A , Ghys PD . PLoS One 2011 6 (3) e17535 BACKGROUND: Several approaches have been used for measuring HIV incidence in large areas, yet each presents specific challenges in incidence estimation. METHODOLOGY/PRINCIPAL FINDINGS: We present a comparison of incidence estimates for Kenya and Uganda using mulitple methods: 1) Epidemic Projections Package (EPP) and Spectrum models fitted to HIV prevalence from antenatal clinics (ANC) and national population-based surveys (NPS) in Kenya (2003, 2007) and Uganda (2004/2005); 2) a survey-derived model to infer age-specific incidence between two sequential NPS; 3) an assay-derived measurement in NPS using the BED IgG capture enzyme immunoassay, adjusted for misclassification using a locally derived false-recent rate (FRR) for the assay; (4) community cohorts in Uganda; (5) prevalence trends in young ANC attendees. EPP/Spectrum-derived and survey-derived modeled estimates were similar: 0.67 [uncertainty range: 0.60, 0.74] and 0.6 [confidence interval: (CI) 0.4, 0.9], respectively, for Uganda (2005) and 0.72 [uncertainty range: 0.70, 0.74] and 0.7 [CI 0.3, 1.1], respectively, for Kenya (2007). Using a local FRR, assay-derived incidence estimates were 0.3 [CI 0.0, 0.9] for Uganda (2004/2005) and 0.6 [CI 0, 1.3] for Kenya (2007). Incidence trends were similar for all methods for both Uganda and Kenya. CONCLUSIONS/SIGNIFICANCE: Triangulation of methods is recommended to determine best-supported estimates of incidence to guide programs. Assay-derived incidence estimates are sensitive to the level of the assay's FRR, and uncertainty around high FRRs can significantly impact the validity of the estimate. Systematic evaluations of new and existing incidence assays are needed to the study the level, distribution, and determinants of the FRR to guide whether incidence assays can produce reliable estimates of national HIV incidence. |
Feasibility of an audio computer-assisted self-interview method to self-assess sexual maturation
Lamb MM , Beers L , Reed-Gillette D , McDowell MA . J Adolesc Health 2011 48 (4) 325-30 PURPOSE: Sexual maturation assessment using physical examination may no longer be feasible in some large epidemiologic surveys, such as National Health and Nutrition Examination Survey, because of the sensitivity of the examination and privacy concerns. This study tested the feasibility of a new automated audio computer-assisted self-interview (ACASI) module for children and adolescents for self-assessment of sexual maturation. METHODS: A cross-sectional feasibility study was conducted at a large urban children/adolescent clinic in Washington D.C. Self-assessed sexual maturation (Tanner stages) was reported by 234 youths (119 boys and 115 girls) aged 8-18 years by using the ACASI module. Girls assessed their breast and pubic hair development, and boys assessed their genital and pubic hair development. Self-assessments were compared with Tanner stages recorded by clinical examiners during routine well-child physical examinations conducted on the same day. RESULTS: There was good/excellent agreement between boy's self-assessment and the examiner's assessment of their genital stage (weighted kappa: .65, 95% confidence interval [CI]: .55-.75) and pubic hair stage (weighted kappa: .78, CI: .70-.86). There was excellent agreement between girl's self-assessment and the examiner's assessment of their breast stage (weighted kappa: .81, CI: .74-.87) and pubic hair stage (weighted kappa: .78, CI: .71-.86). CONCLUSION: The ACASI method is a feasible method of pubertal self-assessment for participants as young as 8 years in large epidemiologic surveys. However, additional testing is needed to determine the validity of this ACASI module. |
Current priorities for public health practice in addressing the role of human genomics in improving population health.
Khoury MJ , Bowen MS , Burke W , Coates RJ , Dowling NF , Evans JP , Reyes M , St Pierre J . Am J Prev Med 2011 40 (4) 486-93 In spite of accelerating human genome discoveries in a wide variety of diseases of public health significance, the promise of personalized health care and disease prevention based on genomics has lagged behind. In a time of limited resources, public health agencies must continue to focus on implementing programs that can improve health and prevent disease now. Nevertheless, public health has an important and assertive leadership role in addressing the promise and pitfalls of human genomics for population health. Such efforts are needed not only to implement what is known in genomics to improve health but also to reduce potential harm and create the infrastructure needed to derive health benefits in the future. |
Strengthening the reporting of genetic risk prediction studies: The GRIPS Statement.
Janssens AC , Ioannidis JP , van Duijn CM , Little J , Khoury MJ . Ann Intern Med 2011 154 (6) 421-425 The rapid and continuing progress in gene discovery for complex diseases is fueling interest in the potential application of genetic risk models for clinical and public health practice. | The number of studies assessing the predictive ability is steadily increasing, but the quality and completeness of reporting varies. | A multidisciplinary workshop sponsored by the Human Genome Epidemiology Network developed a checklist of 25 items recommended for strengthening the reporting of Genetic RIsk Prediction Studies (GRIPS), building on the principles established by prior reporting guidelines. | These recommendations aim to enhance the transparency of study reporting, and thereby to improve the synthesis and application of information from multiple studies that might differ in design, conduct, or analysis. | A detailed Explanation and Elaboration document is published at www.plosmedicine.org. |
Shifting genetic structure of invasive serotype 19A pneumococci in the United States
Beall BW , Gertz RE , Hulkower RL , Whitney CG , Moore MR , Brueggemann AB . J Infect Dis 2011 203 (10) 1360-8 BACKGROUND: Following 7-valent conjugate vaccine introduction in the United States in 2000, invasive serotype (sero19A) pneumococcal disease (IPD) emerged rapidly. Sero19A IPD incidence increased slightly during 2005-2008 (from 2.3 cases to 2.5 cases per 100,000 population), whereas sero19A penicillin resistance (defined as a minimum inhibitor concentration [MIC] ≥2 mug/mL) increased significantly (from 28.7% to 43.7%). To better understand changes, we characterized sero19A isolates recovered during 2004-2008. METHODS: We performed antimicrobial susceptibility testing on all 2767 sero19A IPD isolates identified through the Centers for Disease Control Active Bacterial Core surveillance during 2004-2008. We genotyped 1804 (96.3%) of 1874 sero19A isolates recovered during 2005-2007 and all 148 year 2008 sero19A isolates from children <5 years of age. RESULTS: Resistant clonal complex (CC) 320/271(19A) increased from 20.9% (115 of 550) to 32.9% (208 of 633; P < .001) of IPD isolates during 2005-2007, which paralleled increased sero19A penicillin resistance (from 28.7% [163 of 567 isolates] to 39.5% [261 of 661 isolates]; P < .001). Total IPD due to 320/271(19A) increased during 2005-2007 and increased from 2.1 to 3.6 cases per 100,000 population during 2005-2008 in children <5 years of age. The penicillin-susceptible/intermediate, putative vaccine-escape CC695(19A) increased from 7.5% (41 of 550) to 13.6% (85 of 633) of sero19A isolates during 2005-2007 (P = .002). CONCLUSIONS: Sero19A rates may have plateaued; however, clonal shifts are increasing resistance. Increased IPD caused by CC320/271(19A) and CC695(19A) could reflect additional selective advantages in addition to resistance. |
Trends in human immunodeficiency virus- and sexually transmitted disease-related risk behaviors among U.S. high school students, 1991-2009
Eaton DK , Lowry R , Brener ND , Kann L , Romero L , Wechsler H . Am J Prev Med 2011 40 (4) 427-33 BACKGROUND: People who engage in unprotected sexual intercourse or use injection drugs are at increased risk for HIV infection and sexually transmitted diseases (STDs). Monitoring changes in behaviors over time can provide information about the effectiveness of new policies and programs. PURPOSE: To measure trends in HIV- and STD-related risk behaviors among high school students in the U.S. during 1991-2009. METHODS: Nationally representative data from the 1991-2009 biennial national Youth Risk Behavior Surveys were analyzed to describe trends in HIV- and STD-related risk behaviors. For each cross-sectional national survey, students completed anonymous, self-administered questionnaires assessing risk behavior participation. This study was approved by the CDC IRB, and parental permission was obtained. To assess the significance of time trends for each behavior, logistic regression analyses were conducted that controlled for gender, grade, and race/ethnicity and simultaneously assessed linear and quadratic effects. Data were analyzed in 2010. RESULTS: During 1991-2009, decreases were observed in the percentage of U.S. high school students who ever had sexual intercourse, had multiple sex partners, and who were currently sexually active. The prevalence of condom use increased during 1991-2003 and then leveled off during 2003-2009. However, these changes in risk behaviors were not observed in some gender and racial/ethnic subgroups. CONCLUSIONS: Additional efforts to reduce HIV- and STD-related risk behaviors, particularly among black and Hispanic students, must be implemented to decrease rates of HIV infection and STDs. |
Adolescent pregnancy desire and pregnancy incidence
Sipsma HL , Ickovics JR , Lewis JB , Ethier KA , Kershaw TS . Womens Health Issues 2011 21 (2) 110-6 BACKGROUND: Research has suggested the importance of pregnancy desire in explaining pregnancy risk behavior among adolescent females. Much of the literature, however, uses cross-sectional study designs to examine this relationship. Because bias may strongly influence these results, more prospective studies are needed to confirm the relationship between pregnancy desire and pregnancy incidence over time. METHODS: Nonpregnant adolescents aged 14- to 19 years (n = 208) completed baseline interviews and interviews every 6 months thereafter for 18 months. Logistic regression was used to examine demographic and psychosocial correlates of pregnancy desire. Cox regression analysis was used to determine whether pregnancy desire predicted pregnancy incidence over time after controlling for potential confounders. RESULTS: Twenty-four percent of participants either desired pregnancy or were ambivalent toward pregnancy in the next year. Pregnancy desire was associated with older age, relationship duration of <6 months, and greater perceived stress. After accounting for potential confounders, pregnancy desire doubled the risk of becoming pregnant over the 18-month follow-up period (relative risk, 2.00; 95% confidence interval [CI], 0.99-4.02). Additionally, a heightened risk for pregnancy was found among those who expressed some desire for pregnancy and who were not in school compared with those who expressed no desire for pregnancy and who were in school (relative risk, 4.84; 95% CI, 1.21-19.31). CONCLUSION: Our analysis reinforces the importance of evaluating pregnancy desire among sexually active adolescent females. Interventions should target young women in new romantic relationships and who are not in school to improve pregnancy prevention efforts. Additionally, improving coping abilities may help to reduce feelings of pregnancy desire among adolescent females. |
Driving self-restriction in high-risk conditions: how do older drivers compare to others?
Naumann RB , Dellinger AM , Kresnow MJ . J Safety Res 2011 42 (1) 67-71 INTRODUCTION: Many older drivers self-restrict or avoid driving under high-risk conditions. Little is known about the onset of driving self-restrictions or how widespread self-restrictions are among drivers of all ages. METHODS: The Second Injury Control and Risk Survey (ICARIS-2) was a nationwide cross-sectional, list-assisted random-digit-dial telephone survey from 2001 to 2003. National prevalence estimates and weighted percentages of those reporting driving self-restrictions were calculated. Multivariable logistic regression was used to explore associations between specific self-restrictions and age group, adjusting for other personal characteristics. RESULTS: More than half of all drivers reported at least one driving self-restriction. The most commonly reported restriction was avoidance of driving in bad weather (47.5%), followed by at night (27.9%) and on highways or high-speed roads (19%). A greater percentage of young adult women (18-24 years) reported self-restricting in bad weather compared to women in other age groups, and the percentage of drivers self-restricting at night, in bad weather, and on highways or high-speed roads increased steeply after age 64. We found that women, those in low income groups, and those who had driven low annual mileage were more likely to self-restrict. CONCLUSIONS: In addition to assessing self-restrictions among older drivers, a new finding from our study is that self-restrictions are also quite prevalent among younger age groups. Driving self-restrictions may be better understood as a spectrum across ages in which drivers' reasons for restriction change. IMPACT ON INDUSTRY: Future research on the ability of driving self-restrictions to reduce actual crash risk and prevent injuries is needed. |
Making HIV prevention programming count: identifying predictors of success in a parent-based HIV prevention program for youth
Miller KS , Forehand R , Wiegand R , Fasula AM , Armistead L , Long N , Wyckoff SC . AIDS Educ Prev 2011 23 (1) 38-53 Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents' Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = .68, CI:0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success. |
Monitoring healthy people 2010 arthritis management objectives: education and clinician counseling for weight loss and exercise
Do BT , Hootman JM , Helmick CG , Brady TJ . Ann Fam Med 2011 9 (2) 136-41 PURPOSE: Our goal was to monitor the progress of 3 Healthy People 2010 (HP2010) objectives encouraging self-management education and clinician counseling for weight loss and physical activity among adults with doctor-diagnosed arthritis. METHODS: Using the national 2002 and 2006 National Health Interview Survey (NHIS) and state-based 2003 and 2007 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the change in proportion of persons counseled for each objective, overall and by selected characteristics. RESULTS: Nationally, the proportion of overweight and obese adults with doctor-diagnosed arthritis who were counseled by their clinician to lose weight to lessen their arthritis symptoms increased significantly from 35.0% (95% confidence interval [CI], 32.8%-37.2%) in 2002 to 41.3% (95% CI, 38.7%-44.0%) in 2006 but have yet to reach the 2010 target of 46%. There was no change in the proportion of adults with doctor-diagnosed arthritis who had ever taken a self-management education class (approximately 11%) or who had been counseled to engage in physical activity (approximately 52%), whose targets for 2010 are 13% and 67%, respectively. States had variable findings. CONCLUSIONS: Nationally, significant progress has been made by clinicians for weight counseling of overweight and obese adults with doctor-diagnosed arthritis but not for the other 2 arthritis management objectives. Because clinician counseling can have important effects on the latter, this discrepancy suggests a need to focus on barriers to physician counseling for these outcomes. |
Mother-daughter communication about HPV vaccine
McRee AL , Reiter PL , Gottlieb SL , Brewer NT . J Adolesc Health 2011 48 (3) 314-7 PURPOSE: Parent-child conversations about human papillomavirus (HPV) vaccine may provide parents with the opportunity to talk with their daughters about sexual health. We sought to characterize mothers' communication with their adolescent daughters about HPV vaccine. METHODS: We surveyed 609 mothers of girls aged between 11 and 20 years living in North Carolina in Fall 2008. We used logistic regression to identify the correlates of mother-daughter communication. RESULTS: Most mothers (81%) reported having discussed HPV vaccine with their daughters. For almost half of these families (47%), discussion of HPV vaccine led to a conversation about sex. This was more common among mothers who believed that their daughters may be sexually active (odds ratio [OR]: 1.88; 95% confidence interval [CI]: 1.25-2.83), had greater knowledge of HPV vaccine (OR: 2.46; 95% CI: 1.07-5.64), lived in urban areas (OR: 1.75; 95% CI: 1.21-2.54), or reported being born-again Christians (OR: 1.74; 95% CI: 1.17-2.58). Most mothers who talked with their daughters about HPV vaccine reported having discussed the reasons for and against getting vaccinated (86%). Mothers most commonly reported having discussed the potential HPV vaccine benefits, usually protection against cervical cancer (56%), and less frequently reported having discussed the perceived disadvantages of HPV vaccine. CONCLUSIONS: HPV vaccine conversations may provide opportunities for sexual health promotion and sexually transmitted infection (STI) prevention. |
Calling the nation to act: implementing the national action plan to improve health literacy
Baur C . Nurs Outlook 2011 59 (2) 63-9 The National Action Plan to Improve Health Literacy is a framework that all clinical and public health professionals, including nurses, can use to identify and address health literacy barriers that negatively affect patient care and individual and community health outcomes. Of all the clinical disciplines, nursing has a unique relationship to health literacy because nurses are responsible for the majority of patient, caregiver and community health education, and communication. The information in the Action Plan is applicable to many fields and disciplines, such as healthcare, public health, communication, and education. Leading educators, researchers, practitioners, and administrators in each relevant discipline have a responsibility to be informed about health literacy issues and identify the most promising practices to improve health literacy in their domains. The Action Plan includes goals and strategies that nursing leaders can adapt and use to develop organization-specific action plans for health literacy improvement. The Action Plan is a call to action for all clinical professionals, especially nurses, to choose, implement, and evaluate one or more health literacy strategies so that patients will be more informed and prepared to protect, promote, and manage their health. |
A research framework for reducing preventable patient harm
Pronovost PJ , Cardo DM , Goeschel CA , Berenholtz SM , Saint S , Jernigan JA . Clin Infect Dis 2011 52 (4) 507-13 Programs to reduce central line-associated bloodstream infections (CLABSIs) have improved the safety of hospitalized patients. Efforts are underway to disseminate these successes broadly to reduce other types of hospital-acquired infectious and noninfectious preventable harms. Unfortunately, the ability to broadly measure and prevent other types of preventable harms, especially infectious harms, needs enhancement. Moreover, an overarching research framework for creating and integrating evidence will help expedite the development of national prevention programs. This article outlines a 5-phase translational (T) framework to develop robust research programs that reduce preventable harm, as follows: phase T0, discover opportunities and approaches to prevent adverse health care events; phase T1, use T0 discoveries to develop and test interventions on a small scale; phase T2, broaden and strengthen the evidence base for promising interventions to develop evidence-based guidelines; phase T3, translate guidelines into clinical practice; and phase T4, implement and evaluate T3 work on a national and international scale. Policy makers should use this framework to fill in the knowledge gaps, coordinate efforts among federal agencies, and prioritize research funding. |
Screening and treatment of Chagas disease in organ transplant recipients in the United States: recommendations from the Chagas in transplant working group
Chin-Hong PV , Schwartz BS , Bern C , Montgomery SP , Kontak S , Kubak B , Morris MI , Nowicki M , Wright C , Ison MG . Am J Transplant 2011 11 (4) 672-80 Donor-derived transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, has emerged as an issue in the United States over the past 10 years. Acute T. cruzi infection causes substantial morbidity and mortality in the posttransplant setting if not recognized and treated early. We assembled a working group of transplant infectious disease specialists, laboratory medicine specialists, organ procurement organization representatives and epidemiologists with expertise in Chagas disease. Based on review of published and unpublished data, the working group prepared evidence-based recommendations for donor screening, and follow-up testing and treatment of recipients of organs from infected donors. We advise targeted T. cruzi screening of potential donors born in Mexico, Central America and South America. Programs can consider transplantation of kidneys and livers from T. cruzi-infected donors with informed consent from recipients. However, we recommend against heart transplantation from infected donors. For other organs, we recommend caution based on the anticipated degree of immunosuppression. Our recommendations stress the need for systematic monitoring of recipients by polymerase chain reaction, and microscopy of buffy coat and advance planning for immediate antitrypanosomal treatment if recipient infection is detected. Data on management and outcomes of all cases should be collected to inform future guidelines and to assist in coordination with public health authorities. |
Transmission of Cryptococcus neoformans by organ transplantation
Baddley JW , Schain DC , Gupte AA , Lodhi SA , Kayler LK , Frade JP , Lockhart SR , Chiller T , Bynon JS Jr , Bower WA . Clin Infect Dis 2011 52 (4) e94-8 BACKGROUND: This article describes transmission of Cryptococcus neoformans by solid organ transplantation. METHODS: We reviewed medical records and performed molecular genotyping of isolates to determine potential for donor transmission of Cryptococcus. RESULTS: Cryptococcosis was diagnosed in 3 recipients of organs from a common donor with an undifferentiated neurologic condition at the time of death. Cryptococcal meningoencephalitis was later diagnosed in the donor at autopsy. The liver and 1 kidney recipient developed cryptococcemia and pneumonia and the other kidney recipient developed cryptococcemia and meningitis; 2 patients recovered with prolonged antifungal therapy. We tested 4 recipient isolates with multilocus sequence typing and found they had identical alleles. CONCLUSIONS: Our investigation documents the transmission of Cryptococcus neoformans by organ transplantation. Evaluation for cryptococcosis in donors with unexplained neurologic symptoms should be strongly considered. |
Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007
Blaney DD , Daly ER , Kirkland KB , Tongren JE , Tassler Kelso P , Talbot EA . Am J Infect Control 2011 39 (4) 296-301 BACKGROUND: During December 2006 to March 2007, a substantial increase in norovirus illnesses was noted in northern New England. We sought to identify institutional risk factors for norovirus outbreaks in northern New England long-term care facilities (LTCFs). METHODS: State health departments in Maine, New Hampshire, and Vermont distributed surveys to infection preventionists at all LTCFs in their respective states. We collected information regarding facility attributes, routine staff use of alcohol-based hand sanitizer (ABHS) versus soap and water, facility cleaning practices, and occurrence of any acute gastroenteritis outbreaks during December 2006 to March 2007. Norovirus confirmation was conducted in public health laboratories. Data were analyzed with univariate and logistic regression methods. RESULTS: Of 160 facilities, 91 (60%) provided survey responses, with 61 facilities reporting 73 outbreaks; 29 were confirmed norovirus. Facilities reporting that staff were equally or more likely to use ABHS than soap and water for routine hand hygiene had higher odds of an outbreak than facilities with staff less likely to use ABHS (adjusted odds ratio, 6.06; 95% confidence interval: 1.44-33.99). CONCLUSION: This study suggests that preferential use of ABHS over soap and water for routine hand hygiene might be associated with increased risk of norovirus outbreaks in LTCFs. |
Mycobacterium bovis (Bacille Calmette-Guerin) bacteremia in immunocompetent neonates following vaccination
Thamthitiwat S , Marin N , Baggett HC , Peruski LF , Kiatkulwiwat W , Panumatrasmee V , Varma JK , Nateniyom S , Akarasewi P , Maloney SA . Vaccine 2011 29 (9) 1727-30 We describe four cases of Mycobacterium tuberculosis complex bacteremia diagnosed in immunocompetent neonates, who presented with high fever and/or jaundice within 72 h after Bacille Calmette-Guerin (BCG) vaccination. All neonates were hospitalized, and none received anti-mycobacterial therapy. All recovered completely and remain healthy 2-3.5 years later. Genotyping of one available isolate identified the pathogen as Mycobacterium bovis BCG. The similar clinical presentations and close temporal association between BCG vaccination and illness suggest that all four neonates likely had BCG bacteremia. BCG bacteremia shortly following vaccination among healthy neonates has not been previously described and merits further study to determine its frequency and clinical significance. |
Human papillomavirus vaccine initiation among adolescent girls in high-risk communities
Guerry SL , De Rosa CJ , Markowitz LE , Walker S , Liddon N , Kerndt PR , Gottlieb SL . Vaccine 2011 29 (12) 2235-41 BACKGROUND: We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents' intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer. METHODS: Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11-18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County. RESULTS: We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n=387), 62% said they "probably/definitely will" vaccinate within the next year and 21% were undecided or didn't know; only 11% said they definitely won't. CONCLUSIONS: About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents. |
Winter storm-related injuries in Oklahoma, January 2007
Piercefield E , Wendling T , Archer P , Mallonee S . J Safety Res 2011 42 (1) 27-32 INTRODUCTION: A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel. METHODS: Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12-30, 2007. Medical records were retrospectively abstracted. Risk of injury was described by demographic group, injury type, and mechanism. RESULTS: Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39years. Persons aged≥40years were 1.4 times more likely to experience falls as the cause of injury than those aged <40years, and falls were twice as likely as other mechanisms to cause fractures among persons aged≥40years. Injured persons aged <40years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged≥40years. CONCLUSIONS: Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures. IMPACT ON INDUSTRY: Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults. |
Comparison of 2008 national and state-level self-reported and observed seatbelt use estimates
Ibrahimova A , Shults RA , Beck LF . Inj Prev 2011 17 (3) 201-3 The objective of the study was to compare national and state-level estimates of self-reported and observed seatbelt use for 2008. Self-reported seatbelt use from the 2008 Behavioral Risk Factor Surveillance System was compared with 2008 observed seatbelt use published by the National Highway Traffic Safety Administration. The ratio of self-reported belt use to observed use was calculated for each state, and the correlation between the two seatbelt measures was examined using the Pearson correlation coefficient. The median state ratio of self-reported to observed belt use was 0.97. Self-reported use was lower than observed use in 38 states. A moderate association was revealed between the self-reported and observed use (r=0.71, p<0.01). The findings suggest that, as seatbelt use has increased over time, measures of self-reported and observed use have converged, and any upward bias in self-reported use due to social desirability has substantially declined. |
Vitamin C supplementation lowers urinary levels of 4-hydroperoxy-2-nonenal metabolites in humans
Kuiper HC , Bruno RS , Traber MG , Stevens JF . Free Radic Biol Med 2011 50 (7) 848-53 The lack of suitable biomarkers of oxidative stress is a common problem for antioxidant intervention studies in humans. We evaluated the efficacy of vitamin C supplementation in decreasing biomarkers of lipid peroxidation in nonsmokers and in cigarette smokers, a commonly studied, free-living human model of chronic oxidative stress. Participants received ascorbic acid (500mg twice per day) or placebo for 17days in a double-blind, placebo-controlled, randomized crossover design study. The urinary biomarkers assessed and reported herein are derived from 4-hydroperoxy-2-nonenal (HPNE) and include the mercapturic acid (MA) conjugates of 4-hydroxy-2(E)-nonenal (HNE), 1,4-dihydroxy-2(E)-nonene (DHN), and 4-oxo-2(E)-nonenol(ONO). Vitamin C supplementation decreased the urinary concentrations of both ONO-MA (p=0.0013) and HNE-MA (p=0.0213) by ~30%; however, neither cigarette smoking nor sex affected these biomarkers. In contrast, vitamin C supplementation decreased urinary concentrations of DHN-MA (three-way interaction p=0.0304) in nonsmoking men compared with nonsmoking women (p<0.05), as well as in nonsmoking men compared with smoking men (p<0.05). Vitamin C supplementation also decreased (p=0.0092) urinary total of metabolites by ~20%. Thus, HPNE metabolites can be reduced favorably in response to improved plasma ascorbic acid concentrations, an effect due to ascorbic acid antioxidant function. |
Legionella nagasakiensis sp. nov., isolated from water samples in Japan and Australia and from a patient with pneumonia in the United States
Yang PG , Benson RF , Ratcliff R , Brown EW , Steigerwalt AG , Thacker LW , Daneshvar M , Morey RE , Saito A , Fields BS . Int J Syst Evol Microbiol 2011 62 284-288 A novel Legionella species was identified based on 16S rRNA and mip (macrophage infectivity potentiator) gene sequencing analysis, cellular fatty acids, isoprenoid quinones, biochemical reactions, antigens, and quantitative DNA-DNA hybridization. The strain CDC-1796-JAP-E(T) was isolated from well water at the Nagassaki Municipal Medical Center, Japan. Two strains, CDC-3041-AUS-E and CDC-3558-AUS-E, were isolated from water samples during an outbreak of legionellosis in South Australia. The strain CDC-5427-OH-H was isolated from a 66-year-old female patient diagnosed with Legionnaires' disease in the U.S. The cells from these four strains were gram-negative, non-fluorescent, rod-shaped, and positive for alkaline phosphatase, esterase, leucine arylamidase, catalase, gelatinase, beta-lactamase, and tyrosine browning assay. Phylogenetic analysis of 16S rRNA and mip genes revealed that the four strains formed a distinct cluster within the genus Legionella. The bacteria contained branched-chain fatty acids and quinones that are typical of the genus Legionella. Slide agglutination tests demonstrated no cross-reaction with 52 previously described Legionellaceae. DNA hybridization studies indicated DNAs from the four strains were highly related (78-84%) but showed 29% relatedness to L. oakridgensis (ATCC 33761(T)) and less than 10% to other Legionella species tested. These characterizations suggest that the isolates represent a novel species, for which the name Legionella nagasakiensis sp. nov is proposed, for the type strain CDC-1796-JAP-E(T) (=ATCC BAA-1557(T)=JCM 15315(T)). |
Quantification of organophosphate insecticides in drinking water in urban areas using lyophilization and high-performance liquid chromatography-electrospray ionization-mass spectrometry techniques
Sinha SN , Vasudev K , Rao MVV , Odetokun M . Int J Mass Spectrom 2011 300 (1) 12-20 A sensitive method for the quantification of eight organophosphate pesticides in water samples at the ng L-1 concentration level has been developed. These organophosphates include pesticides, insecticides and herbicides used in agricultural applications. A lyophilization with simple solvent extraction followed by selective analysis using a liquid chromatography-mass spectrometry method was used. This method was accurate (>= 98.9%), as it possessed limits of detection and quantification in the 4.9-51 and 16.5-171 ng L-1 ranges, respectively. Furthermore, the coefficients of variations (>= 0.999) were less than 8.2% at the low ng L-1 end of the linear range of the method. In addition, the percentage recovery of all pesticides at the 0.1 mu g L-1 levels ranged from 96% to 103%. This method was then used for the quantification of organophosphates in drinking and bore water samples collected from different parts of urban areas. We subsequently found detectable levels of monocrotofos, imedacloprid, triazofos, atrazine, propanil, quinolfos and metribuzin in more than 23% of the water samples analyzed. (C) 2010 Elsevier B.V. All rights reserved. |
Quantitative mass spectrometry for bacterial protein toxins - a sensitive, specific, high-throughput tool for detection and diagnosis
Boyer AE , Gallegos-Candela M , Lins RC , Kuklenyik Z , Woolfitt A , Moura H , Kalb S , Quinn CP , Barr JR . Molecules 2011 16 (3) 2391-413 Matrix-assisted laser-desorption time-of-flight (MALDI-TOF) mass spectrometry (MS) is a valuable high-throughput tool for peptide analysis. Liquid chromatography electrospray ionization (LC-ESI) tandem-MS provides sensitive and specific quantification of small molecules and peptides. The high analytic power of MS coupled with high-specificity substrates is ideally suited for detection and quantification of bacterial enzymatic activities. As specific examples of the MS applications in disease diagnosis and select agent detection, we describe recent advances in the analyses of two high profile protein toxin groups, the Bacillus anthracis toxins and the Clostridium botulinum neurotoxins. The two binary toxins produced by B. anthracis consist of protective antigen (PA) which combines with lethal factor (LF) and edema factor (EF), forming lethal toxin and edema toxin respectively. LF is a zinc-dependent endoprotease which hydrolyzes specific proteins involved in inflammation and immunity. EF is an adenylyl cyclase which converts ATP to cyclic-AMP. Toxin-specific enzyme activity for a strategically designed substrate, amplifies reaction products which are detected by MALDI-TOF-MS and LC-ESI-MS/MS. Pre-concentration/purification with toxin specific monoclonal antibodies provides additional specificity. These combined technologies have achieved high specificity, ultrasensitive detection and quantification of the anthrax toxins. We also describe potential applications to diseases of high public health impact, including Clostridium difficile glucosylating toxins and the Bordetella pertussis adenylyl cyclase. |
Advances in the analysis of hepatitis C virus specific T cell responses
Zhang X , Dou J , Germann MW . Mini Rev Med Chem 2011 11 (2) 106-13 There is a growing consensus that cellular immune responses are associated with the clinical outcome of hepatitis C virus infection (HCV). The development of Tetramer staining, ELISpot, flow cytometry and epitope mapping technologies make it possible to enumerate, phenotype and assess the proliferation and function of HCV specific T cells; as well as map and predict T cell epitopes and track the evolution of T cell epitopes. Such information is essential for the development of effective therapeutic and prophylactic HCV vaccines. This article summarizes the technical advances relevant to HCV specific T cell responses. |
Assessment of BED HIV-1 incidence assay in seroconverter cohorts: effect of individuals with long-term infection and importance of stable incidence
McNicholl JM , McDougal JS , Wasinrapee P , Branson BM , Martin M , Tappero JW , Mock PA , Green TA , Hu DJ , Parekh B . PLoS One 2011 6 (3) e14748 BACKGROUND: Performance of the BED assay in estimating HIV-1 incidence has previously been evaluated by using longitudinal specimens from persons with incident HIV infections, but questions remain about its accuracy. We sought to assess its performance in three longitudinal cohorts from Thailand where HIV-1 CRF01_AE and subtype B' dominate the epidemic. DESIGN: BED testing was conducted in two longitudinal cohorts with only incident infections (a military conscript cohort and an injection drug user cohort) and in one longitudinal cohort (an HIV-1 vaccine efficacy trial cohort) that also included long-term infections. METHODS: Incidence estimates were generated conventionally (based on the number of annual serocoversions) and by using BED test results in the three cohorts. Adjusted incidence was calculated where appropriate. RESULTS: For each longitudinal cohort the BED incidence estimates and the conventional incidence estimates were similar when only newly infected persons were tested, whether infected with CRF01_AE or subtype B'. When the analysis included persons with long-term infections (to mimic a true cross-sectional cohort), BED incidence estimates were higher, although not significantly, than the conventional incidence estimates. After adjustment, the BED incidence estimates were closer to the conventional incidence estimates. When the conventional incidence varied over time, as in the early phase of the injection drug user cohort, the difference between the two estimates increased, but not significantly. CONCLUSIONS: Evaluation of the performance of incidence assays requires the inclusion of a substantial number of cohort-derived specimens from individuals with long-term HIV infection and, ideally, the use of cohorts in which incidence remained stable. Appropriate adjustments of the BED incidence estimates generate estimates similar to those generated conventionally. |
Comparison of Etest method with reference broth microdilution method for antimicrobial susceptibility testing of Yersinia pestis
Lonsway DR , Urich SK , Heine HS , McAllister SK , Banerjee SN , Schriefer ME , Patel JB . J Clin Microbiol 2011 49 (5) 1956-60 Utility of Etest for antimicrobial susceptibility testing of Yersinia pestis was evaluated in comparison with broth microdilution and disk diffusion for eight agents. Four laboratories tested 26 diverse strains and found Etest to be reliable for testing antimicrobial agents used to treat Y. pestis, except for chloramphenicol and trimethoprim-sulfamethoxazole. Disk diffusion testing is not recommended. |
Decreased dissolution of ZnO by iron doping yields nanoparticles with reduced toxicity in the rodent lung and zebrafish embryos
Xia T , Zhao Y , Sager T , George S , Pokhrel S , Li N , Schoenfeld D , Meng H , Lin S , Wang X , Wang M , Ji Z , Zink JI , Madler L , Castranova V , Nel AE . ACS Nano 2011 5 (2) 1223-1235 We have recently shown that the dissolution of ZnO nanoparticles and Zn(2+) shedding leads to a series of sublethal and lethal toxicological responses at the cellular level that can be alleviated by iron doping. Iron doping changes the particle matrix and slows the rate of particle dissolution. To determine whether iron doping of ZnO also leads to lesser toxic effects in vivo, toxicity studies were performed in rodent and zebrafish models. First, we synthesized a fresh batch of ZnO nanoparticles doped with 1-10 wt % of Fe. These particles were extensively characterized to confirm their doping status, reduced rate of dissolution in an exposure medium, and reduced toxicity in a cellular screen. Subsequent studies compared the effects of undoped to doped particles in the rat lung, mouse lung, and the zebrafish embryo. The zebrafish studies looked at embryo hatching and mortality rates as well as the generation of morphological defects, while the endpoints in the rodent lung included an assessment of inflammatory cell infiltrates, LDH release, and cytokine levels in the bronchoalveolar lavage fluid. Iron doping, similar to the effect of the metal chelator, DTPA, interfered in the inhibitory effects of Zn(2+) on zebrafish hatching. In the oropharyngeal aspiration model in the mouse, iron doping was associated with decreased polymorphonuclear cell counts and IL-6 mRNA production. Doped particles also elicited decreased heme oxygenase 1 expression in the murine lung. In the intratracheal instillation studies in the rat, Fe doping was associated with decreased polymorphonuclear cell counts, LDH, and albumin levels. All considered, the above data show that Fe doping is a possible safe design strategy for preventing ZnO toxicity in animals and the environment. |
The Pregnancy and Influenza Project: design of an observational case-cohort study to evaluate influenza burden and vaccine effectiveness among pregnant women and their infants
Thompson M , Williams J , Naleway A , Li DK , Chu S , Bozeman S , Hill HA , Cragan J , Shay DK . Am J Obstet Gynecol 2011 204 S69-76 The US Centers for Disease Control and Prevention is conducting an observational study of 300-500 women infected with influenza during pregnancy. Women are being recruited from members of the Kaiser Permanente health plan in 2 metropolitan areas before and during the 2010 through 2011 influenza season either following routine prenatal care visits or presentation with an acute respiratory infection. All enrolled mothers and their infants will be followed up through 1 month after delivery. Infants of mothers who had influenza during pregnancy and 1000 infants of mothers who were not diagnosed with influenza during pregnancy will be followed up for an additional 5 months. The Pregnancy and Influenza Project is focused on better understanding the burden of influenza during and after pregnancy and estimating the effectiveness of maternal influenza vaccination against influenza among women and their infants confirmed by real-time reverse transcription polymerase chain reaction assays. |
The changing prevalence of the autism spectrum disorders
Rice CE . Am Fam Physician 2011 83 (5) 515 Autism spectrum disorders are a group of developmental disabilities characterized by atypical development in socialization, communication, and behavior. The term autism spectrum disorders describes three of the five pervasive developmental disorders, including autistic disorder, Asperger syndrome, and pervasive developmental disorder—not otherwise specified. Symptoms of autism spectrum disorders typically are present before three years of age and often are accompanied by unusual patterns in learning, attention, and sensory processing.1 Based on the most recent report by the Autism and Developmental Disabilities Monitoring (ADDM) Network, an average of one in 110 children was identified with autism spectrum disorders, which translates to about 1 percent of children.2 For every girl, four or five boys were affected by the autism spectrum disorders. Less than one-half of the children with autism spectrum disorders also had an intellectual disability, and 47 percent were diagnosed with autistic disorder by eight years of age. | We know that the number of persons receiving services for autism spectrum disorders has increased substantially since the early 1990s,3,4 but are there really more children today with the cluster of behaviors that make up the autism spectrum disorders than there were in the past? Debates on this issue typically have been dichotomized to indicate that increases in the prevalence of autism spectrum disorders must be explained by changes in identification patterns or by a true increase in symptoms among children born in more recent times. We do know that the way autism spectrum disorders are defined and identified makes a difference in the prevalence estimates. From the time autism was first described in the 1940s until the 1980s, the term primarily referred to more severely affected persons with autistic disorder and was thought to be rare, affecting approximately one in every 2,000 children (0.05 percent).5 Current estimates on the prevalence of autism spectrum disorders based on expanded definitions from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., are approximately 10 to 20 times higher than those using earlier criteria. Some of the most recent studies have documented a prevalence of more than 1 percent of children in multiple areas of the world,2,6–8 with symptoms identified in 2.7 percent of children.9 One effort to retrospectively apply more modern criteria to an older study estimated a prevalence of about four per 1,000 children, indicating that older studies underestimated prevalence because they considered a more strict interpretation of what autism and related disorders look like.10 |
What works? Process evaluation of a school-based fruit and vegetable distribution program in Mississippi
Potter SC , Schneider D , Coyle KK , May G , Robin L , Seymour J . J Sch Health 2011 81 (4) 202-211 BACKGROUND: During the 2004-2005 school year, the Mississippi Department of Education, Office of Child Nutrition, initiated a pilot program to distribute free fruit and vegetable snacks to students during the school day. This article describes the first-year implementation of the Mississippi Fruit and Vegetable Pilot Program. METHODS: The process evaluation addressed where, when, and how produce was distributed; what was distributed; challenges and successes; and recommended modifications. Five of the 25 program schools were selected to participate in the evaluation; selection was based on grade levels served and demographic characteristics. Data were collected from program staff (N = 11) and administrators (N = 6) via interviews and logs; student (N = 42) and parent (N = 19) focus groups; student questionnaires (N = 660); and school staff questionnaires (N = 207). RESULTS: Distributing fresh fruit and vegetable snacks at school was well received by staff and students. Most schools distributed the fresh fruit and vegetable snacks at morning break in classrooms or a central courtyard. Twenty-two types of fresh fruit, 4 types of dried fruit, and 7 types of vegetables were served to students during the program year. Commonly distributed fruit included apples, oranges, pears, bananas, and tangerines. Carrots were the staple vegetable, followed by celery. Key challenges included getting students to try new foods and receiving the produce in a timely manner without spoiling. Main successes included seeing students try new fruit and vegetable snacks, having the program run smoothly, and teacher support. CONCLUSIONS: The program fit well within the school structure and could be an effective component of a multifaceted approach to enhancing child nutrition. |
Awareness of federal dietary guidance in persons aged 16 years and older: results from the National Health and Nutrition Examination Survey 2005-2006
Wright JD , Wang CY . J Am Diet Assoc 2011 111 (2) 295-300 The National Health and Nutrition Examination Survey 2005-2006 included questions on awareness of the Dietary Guidelines for Americans (DGA), the Food Guide Pyramid, and the 5 A Day for Better Health Program. Prevalence of awareness of federal dietary guidance was estimated and differences were tested across demographic traits, health characteristics, and diet-related attitudes and behavior. The continuous National Health and Nutrition Examination Survey uses a nationally representative cross-sectional sample design. The analytic sample consisted of 5,499 persons aged 16 years and older with complete data. Among persons aged 16 years and older, 83.8% had heard of at least one of the initiatives: 49.2% had heard of the DGA, 80.6% had heard of the Food Guide Pyramid, and 51.2% had heard of the 5 A Day program. There was a linear trend of decreasing awareness of at least one of the guidance efforts with increasing age. Differences by sex, race/ethnicity, education, and income were also observed. Differences by body mass index were not statistically significant; however, significant differences were seen with fatalistic beliefs about body weight. Differences by smoking, self-assessed diet quality, and eating out frequency were not statistically significant after adjustment for sex, age, race/ethnicity, education, and income. These results may be useful in promotion of the upcoming edition of the DGA and to suggest population groups that may benefit from strengthened and more innovative education efforts at the public health program level and at the clinic level. |
Does the small farm exemption cost lives?
Somervell PD , Conway GA . Am J Ind Med 2011 54 (6) 461-6 BACKGROUND: Congress has exempted farms with fewer than 11 employees from enforcement of the Occupational Safety and Health Act. Three states (California, Oregon, and Washington) do not observe the exemption. METHODS: We compared rates of fatal occupational injury in agriculture, by year, in 1993-2007, in California, Oregon, and Washington (aggregated), and the remaining states (as two aggregated groups): those with, and those without, state-designed occupational safety and health programs. RESULTS: Fatality rates were approximately 1.6 to 3 times as high in both groups of states observing the small farm exemption as in the group of three states not observing it. Comparisons excluding the agriculture industry showed weaker differences. CONCLUSIONS: The three states' opting out of the small farm exemption may have had substantial direct effects. They may also reflect and/or encourage a generally more effective approach to occupational health and safety. Although alternative explanations must be considered, the stakes are high in terms of injury and loss of life; further investigation seems urgently indicated. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Public support for street-scale urban design practices and policies to increase physical activity
Carlson SA , Guide R , Schmid TL , Moore LV , Barradas DT , Fulton JE . J Phys Act Health 2011 8 Suppl 1 S125-34 BACKGROUND: Street-scale urban design policies are recommended to increase physical activity in communities. Our purpose was to examine U.S. public support for local street-scale urban design features and policies. METHODS: Analysis is based on a cross-sectional national sample of adults (n = 4682) participating in the 2006 HealthStyles mail survey. RESULTS: About 57% of adults rated local street-scale urban design as highly important in determining the amount of physical activity they obtain. Adjusted odds of rating neighborhood features as having high importance were higher in people aged ≥65 years versus those <65 and minority racial/ethnic groups versus non-Hispanic whites. Two-thirds of adults were willing to take civic action to support local street-scale urban design policy. Adjusted odds of being willing to take any action versus none was higher in non-Hispanic blacks and Hispanics versus non-Hispanic whites, was higher in those with household incomes ≥$60,000 versus ≤$15,000 per year, and increased as education and perceived importance of neighborhood features increased. CONCLUSIONS: There are high levels of public support for local street-scale urban design policies; however, demographic differences exist in the level of support. These differences are important considerations for policymakers and for those designing community programs targeting street-scale urban design features and policies. |
Effect of a school-based intervention on physical activity: cluster-randomized trial
Aburto NJ , Fulton JE , Safdie M , Duque T , Bonvecchio A , Rivera JA . Med Sci Sports Exerc 2011 43 (10) 1898-906 PURPOSE: Physical activity in childhood has many health benefits; however, the majority of children in many countries including Mexico are insufficiently active. The objective of this investigation was to test the impact of a school-based environmental intervention on the physical activity and physical fitness of students attending public primary schools in Mexico City. METHODS: Twenty-seven schools were randomly assigned to basic or plus intervention or control. The basic and plus groups were exposed to school environment and policy changes to enhance physical activity. Physical activity was evaluated in 699 randomly selected 4 and 5 grade students by measuring school-day and all-day (24-hour) steps using pedometers worn for five days before and after the 6-month intervention. Physical fitness was assessed by measuring the 9-minute run, flexibility, and sit-ups. We calculated the average change in school-day and all-day steps and fitness measures from baseline to follow-up. Using linear regression, we tested the effect of intervention on change controlling for baseline measures and covariates and accounting for the design effect of school. Using logistic regression, we tested the effect of intervention on reaching step cut-offs at baseline and follow-up. RESULTS: The plus group significantly (p<0.05) increased school-day steps relative to control (change=687 v -639). Significantly (p<0.05) more participants in basic (25.8%) and plus (36.4%) groups reached step cut-offs during school relative to control (12.0%). The basic group significantly (p< 0.05) increased all-day steps (change=581) relative to control (change=581 v -419). The plus group significantly (p=0.05) increased sit-ups relative to control (change=0.3 v -1.7). CONCLUSION: A school-based environmental intervention improved student physical activity during school in public schools in Mexico City. |
Protecting HIV information in countries scaling up HIV services: a baseline study
Beck EJ , Mandalia S , Harling G , Santas XM , Mosure D , Delay PR . J Int AIDS Soc 2011 14 (1) 6 BACKGROUND: Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. METHODS: Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. RESULTS: Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. CONCLUSIONS: Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them. |
Student vaccination requirements of U.S. health professional schools: a survey
Lindley MC , Lorick SA , Spinner JR , Krull AR , Mootrey GT , Ahmed F , Myers R , Bednash GP , Cymet TC , Maeshiro R , Raines CF , Shannon SC , Sondheimer HM , Strikas RA . Ann Intern Med 2011 154 (6) 391-400 BACKGROUND: Unvaccinated health care personnel are at increased risk for transmitting vaccine-preventable diseases to their patients. The Advisory Committee on Immunization Practices (ACIP) recommends that health care personnel, including students, receive measles, mumps, rubella, hepatitis B, varicella, influenza, and pertussis vaccines. Prematriculation vaccination requirements of health professional schools represent an early opportunity to ensure that health care personnel receive recommended vaccines. OBJECTIVE: To examine prematriculation vaccination requirements and related policies at selected health professional schools in the United States and compare requirements with current ACIP recommendations. DESIGN: Cross-sectional study using an Internet-based survey. SETTING: Medical and baccalaureate nursing schools in the United States and its territories. PARTICIPANTS: Deans of accredited medical schools granting MD (n = 130) and DO (n = 26) degrees and of baccalaureate nursing programs (n = 603). MEASUREMENTS: Proportion of MD-granting and DO-granting schools and baccalaureate nursing programs that require that entering students receive vaccines recommended by the ACIP for health care personnel. RESULTS: 563 schools (75%) responded. More than 90% of all school types required measles, mumps, rubella, and hepatitis B vaccines for entering students; varicella vaccination also was commonly required. Tetanus, diphtheria, and acellular pertussis vaccination was required by 66%, 70%, and 75% of nursing, MD-granting, and DO-granting schools, respectively. Nursing and DO-granting schools (31% and 45%, respectively) were less likely than MD-granting schools (78%) to offer students influenza vaccines free of charge. LIMITATIONS: Estimates were conservative, because schools that reported that they did not require proof of immunity for a given vaccine were considered not to require that vaccine. Estimates also were restricted to schools that train physicians and nurses. CONCLUSION: The majority of schools now require most ACIP-recommended vaccines for students. Medical and nursing schools should adopt policies on student vaccination and serologic testing that conform to ACIP recommendations and should encourage annual influenza vaccination by offering influenza vaccination to students at no cost. PRIMARY FUNDING SOURCE: None. |
Generalized second-order partial derivatives of 1/r
Hnizdo V . Eur J Phys 2011 32 (2) 287-297 The generalized second-order partial derivatives of 1/r, where r is the radial distance in three dimensions (3D), are obtained using a result of the potential theory of classical analysis. Some non-spherical-regularization alternatives to the standard spherical-regularization expression for the derivatives are derived. The utility of a spheroidal-regularization expression is illustrated on an example from classical electrodynamics. |
Impact of a new gender-specific definition for binge drinking on prevalence estimates for women
Chavez PR , Nelson DE , Naimi TS , Brewer RD . Am J Prev Med 2011 40 (4) 468-71 BACKGROUND: Binge drinking accounts for more than half of the 79,000 deaths due to excessive drinking in the U.S. each year. In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) lowered the threshold for defining binge drinking among women from ≥5 drinks to ≥4 drinks per occasion, in accordance with national recommendations. PURPOSE: To assess changes in binge-drinking prevalence among women. METHODS: The relative and absolute change in binge drinking among U.S. adult women was assessed using pooled BRFSS data from the 2 years before (2004-2005) and after (2006-2007) the implementation of the new gender-specific definition. Analyses were conducted in 2008-2009. RESULTS: Binge-drinking prevalence among women increased 2.6 percentage points (from 7.3% in 2004-2005 to 9.9% in 2006-2007), a 35.6% relative increase. The percentage of women who reported consuming exactly 4 drinks in 2006 (3.6%) was similar to the increase in the prevalence of binge drinking among women that was observed from 2005 to 2006 (absolute change=2.9 percentage points). CONCLUSIONS: The new gender-specific definition of binge drinking significantly increased the identification of women drinking at dangerous levels. The change in prevalence among women was primarily due to the change in the definition and not to actual changes in drinking behavior. The new gender-specific definition of binge drinking can increase the usefulness of this measure for public health surveillance and support the planning and implementation of effective prevention strategies (e.g., increasing alcohol excise taxes). |
Pathogenicity of two Egyptian H5N1 highly pathogenic avian influenza viruses in domestic ducks
Wasilenko JL , Arafa AM , Selim AA , Hassan MK , Aly MM , Ali A , Nassif S , Elebiary E , Balish A , Klimov A , Suarez DL , Swayne DE , Pantin-Jackwood MJ . Arch Virol 2011 156 (1) 37-51 Domestic ducks have been implicated in the dissemination and evolution of H5N1 highly pathogenic avian influenza (HPAI) viruses. In this study, two H5N1 HPAI viruses belonging to clade 2.2.1 isolated in Egypt in 2007 and 2008 were analyzed for their pathogenicity in domestic Pekin ducks. Both viruses produced clinical signs and mortality, but the 2008 virus was more virulent, inducing early onset of neurological signs and killing all ducks with a mean death time (MDT) of 4.1 days. The 2007 virus killed 3/8 ducks with a MDT of 7 days. Full-genome sequencing and phylogenetic analysis were used to examine differences in the virus genes that might explain the differences observed in pathogenicity. The genomes differed in 49 amino acids, with most of the differences found in the hemagglutinin protein. This increase in pathogenicity in ducks observed with certain H5N1 HPAI viruses has implications for the control of the disease, since vaccinated ducks infected with highly virulent strains shed viruses for longer periods of time, perpetuating the virus in the environment and increasing the possibility of transmission to susceptible birds. |
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 Behavior and Risk
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Physical Activity
- Public Health Law
- Public Health Leadership and Management
- Sciences, General
- Substance Use and Abuse
- Veterinary Medicine
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure