Opportunities for public health communication, intervention, and future research on breast cancer in younger women.
Buchanan N , Roland KB , Rodriguez JL , Miller JW , Fairley T . J Womens Health (Larchmt) 2013 22 (4) 293-8 BACKGROUND: Approximately 6% of breast cancers in the United States occur in women under the age of 40 years. Compared with women ≥40 years of age, younger women are diagnosed at later stages, have higher rates of recurrence and death, and may be predisposed to secondary breast or ovarian cancer. An informal meeting of experts discussed opportunities for research and public health communication related to breast cancer among young (<40 and/or premenopausal) women. METHODS: In September 2011, the Centers for Disease Control and Prevention hosted 18 experts in oncology, genetics, behavioral science, survivorship and advocacy, public health, communication, ethics, nutrition, physical activity, and environmental health. They (1) reviewed research and programmatic knowledge on risk and preventive factors, early detection, and survivorship; and (2) discussed ideas for research, communication, and programmatic efforts related to young women diagnosed with or at risk for early onset breast cancer. RESULTS: Levels of evidence and themes for future research regarding risk and preventive factors, including exposures, were discussed. Early detection strategies, including screening, risk assessment, and genetic counseling, as well as survivorship issues, follow-up care, fertility and reproductive health, and psychosocial care were highlighted. CONCLUSION: Community and academic researchers, providers, advocates, and the federal public health community discussed strategies and opportunities for this unique population. Although the evidence is limited, future research and communication activities may be useful to organize future public health initiatives. |
Psoriasis and psoriatic arthritis: a public health agenda
Helmick CG , Sacks JJ , Gelfand JM , Bebo B Jr , Lee-Han H , Baird T , Bartlett C . Am J Prev Med 2013 44 (4) 424-6 Robust clinical, biomedical, and public health efforts currently address chronic conditions such as heart disease, diabetes, and cancer. However, similar efforts are less common for nonfatal conditions such as psoriasis, which is estimated to affect between 1% and 3% of the adult population,1,2 and psoriatic arthritis, an inflammatory arthritis found in up to one third of adults with psoriasis.3 Both diseases present a substantial public health burden in terms of healthcare costs ($650 million in 1997)1; employment and ability to work4; and quality of life.5,6 | In 2008, the National Psoriasis Foundation (NPF) approached the CDC to explore how a public health perspective could be incorporated into existing clinical and biomedical perspectives. In 2010, the U.S. Congress included funding for the CDC | … to support the collection of epidemiological and longitudinal data on individuals with psoriasis and psoriatic arthritis, including children and adolescents, to better understand the co-morbidities associated with psoriasis, examine the relationship of psoriasis to other public health concerns, and gain insight into the long-term impact and treatment of these two conditions.7 | In other words, the funding was to begin developing and addressing a public health agenda for psoriasis and psoriatic arthritis. |
Rotavirus encephalitis with basal ganglia involvement in an 8-month-old infant
Rath BA , Gentsch J , Seckinger J , Ward K , Deputy S . Clin Pediatr (Phila) 2013 52 (3) 260-4 Rotavirus disease has always been considered an intestinal infection, but viremia and extra-intestinal spread may be more common than expected.1,2 In a recent surveillance study, as many as 90% of children with rotavirus diarrhea had evidence of rotavirus antigenemia, compared with 12% of children with rotavirus-negative diarrhea. All children with rotavirus-positive stool samples showed infectious particles in their plasma.1 Lymphatic spread may be an alternative route of central nervous system (CNS) infection.3 | A total of 33 cases of rotavirus disease with CNS involvement have been reported to date.2-12 Less than half (10/24; 42%) of the patients with reported outcomes recovered completely. Five children (21%) died from the disease, whereas the remaining 37% experienced neurological sequelae. With increased awareness evidence has since grown stronger, and CNS involvement is slowly being recognized as a rare but potentially serious complication in rotavirus gastroenteritis.13-22 The clinical spectrum of CNS involvement with rotavirus infection includes convulsions (with or without fever and including status epilepticus), aseptic meningitis, Reye’s syndrome, encephalopathy syndrome, and encephalitis.2,4 Other patients present with hemorrhagic shock and disseminated intravascular coagulation. Individual case reports have described cerebral edema, diffuse electroencephalogram (EEG) background slowing lasting up to several months after the illness, cerebrospinal fluid (CSF) pleocytosis, unilateral hemispheric edema, decreased regional cerebral blood flow on SPECT, mildly elevated liver transaminases, and irritability with altered mental status.2,4,8,12 Little is known about neuroimaging findings during rotavirus encephalitis as well as long-term cognitive, neurological, and behavioral functioning. | We report a case of rotavirus encephalitis with basal ganglia involvement, persistent irritability and dystonia, loss of developmental milestones, and failure to thrive as long-term sequelae. |
Seroepidemiologic investigation of an outbreak of pandemic influenza A H1N1 2009 aboard a US Navy vessel-San Diego, 2009
Khaokham CB , Selent M , Loustalot FV , Zarecki SM , Harrington D , Hoke E , Faix DJ , Ortiguerra R , Alvarez B , Almond N , McMullen K , Cadwell B , Uyeki TM , Blair PJ , Waterman SH . Influenza Other Respir Viruses 2013 7 (5) 791-8 BACKGROUND: During summer 2009, a US Navy ship experienced an influenza-like illness outbreak with 126 laboratory-confirmed cases of pandemic influenza A (H1N1) 2009 virus among the approximately 2000-person crew. METHODS: During September 24-October 9, 2009, a retrospective seroepidemiologic investigation was conducted to characterize the outbreak. We administered questionnaires, reviewed medical records, and collected post-outbreak sera from systematically sampled crewmembers. We used real-time reverse transcription-PCR or microneutralization assays to detect evidence of H1N1 virus infection. RESULTS: Retrospective serologic data demonstrated that the overall H1N1 virus infection attack rate was 32%. Weighted H1N1 virus attack rates were higher among marines (37%), junior-ranking personnel (34%), and persons aged 19-24 years (36%). In multivariable analysis, a higher risk of illness was found for women versus men (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.1-4.4), marines versus navy personnel (OR = 1.7; 95% CI, 1.0-2.9), and those aged 19-24 versus ≥35 years (OR = 3.9; 95% CI, 1.2-12.8). Fifty-three percent of infected persons did not recall respiratory illness symptoms. Among infected persons, only 35% met criteria for acute respiratory illness and 11% for influenza-like illness. CONCLUSIONS: Approximately half of H1N1 infections were asymptomatic, and thus, the attack rate was higher than estimated by clinical illness alone. Enhanced infection control measures including pre-embarkation illness screening, improved self-reporting of illness, isolation of ill and quarantine of exposed contacts, and prompt antiviral chemoprophylaxis and treatment might be useful in controlling shipboard influenza outbreaks. |
Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study
Terrault NA , Dodge JL , Murphy EL , Tavis JE , Kiss A , Levin TR , Gish RG , Busch MP , Reingold AL , Alter MJ . Hepatology 2013 57 (3) 881-9 The efficiency of hepatitis C virus (HCV) transmission by sexual activity remains controversial. We conducted a cross-sectional study of HCV-positive subjects and their partners to estimate the risk for HCV infection among monogamous heterosexual couples. A total of 500 anti-HCV-positive, human immunodeficiency virus-negative index subjects and their long-term heterosexual partners were studied. Couples were interviewed separately for lifetime risk factors for HCV infection, within-couple sexual practices, and sharing of personal grooming items. Blood samples were tested for anti-HCV, HCV RNA, and HCV genotype and serotype. Sequencing and phylogenetic analysis determined the relatedness of virus isolates among genotype-concordant couples. The majority of HCV-positive index subjects were non-Hispanic white, with a median age of 49 years (range, 26-79 years) and median of 15 years (range, 2-52 years) of sexual activity with their partners. Overall, HCV prevalence among partners was 4% (n = 20), and nine couples had concordant genotype/serotype. Viral isolates in three couples (0.6%) were highly related, consistent with transmission of virus within the couple. Based on 8,377 person-years of follow-up, the maximum incidence rate of HCV transmission by sex was 0.07% per year (95% confidence interval, 0.01-0.13) or approximately one per 190,000 sexual contacts. No specific sexual practices were related to HCV positivity among couples. CONCLUSION: The results of this study provide quantifiable risk information for counseling long-term monogamous heterosexual couples in which one partner has chronic HCV infection. In addition to the extremely low estimated risk for HCV infection in sexual partners, the lack of association with specific sexual practices provides unambiguous and reassuring counseling messages. (HEPATOLOGY 2013). |
Travel-associated sexually transmitted infections: an observational cross-sectional study of the GeoSentinel surveillance database
Matteelli A , Schlagenhauf P , Carvalho AC , Weld L , Davis XM , Wilder-Smith A , Barnett ED , Parola P , Pandey P , Han P , Castelli F . Lancet Infect Dis 2013 13 (3) 205-13 BACKGROUND: Travel is thought to be a risk factor for the acquisition of sexually transmitted infections (STIs), but no multicentre analyses have been done. We aimed to describe the range of diseases and the demographic and geographical factors associated with the acquisition of travel-related STIs through analysis of the data gathered by GeoSentinel travel medicine clinics worldwide. METHODS: We gathered data from ill travellers visiting GeoSentinel clinics worldwide between June 1, 1996, and Nov 30, 2010, and analysed them to identify STIs in three clinical settings: after travel, during travel, or immigration travel. We calculated proportionate morbidity for each of the three traveller groups and did logistic regression to assess the association between STIs and demographic, geographical, and travel variables. FINDINGS: Our final analysis was of 112,180 ill travellers-64,335 patients seen after travel, 38,287 patients seen during travel, and 9558 immigrant patients. 974 patients (0.9%) had diagnoses of STIs, and 1001 STIs were diagnosed. The proportionate STI morbidities were 6.6, 10.2, and 16.8 per 1000 travellers in the three groups, respectively. STIs varied substantially according to the traveller category. The most common STI diagnoses were non-gonococcal or unspecified urethritis (30.2%) and acute HIV infection (27.6%) in patients seen after travel; non-gonococcal or unspecified urethritis (21.1%), epididymitis (15.2%), and cervicitis (12.3%) in patients seen during travel; and syphilis in immigrant travellers (67.8%). In ill travellers seen after travel, significant associations were noted between diagnosis of STIs and male sex, travelling to visit friends or relatives, travel duration of less than 1 month, and not having pretravel health consultations. INTERPRETATION: The range of STIs varies substantially according to traveller category. STI preventive strategies should be particularly targeted at men and travellers visiting friends or relatives. Our data suggest target groups for pretravel interventions and should assist in post-travel screening and decision making. FUNDING: US Centers for Disease Control and Prevention, and International Society of Travel Medicine. |
Unexpectedly high HIV prevalence among female sex workers in Bangkok, Thailand in a respondent-driven sampling survey
Manopaiboon C , Prybylski D , Subhachaturas W , Tanpradech S , Suksripanich O , Siangphoe U , Johnston LG , Akarasewi P , Anand A , Fox KK , Whitehead SJ . Int J STD AIDS 2013 24 (1) 34-8 The pattern of sex work in Thailand has shifted substantially over the last two decades from direct commercial establishments to indirect venues and non-venue-based settings. This respondent-driven sampling survey was conducted in Bangkok in 2007 among female sex workers (FSW) in non-venue-based settings to pilot a new approach to surveillance among this hidden population. Fifteen initial participants recruited 707 consenting participants who completed a behavioural questionnaire, and provided oral fluid for HIV testing, and urine for sexually transmitted infection (STI) testing. Overall HIV prevalence was 20.2% (95% confidence interval [CI] 16.3-24.7). Three-quarters of women were street-based (75.8%, 95% CI 69.9-81.1) who had an especially high HIV prevalence (22.7%, 95% CI 18.2-28.4); about 10 times higher than that found in routine sentinel surveillance among venue-based FSW (2.5%). STI prevalence (Chlamydia trachomatis and Neisseria gonorrhoeae) was 8.7% (95% CI 6.4-10.8) and 1.0% (95% CI 0.2-1.9), respectively. Lower price per sex act and a current STI infection were independently associated with HIV infection (P < 0.05). High HIV prevalence found among FSW participating in the survey, particularly non-venue-based FSW, identifies need for further prevention efforts. In addition, it identifies a higher-risk segment of FSW not reached through routine sentinel surveillance but accessible through this survey method. |
Use of nonpharmaceutical interventions to reduce transmission of 2009 pandemic influenza A (pH1N1) in Pennsylvania public schools
Miller JR , Short VL , Wu HM , Waller K , Mead P , Kahn E , Bahn BA , Dale JW , Nasrullah M , Walton SE , Urdaneta V , Ostroff S , Averhoff F . J Sch Health 2013 83 (4) 281-9 BACKGROUND: School-based recommendations for nonpharmaceutical interventions (NPIs) were issued in response to the threat of 2009 pandemic influenza A (pH1N1). The implementation and effectiveness of these recommendations has not been assessed. METHODS: In November 2009, a Web-based survey of all Pennsylvania public schools was conducted to assess the use of recommended NPIs. RESULTS: Overall, 1040 (31%) of 3351 schools participated in the survey. By fall 2009, 820 (84%) of 979 respondents reported that their school had an influenza plan in place, a 44% higher proportion than in the spring 2009 (p < .01). Most schools communicated health messages (eg, staying home when sick), implemented return to school requirements, and made hand sanitizer available. Schools with a spring influenza plan (N = 568) were less likely to report substantial influenza-like illness (ILI) during the fall wave of influenza than the 299 schools without a spring influenza plan (63% vs 71%, p = .02). This association persisted after controlling for schools with substantial ILI in the spring. CONCLUSION: The reported use of NPIs in participating Pennsylvania public schools improved substantially from spring to fall and was generally consistent with issued recommendations. The proactive implementation of a number of NPIs and the early implementation of communication and education initiatives might have cumulatively reduced the impact of pH1N1 in some schools. |
Use of population-based surveillance to define the high incidence of shigellosis in an urban slum in Nairobi, Kenya
Njuguna HN , Cosmas L , Williamson J , Nyachieo D , Olack B , Ochieng JB , Wamola N , Oundo JO , Feikin DR , Mintz ED , Breiman RF . PLoS One 2013 8 (3) e58437 BACKGROUND: Worldwide, Shigella causes an estimated 160 million infections and >1 million deaths annually. However, limited incidence data are available from African urban slums. We investigated the epidemiology of shigellosis and drug susceptibility patterns within a densely populated urban settlement in Nairobi, Kenya through population-based surveillance. METHODS: Surveillance participants were interviewed in their homes every 2 weeks by community interviewers. Participants also had free access to a designated study clinic in the surveillance area where stool specimens were collected from patients with diarrhea (≥3 loose stools within 24 hours) or dysentery (≥1 stool with visible blood during previous 24 hours). We adjusted crude incidence rates for participants meeting stool collection criteria at household visits who reported visiting another clinic. RESULTS: RShigella species were isolated from 224 (23%) of 976 stool specimens. The overall adjusted incidence rate was 408/100,000 person years of observation (PYO) with highest rates among adults 34-49 years old (1,575/100,000 PYO). Isolates were: Shigella flexneri (64%), S. dysenteriae (11%), S. sonnei (9%), and S. boydii (5%). Over 90% of all Shigella isolates were resistant to trimethoprim-sulfamethoxazole and sulfisoxazole. Additional resistance included nalidixic acid (3%), ciprofloxacin (1%) and ceftriaxone (1%). CONCLUSION: More than 1 of every 200 persons experience shigellosis each year in this Kenyan urban slum, yielding rates similar to those in some Asian countries. Provision of safe drinking water, improved sanitation, and hygiene in urban slums are needed to reduce disease burden, in addition to development of effective Shigella vaccines. |
Norovirus and medically attended gastroenteritis in U.S. children
Payne DC , Vinje J , Szilagyi PG , Edwards KM , Staat MA , Weinberg GA , Hall CB , Chappell J , Bernstein DI , Curns AT , Wikswo M , Shirley SH , Hall AJ , Lopman B , Parashar UD . N Engl J Med 2013 368 (12) 1121-30 BACKGROUND: Cases of rotavirus-associated acute gastroenteritis have declined since the introduction of rotavirus vaccines, but the burden of norovirus-associated acute gastroenteritis in children remains to be assessed. METHODS: We conducted active surveillance for laboratory-confirmed cases of norovirus among children younger than 5 years of age with acute gastroenteritis in hospitals, emergency departments, and outpatient clinical settings. The children resided in one of three U.S. counties during the years 2009 and 2010. Fecal specimens were tested for norovirus and rotavirus. We calculated population-based rates of norovirus-associated acute gastroenteritis and reviewed billing records to determine medical costs; these data were extrapolated to the U.S. population of children younger than 5 years of age. RESULTS: Norovirus was detected in 21% of young children (278 of 1295) seeking medical attention for acute gastroenteritis in 2009 and 2010, with norovirus detected in 22% (165 of 742) in 2009 and 20% (113 of 553) in 2010 (P=0.43). The virus was also detected in 4% of healthy controls (19 of 493) in 2009. Rotavirus was identified in 12% of children with acute gastroenteritis (152 of 1295) in 2009 and 2010. The respective rates of hospitalization, emergency department visits, and outpatient visits for the norovirus were 8.6, 146.7, and 367.7 per 10,000 children younger than 5 years of age in 2009 and 5.8, 134.3, and 260.1 per 10,000 in 2010, with an estimated cost per episode of $3,918, $435, and $151, respectively, in 2009. Nationally, we estimate that the average numbers of annual hospitalizations, emergency department visits, and outpatient visits due to norovirus infection in 2009 and 2010 among U.S. children in this age group exceeded 14,000, 281,000, and 627,000, respectively, with more than $273 million in treatment costs each year. CONCLUSIONS: Since the introduction of rotavirus vaccines, norovirus has become the leading cause of medically attended acute gastroenteritis in U.S. children and is associated with nearly 1 million health care visits annually. (Funded by the Centers for Disease Control and Prevention.). |
The association between racial disparity in income and reported sexually transmitted infections
Owusu-Edusei K Jr , Chesson HW , Leichliter JS , Kent CK , Aral SO . Am J Public Health 2013 103 (5) 910-6 OBJECTIVES: We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. METHODS: Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. RESULTS: Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. CONCLUSIONS: Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income. |
The association between symptoms and microbiologically defined response to tuberculosis treatment
Hales CM , Heilig CM , Chaisson R , Leung CC , Chang KC , Goldberg SV , Gordin F , Johnson JL , Muzanyi G , Saukkonen J , Vernon A , Villarino ME , Burman WJ . Ann Am Thorac Soc 2013 10 (1) 18-25 RATIONALE: The lack of consistent associations between clinical outcomes and microbiological responses to therapy for some infectious diseases has raised questions about the adequacy of microbiological endpoints for tuberculosis treatment trials. OBJECTIVES: To evaluate the association between symptoms and microbiological response to tuberculosis treatment. METHODS: We performed a retrospective analysis of four clinical trials in which participants had culture-positive tuberculosis, standardized symptom assessment, and follow-up mycobacterial cultures. Two trials (studies 22 and 23) followed participants to identify recurrent tuberculosis; participants in studies 27 and 28 were only followed to treatment completion. MEASUREMENTS AND MAIN RESULTS: This analysis included 1,978 participants; 39 (2.0%) had culture-confirmed treatment failure, and 75 (3.9%) had culture-confirmed recurrence. Productive cough was associated with indices of increased mycobacterial burden at diagnosis (acid-fast smear grade, severity of radiographic abnormalities). Fever and sweats improved rapidly with treatment, whereas productive cough decreased more slowly and was present in 20% of visits after treatment completion. During treatment, study participants with productive cough more often had concurrent culture positivity compared with those without productive cough (studies 22 and 23: adjusted odds ratio, 1.80; 95% confidence interval [CI], 1.33-2.44). Finally, symptoms during the latter part of treatment and follow-up were associated with culture-confirmed treatment failure and recurrence in studies 22 and 23 (for cough: adjusted hazard ratio, 2.07; 95% CI, 1.23-3.49; for fever: adjusted hazard ratio, 5.05; 95% CI, 2.76-9.19). CONCLUSIONS: There are consistent relationships between symptoms and microbiological indices of tuberculosis, including measures of mycobacterial burden at baseline, culture positivity during treatment, and time to culture-confirmed treatment failure and recurrence. |
Asthma in patients hospitalized with pandemic influenza A(H1N1)pdm09 virus infection-United States, 2009
McKenna JJ , Bramley AM , Skarbinski J , Fry AM , Finelli L , Jain S . BMC Infect Dis 2013 13 57 BACKGROUND: Asthma was the most common co-morbidity among patients hospitalized with pandemic influenza A(H1N1)pdm09 [pH1N1] infection. The objective was to compare characteristics of hospitalized pH1N1 patients with and without asthma and assess factors associated with severity among asthma patients. METHODS: Patient data were derived from two 2009 pandemic case-series of U.S. pH1N1 hospitalizations. A case was defined as a person ≥ 2 years old hospitalized with laboratory-confirmed pH1N1. Asthma status was determined through chart review. RESULTS: Among 473 cases, 29% had asthma. Persons with asthma were more likely to be 2-17 years old (39% vs. 30%, p = 0.04) and black (29% vs. 18%, p < 0.01), and have chronic obstructive pulmonary disease (13% vs. 9%, p = 0.04) but less likely to have pneumonia (37% vs. 47%, p = 0.05), need mechanical ventilation (13% vs. 23%, p = 0.02), and die (4% vs. 10%, p = 0.04) than those without asthma. Among patients with asthma, those admitted to an intensive care unit (ICU) or who died (n = 38) compared with survivors not admitted to an ICU (n = 99) were more likely to have pneumonia on admission (60% vs. 27%, p < 0.01) or acute respiratory distress syndrome (24% vs. 0%, p < 0.01) and less likely to receive influenza antiviral agents ≤ 2 days of admission (73% vs. 92%, p = 0.02). CONCLUSIONS: The majority of persons with asthma had an uncomplicated course; however, severe disease, including ICU admission and death, occurred in asthma patients who presented with pneumonia. Influenza antiviral agents should be started early in hospitalized patients with suspected influenza, including those with asthma. |
A cluster of primary pneumonic plague transmitted in a truck cab in a new enzootic focus in China
Luo H , Dong X , Li F , Xie X , Song Z , Shao Z , Li Z , Tong Z , Wang G , Zhang H , Yang T , He G , He Z , Fontaine RE , Zeng G . Am J Trop Med Hyg 2013 88 (5) 923-8 We investigated a cluster of five cases of severe pneumonia from one village in Yunnan Province, China. We searched for severe pneumonia in the village and hospitals. We interviewed patients and family members about exposures. We tested acute and convalescent sera for antigen and antibody of severe acute respiratory syndrome, avian influenza, and plague. The only common exposure of the five patients was riding together in the enclosed cab of a truck for 1.5 hours while taking the first patient to the hospital. Seroconversion to plague F1 antigen confirmed plague in three survivors. Unfamiliarity of clinicians with plague and lack of sputum examination, blood culture, or postmortem examination delayed the diagnosis. No plague cases occurred among family and village contacts and health care workers. High infectivity in this cluster was limited to a crowded, poorly ventilated truck. |
Barrier screens: a method to sample blood-fed and host-seeking exophilic mosquitoes
Burkot TR , Russell TL , Reimer LJ , Bugoro H , Beebe NW , Cooper RD , Sukawati S , Collins FH , Lobo NF . Malar J 2013 12 49 BACKGROUND: Determining the proportion of blood meals on humans by outdoor-feeding and resting mosquitoes is challenging. This is largely due to the difficulty of finding an adequate and unbiased sample of resting, engorged mosquitoes to enable the identification of host blood meal sources. This is particularly difficult in the south-west Pacific countries of Indonesia, the Solomon Islands and Papua New Guinea where thick vegetation constitutes the primary resting sites for the exophilic mosquitoes that are the primary malaria and filariasis vectors. METHODS: Barrier screens of shade-cloth netting attached to bamboo poles were constructed between villages and likely areas where mosquitoes might seek blood meals or rest. Flying mosquitoes, obstructed by the barrier screens, would temporarily stop and could then be captured by aspiration at hourly intervals throughout the night. RESULTS: In the three countries where this method was evaluated, blood-fed females of Anopheles farauti, Anopheles bancroftii, Anopheles longirostris, Anopheles sundaicus, Anopheles vagus, Anopheles kochi, Anopheles annularis, Anopheles tessellatus, Culex vishnui, Culex quinquefasciatus and Mansonia spp were collected while resting on the barrier screens. In addition, female Anopheles punctulatus and Armigeres spp as well as male An. farauti, Cx. vishnui, Cx. quinquefasciatus and Aedes species were similarly captured. CONCLUSIONS: Building barrier screens as temporary resting sites in areas where mosquitoes were likely to fly was an extremely time-effective method for collecting an unbiased representative sample of engorged mosquitoes for determining the human blood index. |
Medications as a potential source of exposure to phthalates among women of childbearing age
Hernandez-Diaz S , Su YC , Mitchell AA , Kelley KE , Calafat AM , Hauser R . Reprod Toxicol 2013 37C 1-5 OBJECTIVE: To evaluate the association between the use of medications potentially containing phthalates and urinary concentrations of specific phthalate metabolites around conception. METHODS: Women enrolled in the Environment and Reproductive Health project from 2006 to 2009 completed questionnaires about the use of medications and provided multiple urine samples before and after conception. We compared the mean urinary concentration of phthalate metabolites between users of phthalate containing medications and a matched unexposed control group. RESULTS: One woman used Asacol(R) (mesalamine), which utilizes dibutyl phthalate (DBP) as a delayed release coating material, and had a mean urinary concentration of the main DBP metabolite 200 times higher than the controls (8176mcg/L vs. 37.5mcg/L). The three users of stool softeners had a higher concentration of the main diethyl phthalate (DEP) metabolite (8636mcg/L vs. 714.2mcg/L). Neither the three additional Prilosec(R) (omeprazole) users nor one cyclobenzaprine user had higher urinary concentration than controls. CONCLUSION: Selected medications may be important sources of DBP and DEP exposures around conception. |
Statistical air quality predictions for public health surveillance: evaluation and generation of county level metrics of PM2.5 for the environmental public health tracking network
Vaidyanathan A , Dimmick WF , Kegler SR , Qualters JR . Int J Health Geogr 2013 12 12 BACKGROUND: The Centers for Disease Control and Prevention (CDC) developed county level metrics for the Environmental Public Health Tracking Network (Tracking Network) to characterize potential population exposure to airborne particles with an aerodynamic diameter of 2.5 mcm or less (PM2.5). These metrics are based on Federal Reference Method (FRM) air monitor data in the Environmental Protection Agency (EPA) Air Quality System (AQS); however, monitor data are limited in space and time. In order to understand air quality in all areas and on days without monitor data, the CDC collaborated with the EPA in the development of hierarchical Bayesian (HB) based predictions of PM2.5 concentrations. This paper describes the generation and evaluation of HB-based county level estimates of PM2.5. METHODS: We used three geo-imputation approaches to convert grid-level predictions to county level estimates. We used Pearson (r) and Kendall Tau-B (tau) correlation coefficients to assess the consistency of the relationship, and examined the direct differences (by county) between HB-based estimates and AQS-based concentrations at the daily level. We further compared the annual averages using Tukey mean-difference plots. RESULTS: During the year 2005, fewer than 20% of the counties in the conterminous United States (U.S.) had PM2.5 monitoring and 32% of the conterminous U.S. population resided in counties with no AQS monitors. County level estimates resulting from population-weighted centroid containment approach were correlated more strongly with monitor-based concentrations (r = 0.9; tau = 0.8) than were estimates from other geo-imputation approaches. The median daily difference was -0.2 mcg/m3 with an interquartile range (IQR) of 1.9 mcg/m3 and the median relative daily difference was -2.2% with an IQR of 17.2%. Under-prediction was more prevalent at higher concentrations and for counties in the western U.S. CONCLUSIONS: While the relationship between county level HB-based estimates and AQS-based concentrations is generally good, there are clear variations in the strength of this relationship for different regions of the U.S. and at various concentrations of PM2.5. This evaluation suggests that population-weighted county centroid containment method is an appropriate geo-imputation approach, and using the HB-based PM2.5 estimates to augment gaps in AQS data provides a more spatially and temporally consistent basis for calculating the metrics deployed on the Tracking Network. |
The toxicological profile program at ATSDR
Abadin HG . J Environ Health 2013 75 (7) 42-3 The Superfund Amendments and Reauthorization Act of 1986 (SARA) directs the Agency for Toxic Substances | and Disease Registry (ATSDR) to develop a | prioritized list of hazardous substances of | greatest public health concern at facilities on | the National Priorities List (NPL) and to develop comprehensive Toxicological Profi les | for those substances (Section 104[i][2,3]). | In response to these mandates, ATSDR has | developed a Substance Priority List (SPL), | generated from a catalogue of substances | detected at hazardous waste sites and prioritized according to an algorithm that incorporates information based on toxicity, frequency | of occurrence at NPL sites, and potential | for human exposure. This methodology is | described in the support document to the SPL | found online at www.atsdr.cdc.gov/spl/index. | html (Agency for Toxic Substances and Disease Registry [ATSDR], 2011). Currently, 847 | candidate substances have been identifi ed, of | which the top 275 substances comprise the | SPL. The SPL is updated periodically as additional data regarding candidate substances | become available. |
The role of migration and choice of denominator on the prevalence of cerebral palsy
Van Naarden Braun K , Maenner MJ , Christensen D , Doernberg NS , Durkin MS , Kirby RS , Yeargin-Allsopp M . Dev Med Child Neurol 2013 55 (6) 520-6 AIM: Differential migration and choice of denominator have been hypothesized to contribute to differences between period prevalence and birth prevalence of cerebral palsy (CP). The purpose of this study was to evaluate the effects of migration and choice of denominator on the prevalence of CP. METHOD: Data from the Metropolitan Atlanta Developmental Disabilities Surveillance Program and census and birth certificate files were used to calculate various CP prevalence estimates for 2000. RESULTS: The overall CP period prevalence was 3.2 (95% confidence interval [CI] 2.7-3.8) per 1000 8-year-olds and was similar for those born in Atlanta who resided there at age 8 years (3.3; 95% CI 2.7-4.1) and those born outside Atlanta who moved into Atlanta by age 8 years (3.0; 95% CI 2.3-3.9). CP prevalence in these two migration strata was similar by sex and race/ethnicity. CP birth prevalence of 8-year-olds in Atlanta in 2000 was 2.0 (95% CI 1.6-2.5) per 1000 live births in 1992. INTERPRETATION: The authors found no evidence to support the hypothesis that differential in-migration explained higher period than birth prevalence of CP in Atlanta. Comparability of CP prevalence across geographic areas will be enhanced if future studies report both period and birth prevalence. |
Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008
Shrestha SS , Zhang P , Li R , Thompson TJ , Chapman DP , Barker L . Diabetes Res Clin Pract 2013 100 (1) 102-10 AIM: We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM). METHODS: We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities. RESULTS: Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure. CONCLUSIONS: Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population. |
Metropolitan social environments and pre-HAART/HAART era changes in mortality rates (per 10,000 adult residents) among injection drug users living with AIDS
Friedman SR , West BS , Pouget ER , Hall HI , Cantrell J , Tempalski B , Chatterjee S , Hu X , Cooper HL , Galea S , Des Jarlais DC . PLoS One 2013 8 (2) e57201 BACKGROUND: Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. METHODS: This is an ecological cohort study of 86 large US metropolitan areas from 1993-2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993-1995 to 2004-2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993-1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. RESULTS: In multivariable models, pre-HAART to HAART era increases in 'hard drug' arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. CONCLUSIONS: Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered. |
Estimating prevalence of CKD stages 3-5 using health system data
Shahinian VB , Hedgeman E , Gillespie BW , Young EW , Robinson B , Hsu CY , Plantinga LC , Burrows NR , Eggers P , Saydah S , Powe NR , Saran R . Am J Kidney Dis 2013 61 (6) 930-8 BACKGROUND: The feasibility of using health system data to estimate prevalence of chronic kidney disease (CKD) stages 3-5 was explored. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: A 5% national random sample of patients from the Veterans Affairs (VA) health care system, enrollees in a managed care plan in Michigan (M-CARE), and participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). PREDICTOR: Observed CKD prevalence estimates in the health system population were calculated as patients with an available outpatient serum creatinine measurement with estimated glomerular filtration rate <60 mL/min/1.73 m2, among those with at least one outpatient visit during the year. OUTCOMES & MEASUREMENTS: A logistic regression model was fitted using data from the 2005-2006 NHANES to predict CKD prevalence in those untested for serum creatinine in the health system population, adjusted for demographics and comorbid conditions. Model results then were combined with the observed prevalence in tested patients to derive an overall predicted prevalence of CKD within the health systems. RESULTS: Patients in the VA system were older, had more comorbid conditions, and were more likely to be tested for serum creatinine than those in the M-CARE system. Observed prevalences of CKD stages 3-5 were 15.6% and 0.9% in the VA and M-CARE systems, respectively. Using data from NHANES, the overall predicted prevalences of CKD were 20.4% and 1.6% in the VA and M-CARE systems, respectively. LIMITATIONS: Health system data quality was limited by missing data for laboratory results and race. A single estimated glomerular filtration rate value was used to define CKD, rather than persistence over 3 months. CONCLUSIONS: Estimation of CKD prevalence within health care systems is feasible, but discrepancies between observed and predicted prevalences suggest that this approach is dependent on data availability and quality of information for comorbid conditions, as well as the frequency of testing for CKD in the health care system. |
Completeness of American cancer registry treatment data: implications for quality of care research
Mallin K , Palis BE , Watroba N , Stewart AK , Walczak D , Singer J , Barron J , Blumenthal W , Haydu G , Edge SB . J Am Coll Surg 2013 216 (3) 428-37 BACKGROUND: Evaluating and improving the quality of cancer care requires complete information on cancer stage and treatment. Hospital-based registries are a key tool in this effort, but reports in the 1990s showed that they fail to identify a major fraction of outpatient-administered treatment, including chemotherapy, endocrine therapy, and radiation. This can limit their value for evaluating patterns and quality of care. To determine the completeness of registry data in more recent years, we linked administrative claims from 2 private payers in Ohio to the National Cancer Data Base and Ohio Cancer Incidence and Surveillance System. METHODS: Incident breast and colorectal cancers among Ohio residents diagnosed in 2004-2006 were identified from linkage of the National Cancer Data Base, Ohio Cancer Incidence and Surveillance System, and payer insurance claims using ICD-9 and CPT procedure codes, and ICD-9 diagnosis codes. Linkage was accomplished using patient demographics, surgery dates, and hospital facility. Treatment found in claims and registry data were compared and assessed using the kappa statistic. RESULTS: The analytic cohort included 2,552 breast and 822 colorectal cases. Results showed high agreement for breast surgery type, and moderately high agreement for colorectal surgery type. For breast cases, the registries captured 87% of chemotherapy, 86% of radiation, and 64% of endocrine treatment in claims. For colorectal cases, the registry captured 83% of chemotherapy and 84% of radiation in claims. CONCLUSIONS: Hospital-based registries for breast and colon cancer diagnosed in 2004-2006 captured about 85% of radiation and chemotherapy data compared with claims data, a higher percentage than earlier reports. These findings provide direction and a cautionary note to those using registry data for study of patterns and quality of systemic and radiation therapy care. |
EHS-Net restaurant food safety studies: what have we learned?
Brown LG . J Environ Health 2013 75 (7) 44-5 The Centers for Disease Control and | Prevention’s (CDC) Environmental | Health Specialists Network (EHS-Net) | is a collaborative network focused on understanding factors that contribute to foodborne | illness and improving environmental public | health practice (see www.cdc.gov/nceh/ehs/ | EHSNet/index.htm). EHS-Net includes environmental public health and food safety professionals from federal, state, and local public | health organizations. | During the past 10 years, EHS-Net has | conducted a number of studies on restaurant | food safety. We have focused specifi cally | on restaurants because they are an important source of foodborne illness outbreaks; | half of all foodborne illness outbreaks are | associated with restaurants (Lynch, Painter, | Woodruff, & Braden, 2006). To better | understand the environmental causes of | restaurant-related foodborne illness outbreaks, and subsequently reduce or mitigate | them, EHS-Net studies have been designed | to investigate food preparation practices | and other factors that could contribute to | these types of outbreaks. Our studies have focused on topics that include, among others: ill worker behavior, hand hygiene practices, and egg preparation practices. With | each of these studies, we have gained a better understanding of restaurant food preparation practices and the factors that may | negatively affect those practices and cause | foodborne illness outbreaks. |
Analysis of whole genome sequences of 16 strains of rubella virus from the United States, 1961-2009.
Abernathy E , Chen MH , Bera J , Shrivastava S , Kirkness E , Zheng Q , Bellini W , Icenogle J . Virol J 2013 10 32 Rubella virus is the causative agent of rubella, a mild rash illness, and a potent teratogenic agent when contracted by a pregnant woman. Global rubella control programs target the reduction and elimination of congenital rubella syndrome. Phylogenetic analysis of partial sequences of rubella viruses has contributed to virus surveillance efforts and played an important role in demonstrating that indigenous rubella viruses have been eliminated in the United States. Sixteen wild-type rubella viruses were chosen for whole genome sequencing. All 16 viruses were collected in the United States from 1961 to 2009 and are from 8 of the 13 known rubella genotypes. Phylogenetic analysis of 30 whole genome sequences produced a maximum likelihood tree giving high bootstrap values for all genotypes except provisional genotype 1a. Comparison of the 16 new complete sequences and 14 previously sequenced wild-type viruses found regions with clusters of variable amino acids. The 5' 250 nucleotides of the genome are more conserved than any other part of the genome. Genotype specific deletions in the untranslated region between the non-structural and structural open reading frames were observed for genotypes 2B and genotype 1G. No evidence was seen for recombination events among the 30 viruses. The analysis presented here is consistent with previous reports on the genetic characterization of rubella virus genomes. Conserved and variable regions were identified and additional evidence for genotype specific nucleotide deletions in the intergenic region was found. Phylogenetic analysis confirmed genotype groupings originally based on structural protein coding region sequences, which provides support for the WHO nomenclature for genetic characterization of wild-type rubella viruses. |
RIG-I goes beyond naked recognition.
Bowzard JB , Ranjan P , Sambhara S . Cell Host Microbe 2013 13 (3) 247-9 It is currently unclear at which point during viral replication that RNA genomes are first recognized as nonself by the immune system. In this issue of Cell Host & Microbe, Weber et al. show that incoming nucleocapsid-bound genomes are sufficient to bind and activate innate immune sensors. |
Preconception folic acid supplementation and risk for chromosome 21 nondisjunction: a report from the National Down Syndrome Project.
Hollis ND , Allen EG , Oliver TR , Tinker SW , Druschel C , Hobbs CA , O'Leary LA , Romitti PA , Royle MH , Torfs CP , Freeman SB , Sherman SL , Bean LJ . Am J Med Genet A 2013 161 (3) 438-44 Both a lack of maternal folic acid supplementation and the presence of genetic variants that reduce enzyme activity in folate pathway genes have been linked to meiotic nondisjunction of chromosome 21; however, the findings in this area of research have been inconsistent. To better understand these inconsistencies, we asked whether maternal use of a folic acid-containing supplement before conception reduces risk for chromosome 21 nondisjunction. Using questionnaire data from the National Down Syndrome Project, a population-based case-control study, we compared the use of folic acid-containing supplements among mothers of infants with full trisomy 21 due to maternal nondisjunction (n = 702) and mothers of infants born with no major birth defects (n = 983). Using logistic regression, adjusting for maternal age, race/ethnicity, and infant age at maternal interview, we found no evidence of an association between lack of folic acid supplementation and maternal nondisjunction among all case mothers (OR = 1.16; 95% CI: 0.90-1.48). In analyses stratified by meiotic stage and maternal age (<35 or ≥35 years), we found an association among older mothers experiencing meiosis II nondisjunction errors (OR = 2.00; 95% CI: 1.08-3.71). These data suggest that lack of folic acid supplementation may be associated specifically with MII errors in the aging oocyte. If confirmed, these results could account for inconsistencies among previous studies, as each study sample may vary by maternal age structure and proportion of meiotic errors. (c) 2013 Wiley Periodicals, Inc. |
Draft genome sequences of Bordetella holmesii strains from blood (F627) and nasopharynx (H558).
Tatti KM , Loparev VN , Ranganathanganakammal S , Changayil S , Frace M , Weil MR , Sammons S , Maccannell D , Mayer LW , Tondella ML . Genome Announc 2013 1 (2) e0005613 Bordetella holmesii, a human pathogen, can confound the diagnosis of respiratory illness caused by Bordetella pertussis. We present the draft genome sequences of two B. holmesii isolates, one from blood, F627, and one from the nasopharynx, H558. Interestingly, important virulence genes that are present in B. pertussis are not found in B. holmesii. |
Sexual behaviour and desire to discuss mental health as reported by HIV-infected men who have sex with men
Safran MA , Hoover KW , Tao G , Butler MO . Int J STD AIDS 2013 24 (2) 93-9 We assessed sexually transmitted infection risk behaviours and desire to discuss mental health, as reported by 426 HIV-infected men who have sex with men receiving HIV care in eight urban clinics. Most of these patients (90%) had begun HIV care >1 year ago. In the past year, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had >1 HIV-uninfected partner and 82% used illegal psychoactive drugs. Among those reporting anal intercourse, approximately 61% reported using a condom during the most recent episode. Among all patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Using a two-tailed chi-squared test, we found that patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not (80% versus 62%, P < 0.01); and those who engaged in unprotected insertive anal sex were also more likely to want such a conversation (81% versus 63%, P < 0.01). The findings highlight the prevalence of risky sexual behaviour and of mental health concerns in the participating patient population. Patients reporting risky sexual behaviour were more likely to want to discuss how they felt mentally or emotionally than those not reporting such behaviour. |
Design of a cluster-randomized controlled trial of a diabetes prevention program within African-American churches: the Fit Body and Soul study
Williams LB , Sattin RW , Dias J , Garvin JT , Marion L , Joshua T , Kriska A , Kramer MK , Echouffo-Tcheugui JB , Freeman A , Narayan KM . Contemp Clin Trials 2013 34 (2) 336-47 Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination. |
Infections in long-term care populations in the United States
Dwyer LL , Harris-Kojetin LD , Valverde RH , Frazier JM , Simon AE , Stone ND , Thompson ND . J Am Geriatr Soc 2013 61 (3) 342-9 OBJECTIVES: To estimate infection prevalence and explore associated risk factors in nursing home (NH) residents, individuals receiving home health care (HHC), and individuals receiving hospice care. DESIGN: Cross-sectional. SETTING: Nationally representative samples of 1,174 U.S. NHs in the 2004 National Nursing Home Survey (NNHS) and 1,036 U.S. HHC and hospice agencies in the 2007 National Home and Hospice Care Survey (NHHCS). PARTICIPANTS: A nationally representative sample of 12,270 NH residents, 4,394 individuals receiving HHC, and 4,410 individuals receiving hospice care. MEASUREMENTS: International Classification of Diseases, Ninth Revision, Clinical Modification, codes were used to identify the presence of infection, including community-acquired infection and those acquired during earlier healthcare exposures. RESULTS: Unweighted response rates were 78% for the 2004 NHHS and 67% for the 2007 NHHCS. Approximately 12% of NH residents and 12% of individuals receiving HHC had an infection at the time of the survey interview, and more than 10% of individuals receiving hospice care had an infection when discharged from hospice care. The most common infections were urinary tract infection (3.0-5.2%), pneumonia (2.2-4.4%), and cellulitis (1.6-2.0%). Short length of care and recent inpatient stay in a healthcare facility were associated with infections in all three populations. Taking 10 or more medications and urinary catheter exposure were significant in two of these three long-term care populations. CONCLUSION: Infection prevalence in HHC, hospice, and NH populations is similar. Although these infections may be community acquired or acquired during earlier healthcare exposures, these findings fill an important gap in understanding the national infection burden and may help inform future research on infection epidemiology and prevention strategies in long-term care populations. |
Physicians' confidence in vaccine safety studies
O'Leary ST , Allison MA , Stokley S , Crane LA , Hurley LP , Beaty B , Kempe A . Prev Med 2013 56 231-3 OBJECTIVES: To ascertain, through two separate surveys among nationally representative networks of pediatricians (Peds) and family physicians (FM): 1) physicians' reported level of confidence in pre- and post-licensure vaccine safety studies; and 2) changes in reported level of confidence from 2007 to 2010/11. METHODS: Two surveys were conducted in August to October 2007 and in November 2010 to January 2011. The survey response rates were 81% (FM, 79%, Peds, 84%, p=0.07) for the 2007 survey (691/848) and 66% (FM, 61%, Peds, 70%, p=0.003) for the 2010/11 survey (532/811). RESULTS: One in three family physicians compared to one in ten pediatricians in both surveys reported little or no confidence in pre-licensure vaccine safety studies (p<0.001). Compared to pre-licensure studies, higher percentages of both specialties reported a great deal of confidence in post-licensure vaccine safety studies in both years, and more physicians from both specialties reported a great deal of confidence in 2010/11 than in 2007. CONCLUSION: While most family physicians and pediatricians report confidence in post-licensure vaccine safety studies, one third of family physicians report little or no confidence in pre-licensure studies. More research is needed to better understand the reasons behind some physicians' lack of confidence in vaccine safety studies. |
Human papillomavirus vaccine initiation and awareness: U.S. young men in the 2010 National Health Interview Survey
Lu PJ , Williams WW , Li J , Dorell C , Yankey D , Kepka D , Dunne EF . Am J Prev Med 2013 44 (4) 330-8 BACKGROUND: In 2009, the quadrivalent human papillomavirus (HPV) vaccine was licensed by the U.S. Food and Drug Administration for use in men/boys aged 9-26 years. In 2009, the Advisory Committee on Immunization Practices (ACIP) provided a permissive recommendation allowing HPV vaccine administration to this group. PURPOSE: To assess HPV vaccination initiation and coverage, evaluate awareness of HPV and HPV vaccine, and identify factors independently associated with such awareness among men aged 18-26 years. METHODS: Data from the 2010 National Health Interview Survey were analyzed in 2011. RESULTS: In 2010, HPV vaccination initiation among men aged 18-26 years was 1.1%. Among the 1741 men interviewed in this age group, nearly half had heard of HPV (51.8%). Overall, about one third of these men had heard of the HPV vaccine (34.8%). Factors independently associated with a higher likelihood of awareness of both HPV and HPV vaccine among men aged 18-26 years included having non-Hispanic white race/ethnicity; a higher education level; a U.S. birthplace; more physician contacts; private health insurance; received other vaccines; and reported risk behaviors related to sexually transmitted diseases, including HIV. CONCLUSIONS: HPV vaccination initiation among men aged 18-26 years in 2010 was low. HPV and HPV vaccine awareness were also low, and messages in this area directed to men are needed. Since ACIP published a recommendation for routine use of HPV4 among men/boys in December 2011, continued monitoring of HPV vaccination uptake among men aged 18-26 years is useful for evaluating the vaccination campaigns, and planning and implementing strategies to increase coverage. |
Infection and treatment immunizations for successful parasite vaccines
Mutapi F , Billingsley PF , Secor WE . Trends Parasitol 2013 29 (3) 135-41 Since the advent of techniques for the expression of recombinant peptide antigens, the availability of human vaccines for parasitic diseases has been 'imminent'. Yet vaccines based on recombinant proteins are still largely aspirations, not realities. It is now apparent that vaccine development needs additional knowledge about host protective immune response(s), antigen characteristics, and the delivery required to induce those responses. The most successful immune protection against parasites has been generated by infection and treatment, the induction of protective immunity by truncating the course of an infection with drug treatment. Here, we consider the characteristics of an effective, protective anti-parasite vaccine and propose a conceptual framework to aid parasite vaccine development using malaria and schistosomiasis as examples. |
Associations of school violence with physical activity among U.S. high school students
Demissie Z , Lowry R , Eaton DK , Hertz MF , Lee S . J Phys Act Health 2014 11 (4) 705-11 BACKGROUND: This study investigated associations of violence-related behaviors with physical activity (PA)-related behaviors among U.S. high school students. METHODS: Data from the 2009 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of 9th-12th grade students, were analyzed. Sex-stratified, adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for associations between violence-related behaviors and being physically active for ≥60 minutes daily, sports participation, TV watching for ≥3 hours/day, and video game/computer use for ≥3 hours/day. RESULTS: Among male students, at-school bullying victimization was negatively associated with daily PA (aOR: 0.72; 95%CI: 0.58-0.87) and sports participation; skipping school because of safety concerns was positively associated with video game/computer use (1.42; 1.01-2.00); and physical fighting was positively associated with daily PA. Among female students, at-school bullying victimization and skipping school because of safety concerns were both positively associated with video game/computer use (1.46; 1.19-1.79 and 1.60; 1.09-2.34, respectively), and physical fighting at school was negatively associated with sports participation and positively associated with TV watching. CONCLUSIONS: Bullying victimization emerged as a potentially important risk factor for insufficient PA. Schools should consider the role of violence in initiatives designed to promote PA. |
Epidemiological investigation of a youth suicide cluster: Delaware 2012
Fowler KA , Crosby AE , Parks SE , Ivey AZ , Silverman PR . Del Med J 2013 85 (1) 15-9 In the first quarter of 2012, eight youth (aged 13-21 years) were known to have died by suicide in Kent and Sussex counties, Delaware, twice the typical median yearly number. State and local officials invited the Centers for Disease Control and Prevention to assist with an epidemiological investigation of fatal and nonfatal youth suicidal behaviors in the first quarter of 2012, to examine risk factors, and to recommend prevention strategies. METHODS: Data were obtained from the Delaware Office of the Medical Examiner, law enforcement, emergency departments, and inpatient records. Key informants from youth-serving organizations in the community were interviewed to better understand local context and perceptions of youth suicide. RESULTS: Eleven fatal and 116 nonfatal suicide attempts were identified for the first quarter of 2012 in Kent and Sussex counties. The median age was higher for the fatalities (18 years) than the nonfatal attempts (16 years). More males died by suicide, and more females nonfatally attempted suicide. Fatal methods were either hanging or firearm, while nonfatal methods were diverse, led by overdose/poisoning and cutting. All decedents had two or more precipitating circumstances. Seventeen of 116 nonfatal cases reported that a peer/friend recently died by or attempted suicide. Local barriers to youth services and suicide prevention were identified. DISCUSSION: Several features were similar to previous clusters: Occurrence among vulnerable youth, rural or suburban setting, and precipitating negative life events. Distribution by sex and method were consistent with national trends for both fatalities and nonfatalities. References to the decedents in the context of nonfatal attempts support the concept of 'point clusters' (social contiguity to other suicidal youth as a risk factor for vulnerable youth) as a framework for understanding clustering of youth suicidal behavior. Recommended prevention strategies included: Training to identify at-risk youth and guide them to services; development of youth programs; monitoring trends in youth suicidal behaviors; reviewing evidence-based suicide prevention strategies; and continued implementation of CDC media guidelines for reporting on suicide. |
Lung toxicity and biodistribution of Cd/Se-ZnS quantum dots with different surface functional groups after pulmonary exposure in rats
Roberts JR , Antonini JM , Porter DW , Chapman RS , Scabilloni JF , Young SH , Schwegler-Berry D , Castranova V , Mercer RR . Part Fibre Toxicol 2013 10 5 BACKGROUND: The potential use of quantum dots (QD) in biomedical applications, as well as in other systems that take advantage of their unique physiochemical properties, has led to concern regarding their toxicity, potential systemic distribution, and biopersistence. In addition, little is known about workplace exposure to QD in research, manufacturing, or medical settings. The goal of the present study was to assess pulmonary toxicity, clearance, and biodistribution of QD with different functional groups in rats after pulmonary exposure. METHODS: QD were composed of a cadmium-selenide (CdSe) core (~5nm) with a zinc sulfide (ZnS) shell functionalized with carboxyl (QD-COOH) or amine (QD-NH2) terminal groups. Male Sprague-Dawley rats were intratracheally-instilled (IT) with saline, QD-COOH, or QD-NH2 (12.5, 5.0, or 1.25 mug/rat). On days 0, 1, 3, 5, 7, 14, and 28 post-IT, the left lung, lung-associated lymph nodes (LALN), heart, kidneys, spleen, liver, brain, and blood were collected for metal analysis of Cd content by neutron activation to evaluate clearance and biodistribution. One right lobe was ligated and fixed for microscopy and histopathological analysis. The remaining right lobes from rats in each group were subjected to bronchoalveolar lavage (BAL) to retrieve BAL fluid and cells for analysis of injury and inflammation. RESULTS: Lung injury and inflammation was found to be dose-dependent and peaked at days 7 and 14 post-exposure for both forms of QD, with slight variations in degree of toxicity at early and later time points. Both QD appeared to lose their fluorescent properties and destabilize after 1 week in the lung. Cd persisted up to 28 days for both forms of QD; however, clearance rate was slightly greater for QD-COOH over time. No Cd was detected in the liver, spleen, heart, brain, or blood at any time point. Cd appeared in the LALN and kidneys beginning at 1-2 weeks post-exposure. CONCLUSIONS: QD-COOH and QD-NH2 differed in clearance rate and differed slightly in degree of toxicity at different time points; however, the overall pattern of toxicity and biodistribution was similar between the two particles. Toxicity may be dependent on the dissolution rate and bioavailability of free Cd. |
Quantitation of urinary volatile nitrosamines from exposure to tobacco smoke
Seyler TH , Kim JG , Hodgson JA , Cowan EA , Blount BC , Wang L . J Anal Toxicol 2013 37 (4) 195-202 A sensitive and selective method was developed and validated to detect six volatile nitrosamines (N-nitrosodimethylamine, N-nitrosomethylethylamine, N-nitrosodiethylamine, N-nitrosopiperidine, N-nitrosopyrrolidine and N-nitrosomorpholine) in human urine. This method uses a liquid-liquid extraction cartridge followed by analysis with gas chromatography-tandem mass spectrometry (GC-MS-MS) and quantification based on isotopic dilution. This is the first GC-MS-MS method reported for measuring volatile nitrosamines in human urine. This method reduces the sample volume required in other methods from 5-25 to 2 mL. The limits of detection (2.62, 1.99, 2.73, 0.65, 0.25, 3.66 pg/mL, respectively) were better than existing methods, largely because of improved positive chemical ionization achieved by using ammonia gas and reducing background noise. Using nitrogen as the collision gas allowed the confirmation transition in the low mass region to be monitored. The analysis of human urine using this validated method is accurate (relative bias of 0-19%) and precise (relative standard deviation of 0.2-18% over two months of analyses). The validated method was applied to 100 urine samples and the levels of all six volatile nitrosamines were reported for the first time in urine specimens collected from smokers and nonsmokers, with smoking status determined by urinary cotinine measurement. Among 100 smokers and nonsmokers, the levels of three analytes (N-nitrosodimethylamine, N-nitrosomethylethylamine and N-nitrosopiperidine) were significantly higher in smokers than nonsmokers (p < 0.05). |
Epidemiology of commercial Rhesus monkey kidney (RhMK) cells contaminated with Coccidioides posadasii
Purfield A , Ahmad N , Park BJ , Kuhles D , St George K , Ginocchio C , Harris JR . J Clin Microbiol 2013 51 (6) 2005 On December 28, 2012, the New York State Department of Health (NYSDOH) and the Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC) were notified of Coccidioides spp. contamination in commercially-distributed tubes of Rhesus monkey kidney (RhMK) cells from Company A; Coccidioides posadasii was later identified through gene-specific PCR in two lots (A491216-B and A491206-T) (2).... |
Immunization with Culex tarsalis mosquito salivary gland extract modulates West Nile virus infection and disease in mice
Machain-Williams C , Reagan K , Wang T , Zeidner NS , Blair CD . Viral Immunol 2013 26 (1) 84-92 Mosquito salivary proteins inoculated during blood feeding modulate the host immune response, which can contribute to the pathogenesis of viruses transmitted by mosquito bites. Previous studies with mosquito bite-naive mice indicated that exposure to arthropod salivary proteins resulted in a shift toward a Th2-type immune response in flavivirus-susceptible mice but not flavivirus-resistant animals. In the study presented here, we tested the hypothesis that immunization with high doses of Culex tarsalis salivary gland extracts (SGE) with an adjuvant would prevent Th2 polarization after mosquito bite and enhance resistance to mosquito-transmitted West Nile virus (WNV). Our results indicate that mice immunized with Cx. tarsalis SGE produced increased levels of Th1-type cytokines (IFNgamma and TNFalpha) after challenge with mosquito-transmitted WNV and exhibited both a delay in infection of the central nervous system (CNS) and significantly lower WNV brain titers compared to mock-immunized mice. Moreover, mortality was significantly reduced in the SGE-immunized mice, as none of these mice died, compared to mortality of 37.5% of mock-vaccinated mice by 8 days after infected mosquito bite. These results suggest that development of a mosquito salivary protein vaccine might be a strategy to control arthropod-borne viral pathogens such as WNV. |
Anti-poliovirus activity of protease inhibitor AG-7404, and assessment of in vitro activity in combination with antiviral capsid inhibitor compounds
Rhoden E , Liu HM , Wang-Chern SW , Oberste MS . Antiviral Res 2013 98 (2) 186-91 The National Research Council has recommended that at least one, preferably two, polio antiviral drugs be developed as a supplement to the tools currently available for control of polio outbreaks post-eradication. The primary application of such drugs is expected to be the resolution of chronic poliovirus excretion in persons with primary immunodeficiency disorders. We have assessed the in vitro activity of AG-7404 (also known as "compound 1"), an inhibitor of picornaviral 3C protease, against a large panel of programmatically important poliovirus strains and its activity in combination with two poliovirus capsid inhibitors, V-073 and BTA798. AG-7404 was active against all viruses in this panel, with EC50 values ranging from 0.080 to 0.674muM. Similarly, BTA798 was active against all viruses in this panel, with EC50 values ranging from 0.003 to 0.591muM. By comparison, values for V-073 were 0.003-0.126muM. BTA798 was active against V-073-resistant variants with an alanine to valine change in VP3 at position 24. However, BTA798 was inactive against the V-073-resistant strains with amino acid substitutions at VP1 amino acids 194 (equivalent to 192 in type 3) and 236. As expected from its different mechanism of action, AG-7404 was fully active against all V-073-resistant variants, with EC50 values ranging from 0.218 to 0.819muM, compared to values of 0.202-0.407muM for the V-073-susceptible parental strains. In vitro drug combination experiments demonstrated synergy between AG-7404 and either V-073 or BTA798, whereas the combination of the two capsid inhibitors acted additively. |
The identification and characterization of epitopes in the 30-34kDa Trypanosoma cruzi proteins recognized by antibodies in the serum samples of chagasic patients
Verissimo da Costa GC , Lery LM , da Silva ML , Moura H , Peralta RH , von Kruger WM , Bisch PM , Barr JR , Peralta JM . J Proteomics 2012 80C 34-42 Trypanosoma cruzi proteins with molecular weight between 30 and 34kDa have shown high reactivity in western blot assays with serum samples from chagasic individuals. However, in-depth analysis of the constituents of these protein fractions has not been performed. This is the first report of an immunoaffinity proteomic approach to identify the immunodominant 30-34kDa proteins of T. cruzi that could eventually be used for the diagnosis of Chagas disease. We used two different sample preparation protocols for protein digestion coupled to mass spectrometry to identify proteins in the protein fraction. The immunodominant proteins and their respective epitopes were then identified by co-immunoprecipitation and excision-epitope mapping/mass spectrometry, using human sera followed by the prediction and three-dimensional structural modeling of reactive epitopes. The use of different sample preparation methods allowed the identification of a relatively high number of proteins, some of which were only identified after one or multiple sample preparation and digestion protocols. Seven immunodominant proteins were identified by co-immunoprecipitation with purified IgGs from chagasic serum samples. Moreover, six reactive peptide epitopes were detected in four of these proteins by excision-epitope mapping/mass spectrometry. Three-dimensional structural models were obtained for the immunoreactive peptides, which correlated well with the linear B-cell epitope prediction tools. |
Patterns of preconception, prenatal and postnatal care for diabetic women by obstetrician-gynecologists
Power ML , Wilson EK , Hogan SO , Loft JD , Williams JL , Mersereau PW , Schulkin J . J Reprod Med 2013 58 7-14 OBJECTIVE: To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists. STUDY DESIGN: A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/ high insurance patient populations. RESULTS: Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients' ability to afford healthful food were barriers to quality care. CONCLUSION: According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Postpartum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources. |
Iodine status in pregnant women in the United States: National Children's Study and National Health and Nutrition Examination Survey
Caldwell K , Pan Y , Mortensen ME , Makhmudov A , Merrill L , Moye J . Thyroid 2013 23 (8) 927-37 BACKGROUND: This report presents iodine data from NHANES and from a sample of pregnant women in the National Children's Study (NCS) Vanguard Study. METHODS: UI was measured in a one third subsample of NHANES 2005-2006, and 2009-2010 participants and in all 2007-2008 participants age six years and older. These measurements are representative of the general U.S. population. UI was also measured in a convenience sample of 501 pregnant women enrolled in the NCS initial Vanguard Study from seven study sites across the U.S. RESULTS: NHANES median UI concentration in 2009-2010 (144 microg/L) was significantly lower than in 2007-2008 (164 microg/L). Non-Hispanic blacks had the lowest UI concentrations (131microg/L) compared to non-Hispanic whites or Hispanics (147 and 148 microg/L, respectively). The median for all pregnant women in NHANES 2005-2010 was less than adequate (129 microg/L), the third trimester women had UI concentrations that were adequate ( median UI 172 microg/L). Third trimester women participating in the NCS study similarly had an adequate level of iodine intake, with a median UI concentration of 167microg/L. Furthermore, NCS median UI concentrations varied by geographic location. CONCLUSIONS: Dairy, but not salt, seafood or grain consumption, was significantly positively associated with median UI concentration in women of childbearing age. Pregnant women in their third trimester in the NHANES 2005-2010 had adequate median UI concentrations, but pregnant women in NHANES who were in their first or second trimesters had median UI concentrations that were less than adequate. Non-Hispanic black pregnant women from both the NHANES 2005-20010 and the NCS consistently had lower UI median concentrations than non-Hispanic whites or Hispanics. |
Mortality benefits from US population-wide reduction in sodium consumption: projections from 3 modeling approaches
Coxson PG , Cook NR , Joffres M , Hong Y , Orenstein D , Schmidt SM , Bibbins-Domingo K . Hypertension 2013 61 (3) 564-70 Computer simulations have been used to estimate the mortality benefits from population-wide reductions in dietary sodium, although comparisons of these estimates have not been rigorously evaluated. We used 3 different approaches to model the effect of sodium reduction in the US population over the next 10 years, incorporating evidence for direct effects on cardiovascular disease mortality (method 1), indirect effects mediated by blood pressure changes as observed in randomized controlled trials of antihypertension medications (method 2), or epidemiological studies (method 3). The 3 different modeling approaches were used to model the same scenarios: scenario A, gradual uniform reduction totaling 40% over 10 years; scenario B, instantaneous 40% reduction in sodium consumption sustained for 10 years to achieve a population-wide mean of 2200 mg/d; and scenario C, instantaneous reduction to 1500 mg sodium per day sustained for 10 years. All 3 methods consistently show a substantial health benefit for reductions in dietary sodium under each of the 3 scenarios tested. A gradual reduction in dietary sodium over the next decade (scenario A) as might be achieved with a range of proposed public health interventions would yield considerable health benefits over the next decade, with mean effects across the 3 models ranging from 280,000 to 500,000 deaths averted. Projections of instantaneous reductions illustrate the maximum benefits that could be achieved (0.7-1.2 million deaths averted in 10 years). Under 3 different modeling assumptions, the projected health benefits from reductions in dietary sodium are substantial. |
Electric shocks at work in Europe: development of a job exposure matrix
Huss A , Vermeulen R , Bowman JD , Kheifets L , Kromhout H . Occup Environ Med 2013 70 (4) 261-7 OBJECTIVES: Electric shocks have been suggested as a potential risk factor for neurological disease, in particular for amyotrophic lateral sclerosis. While actual exposure to shocks is difficult to measure, occurrence and variation of electric injuries could serve as an exposure proxy. We assessed risk of electric injury, using occupational accident registries across Europe to develop an electric shock job-exposure-matrix (JEM). MATERIALS AND METHODS: Injury data were obtained from five European countries, and the number of workers per occupation and country from EUROSTAT was compiled at a 3-digit International Standard Classification of Occupations 1988 level. We pooled accident rates across countries with a random effects model and categorised jobs into low, medium and high risk based on the 75th and 90th percentile. We next compared our JEM to a JEM that classified extremely low frequency magnetic field exposure of jobs into low, medium and high. RESULTS: Of 116 job codes, occupations with high potential for electric injury exposure were electrical and electronic equipment mechanics and fitters, building frame workers and finishers, machinery mechanics and fitters, metal moulders and welders, assemblers, mining and construction labourers, metal-products machine operators, ships' decks crews and power production and related plant operators. Agreement between the electrical injury and magnetic field JEM was 67.2%. CONCLUSIONS: Our JEM classifies occupational titles according to risk of electric injury as a proxy for occurrence of electric shocks. In addition to assessing risk potentially arising from electric shocks, this JEM might contribute to disentangling risks from electric injury from those of extremely low frequency magnetic field exposure. |
Evaluation of metal and carbon monoxide exposures during steel slab cutting and slitting
Burr G , Eisenberg J , Jang S . J Occup Environ Hyg 2013 10 (5) D57-61 The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) of a semi-automated caster/slitter operation at a steel mill in response to employee concerns of “bloody noses and dirty nasal passages.” We met with employer and employee representatives; observed work processes, practices, and workplace conditions; reviewed the results of previous environmental sampling conducted by the steel mill; and held confidential interviews with employees to discuss health and workplace concerns. We collected personal breathing zone (PBZ) and general area (GA) air samples for minerals, metals, and carbon monoxide (CO) and evaluated the ventilation systems in the cut-off and slitter control booths (small enclosed rooms that were raised off the main work floor), the shippers’ control room, and two breakrooms. |
Associations between psychological distress and body mass index among law enforcement officers: the National Health Interview Survey 2004-2010
Gu JK , Charles LE , Burchfiel CM , Andrew ME , Ma C , Bang KM , Violanti JM . Saf Health Work 2013 4 (1) 52-62 OBJECTIVES: To investigate the association between psychological distress and obesity among law enforcement officers (LEOs) in the United States. METHODS: Self-reported data on psychological distress based on six key questions were obtained from LEOs who participated in the National Health Interview Survey (2004-2010). We used Prochaska's cut-point of a Kessler 6 score ≥ 5 for moderate/high mental distress in our analysis. Mean levels of body mass index (BMI) were compared across three levels of psychological distress. RESULTS: The average age of LEOs (n = 929) was 39.3 years; 25% were female. Overall, 8.1% of LEOs had moderate or high psychological distress; 37.5% were obese (BMI ≥ 30). Mean BMI increased with increasing psychological distress (no distress, BMI = 27.2 kg/m(2); mild distress, 27.6 kg/m(2); and moderate/high distress, 33.1 kg/m(2); p = 0.016) after adjustment for age, race, income, and education level among female officers only. Physical activity modified the association between psychological distress and BMI but only among male LEOs (interaction p = 0.002). Among male LEOs reporting low physical activity, psychological distress was positively associated with BMI (30.3 kg/m(2) for no distress, 30.7 for mild distress, 31.8 for moderate/high distress; p = 0.179) after adjustment, but not significantly. This association was not significant among males reporting high physical activity. CONCLUSION: Mean BMI significantly increased as psychological distress increased among female LEOs. A longitudinal study design may reveal the directionality of this association as well as the potential role that physical activity might play in this association. |
Business cases: supporting PTD solutions
Biddle E . Prof Saf 2013 58 (3) 56-64 Prevention through design (PTD) efforts focus on improving working conditions. Reasons that employers adopt PTD design solutions vary substantially. A business case can show what the PTD solution has | to offer a company. |
Halicephalobus gingivalis: a rare cause of fatal meningoencephalomyelitis in humans
Papadi B , Boudreaux C , Tucker JA , Mathison B , Bishop H , Eberhard ME . Am J Trop Med Hyg 2013 88 (6) 1062-4 The genus Halicephalobus consists of eight species of free-living nematodes. Only one species (H. gingivalis) has been reported to infect vertebrates. Human infection is extremely rare, and only four cases have been reported in the literature. These nematodes seem to exhibit neurotropism, but their life cycle, mode of infection, and risk factors are poorly understood. Neurohelminthiases are not commonly recognized in the United States and when they do occur, pose great diagnostic challenges because of lack of appropriate non-invasive screening and/or confirmatory tests. We report a challenging case of meningoencephalomyelitis caused by a Halicephalobus sp., in which the patient had a rapidly deteriorating clinical course. The case did not raise any clinical suspicion of neurohelminthiases, although increased eosinophils were present in the cerebrospinal fluid. This case presents an opportunity to highlight the importance of considering parasitic infection in meningoencephalitis or meningoencephalomyelitis presenting atypically. |
Impact of community-based lymphedema management on perceived disability among patients with lymphatic filariasis in Orissa State, India
Budge PJ , Little KM , Mues KE , Kennedy ED , Prakash A , Rout J , Fox LM . PLoS Negl Trop Dis 2013 7 (3) e2100 BACKGROUND: Lymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability. METHODOLOGY/PRINCIPAL FINDINGS: For this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009), and then at regular intervals through 24 months (July, 2011), to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001) from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3) or advanced (Stage 4-7) lymphedema, reporting an adenolymphangitis (ADL) episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001) due to their lymphedema, compared to baseline. SIGNIFICANCE: These results indicate that community-based lymphedema management programs can reduce disability and prevent days of work lost. These effects were sustained over a 24 month period. |
Commentary: Does a mosquito bite when no one is around to hear it?
Lindblade KA . Int J Epidemiol 2013 42 (1) 247-9 Recent declines in malaria-related morbidity and mortality in Africa have been attributed in part to the widespread scale-up of measures for malaria control, including insecticide-treated bednets (ITNs) and indoor residual spraying (IRS). The percentage of households owning an ITN has increased from 3% to 50% in the past decade, and the number of households protected by IRS has more than quintupled during this same period, reaching 11% of the population at risk.1 Both ITNs and IRS are particularly effective at reducing the transmission of malaria because they exploit the indoor (endophagy) and nighttime (nocturnality) biting and indoor resting (endophily) characteristics of the most efficient African Anopheles malaria vectors. In this way, ITNs and IRS provide both direct personal protection against infective mosquito bites as well as indirect community protection resulting from overall decreases in mosquito abundance. |
Awareness and knowledge of the 2008 Physical Activity Guidelines for Americans
Cunningham MA , Carroll DD , Carlson SA , Fulton J . J Phys Act Health 2013 11 (4) 693-8 BACKGROUND: To estimate the proportion of U.S. adults aware and knowledgeable of the 2008 Physical Activity Guidelines for Americans. METHODS: Analysis is based on a cross-sectional national sample of adults in the 2009 (n = 4281) HealthStyles survey. We estimated the prevalence of adults who reported awareness of government physical activity guidelines and who were knowledgeable of the currently recommended moderate-intensity physical activity guideline (i.e., 150 minutes per week) from the 2008 Guidelines. RESULTS: In 2009, the percent of adults who reported being aware of government physical activity (PA) guidelines was 36.1%. The percent of adults knowledgeable of the moderate-intensity physical activity guideline was less than 1% (0.56%). CONCLUSIONS: Most U.S. adults lack sufficient awareness and knowledge of the 2008 Guidelines, putting them at risk of failure to meet them. The nation needs more effective communication strategies to translate and disseminate PA guidelines. |
Awareness and knowledge of the Youth 2008 Physical Activity Guidelines for Americans
Debastiani SD , Carroll DD , Cunningham M , Lee S , Fulton J . J Phys Act Health 2013 11 (3) 495-501 BACKGROUND: To measure parental awareness of government physical activity guidelines and knowledge of the amount of physical activity recommended for youth (i.e., "60 minutes/day, 7 days/week") as specified in the 2008 Physical Activity Guidelines for Americans. METHODS: A cross-sectional national sample of adults responded to physical activity guideline questions added to the HealthStyles survey in 2009 (n = 1552). The prevalence of parents aware of government physical activity guidelines and knowledgeable of the youth physical activity guideline, specifically, was estimated overall and by parental demographic characteristics (sex, education, income level, race/ethnicity, age group, marital status) and body mass index. RESULTS: In 2009, 34.8% of parents reported being aware of physical activity guidelines, and 9.7% were knowledgeable of the amount of physical activity recommended for youth. CONCLUSIONS: Many parents lack awareness and knowledge of the youth physical activity guidelines. The low prevalence estimates suggest the 2008 Physical Activity Guidelines for Americans have not been effectively disseminated. These results may also indicate a need for effective communication strategies to educate and inform parents, an important influencer of children's health behaviors. |
Excess frequent insufficient sleep in American Indians/Alaska Natives
Chapman DP , Croft JB , Liu Y , Perry GS , Presley-Cantrell LR , Ford ES . J Environ Public Health 2013 2013 259645 OBJECTIVE: Frequent insufficient sleep, defined as ≥14 days/past 30 days in which an adult did not get enough rest or sleep, is associated with adverse mental and physical health outcomes. Little is known about the prevalence of frequent insufficient sleep among American Indians/Alaska Natives (AI/AN). METHODS: We assessed racial/ethnic differences in the prevalence of frequent insufficient sleep from the combined 2009-2010 Behavioral Risk Factor Surveillance Survey among 810,168 respondents who self-identified as non-Hispanic white (NHW, n = 671,448), non-Hispanic black (NHB, n = 67,685), Hispanic (n = 59,528), or AI/AN (n = 11,507). RESULTS: We found significantly higher unadjusted prevalences (95% CI) of frequent insufficient sleep among AI/AN (34.2% [32.1-36.4]) compared to NHW (27.4% [27.1-27.6]). However, the age-adjusted excess prevalence of frequent insufficient sleep in AI/AN compared to NHW was decreased but remained significant with the addition of sex, education, and employment status; this latter relationship was further attenuated by the separate additions of obesity and lifestyle indicators, but was no longer significant with the addition of frequent mental distress to the model (PR = 1.05; 95% CI : 0.99-1.13). This is the first report of a high prevalence of frequent insufficient sleep among AI/AN. These results further suggest that investigation of sleep health interventions addressing frequent mental distress may benefit AI/AN populations. |
The impact of parental incarceration on the physical and mental health of young adults
Lee RD , Fang X , Luo F . Pediatrics 2013 131 (4) e1188-95 OBJECTIVES: We investigated the relationship between parental incarceration history and young adult physical and mental health outcomes using Wave 1 and Wave 4 data from the National Longitudinal Study of Adolescent Health. METHODS: Dependent variables included self-reported fair/poor health and health diagnoses. The independent variable was parental incarceration history. Cross-tabulations and logistic regression models were run. RESULTS: Positive, significant associations were found between parental incarceration and 8 of 16 health problems (depression, posttraumatic stress disorder, anxiety, cholesterol, asthma, migraines, HIV/AIDS, and fair/poor health) in adjusted logistic regression models. Those who reported paternal incarceration had increased odds of 8 mental and physical health problems, whereas those who reported maternal incarceration had increased odds of depression. For paternal incarceration, with the exception of HIV/AIDS, larger associations were found for mental health (odds ratios range 1.43-1.72) as compared with physical health (odds ratios range 1.26-1.31) problems. The association between paternal incarceration and HIV/AIDs should be interpreted with caution because of the low sample prevalence of HIV/AIDs. CONCLUSIONS: This study suggests exposure to parental incarceration in childhood is associated with health problems in young adulthood. Extant literature suggests underlying mechanisms that link parental incarceration history to poor outcomes in offspring may include the lack of safe, stable, nurturing relationships and exposure to violence. To prevent poor health in offspring of the incarcerated, additional studies are needed to (1) confirm the aforementioned associations and (2) assess whether adverse experiences and violence exposure in childhood mediate the relationship between parental incarceration history and offspring health problems. |
Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant
Smith SS , Keller PA , Kobinsky KH , Baker TB , Fraser DL , Bush T , Magnusson B , Zbikowski SM , McAfee TA , Fiore MC . Nicotine Tob Res 2013 15 (3) 718-28 INTRODUCTION: Telephone tobacco quitlines are effective and are widely used, with more than 500,000 U.S. callers in 2010. This study investigated the clinical effectiveness and cost-effectiveness of 3 different quitline enhancements: combination nicotine replacement therapy (NRT), longer duration of NRT, and counseling to increase NRT adherence. METHODS: In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 2x2 x 2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (nicotine patch only vs. patch plus nicotine gum), and standard 4-call counseling (SC) versus SC plus medication adherence counseling (MAC). The primary outcome was 7-day point-prevalence abstinence (PPA) at 6 months postquit in intention-to-treat (ITT) analyses. RESULTS: Combination NRT for 6 weeks yielded the highest 6-month PPA rate (51.6%) compared with 2 weeks of nicotine patch (38.4%), odds ratios [OR] = 1.71 (95% confidence interval [CI]:1.20-2.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR = 1.49 (95% CI: 1.04-2.14) but not for 6 weeks of nicotine patch alone (46.2%), OR = 1.38 (95% CI: 0.96-1.97). The MAC intervention effect was nonsignificant. Cost analyses showed that the 2-week combination NRT group had the lowest cost per quit ($442 vs. $464 for 2-week patch only, $505 for 6-week patch only, and $675 for 6-week combination NRT). CONCLUSIONS: Combination NRT for 2 or 6 weeks increased 6-month abstinence rates by 10% and 13%, respectively, over rates produced by 2 weeks of nicotine patch when offered with quitline counseling. A 10% improvement would potentially yield an additional 50,000 quitters annually, assuming 500,000 callers to U.S. quitlines per year. |
Alcohol use, drunkenness and tobacco smoking in rural western Kenya
Lo TQ , Oeltmann JE , Odhiambo FO , Beynon C , Pevzner E , Cain KP , Laserson KF , Phillips-Howard PA . Trop Med Int Health 2013 18 (4) 506-15 OBJECTIVES: To describe the prevalence of smoking and alcohol use and abuse in an impoverished rural region of western Kenya. METHODS: Picked from a population-based longitudinal database of demographic and health census data, 72,292 adults (≥18 years) were asked to self-report their recent (within the past 30 days) and lifetime use of tobacco and alcohol and frequency of recent 'drunkenness'. RESULTS: Overall prevalence of ever smoking was 11.2% (11.0-11.5) and of ever drinking, 20.7% (20.4-21.0). The prevalence of current smoking was 6.3% (6.1-6.5); 5.7% (5.5-5.9) smoked daily. 7.3% (7.1-7.5) reported drinking alcohol within the past 30 days. Of these, 60.3% (58.9-61.6) reported being drunk on half or more of all drinking occasions. The percentage of current smokers rose with the number of drinking days in a month (P < 0.0001). Tobacco and alcohol use increased with decreasing socio-economic status and amongst women in the oldest age group (P < 0.0001). CONCLUSIONS: Tobacco and alcohol use are prevalent in this rural region of Kenya. Abuse of alcohol is common and likely influenced by the availability of cheap, home-manufactured alcohol. Appropriate evidence-based policies to reduce alcohol and tobacco use should be widely implemented and complemented by public health efforts to increase awareness of their harmful effects. |
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