Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care
Ford ES , Capewell S . Annu Rev Public Health 2011 32 5-22 Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments. |
Cigarette smoking and second-hand smoking exposure in adolescents with chronic kidney disease: a study from the Midwest Pediatric Nephrology Consortium
Omoloja A , Chand D , Greenbaum L , Wilson A , Bastian V , Ferris M , Bernert J , Stolfi A , Patel H . Nephrol Dial Transplant 2011 26 (3) 908-13 BACKGROUND: Smoking and second-hand smoking [SHS] cause significant cardiovascular mortality and morbidity. In healthy individuals and adults with chronic kidney disease [CKD], cigarette smoking is associated with albuminuria, increased risk for CKD, increased graft loss and progression of renal insufficiency. In children, SHS has been associated with higher blood pressure variability, blood pressure load, elevated C-reactive protein and decreased cognitive function. Using a survey document and urine cotinine, we sought to investigate prevalence of cigarette use and SHS in adolescents with CKD. METHODS: A cross-sectional study was conducted in which adolescents aged 13 to 18 years with CKD were asked to complete a single anonymous self-administered survey. In addition, a single freshly voided urine sample for cotinine measurement was obtained from eligible subjects. RESULTS: Of 182 subjects, 60 (34%), 25 (14%) and 93 (52%) were transplant recipients, were dialysis dependent and had a glomerulopathy, respectively. Renal status was lacking in four. Twenty-four per cent (24%) had smoked at some point in their lives, and 13% had smoked within the last 30 days of taking the survey. Fifty-two per cent (52%) of all respondents reported living with an adult who smoked, and 54% reported having friends that smoked. Forty-seven per cent (47%) and 44% of those who had never smoked lived with an adult and had friends that smoked, respectively. There was a discrepancy rate of 7% between self-reported non-smokers and urine cotinine, suggesting smoking rates were higher. The highest cotinine/creatinine levels among the non-smokers were observed in those who lived with a smoker and had friends that smoked. CONCLUSION: Among adolescents with CKD, cigarette smoking and SHS exposure are prevalent and may be important variables to consider when evaluating renal and cardiovascular risk factors and outcomes in children with CKD. |
Reflections on pandemics, past and present
Schuchat A . Am J Obstet Gynecol 2011 204 S4-6 The author reflects on her personal experiences during the 2009 H1N1 influenza, acquired immune deficiency syndrome (AIDS), and severe acute respiratory syndrome (SARS) pandemics. The roles played by the Centers for Disease Control and Prevention related to pregnancy-associated influenza during the 2009 pandemic are described. Risk communication principles are summarized and resources provided. |
Trends in diseases reported on US death certificates that mentioned HIV infection, 1996-2006
Adih WK , Selik RM , Xiaohong Hu . J Int Assoc Physicians AIDS Care (Chic) 2011 10 (1) 5-11 OBJECTIVE: We examined trends during 1996-2006 in diseases reported on death certificates that mentioned HIV infection. METHODS: We analyzed multiple-cause mortality data compiled from all US death certificates with any mention of HIV to determine the annual percentages of deaths with various diseases. RESULTS: Deaths reported with HIV during 1996-2006 decreased from 35,340 to 13,750. Standardized percentages of death certificates reporting AIDS-defining opportunistic infections also decreased: pneumocytosis (6.3% to 5.1%), nontuberculous mycobacteriosis (5.5% to 1.8%), cytomegalovirus (5.7% to 1.2%). Non-Hodgkin's lymphoma rose from 4.8% in 1996 to 6.4% in 1997 and declined to 5.0% in 2001, while Kaposi's sarcoma declined from 3.7% in 1996 to 1.7% in 2001; these AIDS-defining cancers had stable percentages after 2001. All other cancers increased during 1996-2006 (2.7% to 7.3%). The percentage of deaths with diseases not specifically attributable to HIV increased: liver disease (5.8% to 13.0%), kidney disease (7.9% to 12.0%), and heart disease (4.9% to 10.2%). CONCLUSION: Among deaths reported with HIV, the percentages reported with HIV-attributable diseases decreased, while the percentages reported with other diseases increased. Consequently, these other life-threatening diseases need more attention in the management of HIV-infected persons. |
Factors associated with HIV infection in married or cohabitating couples in Kenya: results from a nationally representative study
Kaiser R , Bunnell R , Hightower A , Kim AA , Cherutich P , Mwangi M , Oluoch T , Dadabhai S , Mureithi P , Mugo N , Mermin J . PLoS One 2011 6 (3) e17842 BACKGROUND: In order to inform prevention programming, we analyzed HIV discordance and concordance within couples in the Kenya AIDS Indicator Survey (KAIS) 2007. METHODS: KAIS was a nationally representative population-based sero-survey that examined demographic and behavioral indicators and serologic testing for HIV, HSV-2, syphilis, and CD4 cell counts in 15,853 consenting adults aged 15-64 years. We analyzed interview and blood testing data at the sexual partnership level from married or cohabitating couples. Multivariable regression models were used to identify factors independently associated with HIV discordant and concordant status. RESULTS: Of 3256 couples identified in the survey, 2748 (84.4%) had interview and blood testing data. Overall, 3.8% of couples were concordantly infected with HIV, and in 5.8% one partner was infected, translating to 338,000 discordant couples in Kenya. In 83.6% of HIV-infected Kenyans living in married or cohabitating couples neither partner knew their HIV status. Factors independently associated with HIV-discordance included young age in women (AOR 1.5, 95% CI: 1.2-1.8; p<0.0001), increasing number of lifetime sexual partners in women (AOR 1.5, 95% CI: 1.3-1.8; p<0.0001), HSV-2 infection in either or both partners (AOR 4.1, 95% CI: 2.3-7.2; p<0.0001), and lack of male circumcision (AOR 1.6, 95% CI: 1.0-2.5; p = 0.032). Independent factors for HIV-concordance included HSV-2 infection in both partners (AOR 6.5, 95% CI: 2.3-18.7; p = 0.001) and lack of male circumcision (AOR 1.8, 95% CI: 1.0-3.3; p = 0.043). CONCLUSIONS: Couple prevention interventions should begin early in relationships and include mutual knowledge of HIV status, reduction of outside sexual partners, and promotion of male circumcision among HIV-uninfected men. Mechanisms for effective prevention or suppression of HSV-2 infection are also needed. |
First report of Streptococcus pneumoniae serotype 6D in South America
Mercado E , Srinivasan V , Hawkins P , Chochua S , Ochoa T , Beall B , McGee L . J Clin Microbiol 2011 49 (5) 2080-1 Streptococcus pneumoniae includes the two serotypes 6A and 6B as well as two recently discovered serotypes, 6C and 6D, in which the wciNalphagene is replaced by wciNbeta within the cps locus.... |
Hyponatremia, hypochloremia, and hypoalbuminemia predict an increased risk of mortality during the first year of antiretroviral therapy among HIV-infected Zambian and Kenyan women
Dao CN , Peters PJ , Kiarie J , Stringer J , Zulu I , Muiruri P , Ong'ech J , Mutsotso W , Potter D , Njobvu L , Borkowf CB , Bolu O , Weidle P . AIDS Res Hum Retroviruses 2011 27 (11) 1149-55 BACKGROUND: Early mortality rates after initiating antiretroviral therapy (ART) are high in sub-Saharan Africa. We examined whether serum chemistries at ART initiation predicted mortality among HIV-infected women. METHODS: From May 2005-January 2007, we enrolled women initiating ART in a prospective cohort study in Zambia and Kenya. We used Cox proportional hazards models to identify risk factors associated with mortality. RESULTS: Among 661 HIV-infected women, 53 (8%) died during the first year of ART, and tuberculosis was the most common cause of death (32%). Women were more likely to die if they were both hyponatremic (sodium < 135 mmol/L) and hypochloremic (chloride < 95 mmol/L) (37% vs. 6%) or hypoalbuminemic (albumin < 34 g/L, 13% vs. 4%) when initiating ART. A body mass index < 18 kg/m2 (adjusted hazard ratio [aHR] 5.3, 95% confidence interval [CI] 2.6-10.6) and hyponatremia with hypochloremia (aHR 4.5, 95% CI 2.2-9.4) were associated with one-year mortality after adjusting for country, CD4 cell count, WHO clinical stage, hemoglobin, and albumin. Among women with a CD4 cell count >50 cells/microL, hypoalbuminemia was also a significant predictor of mortality (aHR = 3.7, 95% CI 1.4 - 9.8) CONCLUSIONS: Baseline hyponatremia with hypochloremia and hypoalbuminemia predicted mortality in the first year of initiating ART, and these abnormalities might reflect opportunistic infections (e.g., tuberculosis) or advanced HIV disease. Assessment of serum sodium, chloride, and albumin can identify HIV-infected patients at highest risk for mortality who may benefit from more intensive medical management during the first year of ART. |
Danish health register study: a randomised trial with findings about the implementation of chlamydia screening, but not about its benefits
Soldan K , Berman SM . Sex Transm Infect 2011 87 (2) 86-7 Andersen et al1 report findings from 9 years' follow-up in one county in Denmark of 30 000 men and women aged 21–23 years, of whom 9000 (4000 women and 5000 men) were randomly selected in 1997 to receive a mailed invitation to provide a self-obtained specimen for chlamydia screening. That study has exploited the rare opportunity offered by Danish health registers to link longitudinal health records for a cohort of young people, which included men (a rarity). Using an intention-to-treat analysis, the authors conclude that a single postal invite for chlamydia testing, with a repeat offer to those found positive, did not reduce the long-term risk of reproductive complications.1 What do these data add to the evidence base concerning the effectiveness of chlamydia screening? What lessons should inform further studies? | Previous randomised controlled trials (RCTs) of a single chlamydia screen, with 1-year follow-up for the incidence of pelvic inflammatory disease (PID), have noted the limitation of evaluating the impact of a single round of chlamydia screening, because the risk of chlamydia infection is ongoing,2 as should the intervention be.3 The study by Andersen et al1 with its long follow-up for ectopic pregnancy and infertility increases the probability of the acquisition of chlamydia infections after (or before) the intervention and accentuates this bias to a null finding for these outcomes. |
A survey of patients and providers at free clinics across the United States
Gertz AM , Frank S , Blixen CE . J Community Health 2011 36 (1) 83-93 This study set out to demonstrate the need for free clinics on a national level, to identify difference among types of free clinics in the US, to identify which services were commonly used, and to determine where else patients would seek care if not at the free clinics. Two separate, distinct surveys were sent out, one to free clinic directors and another to free clinic patients. Chi-squared tests, two tailed t-tests, and percentages were used to describe results and significant differences. 1,114 free clinics were identified in the US. 172 free clinics and 362 patients responded. Most clinics (44%) were independent. A mean of 4,310 annual visits was reported. Most patients used primary care (86%) and pharmacy (80%) services. If the free clinic did not exist, 24% would not seek care, 21% due to cost. Most would seek care at another free clinic (47%), or the emergency room (23%). Most patients were satisfied with their care at the free clinic (97%). Patient satisfaction correlated with use of primary care (P = 0.0143). Most patients (77%) reported greater satisfaction with the care they received at the free clinic than with their prior care. Free clinics provide primary care to a substantial number of uninsured and working poor. They provide an alternative to patients who might otherwise seek primary care in the emergency room. Even with reform of the national health care system, free clinics will provide primary care to millions of uninsured. How they will adapt to provide this care is yet to be seen. |
Paraplegia and paraparesis from intrathecal methotrexate and cytarabine contaminated with trace amounts of vincristine in China during 2007
Zeng G , Ma H , Wang X , Yan H , Wan X , Jiang B , Fontaine RE , Wu Z , Lin S , Ruan F , Liu H . J Clin Oncol 2011 29 (13) 1765-70 PURPOSE: The production and administration of drugs used intrathecally requires special care to prevent contamination with neurotoxic agents. In 2007, we investigated a widespread outbreak of paraplegia and paraparesis among Chinese patients who received intrathecal drugs to identify the presumed contaminant and its source to prevent further cases. PATIENTS AND METHODS: We defined a case as onset from January 1 to October 31, 2007, of bilateral flaccid paraparesis or paraplegia or retention and incontinence of stool or urine, in a patient receiving intrathecal drugs. Using a retrospective cohort approach, we selected 12 hospitals from all hospitals that had reported cases. In these hospitals, we identified all 448 patients (including 107 cases) who received intrathecal chemotherapy or chemoprophylaxis in 2007. We calculated attack rates and Mantel-Haenszel adjusted risk ratios for intrathecal drug type and lot. RESULTS: All 12 hospitals used intrathecal methotrexate or cytarabine produced by one pharmaceutical plant. Only two lots of each drug were associated with cases. Lot-specific attack rates ranged from 42% to 100% (risk ratio, infinity; lower confidence bounds, 1.8 to 7.3). Vincristine production had immediately preceded production of the implicated lots on the same equipment. By using ultra performance liquid chromatography, we detected vincristine (0.28 to 18 mug) in unused vials from implicated lots of methotrexate and cytarabine. CONCLUSION: Trace amounts of vincristine that contaminated intrathecal drugs caused a large outbreak of severe neurologic damage. Vincristine and other neurotoxic drugs should not be produced on any equipment that is also used for producing drugs that are to be administered intrathecally. |
Unregulated drinking water initiative for environmental surveillance and public health
Backer LC , Tosta N . J Environ Health 2011 73 (7) 31-2 The critical public health need to assess and protect the drinking water used by 37 million Americans requires attention and resources. NCEH, in partnership with states, has begun the process to identify information available on unregulated drinking water sources to improve the availability of data to support decisive public health actions and resource allocation. Far more attention and resources are needed to complete this process. |
Nanotoxicology--a pathologist's perspective
Hubbs AF , Mercer RR , Benkovic SA , Harkema J , Sriram K , Schwegler-Berry D , Goravanahally MP , Nurkiewicz TR , Castranova V , Sargent LM . Toxicol Pathol 2011 39 (2) 301-24 Advances in chemistry and engineering have created a new technology, nanotechnology, involving the tiniest known manufactured products. These products have a rapidly increasing market share and appear poised to revolutionize engineering, cosmetics, and medicine. Unfortunately, nanotoxicology, the study of nanoparticulate health effects, lags behind advances in nanotechnology. Over the past decade, existing literature on ultrafine particles and respirable durable fibers has been supplemented by studies of first-generation nanotechnology products. These studies suggest that nanosizing increases the toxicity of many particulates. First, as size decreases, surface area increases, thereby speeding up dissolution of soluble particulates and exposing more of the reactive surface of durable but reactive particulates. Second, nanosizing facilitates movement of particulates across cellular and intracellular barriers. Third, nanosizing allows particulates to interact with, and sometimes even hybridize with, subcellular structures, including in some cases microtubules and DNA. Finally, nanosizing of some particulates, increases pathologic and physiologic responses, including inflammation, fibrosis, allergic responses, genotoxicity, and carcinogenicity, and may alter cardiovascular and lymphatic function. Knowing how the size and physiochemical properties of nanoparticulates affect bioactivity is important in assuring that the exciting new products of nanotechnology are used safely. This review provides an introduction to the pathology and toxicology of nanoparticulates. |
Quality-of-life and cost-benefit analysis of a home environmental assessment program in Connecticut
Nguyen KH , Boulay E , Peng J . J Asthma 2011 48 (2) 147-55 BACKGROUND: The National Asthma Education Prevention Program's (NAEPP) Expert Panel Report 3 (EPR3) guidelines have stressed the need for environmental control measures for asthma, but there is limited evidence of their efficacy. OBJECTIVE: To examine the effectiveness of an in-home asthma intervention program for children and adults in Connecticut, we conducted a panel study to analyze quality-of-life indicators for asthmatic patients and the cost-benefit relationship in preventive care versus acute care. METHODS: The Asthma Indoor Reduction Strategies (AIRS) program was developed to reduce acute asthma episodes and improve asthma control through patient education and a home environmental assessment. Follow-up was conducted at 2-week, 3-month, and 6-month intervals. Measured quality-of-life indicators included number of unscheduled acute care visits, days absent from school/work due to asthma, times rescue inhaler used, and number of symptom-free days. Repeated measures analysis of variance (ANOVA) was used to determine whether significant differences exist in quality-of-life indicators at follow-up compared to that at the initial visit. Cost-benefit analysis was conducted by tabulating costs associated with physician office visits and emergency department (ED) visits due to asthma for children and adults separately. RESULTS: Twenty percent of participants in the program met the criteria for well-controlled asthma, 16% for not well-controlled asthma, and 64% for very poorly controlled asthma. At 6 months follow-up, the mean number of unscheduled acute care visits, days absent from school/work due to asthma, and times rescue inhaler used in the past week decreased by 87%, 82%, and 74%, respectively, whereas the mean number of symptom-free days increased by 27% compared to the initial visit. Furthermore, the percent of participants with very poorly controlled asthma decreased from 64% at initial visit to 13% at 6 months follow-up. All changes were statistically significant at p < 0.05. A net savings of $26,720 per 100 participants was estimated at 6 months follow-up due to decreases in unscheduled acute care visits for adults and children. CONCLUSION: Significant improvement in quality-of-life and decreases in healthcare resource utilization and costs were found after implementation of the AIRS program in Connecticut. |
Endocrine disruptors and childhood social impairment
Miodovnik A , Engel SM , Zhu C , Ye X , Soorya LV , Silva MJ , Calafat AM , Wolff MS . NeuroToxicology 2011 32 (2) 261-7 Prenatal exposure to endocrine disruptors has the potential to impact early brain development. Neurodevelopmental toxicity in utero may manifest as psychosocial deficits later in childhood. This study investigates prenatal exposure to two ubiquitous endocrine disruptors, the phthalate esters and bisphenol A (BPA), and social behavior in a sample of adolescent inner-city children. Third trimester urines of women enrolled in the Mount Sinai Children's Environmental Health Study between 1998 and 2002 (n=404) were analyzed for phthalate metabolites and BPA. Mother-child pairs were asked to return for a follow-up assessment when the child was between the ages of 7 and 9 years. At this visit, mothers completed the Social Responsiveness Scale (SRS) (n=137), a quantitative scale for measuring the severity of social impairment related to Autistic Spectrum Disorders (ASD) in the general population. In adjusted general linear models increasing log-transformed low molecular weight (LMW) phthalate metabolite concentrations were associated with greater social deficits (beta=1.53, 95% CI 0.25-2.8). Among the subscales, LMWP were also associated with poorer Social Cognition (beta=1.40, 95% CI 0.1-2.7); Social Communication (beta=1.86, 95% CI 0.5-3.2); and Social Awareness (beta=1.25, 95% CI 0.1-2.4), but not for Autistic Mannerisms or Social Motivation. No significant association with BPA was found (beta=1.18, 95% CI -0.75, 3.11). Prenatal phthalate exposure was associated with childhood social impairment in a multiethnic urban population. Even mild degrees of impaired social functioning in otherwise healthy individuals can have very important adverse effects over a child's lifetime. These results extend our previous finding of atypical neonatal and early childhood behaviors in relation to prenatal phthalate exposure. |
Population incidence of Guillain-Barre syndrome: a systematic review and meta-analysis
Sejvar JJ , Baughman AL , Wise M , Morgan OW . Neuroepidemiology 2011 36 (2) 123-133 Population incidence of Guillain-Barre syndrome (GBS) is required to assess changes in GBS epidemiology, but published estimates of GBS incidence vary greatly depending on case ascertainment, definitions, and sample size. We performed a meta-analysis of articles on GBS incidence by searching Medline (1966-2009), Embase (1988-2009), Cinahl (1981-2009) and CABI (1973-2009) as well as article bibliographies. We included studies from North America and Europe with at least 20 cases, and used population-based data, subject matter experts to confirm GBS diagnosis, and an accepted GBS case definition. With these data, we fitted a random-effects negative binomial regression model to estimate age-specific GBS incidence. Of 1,683 nonduplicate citations, 16 met the inclusion criteria, which produced 1,643 cases and 152.7 million person-years of follow-up. GBS incidence increased by 20% for every 10-year increase in age; the risk of GBS was higher for males than females. The regression equation for calculating the average GBS rate per 100,000 person-years as a function of age in years was exp[-12.0771 + 0.01813(age in years)] x 100,000. Our findings provide a robust estimate of background GBS incidence in Western countries. Our regression model may be used in comparable populations to estimate the background age-specific rate of GBS incidence for future studies. |
Given the increasing bias in random digit dial sampling, could respondent-driven sampling be a practical alternative?
Lee R , Ranaldi J , Cummings M , Crucetti JB , Stratton H , McNutt LA . Ann Epidemiol 2011 21 (4) 272-9 PURPOSE: Increasing cellular phone service and nonresponse are causing random digit dial (RDD) users to search for alternative ways of sampling geographically large populations. This study evaluated the feasibility and utility in using a modified version of respondent-driven sampling (RDS) as an alternative method. METHODS: Using RDS, 469 residents of Albany County, New York were enrolled into a telephone-based health survey. Participants answered health and RDS feasibility questions. Results were compared to a previously collected RDD sample and census data. RESULTS: Participation was high (81.4%) and participants referred at least one peer 65.9% of the time. The RDS method produced a more ethnically diverse sample, otherwise respondent demographics were similar to the RDD sample. The most common reason for participating (51.9%) was because a peer told them about the study; 44.9% would not have participated in an RDD study. Persons not willing to participate in a RDD study reported being less healthy and less likely to participate in healthy activities (e.g., have a physical exam in the past 24 months). CONCLUSIONS: Although more research is needed, RDS methods may be developed into a viable alternative for collecting health data from large general populations. |
An outbreak of Escherichia coli O157:H7 infection linked to unpasteurized apple cider in Oklahoma, 1999
Diallo MO , Bradley KK , Crutcher JM , Lytle M , Lee A , Moolenaar RL . Food Prot Trends 2011 31 (2) 88-92 During the fall of 1999, an outbreak with 16 cases (11 confirmed and five probable) of Escherichia coli O157:H7 infections was identified in Oklahoma. Nine persons (82%) experienced bloody diarrhea, six (54%) required hospitalization, and three (27%) developed hemolytic uremic syndrome (HUS). Twelve of the sixteen (75%) cases were children from 2 to 13 years old. All nine available E. coli O157:H7 isolates had an identical pulsed-field gel electrophoresis pattern. Ten of the 11 confirmed patients and none of the 24 control subjects had drunk unpasteurized apple cider from Orchard A (matched odds ratio undefined; P0.00001). All environmental specimen cultures were negative. Orchard A was in compliance with U.S. Food and Drug Administration requirements for product warning labels on unpasteurized products, although only one of eight patients (or surrogates) interviewed recalled having read the label. This outbreak raises questions about whether the current practice of requiring warning labels for unpasteurized cider provides sufficient protection for vulnerable populations, especially children. |
Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: a venue-based study in Kuala Lumpur, Malaysia
Kanter J , Koh C , Razali K , Tai R , Izenberg J , Rajan L , Van Griensven F , Kamarulzaman A . Int J STD AIDS 2011 22 (1) 30-7 This research aimed to determine HIV prevalence, risk behaviour and knowledge of transmission methods among men who have sex with men (MSM) in Kuala Lumpur, Malaysia. Venue-day-time sampling (VDTS) was applied to identify venues where men congregate to solicit sex from other men. Participants recruited from clubs, massage parlours, saunas and one park self-completed a computerized behavioural questionnaire, were administered an oral rapid HIV test and given the opportunity to return later to receive full counselling and learn their HIV status. A total of 517 men were enrolled into the study. The majority were Malays (47.0%) and Chinese (43.7%). Twenty tested HIV positive (3.9%). Significant predictors of HIV infection included having unprotected anal sex with a casual partner (44.9% of participants, odds ratio [OR] = 2.99; 95% confidence interval [CI] 1.13-7.90; P = 0.027), having unprotected receptive anal sex (27.9%, OR = 2.71; 95% CI 1.10-6.54; P = 0.030) and having group sex (33.3%, OR = 3.95; 95% CI 1.55-10.09; P = 0.004). One in five participants (20.1% and 19.5%) did not believe that HIV could be transmitted through insertive or receptive anal sex, respectively. Risk behaviour is high and knowledge of HIV transmission methods was low among MSM in Kuala Lumpur. Future prevention efforts should focus on providing risk reduction education to this community. |
Screening methods for Chlamydia trachomatis and Neisseria gonorrhoeae infections in sexually transmitted infection clinics: what do patients prefer?
Howard EJ , Xu F , Taylor SN , Stoner BP , Mena L , Nsuami MJ , Powell S , Lillis R , Martin DH . Sex Transm Infect 2011 87 (2) 149-51 OBJECTIVES: To meet the need for services at sexually transmitted infection (STI) clinics, self-obtained vaginal (SOV) swabs or first-catch urine (FCU) samples collected at a clinic visit have been proposed as an alternative approach for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) screening. The purpose of this clinic-based survey was to determine if non-invasive clinic-based SOV swabs and FCU samples for CT and GC screening are acceptable replacements for a traditional provider visit. METHODS: Patients seen at STI clinics in three US cities completed a self-administered survey of preferences for methods of CT and GC screening under hypothetical circumstances. RESULTS: A total of 2887 participants completed a self-administered questionnaire that contained multiple-choice questions about their preference. If there was a hypothetical long clinic wait, 58% of the survey participants preferred to wait to see a doctor. If the clinic had to turn patients away, 41% of patients preferred to come back the next business day and 46% preferred to self-collect a sample. The percentages were similar across site, demographic and clinical groups. CONCLUSIONS: Clinic-based self-collected specimens for CT and GC screening were not preferred by most patients who participated in this survey. The findings indicate that more detailed information about self-collection practices must be provided for patients to adopt this new approach. |
Mothers' support for voluntary provision of HPV vaccine in schools
Kadis JA , McRee AL , Gottlieb SL , Lee MR , Reiter PL , Dittus PJ , Brewer NT . Vaccine 2011 29 (14) 2542-7 HPV vaccination rates among adolescents in the United States lag behind some other developed countries, many of which routinely offer the vaccine in schools. We sought to assess mothers' willingness to have their adolescent daughters receive HPV vaccine at school. A national sample of mothers of adolescent females ages 11-14 completed our internet survey (response rate=66%). The final sample (n=496) excluded mothers who did not intend to have their daughters receive HPV vaccine in the next year. Overall, 67% of mothers who intended to vaccinate their daughters or had vaccinated their daughters reported being willing to have their daughters receive HPV vaccine at school. Mothers were more willing to allow their daughters to receive HPV vaccine in schools if they had not yet initiated the vaccine series for their daughters or resided in the Midwest or West (all p<.05). The two concerns about voluntary school-based provision of HPV vaccine that mothers most frequently cited were that their daughters' doctors should keep track of her shots (64%) and that they wished to be present when their daughters were vaccinated (40%). Our study suggests that most mothers who support adolescent vaccination for HPV find school-based HPV vaccination an acceptable option. Ensuring communication of immunization records with doctors and allowing parents to be present during immunization may increase parental support. |
Discussions about prostate cancer screening between U.S. primary care physicians and their patients
Hall IJ , Taylor YJ , Ross LE , Richardson LC , Richards TB , Rim SH . J Gen Intern Med 2011 26 (10) 1098-104 OBJECTIVE: This study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior. METHODS: We analyzed data from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression. RESULTS: Eighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31-40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice. CONCLUSIONS: Both individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S. |
Injection site and risk of medically attended local reactions to acellular pertussis vaccine
Jackson LA , Yu O , Nelson JC , Dominguez C , Peterson D , Baxter R , Hambidge SJ , Naleway AL , Belongia EA , Nordin JD , Baggs J . Pediatrics 2011 127 (3) e581-e587 OBJECTIVE: To assess whether the risk of medically attended local reactions to the fifth dose of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine varies according to injection site (arm versus thigh). METHODS: We conducted a retrospective cohort study of children aged 4 through 6 years in the Vaccine Safety Datalink population who received a DTaP vaccination during the period from 2002 through 2006. Medically attended local reactions to the DTaP vaccine were presumptively identified from administrative data and were confirmed by medical record review. RESULTS: Among the 233,616 children in the study population, 1,017 (0.4%) had a confirmed medically attended local reaction to the fifth dose of the DTaP vaccine. The rate of those reactions was significantly higher with vaccinations given in the arm (47.4 per 10,000 vaccinations) compared with vaccinations given in the thigh (32.1 per 10,000 vaccinations) (P < .001). In a multivariable analysis adjusted for age, gender, and study site, children vaccinated in the arm had a 78% higher risk of a local reaction (relative risk: 1.78 [95% confidence interval: 1.43-2.21]). CONCLUSIONS: Local reactions to the fifth dose of the DTaP vaccine that require medical evaluation are uncommon, but the risk of those reactions is significantly higher when the vaccine is injected in the arm. These findings suggest that the thigh should be considered as an acceptable site of injection for this vaccination. |
Assessing injury-related movement difficulties: a method for analyzing the association between functional limitations and social participation
Loeb M , Chen LH . Disabil Health J 2011 4 (2) 102-11 BACKGROUND: The conceptualization of disability has shifted from a medical to a social model with a consequent focus away from impairments and toward activities and participation. The International Classification of Functioning, Disability and Health (ICF) provides a common point of reference and a common language in a developing disability discourse. OBJECTIVES: We sought to apply a model for the measurement of disability based on the activity and participation constructs of the ICF to persons with movement difficulty as a result of injury-related causes. METHODS: Data from sample adults aged 18 years and over in the 2001-2006 National Health Interview Survey (NHIS) were used for analysis. Disability among adults with injury-related movement difficulty was assessed through measures of difficulty performing basic actions (movement, sensory, emotional, and/or cognitive functioning); and limitations of complex activities (defined through measures of self-care, social participation, and work participation). SUDAAN 9.0 was used in all analyses to account for the complex sampling design and weighting of the NHIS data. RESULTS: Approximately 16% of noninstitutionalized adults who reported movement difficulty mentioned injury as a cause. On average, between 2001 and 2006, about 7.6 million adults had injury-related movement difficulty in the United States. Overall, 50% of adults who experienced injury-related movement difficulty also experienced some complex activity limitation. CONCLUSIONS: Using NHIS data, we have demonstrated the applicability of an approach using basic actions difficulty and complex activity limitations to measure functioning and participation in individuals with a specific type and cause of difficulty: injury-related movement difficulty. The operationalization of these constructs provides a possible tool to monitor progress toward the attainment of the equalization of opportunities among people with injury-related movement difficulty. |
A single base-pair change in 2009 H1N1 hemagglutinin increases human receptor affinity and leads to efficient airborne viral transmission in ferrets
Jayaraman A , Pappas C , Raman R , Belser JA , Viswanathan K , Shriver Z , Tumpey TM , Sasisekharan R . PLoS One 2011 6 (3) e17616 The 2009 H1N1 influenza A virus continues to circulate among the human population as the predominant H1N1 subtype. Epidemiological studies and airborne transmission studies using the ferret model have shown that the transmission efficiency of 2009 H1N1 viruses is lower than that of previous seasonal strains and the 1918 pandemic H1N1 strain. We recently correlated this reduced transmission efficiency to the lower binding affinity of the 2009 H1N1 hemagglutinin (HA) to alpha2-->6 sialylated glycan receptors (human receptors). Here we report that a single point mutation (Ile219-->Lys; a base pair change) in the glycan receptor-binding site (RBS) of a representative 2009 H1N1 influenza A virus, A/California/04/09 or CA04/09, quantitatively increases its human receptor-binding affinity. The increased human receptor-affinity is in the same range as that of the HA from highly transmissible seasonal and 1918 pandemic H1N1 viruses. Moreover, a 2009 H1N1 virus carrying this mutation in the RBS (generated using reverse genetics) transmits efficiently in ferrets by respiratory droplets thereby reestablishing our previously observed correlation between human receptor-binding affinity and transmission efficiency. These findings are significant in the context of monitoring the evolution of the currently circulating 2009 H1N1 viruses. |
Lack of clinical AIDS in SIV-infected sooty mangabeys with significant CD4+ T cell loss is associated with double-negative T cells
Milush JM , Mir KD , Sundaravaradan V , Gordon SN , Engram J , Cano CA , Reeves JD , Anton E , O'Neill E , Butler E , Hancock K , Cole KS , Brenchley JM , Else JG , Silvestri G , Sodora DL . J Clin Invest 2011 121 (3) 1102-10 SIV infection of natural host species such as sooty mangabeys results in high viral replication without clinical signs of simian AIDS. Studying such infections is useful for identifying immunologic parameters that lead to AIDS in HIV-infected patients. Here we have demonstrated that acute, SIV-induced CD4+ T cell depletion in sooty mangabeys does not result in immune dysfunction and progression to simian AIDS and that a population of CD3+CD4-CD8- T cells (double-negative T cells) partially compensates for CD4+ T cell function in these animals. Passaging plasma from an SIV-infected sooty mangabey with very few CD4+ T cells to SIV-negative animals resulted in rapid loss of CD4+ T cells. Nonetheless, all sooty mangabeys generated SIV-specific antibody and T cell responses and maintained normal levels of plasma lipopolysaccharide. Moreover, all CD4-low sooty mangabeys elicited a de novo immune response following influenza vaccination. Such preserved immune responses as well as the low levels of immune activation observed in these animals were associated with the presence of double-negative T cells capable of producing Th1, Th2, and Th17 cytokines. These studies indicate that SIV-infected sooty mangabeys do not appear to rely entirely on CD4+ T cells to maintain immunity and identify double-negative T cells as a potential subset of cells capable of performing CD4+ T cell-like helper functions upon SIV-induced CD4+ T cell depletion in this species. |
Monoclonal antibodies 3C3, 6D4, 7D11, 9G6, 24D11, 27C10, 27E2, and 29E5
Beezhold DH . Hybridoma (Larchmt) 2011 30 (1) 103-103 Antigen Used for Immunization | Stachybotrys chlorohalonata (ATCC 201863) cytolytic antigens (cScp) were semi-purified from tryptic soy broth culture supernatants as previously described.(1) | Method of Immunization | Mice were immunized intraperitoneally at biweekly intervals. Mice were primed with 50 μg of cScp emulsified in equal volumes of TiterMax (TiterMax USA, Norcross, GA). The antigen concentration was reduced by half for each of five subsequent booster immunizations. A final boost of 50 μg was given 3 weeks after the sixth immunization, and mice were sacrificed 3 days later for hybridoma production. | Parental Cell Line Used for Fusion | SP2/0-AG14 myleoma cells (ATCC# CRL-1581). | Selection and Cloning Procedure | Positive clones were identified using 1 μg/mL of cScp in an indirect ELISA. | Heavy and Light Chains of Immunoglobulin | Heavy chain––mu. | Light chain––not determined. | Specificity | Hybridoma tissue culture supernatants (CSN) were screened using an indirect ELISA as previously described.(2) The specificity of MAbs was tested against hyphal extracts of seven S. chartarum isolates, eight isolates of other Stachybotrys species, as well as 39 related and non-related fungi commonly found in indoor environments. All extracts were tested in a capture ELISA using rabbit polyclonal antibodies as solid-phase capture reagent. Specific binding activity was documented using Western blot analysis against mycelial extracts derived from Stachybotrys chlorohalonata and using fluorescent halogen immunostaining with various fungal species. | Specific Antigen Identified | Exoantigens produced by Stachybotrys chlorohalonata. |
Mutagenicity of 11 cigarette smoke condensates in two versions of the mouse lymphoma assay
Guo X , Verkler TL , Chen Y , Richter PA , Polzin GM , Moore MM , Mei N . Mutagenesis 2011 26 (2) 273-81 Cigarette smoke condensate (CSC) is genotoxic in nearly all assays in which it has been tested. In this study, we investigated the mutagenicity of 11 CSCs using the microwell and soft-agar versions of the mouse lymphoma assay (MLA). These CSCs were prepared from commercial or experimental cigarettes, 10 of them were produced using International Organisation for Standardisation (ISO) conditions and one CSC was generated using intense Massachusetts Department of Public Health (MDPH) conditions. In the presence of rat liver S9, the L5178Y/Tk(+/-) mouse lymphoma cells were treated with 11 CSCs at different concentrations (25-200 mug/ml) for 4 h. All CSCs resulted in dose-dependent increases of both cytotoxicity and mutagenicity in both versions of the MLA. The mutagenic potencies of the CSCs were calculated as mutant frequency per microgram CSC from the slope of the linear regression of the dose-response curves and showed no correlations with the tar yield of the cigarette or nicotine concentrations of the CSCs. Comparing two CSCs produced from the same commercial cigarettes using two different smoking conditions, the one generated under ISO conditions was more mutagenic than the other generated under intense conditions on a per microgram CSC basis. We also examined the loss of heterozygosity (LOH) at four microsatellite loci spanning the entire chromosome 11 for the mutants induced by 11 CSCs. The most common type of mutation observed was LOH with chromosome damage spanning less than approximately 34 Mbp. These results indicate that the MLA identifies different genotoxic potencies among a variety of CSCs and that the results from both versions of the assay are comparable. |
Non-HDL cholesterol shows improved accuracy for cardiovascular risk score classification compared to direct or calculated LDL cholesterol in a dyslipidemic population
van Deventer HE , Miller WG , Myers GL , Sakurabayashi I , Bachmann LM , Caudill SP , Dziekonski A , Edwards S , Kimberly MM , Korzun WJ , Leary ET , Nakajima K , Nakamura M , Shamburek RD , Vetrovec GW , Warnick GR , Remaley AT . Clin Chem 2011 57 (3) 490-501 BACKGROUND: Our objective was to evaluate the accuracy of cardiovascular disease (CVD) risk score classification by direct LDL cholesterol (dLDL-C), calculated LDL cholesterol (cLDL-C), and non-HDL cholesterol (non-HDL-C) compared to classification by reference measurement procedures (RMPs) performed at the CDC. METHODS: We examined 175 individuals, including 138 with CVD or conditions that may affect LDL-C measurement. dLDL-C measurements were performed using Denka, Kyowa, Sekisui, Serotec, Sysmex, UMA, and Wako reagents. cLDL-C was calculated by the Friedewald equation, using each manufacturer's direct HDL-C assay measurements, and total cholesterol and triglyceride measurements by Roche and Siemens (Advia) assays, respectively. RESULTS: For participants with triglycerides <2.26 mmol/L (<200 mg/dL), the overall misclassification rate for the CVD risk score ranged from 5% to 17% for cLDL-C methods and 8% to 26% for dLDL-C methods when compared to the RMP. Only Wako dLDL-C had fewer misclassifications than its corresponding cLDL-C method (8% vs 17%; P < 0.05). Non-HDL-C assays misclassified fewer patients than dLDL-C for 4 of 8 methods (P < 0.05). For participants with triglycerides ≥2.26 mmol/L (≥200 mg/dL) and <4.52 mmol/L (<400 mg/dL), dLDL-C methods, in general, performed better than cLDL-C methods, and non-HDL-C methods showed better correspondence to the RMP for CVD risk score than either dLDL-C or cLDL-C methods. CONCLUSIONS: Except for hypertriglyceridemic individuals, 7 of 8 dLDL-C methods failed to show improved CVD risk score classification over the corresponding cLDL-C methods. Non-HDL-C showed overall the best concordance with the RMP for CVD risk score classification of both normal and hypertriglyceridemic individuals. |
Nucleic acid amplification tests are more accurate and cost-effective than the chlamydia rapid test for diagnosing genital chlamydia
Gift TL . Evid Based Nurs 2011 14 (2) 45-6 Chlamydia is the most prevalent bacterial sexually transmitted infection in the world and has been associated with reproductive sequelae in women, though the frequency with which sequelae develop is not precisely known.1 ,2 As most cases of chlamydia are asymptomatic, screening – primarily of women – has been the primary intervention used to control chlamydia.2 Screening programmes typically involve collecting a specimen from a patient, sending it to a lab for processing and notifying the patient of results and arranging treatment if positive. As Hislop and colleagues note, rapid tests have been developed to reduce the delay between specimen collection and treatment and to improve treatment rates in some settings where follow-up with patients is problematic. Rapid tests available at present have improved sensitivity over those available 10–15 years ago, up to 80% compared with nucleic acid amplification tests (NAATs). Some can use urine or vaginal swab specimens. Optimal test selection (lab based vs rapid) depends on case detection, test cost, treatment delay, loss to follow-up and consequences of untreated chlamydial infection (both sequelae and further transmission). |
Pathogenetic elements of hepatitis E and animal models of HEV infection
Krawczynski K , Meng XJ , Rybczynska J . Virus Res 2011 161 (1) 78-83 The pathogenesis of HEV infection responsible for liver pathology and clinical disease is not well understood. The main target for the virus is hepatocyte, where it replicates and is released to bile and gastrointestinal tract. Viremia is regularly seen during the virus replication. The exact mechanism of hepatocytic death is uncertain. In experimentally infected non-human primates, the peak of liver lesions, measured by alanine aminotransferase activity elevation, is concordant with the virus disappearance from stool at the time of dynamic humoral immune response; the role of cellular immunity has not been research adequately, especially HEV-specific immune response in the liver. Non-human primates (chimpanzees, rhesus and cynomolgus macaques) are most widely used animal models for the study of HEV infection, its pathogenesis and vaccine trials. Several other animal models including pigs, rabbits and chickens have recently been established for the study of various aspects of HEV infection. Infectivity studies in susceptible primates were of significance in molecular studies of the virus itself. Preclinical vaccine trials with the use of various recombinant HEV capsid proteins and viral DNA established basic platform for formulation of HEV vaccine applied in HEV-endemic regions (China, Nepal). |
Production and characterization of IgM monoclonal antibodies against hyphal antigens of Stachybotrys species
Nayak AP , Green BJ , Janotka E , Blachere FM , Vesper SJ , Beezhold DH , Schmechel D . Hybridoma (Larchmt) 2011 30 (1) 29-36 Stachybotrys is a hydrophilic fungal genus that is well known for its ability to colonize water-damaged building materials in indoor environments. Personal exposure to Stachybotrys chartarum allergens, mycotoxins, cytolytic peptides, and other immunostimulatory macromolecules has been proposed to exacerbate respiratory morbidity. To date, advances in Stachybotrys detection have focused on the identification of unique biomarkers that can be detected in human serum; however, the availability of immunodiagnostic reagents to Stachybotrys species have been limited. In this study, we report the initial characterization of monoclonal antibodies (MAbs) against a semi-purified cytolytic S. chlorohalonata preparation (cScp) derived from hyphae. BALB/c mice were immunized with cScp and hybridomas were screened against the cScp using an antigen-mediated indirect ELISA. Eight immunoglobulin M MAbs were produced and four were specifically identified in the capture ELISA to react with the cScp. Cross-reactivity of the MAbs was tested against crude hyphal extracts derived from 15 Stachybotrys isolates representing nine Stachybotrys species as well as 39 other environmentally abundant fungi using a capture ELISA. MAb reactivity to spore and hyphal antigens was also tested by a capture ELISA and by fluorescent halogen immunoassay (fHIA). ELISA analysis demonstrated that all MAbs strongly reacted with extracts of S. chartarum but not with extracts of 39 other fungi. However, four MAbs showed cross-reactivity to the phylogenetically related genus Memnoniella. fHIA analysis confirmed that greatest MAb reactivity was ultrastructurally localized in hyphae and phialides. The results of this study further demonstrate the feasibility of specific MAb-based immunoassays for the detection of S. chartarum. |
17beta-Estradiol restores antibody responses to an influenza vaccine in a postmenopausal mouse model
Nguyen DC , Masseoud F , Lu X , Scinicariello F , Sambhara S , Attanasio R . Vaccine 2011 29 (14) 2515-8 Post-menopausal women belong to an age group that is highly susceptible to influenza infection and its most serious complications. However, data on the immunogenicity of influenza vaccines in these women is limited. Therefore, the antibody response to influenza vaccination was assessed in a postmenopausal mouse model. An inactivated-detergent-split vaccine from the A/New Caledonia/20/99 (H1N1) influenza virus strain was given to three groups of mice: ovariectomized (OVEX), OVEX with 17beta-estradiol replacement (OVEX+E2), and sham-OVEX. The OVEX+E2 group produced influenza virus-specific serum antibodies, including neutralizing antibodies, at significantly higher levels (p<0.001) than did OVEX mice. These levels matched those observed in the sham-OVEX group, indicating that ovariectomy negatively modulates the antibody response to the influenza vaccine, whereas 17beta-estradiol replacement restores this response to levels observed in intact animals. Our findings suggest that immunogenicity and efficacy of influenza vaccines need to be evaluated in postmenopausal women, including women receiving hormone replacement therapy. |
Aerosol vaccination induces robust protective immunity to homologous and heterologous influenza infection in mice
Smith JH , Brooks P , Johnson S , Tompkins SM , Custer KM , Haas DL , Mair R , Papania M , Tripp RA . Vaccine 2011 29 (14) 2568-75 Live-attenuated influenza vaccine (LAIV) delivered by large droplet intranasal spray is efficacious against infection. However, many of the large droplets are trapped in the external nares and do not reach the target nasal airway tissues. Smaller droplets might provide better distribution yielding similar protection with lower doses. We evaluated 20 and 30mum aerosol delivery of influenza virus in mice. A 15s aerosol exposure optimally protected against homologous and heterologous influenza infection and induced a robust immune response. These results demonstrate the feasibility of nasal vaccination using aerosolized particles, providing a strategy to improve vaccine efficacy and delivery. |
B cell epitope mapping and characterization of naturally acquired antibodies to the Plasmodium vivax Merozoite Surface Protein-3alpha (PvMSP-3alpha) in malaria exposed individuals from Brazilian Amazon
Lima-Junior JC , Jiang J , Rodrigues-da-Silva RN , Banic DM , Tran TM , Ribeiro RY , Meyer VS , De-Simone SG , Santos F , Moreno A , Barnwell JW , Galinski MR , Oliveira-Ferreira J . Vaccine 2011 29 (9) 1801-11 The Plasmodium vivax Merozoite Surface Protein-3alpha (PvMSP-3alpha) is considered as a potential vaccine candidate. However, the detailed investigations of the type of immune responses induced in naturally exposed populations are necessary. Therefore, we aim to characterize the naturally induced antibody to PvMSP-3alpha in 282 individuals with different levels of exposure to malaria infections residents in Brazilian Amazon. PvMSP3 specific antibodies (IgA, IgG and IgG subclass) to five recombinant proteins and the epitope mapping by Spot-synthesis technique to full-protein sequence of amino acids (15aa sequence with overlapping sequence of 9aa) were performed. Our results indicates that PvMSP3 is highly immunogenic in naturally exposed populations, where 78% of studied individuals present IgG immune response against the full-length recombinant protein (PVMSP3-FL) and IgG subclass profile was similar to all five recombinant proteins studied with a high predominance of IgG1 and IgG3. We also observe that IgG and subclass levels against PvMSP3 are associated with malaria exposure. The PvMSP3 epitope mapping by Spot-synthesis shows a natural recognition of at least 15 antigenic determinants, located mainly in the two blocks of repeats, confirming the high immunogenicity of this region. In conclusion, PvMSP-3alpha is immunogenic in naturally exposed individuals to malaria infections and that antibodies to PvMSP3 are induced to several B cell epitopes. The presence of PvMSP3 cytophilic antibodies (IgG1 and IgG3), suggests that this mechanism could also occur in P. vivax. |
Comparison of serum cotinine concentration within and across smokers of menthol and nonmenthol cigarette brands among non-Hispanic black and non-Hispanic white U.S. adult smokers, 2001-2006
Caraballo RS , Holiday DB , Stellman SD , Mowery PD , Giovino GA , Muscat JE , Eriksen MP , Bernert JT , Richter PA , Kozlowski LT . Cancer Epidemiol Biomarkers Prev 2011 20 (7) 1329-40 BACKGROUND: The Food and Drug Administration (FDA) is examining options for regulating menthol content in cigarettes. There are many pharmacologic properties of menthol that may facilitate exposure to tobacco smoke, and it has been suggested that the preference for menthol cigarettes in black smokers accounts for their higher cotinine levels. OBJECTIVE: To assess cigarette per day (cpd)-adjusted cotinine levels in relation to smoking a menthol or nonmenthol cigarette brand among non-Hispanic black and white U.S. adult smokers under natural smoking conditions. METHOD: Serum cotinine concentrations were measured in 1,943 smokers participating in the 2001 to 2006 National Health and Nutrition Examination Surveys (NHANES). The effect of smoking a menthol brand on cpd-adjusted serum cotinine levels in these two populations was modeled by adjusting for sex, age, number of smokers living in the home, body weight, time since last smoked, and FTC-measured nicotine levels. The 8 or 12 digit Universal Product Code (UPC) on the cigarette label was used to determine the cigarette brand and whether it was menthol. RESULTS: Smoking a menthol cigarette brand versus smoking a nonmenthol cigarette brand was not associated (p≥0.05) with mean serum cotinine concentration in either black or white smokers. CONCLUSIONS: The higher levels of cotinine observed in black smokers compared to white smokers is not explained by their higher preference for menthol cigarette brands. IMPACT: Further studies like ours are needed to improve our ability to understand health consequences of future changes in tobacco product design. |
Detection and quantification of ricin in beverages using isotope dilution tandem mass spectrometry
McGrath SC , Schieltz DM , McWilliams LG , Pirkle JL , Barr JR . Anal Chem 2011 83 (8) 2897-905 The toxic plant protein ricin has gained notoriety due to wide availability and potential use as a bioterrorism agent, with particular concern for food supply contamination. We have developed a sensitive and selective mass spectrometry-based method to detect ricin in tap water, 2% milk, apple juice, and orange juice. Ricin added to beverage matrices was extracted using antibody-bound magnetic beads and digested with trypsin. Absolute quantification was performed using isotope dilution mass spectrometry with a linear ion trap operating in product-ion-monitoring mode. The method allows for identification of ricin A chain and B chain and for distinction of ricin from ricin agglutinin within a single analytical run. Ricin-bound beads were also tested for deadenylase activity by incubation with a synthetic ssDNA oligomer. Depurination of the substrate by ricin was confirmed by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOFMS). This method was used successfully to extract ricin from each beverage matrix. The activity of recovered ricin was assessed, and quantification was achieved, with a limit of detection of 10 fmol/mL (0.64 ng/mL). |
Trends in ectopic pregnancy mortality in the United States: 1980-2007
Creanga AA , Shapiro-Mendoza CK , Bish CL , Zane S , Berg CJ , Callaghan WM . Obstet Gynecol 2011 117 (4) 837-43 OBJECTIVE: To estimate trends in ectopic pregnancy mortality and examine characteristics of recently hospitalized women who died as a result of ectopic pregnancy in the United States. METHODS: We used 1980-2007 national birth and death certificate data to calculate ectopic pregnancy mortality ratios (deaths per 100,000 live births) overall and stratified by maternal age and race. We performed nonparametric tests for trend to assess changes in ectopic pregnancy mortality over time and calculated projected mortality ratios for 2013-2017. Ectopic pregnancy deaths among hospitalized women were identified from 1998-2007 Nationwide Inpatient Sample data. RESULTS: Between 1980 and 2007, 876 deaths were attributed to ectopic pregnancy. The ectopic pregnancy mortality ratio declined by 56.6%, from 1.15 to 0.50 deaths per 100,000 live births between 1980-1984 and 2003-2007; at the current average annual rate of decline, this ratio will further decrease by 28.5% to 0.36 ectopic pregnancy deaths per 100,000 live births by 2013-2017. The ectopic pregnancy mortality ratio was 6.8 times higher for African Americans than whites and 3.5 times higher for women older than 35 years than those younger than 25 years during 2003-2007. Of the 76 deaths among women hospitalized between 1998 and 2007, 70.5% were tubal pregnancies; salpingectomy was performed in 80.6% of cases. Excessive hemorrhage, shock, or renal failure accompanied 67.4% of ectopic pregnancy deaths among hospitalized women. CONCLUSION: Despite a significant decline in ectopic pregnancy mortality since the 1980s, age disparities, and especially racial disparities, persist. Strategies to ensure timely diagnosis and management of ectopic pregnancies can further reduce related mortality and age and race mortality gaps. |
Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation
Vesco KK , Sharma AJ , Dietz PM , Rizzo JH , Callaghan WM , England L , Bruce FC , Bachman DJ , Stevens VJ , Hornbrook MC . Obstet Gynecol 2011 117 (4) 812-8 OBJECTIVE: To estimate risk of delivering macrosomic, large-for-gestational-age and small-for-gestational-age neonates in obese women with gestational weight gain outside the 2009 Institute of Medicine recommendation (11-20 pounds). METHODS: In a retrospective cohort study, we evaluated 2,080 obese women (body mass index 30 or higher) with singleton pregnancies that resulted in term live births within one health maintenance organization between 2000 and 2005; women with diabetes or hypertensive disorders were excluded. Gestational weight gain was categorized as less than 0, 0 to less than 11, 11-20 (referent), greater than 20-30, greater than 30-40, and greater than 40 pounds and as above, below, or within Institute of Medicine recommendations. We conducted multivariable logistic regression to estimate the odds of large for gestational age and small for gestational age (birth weights greater than the 90th percentile and less than the 10th percentile for gestational age, respectively) and macrosomia (greater than 4,500 g) adjusting for potential confounders. RESULTS: Eighteen percent gained below, 25% within, and 57% above Institute of Medicine recommendations. Prevalence of macrosomia, large for gestational age, and small for gestational age were 4.3%, 19.8%, and 4.3%, respectively. Compared with weight gain of 11-20 pounds, weight gain above recommendations did not significantly decrease small-for-gestational-age risk but was associated with increased odds of macrosomia (adjusted odds ratio [OR] 3.36; 95% confidence interval [CI] 1.74-6.51; 6.0% compared with 2.1%) and large for gestational age (adjusted OR 1.80; 95% CI 1.36-2.38; 23.8% compared with 16.6%). Weight gain below recommendations was associated with increased odds of small for gestational age (adjusted OR 3.94; 95% CI 2.04-7.61; 8.8% compared with 2.7%) and decreased odds of large for gestational age (adjusted OR 0.56; 95% CI 0.37-0.84; 11.2% compared with 16.6%). CONCLUSION: Regarding small for gestational age and large for gestational age, there is no benefit of weight gain above Institute of Medicine recommendations. Weight gain below recommendations decreases large for gestational age but increases small-for-gestational-age risk. LEVEL OF EVIDENCE: II. |
Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006
Mei Z , Cogswell ME , Looker AC , Pfeiffer CM , Cusick SE , Lacher DA , Grummer-Strawn LM . Am J Clin Nutr 2011 93 (6) 1312-20 BACKGROUND: Total body iron calculated from serum ferritin and soluble transferrin receptor concentrations allows for the evaluation of the full range of iron status. OBJECTIVE: We described the distribution of total body iron and the prevalence of iron deficiency (ID) on the basis of total body iron in US pregnant women. DESIGN: We examined data from the National Health and Nutrition Examination Survey (NHANES) in 1999-2006 for 1171 pregnant women. RESULTS: ID prevalence (+/-SE) in US pregnant women, which was defined as total body iron <0 mg/kg, was 18.0 +/- 1.4%. Pregnant women in the first trimester had a higher mean total body iron than did pregnant women in the second or third trimesters. ID prevalence in pregnant women increased significantly with each trimester (6.9 +/- 2.2%, 14.3 +/- 2.1%, and 29.5 +/- 2.7% in the first, second, and third trimesters, respectively). Pregnant women with parity ≥2 had the lowest mean total body iron and the highest prevalence of ID compared with values for pregnant women with parity of 0 or 1. The ID prevalence in non-Hispanic white pregnant women was significantly lower than in Mexican American or non-Hispanic black pregnant women. The mean total body iron and the prevalence of ID did not differ by educational level or by family income. CONCLUSIONS: To our knowledge, these are the first data on total body iron distributions for a representative sample of US pregnant women. Low total body iron is more prevalent in pregnant women in the second or third trimesters, in Mexican American pregnant women, in non-Hispanic black pregnant women, and in women with parity ≥2. |
Fatigue risk management: organizational factors at the regulatory and industry/company level
Gander P , Hartley L , Powell D , Cabon P , Hitchcock E , Mills A , Popkin S . Accid Anal Prev 2011 43 (2) 573-90 This paper focuses on the development of fatigue risk management systems (FRMS) in the transport sector. The evolution of regulatory frameworks is traced, from uni-dimensional hours of service regulations through to frameworks that enable multi-dimensional FRMS. These regulatory changes reflect advances in understanding of human error in the aetiology of accidents, and in fatigue and safety science. Implementation of FRMS shifts the locus of responsibility for safety away from the regulator towards companies and individuals, and requires changes in traditional roles. Organizational, ethnic, and national culture need to be considered. Recent trends in the work environment have potential to adversely affect FRMS, including precarious employment and shortages of skilled labour. Essential components of an FRMS, and examples of FRMS in different transport modes, are described. It is vital that regulators, employer, and employees have an understanding of the causes and consequences of fatigue that is sufficient for them to meet their responsibilities in relation to FRMS. While there is a strong evidence base supporting the principles of FRMS, experience with implementation is more limited. The evidence base for effective implementation will expand, since FRMS is data-driven, and ongoing evaluation is integral. We strongly advocate that experience be shared wherever possible. |
Monte Carlo simulation and well testing applied in evaluating reservoir properties in a deforming longwall overburden
Karacan CO , Goodman GVR . Transp Porous Media 2011 86 (2) 445-464 During longwall mining, the intact strata start to deform and fracture as the raining face progresses. Gob gas ventholes (GGVs) are drilled from the surface over a longwall panel before mining to capture methane from the fractured zone. Due to fracturing and bedding-plane separations, reservoir properties change extensively. This poses a major problem for venthole designers and methane control engineers and may become a safety and health concern for underground work force due to unexpected methane emissions: it is difficult to predict the location of major strata separations and their temporal magnitudes to best locate the ventholes. Measurements obtained at different times during longwall mining may not be helpful for this purpose as strata deformation is a dynamic process and the results from different tests may not be lumped together to analyze the data collectively. This article uses a combination of Monte Carlo (MC) simulation and well testing methods to analyze multiple data sets obtained from a GGV at different longwall face locations. The aim was to determine the magnitude of average strata separation before conducting well test analyses to determine the properties of a deformed reservoir. MC simulation was used to process cross-correlated and uncertain data distributions obtained from measurements to generate a set of normally distributed values for each data type. These values were further used to project the amount of strata separation to the timing of well test. Finally, well-test analyses were used to interpret test data and to evaluate reservoir properties. |
New development of expert system module for a decision-making on mine stope stability in underground blasthole mining operations
Vongpaisal S , Li G , Pakalnis R , Brady T . Int J Min Reclam Environ 2011 25 (1) 41-51 This is the first report on the research and development (RD) project for the development of an expert system for 3D stope stability assessment, for underground blasthole mining operations with delayed backfill, at depths from 500 to 2000 m below the ground surface. A new expert system module called the stope stability assessment program (SSAP) was developed based on the data generated from a state-of-the-art 3D elasto-plastic finite element analysis developed by the Canada Centre for Mineral and Energy Technology (CANMET), heuristic rules and case histories. This module mimics the rational processes of rock mechanics experts in providing recommendations to mine operators to make decisions on strategic mine planning and feasibility studies. As a result, planning and decision-making can occur in a quick and efficient manner to minimise the risk of ground failure and optimise mining costs. Consequently, the risks regarding mine safety and productivity can be properly managed. Her Majesty the Queen in Right of Canada. |
Field evaluation of air-blocking shelf for dust control on blasthole drills
Potts JD , Reed WR . Int J Min Reclam Environ 2011 25 (1) 32-40 In previous studies, an air-blocking shelf has been shown to be successful in reducing respirable dust leakage from the drill shroud in a laboratory setting. Dust reductions of up to 81% were achieved with the shelf under operating conditions consisting of a 1.9:1 collector-to-bailing airflow ratio and a 5.1-cm gap between the shroud and ground. Recent research focused on evaluating the shelf on two actual operating blasthole drills, in much more severe environments. In the field, the shelf reduced dust levels in the areas surrounding one operating blasthole drill by 70%. Dust reductions measured in the immediate vicinity of the shroud were reduced by 66% at one mine and 81% at the other mine. These field tests confirm that the air-blocking shelf is useful for reducing respirable dust generation from blasthole drills. |
Modeling and public health emergency responses: lessons from SARS
Glasser JW , Hupert N , McCauley MM , Hatchett R . Epidemics 2011 3 (1) 32-7 Modelers published thoughtful articles after the 2003 SARS crisis, but had limited if any real-time impact on the global response and may even have inadvertently contributed to a lingering misunderstanding of the means by which the epidemic was controlled. The impact of any intervention depends on its efficiency as well as efficacy, and efficient isolation of infected individuals before they become symptomatic is difficult to imagine. Nonetheless, in exploring the possible impact of quarantine, the product of efficiency and efficacy was varied over the entire unit interval. Another mistake was repeatedly fitting otherwise appropriate gamma distributions to times to event regardless of whether they were stationary or not, particularly onset-isolation intervals whose progressive reduction evidently contributed to SARS control. By virtue of their unknown biology, newly-emerging diseases are more challenging than familiar human scourges. Influenza, for example, recurs annually and has been modeled more thoroughly than any other infectious disease. Moreover, models were integrated into preparedness exercises, during which working relationships were established that bore fruit during the 2009 A/H1N1 pandemic. To provide the most accurate and timely advice possible, especially about the possible impact of measures designed to control diseases caused by novel human pathogens, we must appreciate the value and difficulty of policy-oriented modeling. Effective communication of insights gleaned from modeling SARS will help to ensure that policymakers involve modelers in future outbreaks of newly-emerging infectious diseases. Accordingly, we illustrate the increasingly timely care-seeking by which, together with increasingly accurate diagnoses and effective isolation, SARS was controlled via heuristic arguments and descriptive analyses of familiar observations. |
The impact of out-migration on the nursing workforce in Kenya
Gross JM , Rogers MF , Teplinskiy I , Oywer E , Wambua D , Kamenju A , Arudo J , Riley PL , Higgins M , Rakuom C , Kiriinya R , Waudo A . Health Serv Res 2011 46 (4) 1300-18 OBJECTIVE: To examine the impact of out-migration on Kenya's nursing workforce. STUDY SETTING: This study analyzed deidentified nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. STUDY DESIGN: We analyzed trends in Kenya's nursing workforce from 1999 to 2007, including supply, deployment, and intent to out-migrate, measured by requests for verification of credentials from destination countries. PRINCIPLE FINDINGS: From 1999 to 2007, 6 percent of Kenya's nursing workforce of 41,367 nurses applied to out-migrate. Eighty-five percent of applicants were registered or B.Sc.N. prepared nurses, 49 percent applied within 10 years of their initial registration as a nurse, and 82 percent of first-time applications were for the United States or United Kingdom. For every 4.5 nurses that Kenya adds to its nursing workforce through training, 1 nurse from the workforce applies to out-migrate, potentially reducing by 22 percent Kenya's ability to increase its nursing workforce through training. CONCLUSIONS: Nurse out-migration depletes Kenya's nursing workforce of its most highly educated nurses, reduces the percentage of younger nurses in an aging nursing stock, decreases Kenya's ability to increase its nursing workforce through training, and represents a substantial economic loss to the country. |
Antimullerian hormone as a predictor of natural fecundability in women aged 30-42 years
Steiner AZ , Herring AH , Kesner JS , Meadows JW , Stanczyk FZ , Hoberman S , Baird DD . Obstet Gynecol 2011 117 (4) 798-804 OBJECTIVE: To generate estimates of the association between markers of ovarian aging and natural fertility in a community sample at risk for ovarian aging. METHODS: Women aged 30-44 years with no history of infertility who had been trying to conceive for less than 3 months provided early-follicular phase serum and urine (N=100). Subsequently, these women kept a diary to record menstrual bleeding and intercourse and conducted standardized pregnancy testing for up to 6 months. Serum was analyzed for estradiol, follicle-stimulating hormone (FSH), antimullerian hormone, and inhibin B. Urine was analyzed for FSH and estrone 3-glucuronide. Diary data on menstrual cycle day and patterns of intercourse were used to calculate day-specific fecundability ratios. RESULTS: Sixty-three percent of participants conceived within 6 months. After adjusting for age, 18 women (18%) with serum antimullerian hormone levels of 0.7 ng/mL or less had significantly reduced fecundability given intercourse on a fertile day compared with women with higher antimullerian hormone levels (fecundability ratio 0.38; 95% confidence interval [CI] 0.08-0.91). The day-specific fecundability for women with early-follicular phase serum FSH values greater than 10 milli-international units/mL compared with women with lower FSH levels was also reduced, although nonsignificantly (11% of women affected; fecundability ratio 0.44; 95% CI 0.08-1.10). The association with urinary FSH was weaker (27% women affected; fecundability ratio 0.61; 95% CI 0.26-1.26), and the associations for the other markers were weaker still. CONCLUSION: Early-follicular phase antimullerian hormone appears to be associated with natural fertility in the general population. LEVEL OF EVIDENCE: II. |
State and local area estimates of depression and anxiety among adults with disabilities in 2006
Okoro CA , McKnight-Eily LR , Strine TW , Crews JE , Holt JB , Balluz LS . Disabil Health J 2011 4 (2) 78-90 BACKGROUND: Depression and anxiety are prevalent among adults with disabilities. However, little is known regarding the geographic variability of depression and anxiety among adults with disabilities in the United States. OBJECTIVES: We estimated prevalence of current depression, lifetime diagnoses of depression (LD), and lifetime diagnoses of anxiety (LA) among adults with disabilities by state, metropolitan and micropolitan statistical area (MMSA), and county. METHODS: We analyzed Behavioral Risk Factor Surveillance System data from 2006 for 41 states and territories, 74 MMSAs, and 112 counties. Stratified analyses by sociodemographic and health status variables were performed for the 10 MMSAs with the highest estimates of current depression, LD, and LA, respectively. Current depressive symptoms were assessed with the Patient Health Questionnaire-8. RESULTS: Estimates of current depression, LD, and LA among adults with disabilities varied substantially by state, MMSA, and county. Current depression estimates ranged from 14.7% in North Dakota to 30.1% in Mississippi; from 8.4% in San Francisco-Oakland-Fremont, CA, to 36.2% in Jacksonville, FL; and from 12.3% in Cumberland County, ME, to 44% in Orleans Parish, LA. There was major variation within some states (e.g., prevalence of current depression was 8.4% in San Francisco-Oakland-Fremont, CA compared to 25.5% in Los Angeles-Long Beach-Glendale, CA). In the 10 MMSAs with the highest estimates, estimates varied by age, gender, socioeconomic status, and health status. CONCLUSIONS: Public and mental health agencies may find these estimates useful for program planning purposes to address depression and anxiety among adults with disabilities. |
A population-based assessment of the health, functional status, and consequent family impact among children with Down syndrome
Schieve LA , Boulet SL , Kogan MD , Van Naarden-Braun K , Boyle CA . Disabil Health J 2011 4 (2) 68-77 BACKGROUND: Many health conditions have been described in children with Down syndrome (DS). However, there are little comparative population-based data available. OBJECTIVE/HYPOTHESES: We sought to examine the health impacts associated with DS and other disabling conditions in U.S. children included in the 2005-2006 National Survey of Children with Special Health Care Needs. METHODS: We assessed numerous health and functional outcomes in children with DS and without DS but with (1) mental retardation/developmental delay and another developmental disability associated with a high functional impact; (2) mental retardation/developmental delay but no co-occurring high-impact disability; (3) other special health care needs; and (4) no special health care needs (referent). RESULTS: Children with DS and in all 3 special health care needs comparison groups had substantially more health and functional difficulties than did the referent sample. Overall, children with DS were fairly comparable to children in the other mental retardation/developmental delay groups on health indicators; however, young children with DS were more likely than young children in both "other mental retardation" groups to have difficulties with breathing/respiration and swallowing/digestion/metabolism. Children with both DS and mental retardation associated with another high-impact disability had the highest levels of functional difficulties, unmet health needs, and family financial impacts. Nearly 60% of families in both groups provided home health care; in over 40%, a family member stopped working because of the child's condition; and about 40% reported the child's condition caused financial problems. CONCLUSIONS: Children with DS can have substantial health and functional difficulties, with numerous financial impacts on their families. |
Estimating standard errors for life expectancies based on complex survey data with mortality follow-up: a case study using the National Health Interview Survey Linked Mortality Files
Schenker N , Parsons VL , Lochner KA , Wheatcroft G , Pamuk ER . Stat Med 2011 30 (11) 1302-11 Life expectancy is an important measure for health research and policymaking. Linking individual survey records to mortality data can overcome limitations in vital statistics data used to examine differential mortality by permitting the construction of death rates based on information collected from respondents at the time of interview and facilitating estimation of life expectancies for subgroups of interest. However, use of complex survey data linked to mortality data can complicate the estimation of standard errors. This paper presents a case study of approaches to variance estimation for life expectancies based on life tables, using the National Health Interview Survey Linked Mortality Files. The approaches considered include application of Chiang's traditional method, which is straightforward but does not account for the complex design features of the data; balanced repeated replication (BRR), which is more complicated but accounts more fully for the design features; and compromise, 'hybrid' approaches, which can be less difficult to implement than BRR but still account partially for the design features. Two tentative conclusions are drawn. First, it is important to account for the effects of the complex sample design, at least within life-table age intervals. Second, accounting for the effects within age intervals but not across age intervals, as is done by the hybrid methods, can yield reasonably accurate estimates of standard errors, especially for subgroups of interest with more homogeneous characteristics among their members. Published in 2011 by John Wiley & Sons, Ltd. |
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