Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America
Silverberg MJ , Lau B , Justice AC , Engels E , Gill MJ , Goedert JJ , Kirk GD , D'Souza G , Bosch RJ , Brooks JT , Napravnik S , Hessol NA , Jacobson LP , Kitahata MM , Klein MB , Moore RD , Rodriguez B , Rourke SB , Saag MS , Sterling TR , Gebo KA , Press N , Martin JN , Dubrow R . Clin Infect Dis 2012 54 (7) 1026-1034 BACKGROUND: Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends. METHODS: In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34,189 HIV-infected (55% MSM, 19% other men, 26% women) and 114,260 HIV-uninfected individuals (90% men). RESULTS: Among men, the unadjusted anal cancer incidence rates per 100,000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7-151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5-61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100,000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8-6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5-2.2). In comparison with the period 2000-2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3-.9) in 1996-1999 and 0.9 (95% CI, .6-1.2) in 2004-2007. CONCLUSIONS: Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued. |
Strategies to support self-management in osteoarthritis: five categories of interventions, including education
Brady T . Orthop Nurs 2012 31 (2) 124-30 This overview of successful strategies for supporting self-management in patients with osteoarthritis (OA) defines the concepts of self-management, self-management support (SMS), and self-management education (SME); describes five categories of SMS interventions; identifies common elements across SMS categories; and provides evidence for and examples of self-management tools that are useful in OA. SMS categories include SME, other skill-building and behavior-change interventions, supportive provider interactions, ongoing supportive follow-up, and environmental changes. Where available, relevant OA-specific SMS strategies are used to illustrate these categories. |
The impact of osteoarthritis in the United States: a population-health perspective: a population-based review of the fourth most common cause of hospitalization in U.S. adults
Murphy L , Helmick CG . Orthop Nurs 2012 31 (2) 85-91 Arthritis, of which osteoarthritis (OA) is the most common type, is the most frequent cause of disability among adults in the United States. The authors reviewed the epidemiologic literature to identify studies that describe the population-based burden of OA-that is, the burden in all adults in the community. They found that 27 million adults-more than 10% of the U.S. adult population-had clinical OA in 2005, and in 2009 OA was the fourth most common cause of hospitalization. OA is the leading indication for joint replacement surgery; 905,000 knee and hip replacements were performed in 2009 at a cost of $42.3 billion. Obesity is a strong risk factor for OA of the knee and hip. Nurses can improve the quality of life of people with OA by raising awareness among their patients and peers of the substantial OA burden and the strategies, such as physical activity, that can reduce it. |
Annual report to the nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity
Eheman C , Henley J , Ballard-Barbash R , Jacobs EJ , Schymura MJ , Noone A-M , Pan L , Anderson RN , Fulton JE , Kohler BA , Jemal A , Ward E , Plescia M , Ries LAG , Edwards BK . Cancer 2012 118 (9) 2338-66 BACKGROUND: Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS: Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS: Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS: Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States. |
The association between tobacco burden and "dirty chest" is unlikely to follow a linear dose-response pattern
Laney A , Tramma S , Petsonk E , Attfield M . Br J Radiol 2012 85 (1012) 470-1 We read with interest the recent report by Kirchner et al [1] in BJR, which describes the results of the International Labour Office (ILO) classifications of routine digital chest radiographs as well as readings of contrast-enhanced chest CT images among a convenience-based sample of 85 tobacco smokers who were clinically referred for chest imaging, primarily for known or suspected cancer. Chest radiographs for the study were obtained using a storage phosphor digital system, and hard copies were printed from the digital image files via a laser printer. Transparencies were then displayed and classified by two board-certified radiologists. It was not described whether or not the classifications were made independently, and if so, how the readings were summarised. The data were presented as a correlation (see Figure 2) between pack-years and the ILO classification scores, which was found to be significant. Only slightly more than half of the data points were visible in this figure, leaving the reader to infer that some of the points presented represented more than one value. However, the actual distribution of the data cannot be inferred with the presentation of the results in this format. Additionally, there was no mention of how recognised confounding factors, such as age or occupational exposures, were accounted for in the correlation. | A number of previous studies have shown that, in the absence of occupational dust exposures, cigarette smoking and increasing age may lead to a one- or two-subcategory increase in the profusion of irregular type opacities. However, our reading of this report raised a number of concerns regarding study methods, including image acquisition and classification, as well as conclusions. |
Epidemic history of hepatitis C virus infection in two remote communities in Nigeria, West Africa.
Forbi JC , Purdy MA , Campo DS , Vaughan G , Dimitrova ZE , Ganova-Raeva LM , Xia GL , Khudyakov YE . J Gen Virol 2012 93 1410-1421 We investigated the molecular epidemiology and population dynamics of HCV infection among indigenes of two semi-isolated communities in North-Central Nigeria. Despite remoteness and isolation, ~15% of the population had serological or molecular markers of HCV infection. Phylogenetic analysis of the NS5b sequences obtained from 60 HCV infected residents showed that HCV variants belonged to genotype 1 (n=51; 85%) and genotype 2 (n=9; 15%). All sequences were unique and intermixed in the phylogenetic tree with HCV sequences from people infected from other West African countries. The high-throughput 454 pyrosequencing of the HCV hypervariable region 1 and an empirical threshold error correction algorithm were used to evaluate intra-host heterogeneity of HCV strains of genotype 1 (n=43) and genotype 2 (n=6) from residents of the communities. Analysis revealed a rare detectable intermixing of HCV intra-host variants among residents. Identification of genetically close HCV variants among all known groups of relatives suggests a common intra-familial HCV transmission in the communities. Applying Bayesian coalescent analysis to the NS5b sequences, the most recent common ancestors for genotype 1 and 2 variants were estimated to have existed 675 and 286 years ago, respectively. Bayesian skyline plots suggest that HCV lineages of both genotypes identified in the Nigerian communities experienced epidemic growth for 200-300 years until the mid-20th century. The data suggest a massive introduction of numerous HCV variants to the communities during the 20th century in the background of a dynamic evolutionary history of the hepatitis C epidemic in Nigeria over the last 3 centuries. |
Experiences from the shiga toxin-producing escherichia coli O104:H4 outbreak in Germany and research needs in the field, Berlin, 28-29 November 2011
Stark K , Bauerfeind R , Bernard H , Eckmanns T , Ethelberg S , Flieger A , Giesecke J , Greiner M , Karch H , Krause G , Mielke M , O'Brien SJ , Pulz M , Scheutz F , Schielke A , Stahl RA , Takkinen J , Tarr PI , Tauxe RV , Werber D . Euro Surveill 2012 17 (7) This report presents the main findings from an international workshop on Shiga toxin-producing Escherichia coli (STEC), held on 28-29 November 2011, organized by the Robert Koch Institute. The workshop assembled over 100 experts in clinical medicine, epidemiology, public health, microbiology, food safety, and environmental science from various countries. |
Family model of HIV care and treatment: a retrospective study in Kenya
Lewis Kulzer J , Penner JA , Marima R , Oyaro P , Oyanga AO , Shade SB , Blat CC , Nyabiage L , Mwachari CW , Muttai HC , Bukusi EA , Cohen CR . J Int AIDS Soc 2012 15 (1) 8 BACKGROUND: Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal. METHODS: A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach. RESULTS: Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively. CONCLUSIONS: The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement. |
Indirect protection and indirect measures of protection from rotavirus in adults
Lopman BA , Parashar UD . J Infect Dis 2012 205 (11) 1762-5 We read with interest the recent article by Lopman et al [1], who used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) data from the Nationwide Inpatient Sample (NIS) to document a decline in rotavirus and cause-unspecified gastroenteritis in 2008 in patients <24 years of age following widespread implementation of pediatric rotavirus vaccination. Despite the fact that administrative coding (ICD-9CM) data have been widely used [1–6], we are unaware of data regarding how well these codes identify hospitalized adults with all-cause gastroenteritis. In addition, important differences exist in the ICD-9CM codes used in studies, depending on whether the focus was on foodborne illness or all-cause gastroenteritis. Analysis of administrative data that was performed for rotavirus in children showed an underestimation of rotavirus in that population [7]. As part of an institutional review board–approved study of the prevalence of rotavirus among adults hospitalized at Northwestern Memorial Hospital (Chicago, Illinois) from 1 December 2005 through 30 November 2006, who had a stool specimen submitted for bacterial stool culture (BSC) [8], we compared how well ICD-9CM codes were able to identify patients with gastroenteritis when compared with having a BSC obtained, a surrogate for a clinical diagnosis of gastroenteritis. |
Acute viral hepatitis in the United States-Mexico border region: data from the Border Infectious Disease Surveillance (BIDS) project, 2000-2009
Spradling PR , Xing J , Phippard A , Fonseca-Ford M , Montiel S , Guzman NL , Campuzano RV , Vaughan G , Xia GL , Drobeniuc J , Kamili S , Cortes-Alcala R , Waterman SH . J Immigr Minor Health 2012 15 (2) 390-7 Little is known about the characteristics of acute viral hepatitis cases in the United States (US)-Mexico border region. We analyzed characteristics of acute viral hepatitis cases collected from the Border Infectious Disease Surveillance Project from January 2000-December 2009. Over the study period, 1,437 acute hepatitis A, 311 acute hepatitis B, and 362 acute hepatitis C cases were reported from 5 Mexico and 2 US sites. Mexican hepatitis A cases most frequently reported close personal contact with a known case, whereas, US cases most often reported cross-border travel. Injection drug use was common among Mexican and US acute hepatitis B and C cases. Cross-border travel during the incubation period was common among acute viral hepatitis cases in both countries. Assiduous adherence to vaccination and prevention guidelines in the US is needed and strategic implementation of hepatitis vaccination and prevention programs south of the border should be considered. |
The adult population impact of HIV care and antiretroviral therapy (ART)- Nyanza Province, Kenya, 2003-2008
Gargano JW , Laserson K , Muttai H , Odhiambo F , Orimba V , Adamu-Zeh M , Williamson J , Sewe M , Nyabiage L , Owuor K , Broz D , Marston B , Ackers M . AIDS 2012 26 (12) 1545-54 OBJECTIVE: To describe the population uptake of HIV care including antiretroviral therapy (ART) and its impact on adult mortality in a rural area of western Kenya with high HIV prevalence during a period of rapid HIV services scale-up. DESIGN: Adult medical chart data were abstracted at health facilities providing HIV care/ART to residents of a Health and Demographic Surveillance System (HDSS) and linked with HDSS demographic and mortality data. METHODS: We evaluated secular trends in patient characteristics across enrollment years and estimated proportions of HIV-positive adult residents receiving care. We evaluated adult (18-64 years) population mortality trends using verbal autopsy findings. RESULTS: From 2003-2008, 5,421 HDSS-resident adults enrolled in HIV care; 61.4% (n = 3,331) were linked to HDSS follow-up data. As the number of facilities expanded from 1 (2003) to 17 (2008), receipt of HIV services by HIV-positive residents increased from <1% to 29.5%, andART coverage reached 64.0% of adults with CD4 <250. The proportion of patients with WHO stage 4 at enrolment fell from 20.4% to 1.9%, and CD4 testing at enrolment increased from 1.0% to 53.4%. Population-level mortality rates for adults declined 34% for allcauses, 26% for AIDS/tuberculosis, and 47% for other infectious diseases; non-infectious disease mortality rates remained constant. CONCLUSIONS: The initial years of rapid HIV service expansion coincided with a drop in adult mortality by a third. Continued expansion of population access to HIV clinical services, including ART, and program quality improvements will be necessary to achieve further progress in reducing HIV-related morbidity and mortality. |
Cystatin C and baseline renal function among HIV-infected persons in the SUN Study
Overton ET , Patel P , Mondy K , Bush T , Conley L , Rhame F , Kojic EM , Hammer J , Henry K , Brooks JT . AIDS Res Hum Retroviruses 2012 28 (2) 148-55 In the combination antiretroviral therapy (cART) era, renal dysfunction remains common. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) (ClinicalTrials.gov number, NCT00146419) is a prospective observational cohort study of HIV-infected adults. At baseline, comprehensive data were collected, including cystatin C and measures of renal function. Univariate and multivariate regression analyses were performed to identify factors associated with baseline renal dysfunction [estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m(2) calculated using the simplified Modification of Diet in Renal Disease equation] and elevated cystatin C (>1.0 mg/liter) in a cross-sectional analysis. Among 670 subjects with complete data (mean age 41 years, mean CD4 cell count 530 cells/mm(3), 79% prescribed cART), the mean eGFR was 96.8 ml/min/1.73 m(2). Forty percent of subjects had renal dysfunction; 3.3% had chronic kidney disease (eGFR < 60 ml/min/1.73 m(2)). Elevated cystatin C was present in 18% of subjects. In multivariate analysis, renal dysfunction was associated with older age, non-Hispanic white race/ethnicity, higher body mass index (BMI), hypertension, higher cystatin C levels, and current prescription of ritonavir. Factors associated with elevated cystatin C included hepatitis C coinfection, hypertension, current smoking, older age, current tenofovir use, detectable plasma HIV RNA, and elevated microalbuminuria. The prevalence of chronic kidney disease (CKD) was low in this contemporary HIV cohort. However, mild to moderate renal dysfunction was common despite the widespread use of cART. |
Attractive toxic sugar bait (ATSB) methods decimate populations of Anopheles malaria vectors in arid environments regardless of the local availability of favoured sugar-source blossoms
Beier JC , Muller GC , Gu W , Arheart KL , Schlein Y . Malar J 2012 11 (1) 31 BACKGROUND: Attractive toxic sugar bait (ATSB) methods are a new and promising "attract and kill" strategy for mosquito control. Sugar-feeding female and male mosquitoes attracted to ATSB solutions, either sprayed on plants or in bait stations, ingest an incorporated low-risk toxin such as boric acid and are killed. This field study in the arid malaria-free oasis environment of Israel compares how the availability of a primary natural sugar source for Anopheles sergentii mosquitoes: flowering Acacia raddiana trees, affects the efficacy of ATSB methods for mosquito control. METHODS: A 47-day field trial was conducted to compare impacts of a single application of ATSB treatment on mosquito densities and age structure in isolated uninhabited sugar-rich and sugar-poor oases relative to an untreated sugar-rich oasis that served as a control. RESULTS: ATSB spraying on patches of non-flowering vegetation around freshwater springs reduced densities of female An. sergentii by 95.2% in the sugar-rich oasis and 98.6% in the sugar-poor oasis; males in both oases were practically eliminated. It reduced daily survival rates of female An. sergentii from 0.77 to 0.35 in the sugar-poor oasis and from 0.85 to 0.51 in the sugar-rich oasis. ATSB treatment reduced the proportion of older more epidemiologically dangerous mosquitoes (three or more gonotrophic cycles) by 100% and 96.7%, respectively, in the sugar-poor and sugar-rich oases. Overall, malaria vectorial capacity was reduced from 11.2 to 0.0 in the sugar-poor oasis and from 79.0 to 0.03 in the sugar-rich oasis. Reduction in vector capacity to negligible levels days after ATSB application in the sugar-poor oasis, but not until after 2 weeks in the sugar-rich oasis, show that natural sugar sources compete with the applied ATSB solutions. CONCLUSION: While readily available natural sugar sources delay ATSB impact, they do not affect overall outcomes because the high frequency of sugar feeding by mosquitoes has an accumulating effect on the probability they will be attracted to and killed by ATSB methods. Operationally, ATSB methods for malaria vector control are highly effective in arid environments regardless of competitive, highly attractive natural sugar sources in their outdoor environment. |
Visions for the 20th International Epidemiological Association's World Congress of Epidemiology (WCE 2014)
Monsour BB , Johnston JM , Hennessy TW , Schmidt MI , Krieger N . Public Health 2012 126 (3) 274-6 During August 17th-21st, 2014, the University of Alaska Anchorage, along with other local, state, and federal agencies throughout Alaska, will host the 20(th) International Epidemiological Association's (IEA) World Congress of Epidemiology (WCE 2014). The theme for this Congress is "Global Epidemiology in a Changing Environment: The Circumpolar Perspective." The changing environment includes the full range of environments that shape population health and health inequities from the physical to the social and economic. Our circumpolar perspective on these environments includes views on how political systems, work, immigration, Indigenous status, and gender relations and sexuality affect the global world and the health of its people. Suggestions and insights from the 3rd North American Congress of Epidemiology (2011) and the first-ever joint regional workshop co-organized by the IEA North American Region and the IEA Latin American and Caribbean Region held at the 19th IEA World Congress of Epidemiology (2011) have helped direct the focus for WCE 2014. Since the Arctic regions are feeling the effects of climate change first, we believe focusing on the emerging data on the health impacts of climate change throughout the world will be an important topic for this Congress. This will include a broad range of more traditional epidemiology areas such as infectious disease epidemiology, environmental epidemiology, health disparities, and surveillance and emergency preparedness. Addressing health inequities and promoting health equity is likewise a key concern of the Congress. This Congress will also host presentations on injury epidemiology, occupational health, infectious diseases, chronic diseases, maternal and child health, surveillance and field epidemiology, mental health, violence (from self-directed, e.g., suicide, to interpersonal to structural), psychoactive substance use (including tobacco), and measures of subjective health. Attention will be given to epidemiology's theoretical frameworks and emphasizing knowledge translation, from epidemiology to health systems, to policy, and to the broader public. We also plan to offer many hands-on workshops including practical uses of epidemiology to improve health systems and reduce health inequities within and between countries; the manner in which epidemiology can inform public health practice; the understanding and use of the Dictionary of Epidemiology; and many others. |
Poisson cluster analysis of cardiac arrest incidence in Columbus, Ohio
Warden C , Cudnik MT , Sasson C , Schwartz G , Semple H . Prehosp Emerg Care 2012 16 (3) 338-46 BACKGROUND: Scarce resources in disease prevention and emergency medical services (EMS) need to be focused on high-risk areas of out-of-hospital cardiac arrest (OHCA). OBJECTIVE: Cluster analysis using geographic information systems (GISs) was used to find these high-risk areas and test potential predictive variables. METHODS: This was a retrospective cohort analysis of EMS-treated adults with OHCAs occurring in Columbus, Ohio, from April 1, 2004, through March 31, 2009. The OHCAs were aggregated to census tracts and incidence rates were calculated based on their adult populations. Poisson cluster analysis determined significant clusters of high-risk census tracts. Both census tract-level and case-level characteristics were tested for association with high-risk areas by multivariate logistic regression. RESULTS: A total of 2,037 eligible OHCAs occurred within the city limits during the study period. The mean incidence rate was 0.85 OHCAs/1,000 population/year. There were five significant geographic clusters with 76 high-risk census tracts out of the total of 245 census tracts. In the case-level analysis, being in a high-risk cluster was associated with a slightly younger age (-3 years, adjusted odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-1.00), not being white, non-Hispanic (OR 0.54, 95% CI 0.45-0.64), cardiac arrest occurring at home (OR 1.53, 95% CI 1.23-1.71), and not receiving bystander cardiopulmonary resuscitation (CPR) (OR 0.77, 95% CI 0.62-0.96), but with higher survival to hospital discharge (OR 1.78, 95% CI 1.30-2.46). In the census tract-level analysis, high-risk census tracts were also associated with a slightly lower average age (-0.1 years, OR 1.14, 95% CI 1.06-1.22) and a lower proportion of white, non-Hispanic patients (-0.298, OR 0.04, 95% CI 0.01-0.19), but also a lower proportion of high-school graduates (-0.184, OR 0.00, 95% CI 0.00-0.00). CONCLUSIONS: This analysis identified high-risk census tracts and associated census tract-level and case-level characteristics that can be used to target public education efforts to prevent OHCA and to mitigate its occurrence with CPR and automated external defibrillator training. In addition, EMS resources can be redeployed to minimize response times to these census tracts. |
Case-control studies of sporadic enteric infections: a review and discussion of studies conducted internationally from 1990 to 2009
Fullerton KE , Scallan E , Kirk MD , Mahon BE , Angulo FJ , de Valk H , van Pelt W , Gauci C , Hauri AM , Majowicz S , O'Brien SJ . Foodborne Pathog Dis 2012 9 (4) 281-92 Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease. |
Bartonella bacteria in nature: where does population variability end and a species start?
Kosoy M , Hayman DT , Chan KS . Infect Genet Evol 2012 12 (5) 894-904 The application of new molecular approaches has permitted the differentiation of numerous strains belonging to the genus Bartonella and identification of new Bartonella species. However, the molecular typing of these organisms should be coupled with studies aimed at defining the biological properties of the newly described species. The long-history of co-adaptation between bartonella bacteria and their mammalian hosts and possibly arthropod vectors provides a unique opportunity for applying this information for the sub-genus taxonomy. There can be a varying level of association between the bacteria and their hosts, ranging from animal species to animal genus to animal community. The commonality is that any level of association provides a certain degree of isolation for a given bartonella population that can mimic 'biological isolation'. Such an association defines a specific ecological niche and determines some specific characteristics, including sequence types that can be used as markers for demarcation of bacterial species. Usage of a combination of genetic markers and ecological information can delineate a number of species complexes that might combine several genospecies, named strains, and unique genotypes. The identification of such species complexes can be presented as 1) separate phylogenetic lineages distantly related to other species (e.g. Bartonella bacilliformis); 2) clusters of genetically similar strains associated with a specific mammalian group (e.g. Bartonella elizabethae species complex); and 3) clusters of genetically similar strains that combine a number of ecotypes (e.g. Bartonella vinsonii species complex). |
HIV incidence and prevalence among cohorts of women with higher risk behaviour in Bloemfontein and Rustenburg, South Africa: a prospective study
Feldblum PJ , Latka MH , Lombaard J , Chetty C , Chen PL , Sexton C , Fischer S . BMJ Open 2012 2 (1) e000626 OBJECTIVES: The primary objective was to measure HIV incidence in two prospective cohorts of HIV-negative women. Secondary objectives included measuring pregnancy rates and participant retention rates. DESIGN: Cross-sectional HIV screening of women selected for higher risk behaviours, with a subsequent prospective study of uninfected women, followed monthly for up to 6 months. SETTING: Clinics established for research purposes in Bloemfontein and Rustenburg, South Africa. PARTICIPANTS: The authors enrolled women 18-35 years old and presumed at higher risk of sexual acquisition of HIV as indicated by self-reported sexual behaviour or recent sexually transmitted infection symptoms. In Bloemfontein, 1364 women were screened, 1154 were eligible for HIV testing and 1145 agreed to be tested. The prospective study enrolled 401 HIV-negative women. In Rustenburg, 946 women were screened, 540 were eligible and underwent HIV testing and 223 HIV-negative women entered the prospective study. PRIMARY AND SECONDARY OUTCOMES: Baseline prevalences of HIV infection and HIV incidence rates in the prospective cohorts, according to a double rapid test algorithm with a third rapid test for discrepant or indeterminate results. Pregnancy prevalences and pregnancy incidence rate in Bloemfontein. Participant retention rates in the prospective cohort until the study end. RESULTS: In Bloemfontein, 1145 women were tested, 391 entered follow-up and 92.3% of participants completed six study visits. In Rustenburg, 540 women were tested, 194 entered follow-up and retention up to the point of early study termination was 88.6%. Overall HIV prevalence was 21.2% (95% CI 18.9% to 23.6%) in Bloemfontein and 23.5% (95% CI 19.9% to 27.1%) in Rustenburg. Overall HIV incidence was 5.5/100 person-years (95% CI 2.5 to 10.4) in Bloemfontein and 3.0/100 person-years (95% CI 0.4 to 10.8) in Rustenburg. Cross-sectional pregnancy prevalences were 6.5% in Bloemfontein and 8.6% in Rustenburg. CONCLUSIONS: The authors observed substantial HIV incidence rates in both cohorts. Vigorous prevention efforts are needed in these smaller cities. |
Ideal cardiovascular health: start young, finish strong
Ford ES . Circulation 2012 125 (16) 1955-7 Landmark developments during the second half of the 20(th) century established that smoking, hypertension, and hypercholesterolemia constituted cardinal risk factors for cardiovascular morbidity and mortality. These insights proved critical in reversing decades of increases in the mortality rate from coronary heart disease in the United States starting in the late 1960s. As knowledge concerning the pathogenesis and pathophysiology of cardiovascular disease evolved rapidly during ensuing decades, research tended to focus on how much risk for adverse cardiovascular events increased in function of levels of risk factors (high-risk emphasis). However, this paradigm has shifted as research increasingly emphasized that low-risk cardiovascular risk factor profiles were associated with large reductions in cardiovascular mortality and improvements in other outcomes (low-risk emphasis). Thus, the conceptual framework for preventing cardiovascular disease that had been anchored largely in primary prevention increasingly embraced primordial prevention. |
Postlicensure safety surveillance for high-dose trivalent inactivated influenza vaccine in the Vaccine Adverse Event Reporting System, 1 July 2010-31 December 2010.
Moro PL , Arana J , Cano M , Menschik D , Yue X , Lewis P , Haber P , Martin D , Broder K . Clin Infect Dis 2012 54 (11) 1608-14 BACKGROUND: In December 2009, a new high-dose, trivalent, inactivated influenza vaccine (TIV-HD) was licensed for adults aged ≥65 years. We characterized clinical patterns of reports to the Vaccine Adverse Event Reporting System (VAERS) among older adults who received TIV-HD. METHODS: We searched VAERS for reports involving persons aged ≥65 years who received TIV-HD or TIV (standard dose) from 1 July 2010 through 31 December 2010. Medical records were requested for serious reports (ie, those associated with death, hospitalization or prolonged hospitalization, life-threatening illness, or disability). Clinicians reviewed information and assigned a diagnostic category to each report. Empirical Bayesian data mining was used to identify disproportional reporting following TIV-HD in VAERS. Reporting rates were calculated for reports of Guillain-Barre syndrome and anaphylaxis. RESULTS: VAERS received 606 reports after TIV-HD in persons aged ≥65 years (8.2% of reports involved serious events). The number of reports yielded by searches using the terms "ocular hyperemia" and "vomiting" exceeded the data mining threshold; >80% of these reports were nonserious. Clinical review of serious reports found that a greater proportion involving gastrointestinal events were made after TIV-HD receipt (5 of 51 [9.8%]) than after TIV receipt (1 of 123 [0.8%]). Four persons who received TIV-HD had gastroenteritis, and 1 had multiple gastrointestinal symptoms; all recovered. A higher proportion of cardiac events were noted after receipt of TIV-HD (9 of 51 [17.6%]) than after receipt of TIV (6 of 123 [4.9%]). No concerning clinical pattern was apparent. The reporting rates of Guillain-Barre syndrome and anaphylaxis after TIV-HD receipt were 1.4 and 1.0 reports per million doses distributed, respectively. CONCLUSIONS: During the first year after US licensure of TIV-HD, no new serious safety concerns were identified in VAERS. Our analyses suggested a clinically important imbalance between the reported and expected number of gastrointestinal events after TIV-HD receipt. Future studies should assess this potential association. |
Expanding the recommendations for annual influenza vaccination to school-age children in the United States
Fiore AE , Epperson S , Perrotta D , Bernstein H , Neuzil K . Pediatrics 2012 129 Suppl 2 S54-62 BACKGROUND: Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. METHODS: A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. RESULTS: Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. CONCLUSIONS: Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact. |
Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate
Gargano LM , Thacker N , Choudhury P , Weiss PS , Pazol K , Bahl S , Jafari HS , Arora M , Orenstein WA , Hughes JM , Omer SB . Pediatr Infect Dis J 2012 31 (2) e37-42 BACKGROUND: India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage. METHODS: A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys. RESULTS: The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible. CONCLUSIONS: Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar. |
A comparison of parent and provider reported influenza vaccination status of adolescents
Lu PJ , Dorell C , Yankey D , Santibanez TA , Singleton JA . Vaccine 2012 30 (22) 3278-85 OBJECTIVE: To compare parent and provider reported influenza vaccination status among adolescents. METHODS: Data from the 2009 National Immunization Survey-Teen (NIS-Teen) were analyzed. The NIS-Teen is a nationally representative random-digit-dialed telephone survey of households with adolescents 13-17years at the time of interview, followed by a mail survey to the adolescent's vaccination providers to obtain provider-reported vaccination histories. During the interview a parent or guardian was asked if the adolescent had received an influenza vaccination and whether their response was based upon recall only or from consulting a parent-held vaccination record (i.e., shot card) with recall of additional vaccinations not recorded on the shot card. Parent-reported influenza vaccination status was compared with provider-reported vaccination status by calculating various validity measures (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and kappa), overall and stratified by several demographic characteristics. In the main analysis, provider-reported vaccinations were considered the gold standard. To evaluate the completeness of provider-reporting, we conducted additional analysis that also considered vaccinations reported by parents from the shot card or reported received in a non-medical setting as "true" vaccinations. RESULTS: During the 2008-2009 season, influenza vaccination coverage among adolescents based on provider report was 11.3%. Based on parent report, influenza vaccination coverage was 21.7%. Twenty-two percent of parents retrieved and referred to a shot card during the interview. In the shot card group, provider versus parent reported coverage was 12.5% versus 18.2% while among the recall only group coverage was 10.9% versus 22.7%, respectively. Overall, compared to provider report as the gold standard, parental report of influenza vaccination had a sensitivity of 86.7%, a specificity of 86.2%, a positive predictive value (PPV) of 43.1%, and a negative predictive value (NPV) of 98.0%. Among the shot card group, of vaccinations reported either by provider or by parent reading vaccination off shot card, only 66% were reported by providers. In the shot card group, the "true" vaccination level (16-17%) was closer to the parent reported coverage when it was assumed that vaccinations read by the parent from a shot card but not reported by a provider were considered true vaccinations. Overall, assuming that providers reported 64% of "true" vaccinations, sensitivity increased to 91%, specificity to 93%, and PPV to 71%. CONCLUSIONS: Overall estimated influenza vaccination coverage was more than ten percentage points higher based on parental report than on provider report, with the difference between provider and parent report greater among the recall only group. The two estimates are closer for those with shot cards, but few parents utilized shot cards in our study and most national surveys do not ask parents to consult shot cards when responding about their adolescent's vaccination. The actual vaccination coverage of adolescents studied is likely between coverage estimates obtained from parent report and provider report. |
Multiple traumas, postelection violence, and posttraumatic stress among impoverished Kenyan youth
Harder VS , Mutiso VN , Khasakhala LI , Burke HM , Ndetei DM . J Trauma Stress 2012 25 (1) 64-70 Research on posttraumatic stress disorder (PTSD) among youth has focused on specific subgroups from developed countries. Most of the world's youth and war-like violence, however, is concentrated in developing countries, yet there is limited mental health data within affected countries. This study focused on a random community-based sample of 552 impoverished youth ages 6-18 within an informal settlement in Nairobi, Kenya, which experienced war-like violence for a month following the contested presidential election of 2007. Six months after the violence ended, 99 (18%) had PTSD according to the UCLA PTSD Reaction Index (Steinberg, Brymer, Decker, & Pynoos, 2004), and an additional 18 (3%) were found to have partial PTSD due to high overall scores. Kenyan psychologists conducted diagnostic interviews and found the positive predictive value of the assessment tool to be 72% in this sample; the confirmed prevalence was 12%. Similar to other studies worldwide, Criterion C (avoidance) was the limiting factor for diagnosing PTSD according to the DSM-IV-TR, and parent-child agreement was at best fair. The number of traumatic experiences was strongly associated with PTSD outcomes. Differences due to age or sex were not found. The findings indicate the need for universal mental health services for trauma-exposed youth and their families in the impoverished informal settlements of Nairobi, Kenya. |
Molecular signatures associated with Mx1-mediated resistance to highly pathogenic influenza virus infection: mechanisms of survival.
Cilloniz C , Pantin-Jackwood MJ , Ni C , Carter VS , Korth MJ , Swayne DE , Tumpey TM , Katze MG . J Virol 2012 86 (5) 2437-46 Understanding the role of host factors during lethal influenza virus infection is critical to deciphering the events that determine the fate of the host. One such factor is encoded by the Mx1 gene, which confers resistance to influenza virus infection. Here, we compared pathology and global gene expression profiles in lung tissue from BALB/c (Mx1(-)) and BALB . A2G-Mx1 mice (Mx1(+/+)) infected with the fully reconstructed 1918 pandemic influenza virus. Mx1(+/+) mice showed less tissue damage than Mx(-) animals, and pathology and mortality were further reduced by treating the mice with interferon prior to infection. Using global transcriptional profiling, we identified distinct molecular signatures associated with partial protection, complete protection, and the contribution of interferon to the host response. In the absence of interferon treatment, partial protection was characterized by the generation of an acute response with the upregulation of genes associated with apoptosis, reactive oxygen species, and cell migration. Complete protection was characterized by the downregulation of cytokine and chemokine genes previously associated with influenza virus pathogenesis. The contribution of interferon treatment to total protection in virus-infected Mx1(+/+) mice was characterized by the altered regulation of cell cycle genes. These genes were upregulated in Mx1(+/+) mice treated with interferon but downregulated in the absence of interferon treatment. Our results suggest that Mx1(+/+) mice generate a protective antiviral response by controlling the expression of key modulator molecules associated with influenza virus lethality. |
Analysis of influenza viruses from patients clinically suspected of infection with an oseltamivir resistant virus during the 2009 pandemic in the United States.
Nguyen HT , Trujillo AA , Sheu TG , Levine M , Mishin VP , Shaw M , Ades EW , Klimov AI , Fry AM , Gubareva LV . Antiviral Res 2012 93 (3) 381-6 During the 2009 influenza pandemic, the Centers for Disease Control and Prevention provided antiviral susceptibility testing for patients infected with suspected drug-resistant viruses. Specimens from 72 patients admitted to an intensive care unit or with a severe immunocompromising condition, who failed to clinically improve after oseltamivir treatment, were accepted for testing. Respiratory specimens were tested for the presence of the oseltamivir resistance-conferring H275Y substitution in the neuraminidase (NA) by pyrosequencing. Virus isolates propagated in MDCK cells were tested in phenotypic NA inhibition (NI) assays using licensed NA inhibitors (NAIs), zanamivir and oseltamivir, and investigational NAIs, peramivir and laninamivir. Conventional sequencing and plaque purification were conducted on a subset of viruses. Pyrosequencing data were obtained for 87 specimens collected from 58 of the 72 (81%) patients. Of all patients, 27 (38%) had at least one specimen in which H275Y was detected. Analysis of sequential samples from nine patients revealed intra-treatment emergence of H275Y variant and a shift from wildtype-to-H275Y in quasispecies during oseltamivir therapy. A shift in the H275Y proportion was observed as a result of virus propagation in MDCK cells. Overall, the NI method was less sensitive than pyrosequencing in detecting the presence of H275Y variants in virus isolates. Using the NI method, isolates containing H275Y variant at 50% exhibited resistance to oseltamivir and peramivir, but retained full susceptibility to zanamivir. H275Y viruses recovered from two patients had an additional substitution I223K or I223R that conferred a 38-52- and 33-97-fold enhancement in oseltamivir- and peramivir-resistance, respectively. These viruses also showed decreased susceptibility to zanamivir and laninamivir. These data suggest that pyrosequencing is a powerful tool for timely detection of NAI resistant viruses and that NI assays are needed for comprehensive testing to detect novel resistance substitutions. |
Pooling nasopharyngeal/throat swab specimens to increase testing capacity for influenza viruses by PCR.
Van TT , Miller J , Warshauer DM , Reisdorf E , Jernigan D , Humes R , Shult PA . J Clin Microbiol 2012 50 (3) 891-6 Real-time PCR methodology can be applied to rapidly and accurately detect influenza viruses. During times of surge testing or enhanced pandemic surveillance, public health laboratories (PHLs) may experience overwhelming demand for testing, even while the prevalence of positive specimens remains low. To improve laboratory capacity and testing efficiency during surges, we evaluated whether nasopharyngeal (NP)/throat swab specimens can be pooled and tested for the presence of the 2009 H1N1 influenza virus without a reduction in sensitivity. Pools of 10 specimens were extracted and concentrated upon elution on the MagNA Pure LC instrument, and real-time PCR was performed on the Applied Biosystems 7500 Fast platform, using the CDC swine influenza virus real-time RT-PCR detection panel (rRT-PCR swine flu panel). Specimens in positive pools were singly re-extracted and retested by PCR to identify individual positive samples. Initial studies showed that spiking a pool of nine negative specimens (100 mcl each) or 900 mcl of virus transport medium with 100 mcl of a positive clinical specimen caused no loss of sensitivity by rRT-PCR testing. Pools containing either multiple positive specimens or specimens positive for other respiratory viruses also showed no negative effect on crossing threshold (C(T)) values. To test the robustness of the pooling protocol, a panel of 50 blinded samples was sent to three PHLs and tested in five pools of 10. All PHLs correctly identified the positive specimens. This study demonstrates the feasibility of using a pooling strategy to increase capacity and conserve resources during surge testing and periods of enhanced influenza surveillance when the prevalence is low. |
Molecular genetic testing for fragile X syndrome: laboratory performance on the College of American Pathologists proficiency surveys (2001-2009).
Weck KE , Zehnbauer B , Datto M , Schrijver I . Genet Med 2012 14 (3) 306-12 PURPOSE: The College of American Pathologists offers biannual proficiency testing for molecular analysis of fragile X syndrome. The purpose of this study was to analyze laboratory performance on the fragile X proficiency surveys from 2001 to 2009. METHODS: Individual laboratory responses were analyzed for accuracy of genotype determination (normal, gray zone, premutation, or full mutation) and size analysis of the FMR1 trinucleotide repeat region. The analytical sensitivity and specificity of testing for fragile X were calculated, and laboratory performance for trinucleotide repeat sizing was evaluated. RESULTS: Overall, laboratories demonstrated analytical sensitivity of 99% and 96% for detection of full mutations associated with fragile X syndrome in males and females, respectively; analytical sensitivity of 98% for detection of premutations; and analytical specificity of 99.9%. Size measurements of the CGG repeat region were acceptable from most laboratories, with an increase in the range of reported sizes observed for larger repeat expansions. CONCLUSIONS: Molecular genetic testing for fragile X syndrome demonstrated excellent sensitivity and specificity by laboratories participating in the College of American Pathologists (CAP) surveys. Allele sizing demonstrated good performance overall with improved accuracy over the study period. Participation in proficiency testing can aid laboratories in assessing individual performance and need for calibration of assays. |
An inter-laboratory study to determine the effectiveness of procedures for discriminating amphibole asbestos fibers from amphibole cleavage fragments in fiber counting by phase-contrast microscopy
Harper M , Lee EG , Slaven JE , Bartley DL . Ann Occup Hyg 2012 56 (6) 645-59 The US Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration do not regulate cleavage fragments of amphibole and serpentine minerals as asbestos, even when particles meet the dimensional criteria for counting under standard phase-contrast microscopy methods. The OSHA ID-160 method cautions that discriminatory counting is difficult and should not be attempted unless necessary and no procedure is provided for differentiation. A standard published by the American Society for Testing and Materials (ASTM International D7200-06) includes an attempt to codify a procedure but recognizes that the procedure should be validated in an inter-laboratory study. The US National Institute for Occupational Safety and Health has carried out such a study with multiple laboratories using slides made from riebeckite and crocidolite, grunerite and amosite, tremolite and tremolite asbestos, and actinolite and actinolite asbestos using two different measurement aids (graticules). The asbestos fibers had dimensions consistent with those reported for air samples from actual amphibole asbestos operations, and the cleavage fragments were also dimensionally consistent with those found in non-asbestos mining and milling operations. The procedure for discriminating asbestos fibers from other mineral particles in the ASTM Standard calls for the recognition of characteristics supposedly common to asbestos. For the asbestos fibers created in this study, these characteristics were found not to be common and generally a function of length. More importantly, different laboratories did not recognize these features consistently. Laboratories were much more consistent in measuring dimensions, but excessive overlap in the lengths of asbestos fibers and cleavage fragments rendered length a poor criterion for discrimination. The ASTM discrimination procedure as written could not be supported on the basis of this study. Width was a much more consistent parameter for distinguishing the asbestos and non-asbestos fibers in this study and inclusion of aspect ratio, while considered important by some researchers, did not refine the discrimination further. The ability of the majority of microscopists in this study to discriminate fibers and cleavage fragments through measurement of particle widths was determined and found to be within limits of uncertainty typical for air sampling measurements. A width criterion might be a very simple and useful aid where discrimination between asbestos and non-asbestos fibers in fiber counting by phase-contrast microscopy is required for further investigation. Recognition of asbestos features can also be retained as excessive recognition by some laboratories will lead to a conservative decision for additional investigation. |
International Circumpolar Surveillance interlaboratory quality control program for serotyping Haemophilus influenzae and serogrouping Neisseria meningitidis, 2005 to 2009
Tsang RS , Rudolph K , Lovgren M , Bekal S , Lefebvre B , Lambertsen L , Zulz T , Bruce M . J Clin Microbiol 2012 50 (3) 651-6 The International Circumpolar Surveillance (ICS) program was initiated in 1999 to conduct population-based surveillance for invasive pneumococcal disease in select regions of the Arctic. The program was expanded to include the surveillance of invasive diseases caused by Neisseria meningitidis and Haemophilus influenzae. An interlaboratory quality control (QC) program to monitor laboratory proficiencies in the serogrouping of N. meningitidis and serotyping of H. influenzae strains was codeveloped by the Arctic Investigations Program (Anchorage, AK) and the Public Health Agency of Canada National Microbiology Laboratory (Winnipeg, Manitoba, Canada) and introduced into the ICS program in 2005. Other participating laboratories included the Provincial Laboratory for Public Health (Edmonton, Alberta, Canada), Laboratoire Sante Publique du Quebec (Sainte-Anne-de-Bellevue, Quebec, Canada), and Statens Serum Institut (Copenhagen, Denmark). From 2005 through 2009, 50 isolates (24 N. meningitidis and 26 H. influenzae isolates) were distributed among the five participating laboratories. The overall serogroup concordance for N. meningitidis strains was 92.3% (96/104), without including three isolates that were found to express both serogroup Y and W135 specificities. Concordant results were obtained for serogroups A, B, C, and Y among all laboratories. Discrepancies were observed most frequently for serogroups W135, X, Z, and 29E. The overall serotype concordance for H. influenzae was 98% (125/127 attempts). The two discrepant results involved a serotype c strain and a serotype e strain, and in both cases, the serotypeable H. influenzae isolates were misidentified as being nontypeable. These data demonstrate a high degree of concordance for serogroup and serotype determinations of N. meningitidis and H. influenzae isolates, respectively, among the five laboratories participating in this quality control program. |
Characterization of multi-drug resistant Salmonella enterica serovar Heidelberg from a ground turkey-associated outbreak in the United States, 2011
Folster JP , Pecic G , Rickert R , Taylor J , Zhao S , Fedorka-Cray PL , Whichard J , McDermott P . Antimicrob Agents Chemother 2012 56 (6) 3465-6 Salmonella serotype Heidelberg is the fifth most common serotype that causes human disease in the United States and appears to be more invasive than other nontyphoidal serotypes (3, 6).... |
Commentary on the history and quantitative nature of filter paper used in blood collection devices
De Jesus VR , Chace DH . Bioanalysis 2012 4 (6) 645-7 It is with great interest that we read Peter T. Kissinger’s commentary about the use of dried-blood spots (DBS) for pharmacokinetic assays and therapeutic drug monitoring (Bioanalysis 2011, 3(20), 2263–2266). We appreciate Dr. Kissinger’s efforts to stimulate debate regarding the utility of DBS in these two types of applications. However, we would like to dispel some misconceptions about DBS and their filter paper matrix that readers, unaware of their many complexities, may derive from his commentary. Our intent is to provide information supporting the use of DBS in many applications, based on 50 years of DBS use by newborn screening (NBS) laboratories in the US. |
The role of the President's Emergency Plan for AIDS Relief in infant and young child feeding guideline development and program implementation
Adler MR , Brewinski M , Heap AN , Bolu O . Adv Exp Med Biol 2012 743 247-60 The basic science and clinical research investigating the relationship between HIV and breastfeeding has provided much of the evidence base for the development of public health policies and practice guidelines aimed at preventing mother-to-child transmission (PMTCT) of HIV. Programmatically, however, translating the evidence into practice has been challenging. In 2003, President George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR) to “turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.” Through multiple US agencies, PEPFAR will have provided $63 billion between 2004 and 2013 in direct financial support and technical assistance for the implementation of HIV prevention, care, and treatment programs throughout the world. Focusing on PEPFAR’s role in infant feeding guideline modification and implementation, this chapter reviews the history of infant feeding guideline revisions based on evolving research and evaluation, highlights the successes and challenges of translating this rapidly changing evidence into practice, and concludes with a discussion of potential strategies for the adoption and implementation of 2010 WHO PMTCT and infant feeding guidelines. |
The National Perinatal Hepatitis B Prevention Program, 1994-2008
Smith EA , Jacques-Carroll L , Walker TY , Sirotkin B , Murphy TV . Pediatrics 2012 129 (4) 609-16 OBJECTIVE: To determine the trends and outcomes of the national Perinatal Hepatitis B Prevention Program (PHBPP) for infants born from 1994 to 2008. METHODS: PHBPPs in state and city public health jurisdictions annually submitted program outcome reports to the Centers for Disease Control and Prevention. The annual number of births to hepatitis B surface antigen (HBsAg)-positive women was estimated and used to evaluate the percentage of PHBPP-identified HBsAg-positive pregnant women. PHBPP reports were used to assess program objectives achieved, and infant outcomes by 12 to 24 months of age. RESULTS: From 1994 to 2008, the estimated number of annual births to HBsAg-positive women increased from 19,208 to 25,600 (P < .001). The annual number of PHBPP-managed infants increased (P < .001), comprising 40.8% to 50.5% of the estimated number. On average, 94.4% of PHBPP-managed infants received hepatitis B immunoglobulin and hepatitis B vaccine within 1 day of birth. The percentage of infants who completed the vaccine series by age 12 months decreased from 86.0% to 77.7% (P = .004), but the percentage who received postvaccination testing increased from 25.1% to 56.0% (P < .001). Incidence of chronic hepatitis B virus infection among tested infants decreased from 2.1% in 1999 to 0.8% in 2008 (P = .001). CONCLUSIONS: The PHBPP achieved substantial progress in preventing perinatal hepatitis B virus infection in the United States, despite an increasing number of at-risk infants. Significant gaps remain in identifying HBsAg-positive pregnant women, and completing management and assessment of their infants to ensure prevention of perinatal hepatitis B virus transmission. |
Early diagnosis of HIV infection in the breastfed infant
Ou CY , Fiscus S , Ellenberger D , Parekh B , Korhonen C , Nkengasong J , Bulterys M . Adv Exp Med Biol 2012 743 51-65 More than 90% of the 370,000 pediatric human immunodeficiency virus type 1 (HIV-1) infections globally in 2009 were acquired through mother-to-child transmission (MTCT) [1], and most of these transmissions occurred in sub-Saharan Africa. MTCT of HIV-1 occurs either during late pregnancy, the intrapartum period, or breastfeeding [2, 3]. With the application of prophylactic antiretroviral (ARV) therapy and breastfeeding avoidance, MTCT is now observed in only 1–2% of at-risk infants in developed countries [4, 5]. The majority of pregnant women residing in high HIV-burden, resource-limited countries (RLCs) are still not aware of their infection status and do not receive timely intervention measures to prevent vertical transmission [6–11]. Untreated infected infants have high HIV-related morbidity and mortality. Approximately 33% of the untreated infected infants in RLCs die during their first year of life, and >50% die within their first 2 years [12]. Treating infants early greatly reduces mortality and morbidity [13]. Recognition of the importance of reducing infant HIV mortality has facilitated the development of methods to bring appropriate testing closer to pregnant and lactating mothers, to identify HIV-infected infants earlier, and to provide timely access to life-saving ARV treatment and care. New and accurate diagnostic methods have emerged in the last few years, and many of these methods have been field-validated. This diagnostic service should not comprise a stand-alone program but must be integrated into the overall mother and child health programs to achieve the goal of prevention of mother-to-child transmission (PMTCT) [14, 15]. In this chapter, we review currently available diagnostic methodologies, including their advantages and disadvantages, their testing algorithms, and their quality assurance requirements, with a particular focus on early HIV diagnosis in the breastfed infant. Further, we discuss efforts toward the development of simple, accurate, and rapid diagnostic applications. |
The future of breastfeeding in the face of HIV-1 infection: science and policy
Bulterys M , Kourtis AP . Adv Exp Med Biol 2012 743 301-4 This book presents a comprehensive and detailed overview of transmission of HIV-1 to the infant via the infected mother’s breast milk. There is no question that breast milk is the ideal food for the infant—with numerous nutritional, immunologic, cognitive, and psychological benefits for the mother/infant dyad, it is a food evolutionarily designed and uniquely tailored to the needs of the developing infant. Promotion of breastfeeding is now recognized throughout the world—and especially in resource-limited settings—as one of the most critical interventions to prevent infant and young child mortality [1–4]. Derrick Jelliffe, one of the founding fathers of developing world pediatrics and child health/nutrition, aptly described the result of promotional practices of the formula industry in the 1960s and 1970s as “commerciogenic malnutrition” [5–7]. |
HIV-1 resistance to antiretroviral agents: relevance to mothers and infants in the breastfeeding setting
McConnell MS , Palumbo P . Adv Exp Med Biol 2012 743 81-8 HIV is a retrovirus whose genetic material is comprised of RNA. It is a decidedly adaptable virus with properties of high replication rates in association with an RNA copying enzyme—reverse transcriptase—which possesses a relatively high copying error rate, in the order of 1 error or mutation for every 10,000 nucleotides copied. This translates to a single mutation for every viral replication event on average in the setting of a billion viral copies produced daily in an infected individual. As such, the viral quasispecies (the pool of viral variants present at a given time) can and does adapt rapidly to environmental pressures such as the immune response or antiretroviral agents. It should not be surprising, therefore, that as antiretroviral agents have been developed and deployed, mutations in HIV genes associated with ARV resistance have rapidly been detected, underscoring the strategy of multiple agent and multiple class ARV therapy known as highly active antiretroviral therapy (HAART). |
Among children with food allergy, do sociodemographic factors and healthcare use differ by severity?
Branum AM , Simon AE , Lukacs SL . Matern Child Health J 2012 16 Suppl 1 S44-50 Among children with food allergy, we aim to describe differences in allergy severity by sociodemographic characteristics and potential differences in healthcare characteristics according to food allergy severity. Using the 2007 National Survey of Children's Health, we identified children with food allergies based on parental report (n = 4,657). Food allergic children were classified by the severity of their food allergy, as either mild (n = 2,333) or moderate/severe (n = 2,285). Using logistic regression, we estimated the odds of having moderate/severe versus mild food allergy by sociodemographic characteristics and the odds of having selected healthcare characteristics by food allergy severity. Among children with food allergy, those who were older (ages 6 through 17 years) and those who had siblings were more likely to have moderate/severe allergy compared to their younger and only-child counterparts. There were no significant differences in severity by other sociodemographic characteristics. Children with a moderate/severe food allergy were more likely to report use of an Individual Education Plan (OR = 1.88 [1.31, 2.70]) and to have seen a specialist than those with mild food allergy. Among younger children with food allergy, those with moderate/severe food allergy were more likely to require more services than is usual compared with those with mild allergy. Associations between allergy severity and health care-related variables did not differ significantly by race/ethnicity, income level, or maternal education. We report few differences in allergy severity by sociodemographic characteristics of food allergic children. In addition, we found that associations between allergy severity and use of health related services did not differ significantly by race/ethnicity or poverty status among children with food allergy. Given the importance of food allergy as an emerging public health issue, further research to confirm these findings would be useful. |
Antiretroviral drugs during breastfeeding for the prevention of postnatal transmission of HIV-1
Kourtis AP , de Vincenzi I , Jamieson DJ , Bulterys M . Adv Exp Med Biol 2012 743 173-83 The global pediatric human immunodeficiency virus (HIV) type 1 epidemic is fueled to a large extent by postnatal transmission from mother to infant through breastfeeding. As many as 90% of the estimated 430,000 new HIV infections in children less than 15 years of age in 2008 were due to mother-to-child transmission (MTCT) [1]. MTCT can occur in utero, intrapartum, or postpartum through breastfeeding; among children with known timing of infection, as much as 30–40% of MTCT of HIV-1 is attributable to breastfeeding; this proportion may be even higher in settings where effective interventions that decrease in utero and intrapartum transmission are being implemented [2–4]. |
Breastfeeding and HIV infection in China
Korhonen C , Wang L , Wang L , Fuller S , Wang F , Bulterys M . Adv Exp Med Biol 2012 743 237-45 Breast milk is the ideal food source for human infants, and breastfeeding is known to have many beneficial effects for both infants and mothers including providing proper nutrition, supporting the infant immune system, enhancing mother–infant bonding, and providing a decreased risk for maternal breast and ovarian cancer [1–5]. Longer term benefits of breastfeeding have also been observed including decreased risk of asthma and diabetes later in life [4]. However, breastfeeding carries a significant risk of transmission of HIV-1 (further referred to as HIV), especially in late stages of maternal disease [6–8]. In order to avoid transmitting HIV postnatally, women with HIV infection have been advised to avoid breastfeeding under certain conditions [9]. China has adopted a national policy of recommending replacement feeding for HIV-infected mothers where replacement feeding is acceptable, feasible, affordable, sustainable, and safe (AFASS) [10] through the national prevention of mother-to-child transmission of (PMTCT) HIV program. In 2008, 89% of the population were reported to have access to improved water sources [11], and AFASS conditions are met in most localities in China except certain remote, mountainous, and/or ethnic minority areas. |
Relationship between radiated seismic energy and explosive pressure for controlled methane and coal dust explosions in an underground mine
Murphy MM , Westman EC , Iannacchione A , Barczak TM . Tunn Undergr Space Technol 2012 28 278-286 Examination of seismic records during the time interval of the Sago Mine disaster in 2006 revealed a small amplitude signal possibly associated with an event in the mine. Although the epicenter of the signature was located in the vicinity where the explosion occurred, it could not be unequivocally attributed to the explosion. A greater understanding about the seismicity from mine explosions is required in order to properly interpret critical seismic information. A seismic monitoring system located at NIOSH’s Lake Lynn Experimental Mine has monitored 16 experimental methane and coal dust-based explosions. This paper describes the research conducted to quantify a relationship between measured values of radiated seismic energy and peak explosive pressure generated. The radiated seismic energy takes into account seismic signature characteristics such as the frequency content, amplitude, and duration. On the other hand, the size of the explosion is a function of the experimental design, dependent on factors such as the presence of an explosion-containment structure, the mine geometry, and the amount of initial explosive fuel used during the explosion. The seismic signatures from methane and coal dust explosions were analyzed using standard waveform analysis procedures. The procedures used to estimate the radiated seismic energy were conducted using self-produced programs, which are explained in this paper. The radiated seismic energy estimates were considered to be relative values for each experiment. A relationship was derived to correlate the relative radiated seismic energy to the size of the explosion, defined as the peak pressure generated. It was also observed during this study that an explosion-containment structure can act as a major seismic source. Recommendations are made, based upon the findings of this study, for improved collection of seismic data in the future. |
Usual folic acid intakes: a modelling exercise assessing changes in the amount of folic acid in foods and supplements, National Health and Nutrition Examination Survey, 2003-2008
Tinker SC , Cogswell ME , Hamner HC , Berry RJ . Public Health Nutr 2012 15 (7) 1-12 OBJECTIVE: The USA currently fortifies enriched cereal grain products (ECGP) with folic acid at 140 mcg/100 g. In addition, folic acid can be voluntarily added to ready-to-eat cereals (RTEC) up to 400 mcg/serving and it is found in many dietary supplements, most often at a dose of 400 mcg. We sought to model folic acid intake under various fortification and supplementation scenarios. DESIGN: The National Health and Nutrition Examination Survey is a population-based cross-sectional survey representative of the non-institutionalized, civilian US population. Information on folic acid intake is collected in two 24 h dietary recalls and survey questions on dietary supplement use, which allows estimation of usual total folic acid intake. We modelled five different levels of folic acid fortification in ECGP, while varying the amounts in RTEC and dietary supplements. SETTING: United States. SUBJECTS: US adults (n 14,353) aged ≥19 years; non-pregnant women of childbearing age (n 4272). RESULTS: The percentage of adults with usual daily folic acid intake above the tolerable upper intake level of 1000 mcg was influenced more by the typical amount in supplements, while the median intake was influenced more by the ECGP fortification level. By manipulating the amount in at least two sources, it was possible to shift the distribution such that more women of childbearing age consumed the recommended intake of 400 mcg of folic acid without increasing the percentage of adults with intake above the tolerable upper intake level. The results varied among population subgroups. CONCLUSIONS: Our results suggest that combined strategies are required to meet population recommendations for folic acid intake. |
Factors associated with sugar-sweetened beverage intake among United States high school students
Park S , Blanck HM , Sherry B , Brener N , O'Toole T . J Nutr 2012 142 (2) 306-12 This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks]. Nationwide, 64.9% of high school students drank SSB ≥1 time/d, 35.6% drank SSB ≥2 times/d, and 22.2% drank SSB ≥3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (≥3 times/d) were male gender [OR = 1.66 (95% CI = 1.41,1.95); P < 0.05], being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P < 0.05], eating at fast-food restaurants 1-2 d/wk or eating there ≥3 d/wk [OR = 1.25 (95% CI = 1.05, 1.50); P < 0.05 and OR = 2.94 (95% CI = 2.31, 3.75); P < 0.05, respectively] and watching television >2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P < 0.05]. Non-Hispanic other/multiracial [OR = 0.67 (95% CI = 0.47, 0.95); P < 0.05] and being physically active ≥60 min/d on <5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P < 0.05]. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations. |
Characteristics associated with health care professional diagnosis of work-related asthma among individuals who describe their asthma as being caused or made worse by workplace exposures
Knoeller GE , Mazurek JM , Moorman JE . J Occup Environ Med 2012 54 (4) 485-90 OBJECTIVE: To identify factors associated with health care professional-diagnosed work-related asthma (WRA) among adults who describe their asthma as being caused or made worse by workplace exposures (possible WRA). METHODS: We calculated prevalence ratios adjusted for age and sex using data from the 2006 to 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma and possible WRA. RESULTS: An estimated 17.6% of ever-employed adults with current asthma and possible WRA had health care professional-diagnosed WRA. Health care professional-diagnosed WRA was associated with age, income, employment status, asthma control level, asthma attack, emergency department visit, hospitalization, urgent treatment, and changing/quitting a job due to asthma. CONCLUSIONS: Among ever-employed adults with possible WRA, health care professional-diagnosed WRA is associated with poorer asthma control and frequent unscheduled health care visits. |
A provenance study of mineral matter in coal from Appalachian Basin coal mining regions and implications regarding the respirable health of underground coal workers: a geochemical and Nd isotope investigation
Schatzel SJ , Stewart BW . Int J Coal Geol 2012 94 123-136 This study presents geochemical data produced from the analysis of coal and adjacent rock samples retrieved from coal mining regions in the U.S. to examine mineral matter provenance. Study sites included the Northern Appalachian Basin, where the units of interest were the Lower Kittanning Coal bed, the overlying Columbiana Shale, and the underlying paleosol (Allegheny Formation). Additional study sites were located in the Central Appalachian Basin, where sampling was conducted on strata associated with multiple coal beds of Middle and Lower Pennsylvanian age. The Central Appalachian Basin rock and coal samples were much lower in overall mineral matter and contained very little carbonate (calcite and siderite) or pyrite mineralogy, which was common at the Northern Appalachian Basin sites. Elemental analysis of rock samples indicated a trend of enrichment in Ca, Mg, Mn, Na, and K cations in the immediate overburden compared to the underlying rock in the Central Appalachian Basin. A similar trend was observed in coal related strata from the Northern Appalachian Basin which was attributed to epigenetic marine incursions. Rare earth element (REE) concentrations were determined in the samples, and showed Eu and Ce anomalies when normalized by chondritic values. The total REE content of the overburden is generally less than that of the underlying rock units. Neodymium isotopic analysis of the Lower Kittanning coal, overburden, and paleosol from the Northern Basin indicate partial resetting of the Sm–Nd system close to the time of deposition. The data indicate a common Appalachian source for the clastic mineral matter in the overburden, underclay, and coal mineral matter. The geochemical findings of this study may provide a viable method for distinguishing respirable dust sources in both Appalachian Basins. There are potential applications for this research to aid in the respiratory health of underground coal miners. |
Combination of probenecid-sulphadoxine-pyrimethamine for intermittent preventive treatment in pregnancy
Gutman J , Kachur SP , Slutsker L , Nzila A , Mutabingwa T . Malar J 2012 11 39 The antifolate sulphadoxine-pyrimethamine (SP) has been used in the intermittent prevention of malaria in pregnancy (IPTp). SP is an ideal choice for IPTp, however, as resistance of Plasmodium falciparum to SP increases, data are accumulating that SP may no longer provide benefit in areas of high-level resistance. Probenecid was initially used as an adjunctive therapy to increase the blood concentration of penicillin; it has since been used to augment concentrations of other drugs, including antifolates. The addition of probenecid has been shown to increase the treatment efficacy of SP against malaria, suggesting that the combination of probenecid plus SP may prolong the useful lifespan of SP as an effective agent for IPTp. Here, the literature on the pharmacokinetics, adverse reactions, interactions and available data on the use of these drugs in pregnancy is reviewed, and the possible utility of an SP-probenecid combination is discussed. This article concludes by calling for further research into this potentially useful combination. |
Collaboration in state health departments on the immunization program during the H1N1 response
Redd SC , Kosmos CA . Biosecur Bioterror 2012 10 (1) 155-7 The 2009 H1N1 influenza pandemic was the longest and most intense public health response since the improvements in public health preparedness were initiated in the years after the 2001 World Trade Center and anthrax attacks. In addition to this general preparedness and response work, more focused preparations for an influenza pandemic were begun in 2005 with additional resources and focus as the H5N1 virus emerged in Asia and policymakers recognized its potential to cause a catastrophic public health emergency. These preparations undoubtedly set the stage for the work undertaken to respond to the H1N1 pandemic.1 In looking back on the H1N1 pandemic, it is vital that we work to understand what elements of our preparation were most effective and how our response might have been improved, so that we can prepare and respond more effectively in the future. The research reported in this issue of the Journal by Chamberlain and colleagues is an important contribution to what we must learn from the experiences of the H1N1 pandemic.2 The work was conducted by 1 of 9 CDC-funded Preparedness and Emergency Response Research Centers; each pursues multidisciplinary public health systems research aimed at improving the nation's public health system preparedness and response capabilities. | With the aim of improving emergency immunization efforts, the Chamberlain et al article offers insights into the perspectives of immunization program managers on work done before and during the H1N1 immunization program. Although conditions differed in states, there are at least 3 general lessons. The first is that the routine, everyday public health systems are the foundation for public health responses. The second lesson is that an effective planning process must delineate how those everyday systems will be adapted to create a unified response system, where capabilities from multiple public health areas must work together. And third, an exercise and training program is necessary to assure that the people who will be staffing the response understand and have practiced their roles as envisioned in the response plan. We briefly review these 3 lessons and what the Chamberlain et al article teaches us about the collaboration between state preparedness directors and immunization program managers. |
Highlights and conclusions from the Eastern Mediterranean Public Health Network (EMPHNET) conference 2011
Al Nsour M , Kaiser R , Elkreem EA , Walke H , Kandeel A , Bloland P . East Mediterr Health J 2012 18 (2) 189-191 As a follow up of a short communication that the Eastern Mediterranean Health Journal published in December 2011, this article reports on highlights and conclusions from scientific abstracts, methodology workshops and plenary sessions that were presented as part of the Eastern Mediterranean Public Health Network (EMPHNET) conference held from 6 to 9 December 2011 in Sharm Al Sheikh, Egypt. |
Recent advances in research on school-based extracurricular activities and adolescent development
Farb AF , Matjasko JL . Dev Rev 2012 32 (1) 1-48 Updating a previous systematic review of the literature, this review summarizes the literature over the last 5 years on the relationship between school-based extracurricular activity participation and academic achievement, substance use, sexual activity, psychological adjustment, and delinquency. The review also considers mediators and moderators of these relationships. This review also discusses recent advances in activity research including participation measurement (intensity, breadth, and duration), person-centered approaches, and an exploration of the overscheduling hypothesis. The review reveals a mixed picture of the relationship between activity participation and these adolescent developmental outcomes. A call for continued exploration into measurement issues, analysis approaches, outcome measures, and causal models of activities and adolescent functioning is made. ((PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract).) |
Health outcomes by closeness of sexual abuse perpetrator: a test of betrayal trauma theory
Edwards VJ , Freyd JJ , Dube SR , Anda RF , Felitti VJ . J Aggress Maltreat Trauma 2012 21 (2) 133-148 Betrayal trauma theory (Freyd, 1996) postulates childhood abuse perpetrated by a caregiver or someone close to the victim results in worse mental health than abuse perpetrated by a noncaregiver. Using the Adverse Childhood Experiences (ACE) data, we tested whether adults with high betrayal (HB) abuse would report poorer functional and mental health than low betrayal (LB) abuse victims. Among those participants reporting childhood sexual abuse, 32% experienced HB abuse. HB victims had a higher average ACE score than LB victims (2.72 vs. 1.87, p < .001), had significantly lower functional health scores on 4 of the 7 SF-36 Health Survey scales (all p < .04), and reported higher depression, anxiety, suicidality, panic, and anger (all p < .05). (Copyright Taylor and Francis Group, LLC 2012.) |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
- Immunity and Immunization
- Injury and Violence
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- Occupational Safety and Health - Mining
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