Sickle cell disease-related pediatric medical expenditures in the U.S.
Amendah DD , Mvundura M , Kavanagh PL , Sprinz PG , Grosse SD . Am J Prev Med 2010 38 S550-6 BACKGROUND: Although it is known that people with sickle cell disease (SCD) have relatively high utilization of medical care, most previous estimates of SCD-attributable expenditures have been limited to either inpatient care or single-state data. PURPOSE: To extend known findings by measuring the attributable or incremental expenditures per child with SCD compared to children without this illness and to thereby estimate SCD-attributable expenditures among children in the U.S. METHODS: MarketScan Medicaid and Commercial Claims databases for 2005 were used to estimate total medical expenditures of children with and without SCD. Expenditures attributable to SCD were calculated as the difference in age-adjusted mean expenditures during 2005 for children with SCD relative to children without SCD in the two databases. RESULTS: Children with SCD incurred medical expenditures that were $9369 and $13,469 higher than those of children without SCD enrolled in Medicaid and private insurance, respectively. In other words, expenditures of children with SCD were 6 and 11 times those of children without SCD enrolled in Medicaid and private insurance, respectively. CONCLUSIONS: Using a large, multistate, multipayer patient sample, SCD-attributable medical expenditures in children were conservatively and approximately estimated at $335 million in 2005. |
Venous thromboembolism: a public health concern
Beckman MG , Hooper WC , Critchley SE , Ortel TL . Am J Prev Med 2010 38 S495-501 Venous thromboembolism (VTE), defined as deep vein thrombosis, pulmonary embolism, or both, affects an estimated 300,000-600,000 individuals in the U.S. each year, causing considerable morbidity and mortality. It is a disorder that can occur in all races and ethnicities, all age groups, and both genders. With many of the known risk factors-advanced age, immobility, surgery, obesity-increasing in society, VTE is an important and growing public health problem. Recently, a marked increase has occurred in federal and national efforts to raise awareness and acknowledge the need for VTE prevention. Yet, many basic public health functions-surveillance, research, and awareness-are still needed. Learning and understanding more about the burden and causes of VTE, and raising awareness among the public and healthcare providers through a comprehensive public health approach, has enormous potential to prevent and reduce death and morbidity from deep vein thrombosis and pulmonary embolism throughout the U.S. |
Late preterm birth and risk of developing asthma
Abe K , Shapiro-Mendoza CK , Hall LR , Satten GA . J Pediatr 2010 157 (1) 74-8 OBJECTIVE: To evaluate the association between gestational age at birth (late preterm vs term) and risk for physician-diagnosed asthma. STUDY DESIGN: We conducted a retrospective cohort study using the Third National Health and Nutrition Examination Survey (1988-1994) linked natality files. The study included children age 2-83 months from singleton births, born late preterm (n = 537) or term (n = 5650). Using survival analysis, we modeled time to diagnosis of asthma; children with no asthma diagnosis were censored at the age of their survey interview. We used Cox proportional hazard regression to estimate hazard ratios and 95% confidence intervals for gestational age and asthma risk, adjusting for maternal age, maternal education, parental history of asthma/hay fever, maternal smoking history during pregnancy, race/ethnicity, and sex of the child. RESULTS: Adjusted analysis showed that physician-diagnosed asthma was modestly associated with late preterm birth (hazard ratio, 1.3; 95% confidence interval, 0.8-2.0), but this association was not statistically significant (P = .30). CONCLUSIONS: Our study found that late preterm birth was not associated with a diagnosis of asthma in early childhood. |
Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence
Ford ES , Zhao G , Li C . J Am Coll Cardiol 2010 55 (13) 1310-7 OBJECTIVES: Our objective was to estimate the magnitude of the relative risk (RR) for cardiovascular disease associated with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) from published prospective observational studies. BACKGROUND: Hyperglycemia is a known risk factor for cardiovascular disease. However, the magnitude of the RR for cardiovascular disease associated with IFG and IGT is unclear. METHODS: We searched PubMed from 1997 through 2008 for relevant publications and performed a meta-analysis. RESULTS: In 18 publications with information about IFG (110 to 125 mg/dl) (IFG 110), estimates of RR ranged from 0.65 to 2.50. The fixed-effects summary estimate of RR was 1.20 (95% confidence interval [CI]: 1.12 to 1.28). In 8 publications with information about IFG (100 to 125 mg/dl) (IFG 100), estimates of RR ranged from 0.87 to 1.40. The fixed-effects summary estimate of RR was 1.18 (95% CI: 1.09 to 1.28). In 8 publications with information about IGT, estimates of RR ranged from 0.83 to 1.34. The fixed-effects summary estimate of RR was 1.20 (95% CI: 1.07 to 1.34). Five studies combined IFG and IGT, yielding a fixed-effects summary estimate of RR of 1.10 (95% CI: 0.99 to 1.23). No significant difference between the summary estimates for men and women were detected (IFG 110: men: 1.17 [95% CI: 1.05 to 1.31], women: 1.30 [95% CI: 1.10 to 1.54]; IFG 100: men: 1.23 [95% CI: 1.06 to 1.42], women: 1.16 [95% CI: 0.99 to 1.36]). CONCLUSIONS: Impaired fasting glucose and IGT are associated with modest increases in the risk for cardiovascular disease. |
Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes
Plantinga LC , Crews DC , Coresh J , Miller ER 3rd , Saran R , Yee J , Hedgeman E , Pavkov M , Eberhardt MS , Williams DE , Powe NR . Clin J Am Soc Nephrol 2010 5 (4) 673-82 BACKGROUND AND OBJECTIVES: Prevalence of chronic kidney disease (CKD) in people with diagnosed diabetes is known to be high, but little is known about the prevalence of CKD in those with undiagnosed diabetes or prediabetes. We aimed to estimate and compare the community prevalence of CKD among people with diagnosed diabetes, undiagnosed diabetes, prediabetes, or no diabetes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The 1999 through 2006 National Health and Nutrition Examination Survey is a representative survey of the civilian, noninstitutionalized US population. Participants who were aged ≥20 years; responded to the diabetes questionnaire; and had fasting plasma glucose (FPG), serum creatinine, and urinary albumin-creatinine ratio measurements were included (N = 8188). Diabetes status was defined as follows: Diagnosed diabetes, self-reported provider diagnosis (n = 826); undiagnosed diabetes, FPG ≥126 mg/dl without self-reported diagnosis (n = 299); prediabetes, FPG ≥100 and <126 mg/dl (n = 2272); and no diabetes, FPG <100 mg/dl (n = 4791). Prevalence of CKD was defined by estimated GFR 15 to 59 ml/min per 1.73 m(2) or albumin-creatinine ratio ≥30 mg/g; adjustment was performed with multivariable logistic regression. RESULTS: Fully 39.6% of people with diagnosed and 41.7% with undiagnosed diabetes had CKD; 17.7% with prediabetes and 10.6% without diabetes had CKD. Age-, gender-, and race/ethnicity-adjusted prevalence of CKD was 32.9, 24.2, 17.1, and 11.8%, for diagnosed, undiagnosed, pre-, and no diabetes, respectively. Among those with CKD, 39.1% had undiagnosed or prediabetes. CONCLUSIONS: CKD prevalence is high among people with undiagnosed diabetes and prediabetes. These individuals might benefit from interventions aimed at preventing development and/or progression of both CKD and diabetes. |
The public health response to blood disorders
Atrash HK , Parker CS . Am J Prev Med 2010 38 S451-5 Nonmalignant blood disorders meet all criteria for qualifying, as a group, as a very important public health problem with serious morbidities affecting over 1 million Americans every year, not including an additional 8 million individuals suffering from anemia. Many of these conditions and the morbidities and mortalities associated with them are, to a large extent, preventable. Further, the changing demographic composition of the American population is sure to increase the number of individuals affected by these conditions. Yet, nonmalignant blood disorders have not been recognized as important public health priorities. Immediate action is needed to meet the increasing challenge of blood disorders in public health. We propose a national, comprehensive, organized, coordinated, institutionalized, sustainable public health response to blood disorders based on the three core functions and the ten essential services of public health. Immediate action needs to be taken to improve surveillance and monitoring, increase public and provider awareness, increase the use of evidence-based practices, and enhance epidemiologic research on the causes, prevention, and treatment of conditions resulting in adverse outcomes. |
Burden of disease resulting from hemophilia in the U.S
Siddiqi AE , Ebrahim SH , Soucie JM , Parker CS , Atrash HK . Am J Prev Med 2010 38 S482-8 BACKGROUND: Hemophilia is a hereditary bleeding disorder. Its complications can result in substantial morbidity, but few efforts have been made to quantify the disease burden. PURPOSE: The objective of this analysis was to estimate the burden of disease due to hemophilia (A and B) in the U.S., using disability-adjusted life years (DALY). METHODS: The approach taken by the WHO in its Global Burden of Disease study was followed. Assumptions were drawn from published literature, and population estimates from the U.S. Census Bureau for the Year 2007 were used. Estimations of years of life lost resulting from mortality (YLL) and years of life lost resulting from morbidity (YLD) were done separately by gender, 5-year age intervals, and severity of disease (morbidity only) with their sum representing DALYs. Disability weights were derived from the quality-of-life tool EuroQol (EQ-5D). The stability of burden estimates was tested by performing sensitivity analyses, changing one assumption at a time. RESULTS: In the U.S. in 2007, hemophilia resulted in 110,095 DALYs, composed of 13,418 YLLs and 96,677 YLDs. Large differences between men/boys (107,346) and women/girls (2749) were observed, given that females are genetic carriers of the disorder and rarely present with disease. Sensitivity analyses revealed a relatively robust estimate with a maximum variation of 4.49%. CONCLUSIONS: This first estimate of hemophilia-related DALYs in the U.S. indicates that control of hemophilia can potentially result in a gain of 1 healthy year of life for every 2700 people in the population. |
Clinical assessment of self-reported acute flaccid paralysis in a population-based setting in Guatemala
Sejvar JJ , Lindblade KA , Arvelo W , Padilla N , Pringle K , Zielinski-Gutierrez E , Farnon E , Schonberger LB , Dueger E . Am J Trop Med Hyg 2010 82 (4) 712-6 Historically, poliovirus infection has been an important cause of acute flaccid paralysis (AFP) worldwide; however, successful elimination of wild-type poliovirus in much of the world has highlighted the importance of other causes of AFP. Despite the evolving etiology, AFP surveillance in most developing countries still focuses on poliovirus detection and fails to detect many AFP cases, particularly among adults. We assessed 41 subjects self-reporting symptoms suggestive of AFP during a population-based health survey in the Department of Santa Rosa, Guatemala. Thirty-five (85%) of the suspected cases were not hospitalized. Most subjects (37) did not have features consistent with AFP or had other diagnoses explaining weakness. We identified two adults who had not received medical attention for a clinical illness consistent with Guillain-Barre syndrome, the most important cause of non-poliovirus AFP. Usual surveillance methods for AFP, particularly in developing countries, may underestimate the true burden of non-poliovirus AFP. |
Comparison of cardiovascular risk factors in five regions of Thailand: InterASIA data
Chongsuvivatwong V , Yipintsoi T , Suriyawongpaisal P , Cheepudomwit S , Aekplakorn W , Faramnuayphol P , Tatsanavivat P , Kosulwat V , Thamthitiwat S , Nuntawan C . J Med Assoc Thai 2010 93 (1) 17-26 BACKGROUND: Age- and sex- standardized mortality rate of cardiovascular disease (CVD) was high in Bangkok and central Thailand in the year 2000. This may partially be related to differences in risk factors. OBJECTIVE: To compare prevalence of CVD risk factors among regions in Thailand in the same period. MATERIAL AND METHOD: From a survey in 2000 (InterASIA) which involved 5 regions in Thailand, conventional CVD risk factors were compared multivariate-wise among regions and subsequently aligned with CVD deaths obtained within similar regions from the registry. RESULTS: Bangkok and a central province had a higher prevalence of the following: hypertension, elevated body mass index, large waist circumference, elevated lipid associated with low density lipoprotein cholesterol and diabetes mellitus. The Northeast had a higher prevalence of smoking, low values of high density lipoprotein cholesterol and high triglyceride. CONCLUSION: Definite regional differences existed of CVD risks and death in Thailand in 2000. Some of the metabolic risk factors may be more important than smoking in the link with CVD death in Thailand |
Reduction in gastroenteritis in United States children and correlation with early rotavirus vaccine uptake from national medical claims databases
Cortese MM , Tate JE , Simonsen L , Edelman L , Parashar UD . Pediatr Infect Dis J 2010 29 (6) 489-94 BACKGROUND: We sought to estimate rotavirus disease reduction among children in hospital and office settings in the 4 US regions following rotavirus vaccine introduction and to estimate vaccine uptake. METHODS: Two national third-party payer medical claims databases were used to examine the number of visits for gastroenteritis per annual nongastroenteritis visits among children aged <5 years during July 2003 to June 2008 in hospital and office settings. The gastroenteritis burden attributable to rotavirus was computed as the excess of all gastroenteritis visits during rotavirus seasons above the baseline of visits during nonrotavirus periods. Rotavirus vaccine uptake was estimated by comparing claims for rotavirus vaccine with those for diphtheria-tetanus-acellular pertussis vaccines. RESULTS: In the South, Northeast, and Midwest, the typical winter-spring gastroenteritis peak due to rotavirus was markedly dampened in 2007-2008. Compared with the mean for 3 prevaccine seasons, the excess gastroenteritis visits that occurred during the 2007-2008 rotavirus season was reduced by >90% among infants in all care settings in 3 regions and by >70% among children aged 1 to 4 years. In the West, disease reductions were lower (53%-63% reduction among hospitalized infants). At the onset of the 2007-2008 season, coverage with ≥1 rotavirus vaccine dose was an estimated 57% among infants, 17% among children aged 1 year, and 0 among those aged 2 to 4 years. CONCLUSIONS: The rotavirus burden in 2007-2008 was markedly reduced in all US regions and exceeded that explained by only direct protection of the youngest vaccinated children. |
Rubella virus genotypes in People's Republic of China between 1979 and 2007: a shift in endemic viruses during the 2001 rubella epidemic
Zhu Z , Abernathy E , Cui A , Zhang Y , Zhou S , Zhang Z , Wang C , Wang T , Ling H , Zhao C , Chen Y , He J , Sun L , Chen X , Tang J , Feng D , Wang Y , Ba Z , Fan L , Chen H , Pan Z , Zhan J , Zheng L , Gao H , Liang Y , Dai D , Icenogle J , Xu W . J Clin Microbiol 2010 48 (5) 1775-81 The incidence of rubella cases in China from 1991 to 2007 was reviewed, and the nucleotide sequences from 123 rubella viruses collected during 1999-2007 and 4 viral sequences previously reported from 1979 to 1984 were phylogenetically analyzed. Rubella vaccination was not included in national immunization programs in China before 2007. Changes in endemic viruses were compared with incidences of rubella epidemics. The results showed that rubella epidemics occur approximately every 6-8 years (1993/1994, 2001, and 2007), and a shift of disease burden to susceptible young adults was observed. The Chinese rubella sequences were categorized into 5 of the 13 rubella genotypes, 1a, 1E, 1F, 2A, and 2B; co-circulations of these different genotypes were found in China. In Anhui province, a shift in the predominant genotype from 1F and 2B to 1E coincided with the 2001 rubella epidemic. This shift may have occurred throughout China during 2001-2007. This study investigated the genotype distribution of rubella viruses in China over a 28-year period to establish an important genetic baseline in China during its pre-vaccination era. |
Likely transmission of norovirus on an airplane, October 2008
Kirking HL , Cortes J , Burrer S , Hall AJ , Cohen NJ , Lipman H , Kim C , Daly ER , Fishbein DB . Clin Infect Dis 2010 50 (9) 1216-21 BACKGROUND: On 8 October 2008, members of a tour group experienced diarrhea and vomiting throughout an airplane flight from Boston, Massachusetts, to Los Angeles, California, resulting in an emergency diversion 3 h after takeoff. An investigation was conducted to determine the cause of the outbreak, assess whether transmission occurred on the airplane, and describe risk factors for transmission. METHODS: Passengers and crew were contacted to obtain information about demographics, symptoms, locations on the airplane, and possible risk factors for transmission. Case patients were defined as passengers with vomiting or diarrhea (3 loose stools in 24 h) and were asked to submit stool samples for norovirus testing by real-time reverse-transcription polymerase chain reaction. RESULTS: Thirty-six (88%) of 41 tour group members were interviewed, and 15 (41%) met the case definition (peak date of illness onset, 8 October 2008). Of 106 passengers who were not tour group members, 85 (80%) were interviewed, and 7 (8%) met the case definition after the flight (peak date of illness onset, 10 October 2008). Multivariate logistic regression analysis showed that sitting in an aisle seat (adjusted relative risk, 11.0; 95% confidence interval, 1.4-84.9) and sitting near any tour group member (adjusted relative risk, 7.5; 95% confidence interval, 1.7-33.6) were associated with the development of illness. Norovirus genotype II was detected by reverse-transcription polymerase chain reaction in stool samples from case patients in both groups. CONCLUSIONS: Despite the short duration, transmission of norovirus likely occurred during the flight. |
Household transmission of pandemic (H1N1) 2009, San Antonio, Texas, USA, April-May 2009
Morgan OW , Parks S , Shim T , Blevins PA , Lucas PM , Sanchez R , Walea N , Loustalot F , Duffy MR , Shim MJ , Guerra S , Guerra F , Mills G , Verani J , Alsip B , Lindstrom S , Shu B , Emery S , Cohen AL , Menon M , Fry AM , Dawood F , Fonseca VP , Olsen SJ . Emerg Infect Dis 2010 16 (4) 631-7 To assess household transmission of pandemic (H1N1) 2009 in San Antonio, Texas, USA, during April 15-May 8, 2009, we investigated 77 households. The index case-patient was defined as the household member with the earliest onset date of symptoms of acute respiratory infection (ARI), influenza-like illness (ILI), or laboratory-confirmed pandemic (H1N1) 2009. Median interval between illness onset in index and secondary case-patients was 4 days (range 1-9 days); the index case-patient was likely to be < or =18 years of age (p = 0.034). The secondary attack rate was 4% for pandemic (H1N1) 2009, 9% for ILI, and 13% for ARI. The secondary attack rate was highest for children <5 years of age (8%-19%) and lowest for adults > or =50 years of age (4%-12%). Early in the outbreak, household transmission primarily occurred from children to other household members and was lower than the transmission rate for seasonal influenza. |
Crimean-Congo hemorrhagic fever in Europe: current situation calls for preparedness
Maltezou HC , Andonova L , Andraghetti R , Bouloy M , Ergonul O , Jongejan F , Kalvatchev N , Nichol S , Niedrig M , Platonov A , Thomson G , Leitmeyer K , Zeller H . Euro Surveill 2010 15 (10) 19504 During the last decade Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation, and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened. |
Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains?
Ahluwalia IB , Robinson D , Vallely L , Gieseker KE , Kabakama A . Glob Health Promot 2010 17 (1) 39-49 OBJECTIVE: To examine the remains of the Community-Based Reproductive Health Project (CBRHP) implemented by CARE-Tanzania to address high maternal mortality in two rural districts. METHODS: In early 2007, data were collected from 29 villages and used to assess sustainability of emergency transport systems, retention of village health workers (VHWs), and their potential impact on maternal health. Surveillance data from the Ministry of Health were reviewed to assess changes in prenatal and service use indicators. RESULTS: From 2001 through 2006, the CBRHP-trained VHWs have continued to provide education and referrals to women in their communities including prenatal and emergency obstetric care; six villages with emergency transport systems have continued for more than 5 years providing free or low-cost transport to health facilities. Selected maternal and infant health indicators, such as early prenatal care, identification of pregnancy-related danger signs, and data on maternal and infant outcomes, improved in the two targeted districts over time. CONCLUSIONS: The two components of CBRHP, work of VHWs and community-financing for emergency transport systems in six villages, have continued. Both of these promote maternal health and linkages with the health delivery systems. Surveillance data show changes in maternal health indicators that were targeted by the district-wide CBRHP interventions. Programs such as CBRHP, with focus on capacity-building and empowerment, can assist in mobilizing the formal and informal systems in communities, components of which may be sustained over time. |
Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households--Nyanza Province, Western Kenya, 2007
Blanton E , Ombeki S , Oluoch GO , Mwaki A , Wannemuehler K , Quick R . Am J Trop Med Hyg 2010 82 (4) 664-71 We installed drinking water and handwashing stations in 17 rural schools and trained teachers to promote water treatment and hygiene to pupils. We gave schools flocculent-disinfectant powder and hypochlorite solution for water treatment. We conducted a baseline water handling survey of pupils' parents from 17 schools and tested stored water for chlorine. We trained teachers and students about hygiene, installed water stations, and distributed instructional comic books to students. We conducted follow-up surveys and chlorine testing at 3 and 13 months. From baseline to 3-month follow-up, parental awareness of the flocculent-disinfectant increased (49-91%, P < 0.0001), awareness of hypochlorite remained high (93-92%), and household use of flocculent-disinfectant (1-7%, P < 0.0001) and hypochlorite (6-13%, P < 0.0001) increased, and were maintained after 13 months. Pupil absentee rates decreased after implementation by 26%. This school-based program resulted in pupil-to-parent knowledge transfer and significant increases in household water treatment practices that were sustained over 1 year. |
Integration of HIV testing and linkage to care by the Baltimore City Health Department
Tanner AE , Muvva R , Miazad R , Johnson S , Burnett P , Olthoff G , Jackson S , Freeman D , Ellen JM . Sex Transm Dis 2010 37 (2) 129-30 With an estimated 25% of HIV-infected persons nationwide unaware of their infection status,1 HIV testing and then connection to care is crucial care. In response to the high HIV incidence in Baltimore,2 the Baltimore City Health Department (BCHD) developed strategies to increase status awareness among HIV-infected individuals who are difficult to reach, including utilizing alternative venue testing (AVT) methods.3,4 This letter describes the outcomes of BCHD's effort to connect into care individuals identified through the enhanced and integrated HIV testing and care linkage program. | To connect people with care, BCHD first checked names of individuals testing HIV-positive in Baltimore against names in the BCHD, MD state, and clinic HIV-databases. If it was determined to be new case and/or the individual was not currently in care, the case was followed up for care linkage by health department disease intervention specialist. The possible care linkage outcomes where the individual was (1) linked to care, (2) already in care, (3) refused care, (4) out of jurisdiction, or (5) not located. Data were collected as usual practice by BCHD with the secondary data analysis approved by the Johns Hopkins School of Medicine Institutional Review Board. |
Impact of poor-quality medicines in the 'developing' world
Newton PN , Green MD , Fernandez FM . Trends Pharmacol Sci 2010 31 (3) 99-101 Since our ancestors began trading several millennia ago, counterfeit and substandard medicines have been a recurring problem, with history punctuated by crises in the supply of anti-microbials, such as fake cinchona bark in the 1600s and fake quinine in the 1800s. Unfortunately this problem persists, in particular afflicting unsuspecting patients in 'developing' countries. Poor-quality drugs are a vital (but neglected) public health problem. They contribute to a 'crevasse' between the enormous effort in therapeutic research and policy decisions and implementation of good-quality medicines. |
Recreational exposure to microcystins during algal blooms in two California lakes
Backer LC , McNeel SV , Barber T , Kirkpatrick B , Williams C , Irvin M , Zhou Y , Johnson TB , Nierenberg K , Aubel M , LePrell R , Chapman A , Foss A , Corum S , Hill VR , Kieszak SM , Cheng YS . Toxicon 2010 55 (5) 909-21 We conducted a study of recreational exposure to microcystins among 81 children and adults planning recreational activities on either of three California reservoirs, two with significant, ongoing blooms of toxin-producing cyanobacteria, including Microcystis aeruginosa (Bloom Lakes), and one without a toxin-producing algal bloom (Control Lake). We analyzed water samples for algal taxonomy, microcystin concentrations, and potential respiratory viruses (adenoviruses and enteroviruses). We measured microcystins in personal air samples, nasal swabs, and blood samples. We interviewed study participants for demographic and health symptoms information. We found highly variable microcystin concentrations in Bloom Lakes (<10 microg/L to >500 microg/L); microcystin was not detected in the Control Lake. We did not detect adenoviruses or enteroviruses in any of the lakes. Low microcystin concentrations were found in personal air samples (<0.1 ng/m(3) [limit of detection]-2.89 ng/m(3)) and nasal swabs (<0.1 ng [limit of detection]-5 ng). Microcystin concentrations in the water-soluble fraction of all plasma samples were below the limit of detection (1.0 microg/L). Our findings indicate that recreational activities in water bodies that experience toxin-producing cyanobacterial blooms can generate aerosolized cyanotoxins, making inhalation a potential route of exposure. Future studies should include collecting nasal swabs to assess upper respiratory tract deposition of toxin-containing aerosols droplets. |
Medical toxicology and public health: update on research and activities at the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry : introduction to activities at the Radiation Studies Branch
Kazzi ZN , Nemhauser JB , Ansari A , McCurley C , Whitcomb R , Miller C . J Med Toxicol 2010 6 (2) 230-3 The Radiation Studies Branch (RSB) was formed in 1989 | as part of the Division of Environmental Hazards and | Health Effects in the Centers for Disease Control and | Prevention’s National Center for Environmental Health | (NCEH) [Fig. 1]. At that time, branch staff focused | primarily on assessing the potential environmental health | effect of radiation released from Department of Energy | Nuclear Weapons Production Facilities. After the events of | September 11, 2001, however, the RSB assumed additional | responsibilities in public health preparedness. This effort is | largely directed toward preparing the nation’s public health | community, healthcare providers, and citizens for various | scenarios. These include intentional (i.e., terrorism-related) | radiological incidents, accidents involving radiation exposure, and unintentional environmental releases of radioactive materials. |
Body burdens of brominated flame retardants and other persistent organo-halogenated compounds and their descriptors in US girls
Windham GC , Pinney SM , Sjodin A , Lum R , Jones RS , Needham LL , Biro FM , Hiatt RA , Kushi LH . Environ Res 2010 110 (3) 251-7 BACKGROUND: Levels of brominated flame retardants are increasing in US populations, yet little data are available on body burdens of these and other persistent hormonally active agents (HAAs) in school-aged children. Exposures to such chemicals may affect a number of health outcomes related to development and reproductive function. OBJECTIVE: Determine the distribution of biomarkers of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), and organo-chlorinated pesticides (OCPs), such as DDT/DDE, in children, and their variation by key descriptor variables. METHODS: Ethnically diverse cohorts of girls 6-8 y old at baseline are being followed for growth and pubertal development in a multi-site, longitudinal study. Nearly 600 serum samples from the California and Ohio sites were analyzed for lipids, 35 PCB congeners, 11 PBDE congeners, and 9 OCPs. The biomarker distributions were examined and geometric means compared for selected analytes across categories of age, race, site, body mass index (BMI), parental education, maternal age at delivery, and breast feeding in adjusted models. RESULTS: Six PBDE congeners were detected among greater than 70% of samples, with BDE-47 having the highest concentration (median 42.2, range 4.9-855 ng/g lipid). Girls in California had adjusted geometric mean (GM) PBDE levels significantly higher than girls in Ohio. Furthermore, Blacks had significantly higher adjusted GMs of all six PBDE congeners than Whites, and Hispanics had intermediate values. GMs tended to be lower among more obese girls, while other variables were not strongly associated. In contrast, GMs of the six PCB congeners most frequently detected were significantly lower among Blacks and Hispanics than Whites. PCBs and the three pesticides most frequently detected were also consistently lower among girls with high BMI, who were not breast-fed, whose mothers were younger, or whose care-givers (usually parents) were less educated. Girls in California had higher GMs than in Ohio for the pesticides and most PCB congeners, but the opposite for CB-99 and -118. CONCLUSIONS: Several of these potential HAAs were detected in nearly all of these young girls, some at relatively high levels, with variation by geographic location and other demographic factors that may reflect exposure pathways. The higher PBDE levels in California likely reflect differences in fire regulation and safety codes, with potential policy implications. |
Sentinel surveillance for patients with acute hepatitis in Egypt, 2001-04
Talaat M , El-Sayed N , Kandeel A , Azab MA , Afifi S , Youssef FG , Ismael T , Hajjeh R , Mahoney FJ . East Mediterr Health J 2010 16 (2) 134-140 Viral hepatitis is a major problem in Egypt. To define the epidemiology of the disease, sentinel surveillance was established in 5 hospitals in diverse areas of the country in 2001. Data were completed for patients meeting the case definition for viral hepatitis. Of a total of 5909 patients evaluated, 4189 (70.9%) showed positive antibody markers for hepatitis. Out of those, 40.2% had evidence of hepatitis A virus (HAV) infection, 30.0% hepatitis B virus (HBV) and 29.8% hepatitis C virus (HCV) infection. This surveillance system was useful in identifying the variable endemicity of acute HAV infection in different regions and for better understanding the epidemiology of HBV and HCV infection. |
The Universal Data Collection surveillance system for rare bleeding disorders
Soucie JM , McAlister S , McClellan A , Oakley M , Su Y . Am J Prev Med 2010 38 S475-81 Since 1998, the CDC has coordinated a national public health surveillance project-the Universal Data Collection (UDC) program-on chronic, rare, inherited bleeding disorders. In this program, uniform data are gathered through a network of 130 hemophilia treatment centers (HTCs) throughout the U.S. and its territories. Initially, the program was designed to address two primary goals: (1) establishment of a blood-safety monitoring system among people with bleeding disorders, and (2) collection of a uniform set of clinical outcomes data that could be used to monitor trends in the prevalence of infectious diseases and joint complications among this population. To this end, the program has been acquiring useful longitudinal data to monitor complications of bleeding disorders. For example, with the establishment of range-of-motion measurements for joints as required data elements, a large database has been developed for studies examining risk factors for joint-disease progression. The UDC program data have been used to provide evidence for a national prevention campaign to promote the need for patients with hemophilia to establish or maintain a healthy weight to help prevent joint disease. Risk factors leading to complications such as joint infection have also been identified. The application of geographic information systems technology to UDC program data has helped identify needs for outreach and availability of blood products and sources of care. Future analyses of data collected on babies, women, and individuals with rarer bleeding disorders than hemophilia will provide further information, leading to improved public health prevention strategies. |
Mortality rate and confidence interval estimation in humanitarian emergencies
Sullivan K , Hossain SM , Woodruff BA . Disasters 2010 34 (1) 164-75 Surveys are conducted frequently in humanitarian emergencies to assess the health status of the population. Most often, they employ complex sample designs, such as cluster sampling. Mortality is an indicator commonly estimated in such surveys. Confidence limits provide information on the precision of the estimate and it is important to ensure that confidence limits for a mortality rate account for the survey design and utilise an acceptable methodology. This paper describes the calculation of confidence limits for mortality rates from surveys using complex sampling designs and a variety of software programmes and methods. It contains an example that makes use of the SAS, SPSS, and Epi Info software programmes. Of the three confidence interval methods examined--the ratio command approach, the modified rate approach, and the modified proportion approach--the paper recommends the ratio command approach to estimate mortality rates with confidence limits. |
Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006
Cowie CC , Rust KF , Byrd-Holt DD , Gregg EW , Ford ES , Geiss LS , Bainbridge KE , Fradkin JE . Diabetes Care 2010 33 (3) 562-8 OBJECTIVE: We examined prevalences of previously diagnosed diabetes and undiagnosed diabetes and high risk for diabetes using recently suggested A1C criteria in the U.S. during 2003-2006. We compared these prevalences to those in earlier surveys and those using glucose criteria. RESEARCH DESIGN AND METHODS: In 2003-2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged > or =12 years. Participants were classified on glycemic status by interview for diagnosed diabetes and by A1C, fasting, and 2-h glucose challenge values measured in subsamples. RESULTS: Using A1C criteria, the crude prevalence of total diabetes in adults aged > or =20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C > or =6.5%). Another 3.5% of adults (7.4 million) were at high risk for diabetes (A1C 6.0 to <6.5%). Prevalences were disproportionately high in the elderly. Age-/sex-standardized prevalence was more than two times higher in non-Hispanic blacks and Mexican Americans versus non-Hispanic whites for diagnosed, undiagnosed, and total diabetes (P < 0.003); standardized prevalence at high risk for diabetes was more than two times higher in non-Hispanic blacks versus non-Hispanic whites and Mexican Americans (P < 0.00001). Since 1988-1994, diagnosed diabetes generally increased, while the percent of diabetes that was undiagnosed and the percent at high risk of diabetes generally decreased. Using A1C criteria, prevalences of undiagnosed diabetes and high risk of diabetes were one-third that and one-tenth that, respectively, using glucose criteria. CONCLUSIONS: Although A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected. |
Emergency department visits made by patients with sickle cell disease: a descriptive study, 1999-2007
Yusuf HR , Atrash HK , Grosse SD , Parker CS , Grant AM . Am J Prev Med 2010 38 S536-41 BACKGROUND: Patients with sickle cell disease (SCD) often use emergency department services to obtain medical care. Limited information is available about emergency department use among patients with SCD. PURPOSE: This study assessed characteristics of emergency department visits made nationally by patients with SCD. METHODS: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 1999-2007 were analyzed. The NHAMCS is a survey of hospital emergency department and outpatient visits. Emergency department visits by patients with SCD were identified using ICD-9-CM codes, and nationally weighted estimates were calculated. RESULTS: On average, approximately 197,333 emergency department visits were estimated to have occurred each year between 1999 and 2007 with SCD as one of the diagnoses listed. The expected source of payment was private insurance for 14%, Medicaid/State Children's Health Insurance Program for 58%, Medicare for 14%, and other/unknown for 15%. Approximately 29% of visits resulted in hospital admission; this was 37% among patients aged 0-19 years, and 26% among patients aged ≥20 years. The episode of care was indicated as a follow-up visit for 23% of the visits. Patient-cited reasons for the emergency department visit included chest pain (11%); other pain or unspecified pain (67%); fever/infection (6%); and shortness of breath/breathing problem/cough (5%), among other reasons. CONCLUSIONS: Substantial numbers of emergency department visits occur among people with SCD. The most common reason for the emergency department visits is pain symptoms. The findings of this study can help to improve health services delivery and utilization among patients with SCD. |
Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification codes for reporting methicillin-resistant staphylococcus aureus infections at a hospital in Illinois
Schaefer MK , Ellingson K , Conover C , Genisca AE , Currie D , Esposito T , Panttila L , Ruestow P , Martin K , Cronin D , Costello M , Sokalski S , Fridkin S , Srinivasan A . Infect Control Hosp Epidemiol 2010 31 (5) 463-8 BACKGROUND: States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA). OBJECTIVE: To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting. METHODS: We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections. RESULTS: We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed ([Formula: see text]). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections ([Formula: see text]). CONCLUSIONS: Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections. |
The impact of differences in methodology and population characteristics on the prevalence of hypertension in US adults in 1976-1980 and 1999-2002
Wright JD , Stevens J , Poole C , Flegal KM , Suchindran C . Am J Hypertens 2010 23 (6) 620-6 BACKGROUND: Results from the National Health and Nutrition Examination Survey (NHANES) indicate that hypertension prevalence declined by 9% points from 34% in 1976-1980 to 25% in 1999-2002 in adults 20-74 years. The purpose of this study was to estimate the impact on hypertension prevalence of measurement error and selected risk factors. METHODS: Using cross-sectional survey data from NHANES, we estimated the effect on hypertension of incorrect blood pressure (BP) cuff size and zero end-digit preference and the effect of changes in the distribution of age, body mass index (BMI), sex, race-ethnicity, smoking, and education. The analytic sample of persons 20-74 years consisted of 11,563 from 1976-1980 and 7,901 from 1999-2002 NHANES. Covariate-adjusted prevalences were calculated using log-linear regression models to produce predictive margins. RESULTS: After adjustment to age, BMI, sex, race-ethnicity, smoking, and education, the prevalence difference became higher, changing from -9% (95% confidence interval (CI): -11, -6) to -14% (95 CI: -17, -11). After adjustment to these risk factors and correction for measurement error the prevalence difference was -9% (95 CI: -11, -6). CONCLUSIONS: Measurement error, mainly from cuff size differences, inflated the temporal decline in hypertension prevalence. The results indicate that age, sex, race-ethnicity, smoking, or education did not fully explain the lower prevalence of measured hypertension in all BMI groups and suggest that a change in some unmeasured factor or factors contributed to the decline.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.40. |
Incidence of respiratory pathogens in persons hospitalized with pneumonia in two provinces in Thailand
Olsen SJ , Thamthitiwat S , Chantra S , Chittaganpitch M , Fry AM , Simmerman JM , Baggett HC , Peret TC , Erdman D , Benson R , Talkington D , Thacker L , Tondella ML , Winchell J , Fields B , Nicholson WL , Maloney S , Peruski LF , Ungchusak K , Sawanpanyalert P , Dowell SF . Epidemiol Infect 2010 138 (12) 1-12 Although pneumonia is a leading cause of death from infectious disease worldwide, comprehensive information about its causes and incidence in low- and middle-income countries is lacking. Active surveillance of hospitalized patients with pneumonia is ongoing in Thailand. Consenting patients are tested for seven bacterial and 14 viral respiratory pathogens by PCR and viral culture on nasopharyngeal swab specimens, serology on acute/convalescent sera, sputum smears and antigen detection tests on urine. Between September 2003 and December 2005, there were 1730 episodes of radiographically confirmed pneumonia (34.6% in children aged <5 years); 66 patients (3.8%) died. A recognized pathogen was identified in 42.5% of episodes. Respiratory syncytial virus (RSV) infection was associated with 16.7% of all pneumonias, 41.2% in children. The viral pathogen with the highest incidence in children aged <5 years was RSV (417.1/100 000 per year) and in persons aged 50 years, influenza virus A (38.8/100 000 per year). These data can help guide health policy towards effective prevention strategies. |
Administrative data sets and health services research on hemoglobinopathies: a review of the literature
Grosse SD , Boulet SL , Amendah DD , Oyeku SO . Am J Prev Med 2010 38 S557-67 CONTEXT: Large administrative healthcare data sets are an important source of data for health services research on sickle cell disease (SCD) and thalassemia. This paper identifies and describes major U.S. healthcare administrative databases and their use in published health services research on hemoglobinopathies. EVIDENCE ACQUISITION: Publications that used U.S. administrative healthcare data sets to assess healthcare use or expenditures were identified through PubMed searches using key words for SCD and either costs, expenditures, or hospital discharges; no additional articles were identified by using thalassemia as a key word. Additional articles were identified through manual searches of related articles or reference lists. EVIDENCE SYNTHESIS: A total of 26 original health services research articles were identified. The types of administrative data used for health services research on hemoglobinopathies included federal- and state-specific hospital discharge data sets and public and private health insurance claims databases. Gaps in recent health services research on hemoglobin disorders included a paucity of research related to thalassemia, few studies of adults with hemoglobinopathies, and few studies focusing on emergency department or outpatient clinic use. CONCLUSIONS: Administrative data sets provide a unique means to study healthcare use among people with SCD or thalassemia because of the ability to examine large sample sizes at fairly low cost, resulting in greater generalizability than is the case with clinic-based data. Limitations of administrative data in general include potential misclassification, under-reporting, and lack of sociodemographic information. |
A community-based study of factors associated with continuing transmission of lymphatic filariasis in Leogane, Haiti
Boyd A , Won KY , McClintock SK , Donovan CV , Laney SJ , Williams SA , Pilotte N , Streit TG , Beau de Rochars MV , Lammie PJ . PLoS Negl Trop Dis 2010 4 (3) e640 Seven rounds of mass drug administration (MDA) have been administered in Leogane, Haiti, an area hyperendemic for lymphatic filariasis (LF). Sentinel site surveys showed that the prevalence of microfilaremia was reduced to <1% from levels as high as 15.5%, suggesting that transmission had been reduced. A separate 30-cluster survey of 2- to 4-year-old children was conducted to determine if MDA interrupted transmission. Antigen and antifilarial antibody prevalence were 14.3% and 19.7%, respectively. Follow-up surveys were done in 6 villages, including those selected for the cluster survey, to assess risk factors related to continued LF transmission and to pinpoint hotspots of transmission. One hundred houses were mapped in each village using GPS-enabled PDAs, and then 30 houses and 10 alternates were chosen for testing. All individuals in selected houses were asked to participate in a short survey about participation in MDA, history of residence in Leogane and general knowledge of LF. Survey teams returned to the houses at night to collect blood for antigen testing, microfilaremia and Bm14 antibody testing and collected mosquitoes from these communities in parallel. Antigen prevalence was highly variable among the 6 villages, with the highest being 38.2% (Dampus) and the lowest being 2.9% (Corail Lemaire); overall antigen prevalence was 18.5%. Initial cluster surveys of 2- to 4-year-old children were not related to community antigen prevalence. Nearest neighbor analysis found evidence of clustering of infection suggesting that LF infection was focal in distribution. Antigen prevalence among individuals who were systematically noncompliant with the MDAs, i.e. they had never participated, was significantly higher than among compliant individuals (p<0.05). A logistic regression model found that of the factors examined for association with infection, only noncompliance was significantly associated with infection. Thus, continuing transmission of LF seems to be linked to rates of systematic noncompliance. |
Gene polymorphisms in association with emerging cardiovascular risk markers in adult women.
Fan AZ , Yesupriya A , Chang MH , House M , Fang J , Ned R , Hayes D , Dowling NF , Mokdad AH . BMC Med Genet 2010 11 6 BACKGROUND: Evidence on the associations of emerging cardiovascular disease risk factors/markers with genes may help identify intermediate pathways of disease susceptibility in the general population. This population-based study is aimed to determine the presence of associations between a wide array of genetic variants and emerging cardiovascular risk markers among adult US women. METHODS: The current analysis was performed among the National Health and Nutrition Examination Survey (NHANES) III phase 2 samples of adult women aged 17 years and older (sample size n = 3409). Fourteen candidate genes within ADRB2, ADRB3, CAT, CRP, F2, F5, FGB, ITGB3, MTHFR, NOS3, PON1, PPARG, TLR4, and TNF were examined for associations with emerging cardiovascular risk markers such as serum C-reactive protein, homocysteine, uric acid, and plasma fibrinogen. Linear regression models were performed using SAS-callable SUDAAN 9.0. The covariates included age, race/ethnicity, education, menopausal status, female hormone use, aspirin use, and lifestyle factors. RESULTS: In covariate-adjusted models, serum C-reactive protein concentrations were significantly (P value controlling for false-discovery rate < or = 0.05) associated with polymorphisms in CRP (rs3093058, rs1205), MTHFR (rs1801131), and ADRB3 (rs4994). Serum homocysteine levels were significantly associated with MTHFR (rs1801133). CONCLUSION: The significant associations between certain gene variants with concentration variations in serum C-reactive protein and homocysteine among adult women need to be confirmed in further genetic association studies. |
Complications associated with carrier status among people with blood disorders: a commentary
Hooper WC , Miller CH , Key NS . Am J Prev Med 2010 38 S456-8 Advances in human genomics, such as the completion of the human genome project, have sparked the development of new technologies and have enhanced our understanding of the molecular basis of disease. One important consequence of the genomic revolution has been an explosion in the number of genetic tests available to the public that promise to provide information on risk and/or susceptibility to disease. The potential for genomics and genetic testing to be part of a public health toolkit has launched the new field of public health genomics.1, 2, 3 As described by Gwinn et al.,3 an opportunity now exists to initiate a translational program integrating genomics into policies and programs to benefit the public at large. | Genetic testing at the population level remains an issue of significant debate in public health genomics today. As newborn screening has long been an integral part of public health practice, much of the discussion in the field of public heath related to genetic testing has been driven by lessons learned from and questions related to newborn screening policies and programs.3, 4 An early success and lesson learned was that these programs contributed to significant reduction of mortality and morbidity from genetic disorders in children. Now that large-scale genetic testing is technologically possible, the number of molecular tests that could be potentially incorporated into newborn screening with the hope of a broader impact has significantly increased.2 Because of this array of available tests, there was little agreement initially among the states in the U.S on which tests to include3; now, with agreement among all states to use the same newborn testing panel, this impact can soon be evaluated.4 |
Television watching and incident diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study
Ford ES , Schulze MB , Kröger J , Pischon T , Bergmann MM , Boeing H . J Diabetes 2010 2 (1) 23-27 BACKGROUND: The aim of the present study was to examine whether the amount of time spent watching television is a potential risk factor for incident diabetes and to what extent this association may be explained by obesity. METHODS: We used data for 23 855 men and women from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. During an average of 7.8 years of follow-up, 927 participants developed diabetes. Incident diabetes was identified on the basis of self-report and was verified by contacting the patient's attending physician. The amount of time spent watching television was self-reported. RESULTS: The mean time that the participants who developed diabetes watched television was 2.4 h/week, compared with 2.0 h/week for those who did not develop diabetes (P<0.001). After adjusting for age, sex, educational status, smoking status, alcohol use, occupational activity, physical activity, the intake of various foods, and systolic blood pressure, the adjusted hazard ratio for diabetes among participants who watched ≥4 h/day of television compared with those who watched <1 h/day was 1.63 [95% confidence interval (CI): 1.17-2.27]. After additional adjustment for waist circumference and body mass index, the hazard ratio was reduced to 1.14 (95% CI: 0.81-1.61). CONCLUSIONS: In the present study, the amount of time spent watching television was an independent predictor of incident diabetes only in models that adjusted for sociodemographic characteristics, lifestyle behaviors, and systolic blood pressure. The attenuation of the association after adjusting for anthropometric measures may represent an explanatory mechanism for our findings. |
Perceived control over condom use among sex workers in Madagascar: a cohort study
Pettifor A , Turner AN , Swezey T , Khan M , Raharinivo MS , Randrianasolo B , Penman-Aguilar A , Van Damme K , Jamieson DJ , Behets F . BMC Womens Health 2010 10 4 BACKGROUND: Women's perceived control over condom use has been found to be an important determinant of actual condom use in some studies. However, many existing analyses used cross-sectional data and little quantitative information exists to characterize the relationships between perceived control and actual condom use among sex worker populations. METHODS: We assessed the association between measures of perceived condom use control and self-reported use of male condoms employing data from a longitudinal pilot study among 192 sex workers in Madagascar. RESULTS: In multivariable models, a lack of perceived control over condom use with a main partner and having a main partner ever refuse to use a condom when asked were both associated with an increased number of sex acts unprotected by condoms in the past week with a main partner (RR 1.86; 95% CI 1.21-2.85; RR 1.34; 95% CI 1.03-1.73, respectively). Conversely, no measure of condom use control was significantly associated with condom use with clients. CONCLUSION: Perceived control over condom use was an important determinant of condom use with main partners, but not clients, among sex workers in Madagascar. Programs working with sex workers should reach out to main and commercial partners of sex workers to increase male condom use. |
Intimate partner violence and other partner-related factors: correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women
Seth P , Raiford JL , Robinson LS , Wingood GM , Diclemente RJ . Sex Health 2010 7 (1) 25-30 BACKGROUND: Intimate partner violence and other partner-related factors have been associated with acquiring sexually transmissible infections (STIs) and engaging in risky sexual behaviour. The present study examined partner-related risk factors for STIs and risky sexual behaviours among an urban sample of African American women. METHODS: African American women, between 18 and 29 years (n = 848), participated in the study at baseline. Participants completed a 40-min Audio Computer Assisted Survey Interview assessing sociodemographics, partner-related factors and HIV/STI-associated sexual risk behaviours. Subsequently, participants provided two vaginal swab specimens for STIs. RESULTS: The findings indicated that risky sexual behaviours and STIs were prevalent in this sample: 35.6% reported a risky sexual partner, 65.4% reported inconsistent condom use and 17% tested positive for a laboratory-confirmed STI. Women reporting a history of intimate partner violence were more likely to report risky sexual partners (adjusted odds ratio (AOR) = 2.00; 95% confidence interval (CI) = 1.5-2.8), inconsistent condom use (AOR = 1.60; 95% CI = 1.1-2.3) and test positive for an STI (AOR = 1.46; 95% CI = 0.99-2.1). Women reporting high partner-related barriers to condom use were more likely to report risky sexual partners (AOR = 1.69; 95% CI = 1.2-2.3), inconsistent condom use (AOR = 2.13; 95% CI = 1.5-3.0) and test positive for an STI (AOR = 1.98; 95% CI = 1.3-3.0). Finally, women with older partners were more likely to report risky sexual partners (AOR = 1.53; 95% CI = 1.1-2.1) and test positive for an STI (AOR = 1.46; 95% CI = 1.0-2.2). CONCLUSIONS: This study examines partner-related risk factors for STIs and risky sexual behaviours among African American women. These findings underscore the need for combined intimate partner violence and HIV/STI prevention programs for this disproportionately affected high-risk group. |
Connectedness as a predictor of sexual and reproductive health outcomes for youth
Markham CM , Lormand D , Gloppen KM , Peskin MF , Flores B , Low B , House LD . J Adolesc Health 2010 46 S23-41 To review research examining the influence of "connectedness" on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985-2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of >or=100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent-adolescent general communication (16 studies), parent-adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent-adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent overcontrol sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people's pro-social relationships are a promising target for approaches to promote ASRH. Further study regarding specific sub-constructs as well as their combined influence is needed. |
Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures
Gutelius B , Perz JF , Parker MM , Hallack R , Stricof R , Clement EJ , Lin Y , Xia GL , Punsalang A , Eramo A , Layton M , Balter S . Gastroenterology 2010 139 (1) 163-70 BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted during administration of intravenous anesthesia when medication vials are used for multiple patients using incorrect technique. We investigated an outbreak of acute HBV and HCV infections among patients who received anesthesia during endoscopy procedures from the same anesthesiologist (Anesthesiologist 1), in two different gastroenterology clinics. METHODS: Chart reviews, patient interviews, clinic site visits and infection control assessments, and molecular sequencing of patient isolates were performed. Patients treated by Anesthesiologist 1 on specific procedure days were offered testing for bloodborne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed. RESULTS: Six cases of outbreak-associated HCV infection and six cases of outbreak-associated HBV infection were identified in Clinic 1. One outbreak-associated HCV infection was identified in Clinic 2. HCV quasispecies sequences from the patients were nearly identical (96.9%-100%) to those from source patients with chronic viral hepatitis. All affected patients in both clinics received propofol from Anesthesiologist 1, who inappropriately used a single-use vial of propofol for multiple patients. Reuse of syringes to re-dose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission. CONCLUSIONS: Twelve persons acquired HBV and HCV infections (six hepatitis C, five hepatitis B, and one coinfection) in two separate offices as a result of receiving anesthesia from Anesthesiologist 1. Gastroenterologists are urged to carefully review the injection, medication handling and other infection control practices of all staff under their supervision, including anesthesia services. |
Assessing emerging infectious threats to blood safety for the blood disorders community
Trimble SR , Parker CS , Grant AM , Soucie JM , Reyes N . Am J Prev Med 2010 38 S468-74 Technologic advances in diagnostic testing, vaccinations, pathogen inactivation, and vigilant donor screening have greatly reduced the risk of transmitting pathogens through blood transfusion. Nevertheless, transfusion-related infections and fatalities continue to be reported, and emerging pathogens continue to become an increasing threat to the blood supply. This threat is even greater to patients with blood disorders, who are heavily transfused and rely on safe blood products. This article describes some of the emerging and re-emerging transfusion-transmitted pathogens that have increased in incidence in the U.S. in recent years. Peer-reviewed articles and agency websites were the sources of information. The article focuses on the treatment of hereditary blood disorders including hemophilia and thalassemia, and hereditary bone marrow failure. A coordinated approach to addressing blood safety and continued development of sensitive diagnostic testing are necessary to reduce risk in an increasingly globalized society. |
Catheter-related polymicrobial bloodstream infections among pediatric bone marrow transplant outpatients-Atlanta, Georgia, 2007
Wiersma P , Schillie S , Keyserling H , Watson JR , De A , Banerjee SN , Drenzek CL , Arnold KE , Shivers C , Kendrick L , Ryan LG , Jensen B , Noble-Wang J , Srinivasan A . Infect Control Hosp Epidemiol 2010 31 (5) 522-7 OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital. METHODS: All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression. RESULTS: Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-infinity), catheter access (OR, 13.7 [95% CI, 1.8-infinity]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care. CONCLUSION: We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges. |
Incremental effectiveness of second dose varicella vaccination for outbreak control at an elementary school in Philadelphia, Pennsylvania, 2006
Nguyen MD , Perella D , Watson B , Marin M , Renwick M , Spain CV . Pediatr Infect Dis J 2010 29 (8) 685-9 BACKGROUND: In 2006, the Philadelphia Department of Public Health conducted an investigation of a varicella outbreak at an elementary school in which second-dose vaccination for outbreak control (VOC) was implemented. We evaluated the effectiveness of this intervention. METHODS: Self-administered questionnaires collected varicella disease and vaccination information. Students eligible for second-dose VOC were 1-dose vaccine recipients without prior varicella disease. A breakthrough varicella case was defined as a maculopapulovesicular rash in a student with onset >42 days after 1-dose vaccination without other apparent cause. Vaccine effectiveness was evaluated using survival analysis techniques and analyzed by vaccine status (first dose versus second dose). Multivariable Cox proportional hazard models were used to identify statistical interactions and adjust for confounders. RESULTS: The questionnaire response rate was 92% (342/370). Of the 286 eligible students, 187 (65%) received a second-dose VOC. The crude attack rate was 9/187 (5%) among second-dose VOC recipients; 43/99 (43%) among 1-dose recipients, and 5/6 (83%) among unvaccinated students. Second-dose VOC recipients had milder rashes, compared with 1-dose or unvaccinated students. The adjusted incremental second-dose vaccine effectiveness was 76% (95% confidence interval: 44%-90%) for students with classroom exposure. Incremental effectiveness was similar (79%) when we extended the immune response time from 4 days to 7 days after second-dose VOC. CONCLUSIONS: Second-dose VOC resulted in a substantial reduction in varicella incidence for students with classroom exposure. Until high rates of routine second-dose vaccine coverage are achieved, clinicians should consider second-dose VOC an appropriate intervention to reduce disease transmission in institution-based outbreaks. |
Alcohol-associated injury visits to emergency departments in Pasto, Colombia in 2006
Espitia-Hardeman V , Hungerford D , Hill HA , Betancourt CE , Villareal AN , Caycedo LD , Portillo C . Int J Inj Contr Saf Promot 2010 17 (2) 1-5 According to the Pan American Health Organization (PAHO), alcohol is the most important risk to health in low- and middle-income countries in the Americas and the second in developed countries (Monteiro, 1993). Despite regional variation, alcohol consumption in the Americas averaged more than 50% higher than worldwide consumption (Rehm & Monteiro, Citation2005). The biggest problem is not alcoholism, but excessive consumption by people who drink socially. | In Colombia, the relationship between alcohol use and injuries has not been well studied. In a national survey (Republica de Colombia, Ministerio del Interior y de Justicia. Direccion Nacional de Estupefacientes. Estudio Nacional sobre Consumo de Sustancias Sicoactivas. Departamento Nacional de Estupefacientes, Citation1996), 59.8% of respondents consumed alcohol in the previous year and 35% in the last month. The Forensic Medicine Institute, which tests blood alcohol concentration (BAC) identified excessive consumption as a precipitating factor for child maltreatment, and intimate partner violence (Forensis, Datos para la Vida. Instituto Nacional de Medicina Legal y Ciencias Forenses, Citation2006). In 2006, 13% of homicides and 17% of road traffic-related deaths had a positive BAC (C.E. Betancourt, S. Morales, & K. Balvuena, personal communication, September 2008). The Road Traffic Prevention Foundation reported that alcohol consumption was also an important cause of pedestrian injuries (Fondo de Prevención Vial – Fonvial, Citation2005). |
Nocardia niwae sp. nov., isolated from human pulmonary sources.
Moser BD , Klenk HP , Schumann P , Potter G , Lasker BA , Steigerwalt AG , Hinrikson HP , Brown JM . Int J Syst Evol Microbiol 2010 61 438-442 Members of the genus Nocardia are responsible for cutaneous, pulmonary and disseminated human infections. From 2003 to 2008, four nocardioform strains (W8027, W8681, W9071, W9241T) were isolated from persons in the state of Florida, USA. Ribosomal gene sequencing analysis suggested that a novel Nocardia species had been isolated. These strains underwent polyphasic taxonomic analysis. Phenotypic analyses included morphologic examination, biochemical profiling and antimicrobial susceptibility testing. Molecular studies included 16S rRNA and DNA gyrase B subunit (gyrB) gene sequence analyses and DNA-DNA hybridization. Phylogenetic neighbours were determined through 16S rRNA and gyrB gene sequence analyses. Differential phenotypic characteristics of the novel Nocardia species compared to phylogenetically related species were growth at 45C and 3 out of 4 novel strains utilized L-rhamnose. The antimicrobial profiles could not reliably distinguish the novel species from related nocardiae. Analysis showed that the 16S rRNA gene sequences of the four novel isolates were identical. The BLAST analysis of the near full length 16S rRNA gene showed 99.2 % sequence similarity to N. araoensis DSM 44729T, N. arthritidis DSM 44731T and N. beijingensis JCM 10666 T, 98.7 % to N. amamiensis DSM 45066T, 98.2 % to N. pneumoniae JCM 12119T and 97.8 % to N. takedensis JCM 13313T; the analysis of partial gyrB gene sequences showed 95.4 % similarity to N. arthritidis DSM 44731T, 95.3 % to N. gamkensis DSM 44956T, 94.4 % to N. pneumoniae JCM 12119T, 93.8 % to asiatica DSM44668T, 93.5 % to N. amamiensis DSM 45066T, 93.4 % to N. beijingensis JCM 10666 T and 93.2 % to N. araoensis DSM 44729T. The DNA-DNA hybridization percentages among the four novel strains were 86-89 %; the hybridization percentages of W9241T compared to N. beijingensis JCM 10666T was 47 %, to N. araoensis DSM 44729T was 46 %, to N. arthritidis DSM 44731T was 44 %, to N. amamiensis DSM 45066T was 32 % and to N. asiatica DSM 44668T was 20 %. The results of our polyphasic taxonomic analysis suggested that a novel species of Nocardia was identified for which we propose the name Nocardia niwae sp. nov. The type strain is W9241T ( = DSM 45340T = CCUG 57756T). |
Structure and receptor binding properties of a pandemic H1N1 virus hemagglutinin
Yang H , Carney P , Stevens J . PLoS Curr 2010 2 RRN1152 The 3D-structure of the major surface viral antigen from the recent H1N1 pandemic influenza virus (A/Darwin/2001/2009) was determined to 2.8 A resolution. The structure was used to analyze changes in the HA that have emerged during the first 11 months of the pandemic and have raised public health concerns. Receptor binding properties of this protein reveals a strict preference for human-type receptors. |
Subpopulations of Francisella tularensis ssp. tularensis and holarctica: identification and associated epidemiology
Petersen JM , Molins CR . Future Microbiol 2010 5 (4) 649-61 Tularemia is primarily caused by two subspecies of Francisella tularensis worldwide, ssp. tularensis (type A) and ssp. holarctica (type B), which were originally delineated by phenotypic differences. Application of molecular typing methods to investigate population structure of F. tularensis has confirmed that catagorizing the two subspecies via phenotypic characteristics corresponds with genotypic differentiation. In addition, genotyping methods have demonstrated that both subspecies, type A and type B, can be further distinguished into subpopulations and, in some cases, biological relevance has been ascribed to these identified subpopulations. Genetic variation among both type A and type B subpopulations has been shown to correlate with differences in geographic distribution and has also been coupled to distinct ecological niches, animal hosts and replication foci. Among type A subpopulations, strain variation is linked to differing clinical manifestations in humans and virulence in mice. This article will highlight our current understanding of F. tularensis subpopulations, including methods for their detection, their observed epidemiologic differences, implications for public health and basic research programs, as well as future challenges yet to be solved. |
Methodology for collecting, storing, and analyzing human milk for volatile organic compounds
Blount BC , McElprang DO , Chambers DM , Waterhouse MG , Squibb KS , Lakind JS . J Environ Monit 2010 12 (6) 1265-73 Biomonitoring, or the measurement of environmental chemicals in human tissues and fluids, is used to supplement-and in some cases replace-more traditional exposure assessments which measure chemicals in environmental media. Volatile organic compounds (VOCs) in physiological fluids are biomarkers of exposure that present numerous challenges for sample collection and analysis. To date, a thorough evaluation of methods for collection and analysis of breast milk samples for volatiles has not been conducted. In this paper, we describe the development and validation of methods for collecting, storing, and analyzing 36 volatile organic compounds (VOCs) in breast milk to assess VOC exposure of lactating women and nursing infants. Volatile analyte loss was minimized by collecting and storing samples in containers with small headspace volume resulting in recovery ≥70% for all 10 VOCs detected in most breast milk samples. Potential contamination by chloroform, benzene, toluene, ethylbenzene, xylenes, and methyl-tert-butyl ether was minimized by using specially treated sample collection materials. Method detection limits in the low parts per trillion range were achieved by using solid-phase microextraction headspace sampling, gas chromatography, and selective ion monitoring mass spectrometry. We used this method to analyze 3 mL aliquots of breast milk collected from 12 women and found that 10 of the 36 VOCs were detectable in most samples (median values follow): m/p-xylene, 0.539 ng mL(-1); toluene, 0.464 ng mL(-1); 1,4-dichlorobenzene, 0.170 ng mL(-1); tetrachloroethylene, 0.165 ng mL(-1); o-xylene, 0.159 ng mL(-1); ethylbenzene, 0.0149 ng mL(-1); styrene, 0.129 ng mL(-1); benzene, 0.080 ng mL(-1); chloroform, 0.030 ng mL(-1); and methyl-tert-butyl ether, 0.016 ng mL(-1). |
Effect of serum and surface characteristics on Candida albicans biofilm formation
Frade JP , Arthington-Skaggs BA . Mycoses 2010 54 (4) e154-62 Candida spp. biofilms can be established on a wide range of materials, including implanted medical devices, and can display a resistant phenotype to antifungal drugs. Several factors, including host and surface properties, may influence the establishment and the development of Candida albicans biofilms on biotic and abiotic surfaces. We therefore selected a collection of C. albicans clinical isolates to evaluate the effect of surface and serum on biofilm attachment and development. Disc coupons from the CDC biofilm reactor were used in a well plate assay to study biofilm production on six different surfaces with or without the addition of serum: polycarbonate, polystyrene, stainless steel, Teflon, polyvinyl chloride or hydroxyapatite. Our results showed that serum increases in vitro C. albicans biofilm formation on a wide range of distinct surfaces including metallic and non-metallic materials, and that roughness and hydrophobicity can modulate C. albicans biofilm formation. These findings were also confirmed by scanning electron microscopy and it revealed the deposition of extracellular material on hyphae attached to a solid surface. Interestingly, adhesion can be significantly increased in the early stages of colonisation when serum is provided as a conditioning film in a surface-dependent manner. |
Genetic polymorphisms of Echinococcus tapeworms in China as determined by mitochondrial and nuclear DNA sequences
Nakao M , Li T , Han X , Ma X , Xiao N , Qiu J , Wang H , Yanagida T , Mamuti W , Wen H , Moro PL , Giraudoux P , Craig PS , Ito A . Int J Parasitol 2010 40 (3) 379-85 The genetic polymorphisms of Echinococcus spp. in the eastern Tibetan Plateau and the Xinjiang Uyghur Autonomous Region were evaluated by DNA sequencing analyses of genes for mitochondrial cytochrome c oxidase subunit 1 (cox1) and nuclear elongation factor-1 alpha (ef1a). We collected 68 isolates of Echinococcus granulosus sensu stricto (s.s.) from Xinjiang and 113 isolates of E. granulosus s. s., 49 isolates of Echinococcus multilocularis and 34 isolates of Echinococcus shiquicus from the Tibetan Plateau. The results of molecular identification by mitochondrial and nuclear markers were identical, suggesting the infrequency of introgressive hybridization. A considerable intraspecific variation was detected in mitochondrial cox1 sequences. The parsimonious network of cox1 haplotypes showed star-like features in E. granulosus s. s. and E. multilocularis, but a divergent feature in E. shiquicus. The cox1 neutrality indexes computed by Tajima's D and Fu's Fs tests showed high negative values in E. granulosus s. s. and E. multilocularis, indicating significant deviations from neutrality. In contrast, the low positive values of both tests were obtained in E. shiquicus. These results suggest the following hypotheses: (i) recent founder effects arose in E. granulosus and E. multilocularis after introducing particular individuals into the endemic areas by anthropogenic movement or natural migration of host mammals, and (ii) the ancestor of E. shiquicus was segregated into the Tibetan Plateau by colonising alpine mammals and its mitochondrial locus has evolved without bottleneck effects. |
In vitro antiviral activity of favipiravir (T-705) against drug-resistant influenza and 2009 A(H1N1) viruses
Sleeman K , Mishin VP , Deyde VM , Furuta Y , Klimov AI , Gubareva LV . Antimicrob Agents Chemother 2010 54 (6) 2517-24 Favipiravir (T-705) has previously been shown to have a potent antiviral effect against influenza virus and some other RNA viruses in both cell culture and in animal models. Currently, favipiravir is undergoing clinical evaluation for the treatment of influenza A and B virus infections. In this study, favipiravir was evaluated in vitro for its ability to inhibit the replication of a representative panel of seasonal influenza viruses, the 2009 A(H1N1) strains and animal viruses with pandemic potential (swine triple-reassortants, H2N2, H4N2, avian H7N2, and avian H5N1), including viruses which are resistant to the currently licensed anti-influenza drugs. All viruses were tested in a plaque reduction assay in MDCK cells, and a subset was also tested in both yield reduction and focus inhibition assays. For the majority of viruses tested, favipiravir significantly inhibited plaque formation at 3.2 muM (0.5mug/ml) (EC50s 0.19 - 22.48 muM, 0.03 - 3.53 mug/ml), and for all viruses, with the exception of a single dual resistant 2009 A(H1N1) virus, complete inhibition of plaque formation was seen at 3.2 muM (0.5mug/ml). Due to the 2009 pandemic and increased drug resistance in circulating seasonal influenza viruses, there is an urgent need for new drugs which target influenza. This study demonstrates that favipiravir inhibits in vitro replication of a wide range of influenza viruses, including those resistant to currently available drugs. |
Indirubins deplete striatal monoamines in the Intact and MPTP-treated mouse brain and block kainate-induced striatal astrogliosis
Magiatis P , Polychronopoulos P , Skaltsounis AL , Lozach O , Meijer L , Miller DB , O'Callaghan JP . Neurotoxicol Teratol 2010 32 (2) 212-9 The indirubins long have been used in Chinese medicine for treatment of myelocytic leukemia. Among the many more recently described biological activities of the indirubins, attention has been directed toward the ability of these compounds to inhibit GSK-3 and CDKs, kinases implicated in neurodegenerative conditions. Little information is available on effects of indirubins on chemically-induced neurodegeneration. Here we examined the influence of three indirubins on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)- and kainic acid (KA)-induced neurotoxicity in the mouse. The three indirubins examined were 6-bromoindirubin-3'-oxime (6BIO), 5-bromoindirubin-3'-oxime (5BIO) and 5-amino-6-bromoindirubin (5A6BI). The first two derivatives were previously described indirubins with low nanomolar inhibitory activity against GSK-3 and CDKs. The third compound was synthesized by the dimerization of 5-amino-6-bromoisatin with 3-acetoxyindol. The synthesis of the key compound 5-amino-6-bromoisatin was based on the bromination of the ketal of 5-amino-isatin. All indirubins examined decreased various measures associated with dopaminergic neurotransmission in striatum. These effects occurred alone or over and above the decrements seen following administration of the dopaminergic neurotoxicant, MPTP. Striatal serotonin and serotonin turnover were decreased by the indirubins in MPTP-treated mice. None of these striatal effects of the indirubins alone were associated with evidence of astrogliosis, an indicator of underlying neuropathology, nor did they potentiate the astrogliosis accompanying administration of MPTP. In general, the indirubins reduced KA-associated mortality and striatal but not hippocampal astrogliosis due to this toxicant. The data suggest that indirubins affect striatal biogenic amine levels and turnover in intact mice. The data do not indicate a neuroprotective action of indirubins in mice treated with MPTP but that they do suggest that they may be neuroprotective against KA-induced injury of the neostriatum. |
Isolation, morphologic, serologic and molecular identification of Acanthamoeba T4 genotype from the liver of a Temminck's tragopan (Tragopan temminckii)
Visvesvara GS , Shoff ME , Sriram R , Booton GC , Crary M , Fuerst PA , Hanley CS , Garner MM . Vet Parasitol 2010 170 197-200 Members of the genus Acanthamoeba are usually free-living amoebae that are found in a variety of ecological niches including soil, fresh and brackish water, dust in the air, heating, ventilating, and air conditioning filters, swimming pools and hot tubs. Occasionally they are also known to cause central nervous system infections in humans and animals. We isolated into culture an amoeba from the liver of a Temminck's tragopan (horned pheasant) (Tragopan temminckii) that died of amoebic infection. We identified the infecting amoeba as Acanthamoeba sp. based on culture characteristics, cyst morphology and immunofluorescence assays. Additionally, we identified the amoeba as Acanthamoeba, genotype T4, by sequencing a diagnostic region of the nuclear small subunit ribosomal RNA gene. |
Challenge pools of hepatitis C virus genotypes 1-6 prototype strains: replication fitness and pathogenicity in chimpanzees and human liver-chimeric mouse models
Bukh J , Meuleman P , Tellier R , Engle RE , Feinstone SM , Eder G , Satterfield WC , Govindarajan S , Krawczynski K , Miller RH , Leroux-Roels G , Purcell RH . J Infect Dis 2010 201 (9) 1381-9 Chimpanzees represent the only animal model for studies of the natural history of hepatitis C virus (HCV). To generate virus stocks of important HCV variants, we infected chimpanzees with HCV strains of genotypes 1-6 and determined the infectivity titer of acute-phase plasma pools in additional animals. The courses of first- and second-passage infections were similar, with early appearance of viremia, HCV RNA titers of >10(4.7) IU/mL, and development of acute hepatitis; the chronicity rate was 56%. The challenge pools had titers of 10(3)-10(5) chimpanzee infectious doses/mL. Human liver-chimeric mice developed high-titer infections after inoculation with the challenge viruses of genotypes 1-6. Inoculation studies with different doses of the genotype 1b pool suggested that a relatively high virus dose is required to consistently infect chimeric mice. The challenge pools represent a unique resource for studies of HCV molecular virology and for studies of pathogenesis, protective immunity, and vaccine efficacy in vivo. |
The comparison of different pre- and post-analysis filters for determination of exon-level alternative splicing events using affymetrix arrays
Whistler T , Chiang CF , Lin JM , Lonergan W , Reeves WC . J Biomol Tech 2010 21 (1) 44-53 Understanding the biologic significance of alternative splicing has been impeded by the difficulty in systematically identifying and validating transcript isoforms. Current exon array workflows suggest several different filtration steps to reduce the number of tests and increase the detection of alternative splicing events. In this study, we examine the effects of the suggested pre-analysis filtration by detection above background P value or signal intensity. This is followed post-analytically by restriction of exon expression to a fivefold change between groups, limiting the analysis to known alternative splicing events, or using the intersection of the results from different algorithms. Combinations of the filters are also examined. We find that none of the filtering methods reduces the number of technical false-positive calls identified by visual inspection. These include edge effects, nonresponsive probe sets, and inclusion of intronic and untranslated region probe sets into transcript annotations. Modules for filtering the exon microarray data on the basis of annotation features are needed. We propose new approaches to data filtration that would reduce the number of technical false-positives and therefore, impact the time spent performing visual inspection of the exon arrays. |
Sickle cell disease and pregnancy outcomes: women of African descent
Barfield WD , Barradas DT , Manning SE , Kotelchuck M , Shapiro-Mendoza CK . Am J Prev Med 2010 38 S542-9 BACKGROUND: Sickle cell disease (SCD) is a severe hematologic condition that presents unique complications among affected pregnant women. Many studies of adverse perinatal outcomes associated with SCD are limited by small samples or fail to consider important risk factors. PURPOSE: This study compared perinatal outcomes among women of African ancestry with and without SCD in a large, population-based sample. METHODS: Data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System were analyzed during June-August 2009 to identify in-state deliveries to resident women of African descent. Logistic regression analyses compared perinatal outcomes for deliveries among women with and without SCD, adjusted for maternal age, education, parity, plurality, insurance status, adequacy of prenatal care, smoking during pregnancy, and infant gender. RESULTS: During 1998-2006, there were 116,076 deliveries to 84,561 women; SCD prevalence was 0.6%. Adjusted odds of fetal death among deliveries to women with SCD were 2.2 times those among women without SCD (95% CI=1.2, 4.2). Compared to women without SCD, the odds of preterm delivery, low birth weight, and having babies small for gestational age (SGA) among women with SCD were 1.5 (95% CI=1.2, 1.8); 1.7 (95% CI=1.1, 2.6); and 1.3 (95% CI=1.0, 1.7), respectively. Sickle cell disease was positively associated with cesarean delivery and inductions. CONCLUSIONS: Population-based linked data systems are useful for assessing risks of adverse health outcomes among women with specific medical conditions, such as SCD. Women with SCD should seek preconception care to identify and modify risk behaviors and receive counseling regarding potential adverse sequelae associated with pregnancy-related morbidity and preterm delivery. |
Trends in postpartum hemorrhage: United States, 1994-2006
Callaghan WM , Kuklina EV , Berg CJ . Am J Obstet Gynecol 2010 202 (4) 353 e1-6 OBJECTIVE: The purpose of this study was to estimate the incidence of postpartum hemorrhage (PPH) in the United States and to assess trends. STUDY DESIGN: Population-based data from the 1994-2006 National Inpatient Sample were used to identify women who were hospitalized with postpartum hemorrhage. Data for each year were plotted, and trends were assessed. Multivariable logistic regression was used in an attempt to explain the difference in PPH incidence between 1994 and 2006. RESULTS: PPH increased 26% between 1994 and 2006 from 2.3% (n = 85,954) to 2.9% (n = 124,708; P < .001). The increase primarily was due to an increase in uterine atony, from 1.6% (n = 58,597) to 2.4% (n = 99,904; P < .001). The increase in PPH could not be explained by changes in rates of cesarean delivery, vaginal birth after cesarean delivery, maternal age, multiple birth, hypertension, or diabetes mellitus. CONCLUSION: Population-based surveillance data signal an apparent increase in PPH caused by uterine atony. More nuanced clinical data are needed to understand the factors that are associated with this trend. |
The effect of nutritional supplementation on physical activity and exploratory behavior of Mexican infants aged 8-12 months
Aburto NJ , Ramirez-Zea M , Neufeld LM , Flores-Ayala R . Eur J Clin Nutr 2010 64 (6) 644-51 BACKGROUND/OBJECTIVES: Physical activity and exploration in infancy affect physical and cognitive development. Nutritional supplementation improves activity in severely malnourished infants, but the evidence in mild-to-moderately malnourished and nutritionally at-risk infants is equivocal. We tested the effect of multiple-micronutrient supplementation on physical activity and exploration in Mexican infants. SUBJECTS/METHODS: Using a quasi experimental design, we analyzed data from a supplementation study that lacked a placebo-control group. We compared infants between 8 and 12 months measured at baseline who had received no supplementation (comparison group, n=78), with infants 8-12 months measured after 4 months of daily supplementation (treatment group, n=109). The treatment consisted of three supplement types: micronutrient powder, syrup (each containing only micronutrients) and a milk-based, fortified-food supplement (FFS; containing micronutrients and macronutrients). We formed the micronutrient-only group (MM) by combining the micronutrient powder and syrup groups. We measured activity and exploration by direct observation and used cluster analysis to form and characterize activity and exploration clusters. We performed logistic regression with activity or exploration cluster as the outcome variable and treatment versus comparison and MM or FFS versus comparison as the predictor variables. RESULTS: Treatment versus comparison increased the odds of being in the high activity (odds ratio (OR)=2.35, P<0.05) and high exploration (OR=1.87, P<0.05) cluster. MM increased the odds of being in the high activity (OR=2.64, P<0.05) cluster and FFS increased the odds (OR=3.16, P<0.05) of being in the high exploration cluster. CONCLUSIONS: Nutritional supplementation benefited activity and exploration in this sample of Mexican infants. European Journal of Clinical Nutrition advance online publication, 31 March 2010; doi:10.1038/ejcn.2010.52. |
Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers
Roberge RJ , Coca A , Williams WJ , Palmiero AJ , Powell JB . Respirology 2010 15 (3) 516-21 BACKGROUND AND OBJECTIVE: Filtering facepiece respirators ('N95 Masks') may be in short supply during large-scale infectious outbreaks. Suggestions have been made to extend their useful life by using a surgical mask as an outer barrier, but the physiological impact of this added barrier upon the wearer has not been studied. METHODS: A surgical mask was worn over an N95 filtering facepiece respirator by 10 healthcare workers for 1 h at each of two work rates. Heart rate, respiratory rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide levels and respirator dead space gases were monitored and compared with controls (N95 filtering facepiece respirator without a surgical mask). Subjective perceptions of exertion and comfort were assessed by numerical rating scales. RESULTS: There were no significant differences in physiological variables between those who used surgical masks and controls. Surgical masks decreased dead space oxygen concentrations of the filtering facepiece respirators at the lesser work rate (P = 0.03) and for filtering facepiece respirators with an exhalation valve at the higher work rate (P = 0.003). Respirator dead space oxygen and carbon dioxide levels were not harmonious with Occupational Safety and Health Administration workplace ambient atmosphere standards. Exertion and comfort scores were not significantly impacted by the surgical mask. CONCLUSIONS: Use of a surgical mask as an outer barrier over N95 filtering facepiece respirators does not significantly impact the physiological burden or perceptions of comfort and exertion by the wearer over that experienced without use of a surgical mask. |
Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain
Holzbauer SM , DeVries AS , Sejvar JJ , Lees CH , Adjemian J , McQuiston JH , Medus C , Lexau CA , Harris JR , Recuenco SE , Belay ED , Howell JF , Buss BF , Hornig M , Gibbins JD , Brueck SE , Smith KE , Danila RN , Lipkin WI , Lachance DH , Dyck PJ , Lynfield R . PLoS One 2010 5 (3) e9782 BACKGROUND: In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. METHODS AND RESULTS: Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004-November 2007. Median age was 32 years (range, 21-55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6-26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5-68.5), and worked within 0-10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2-80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNgamma) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). DISCUSSION: This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNgamma in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting. |
Physical activity and sedentary behavior among schoolchildren: A 34-country comparison
Guthold R , Cowan MJ , Autenrieth CS , Kann L , Riley LM . J Pediatr 2010 157 (1) 43-49 e1 OBJECTIVE: To describe and compare levels of physical activity and sedentary behavior in schoolchildren from 34 countries across 5 WHO Regions. STUDY DESIGN: The analysis included 72,845 schoolchildren from 34 countries that participated in the Global School-based Student Health Survey (GSHS) and conducted data collection between 2003 and 2007. The questionnaire included questions on overall physical activity, walking, or biking to school, and on time spent sitting. RESULTS: Very few students engaged in sufficient physical activity. Across all countries, 23.8% of boys and 15.4% of girls met recommendations, with the lowest prevalence in Philippines and Zambia (both 8.8%) and the highest in India (37.5%). The prevalence of walking or riding a bicycle to school ranged from 18.6% in United Arab Emirates to 84.8% in China. In more than half of the countries, more than one third of the students spent 3 or more hours per day on sedentary activities, excluding the hours spent sitting at school and doing homework. CONCLUSIONS: The great majority of students did not meet physical activity recommendations. Additionally, levels of sedentariness were high. These findings require immediate action, and efforts should be made worldwide to increase levels of physical activity among schoolchildren. |
Newborn screening system Performance Evaluation Assessment Scheme (PEAS)
Therrell BL Jr , Schwartz M , Southard C , Williams D , Hannon WH , Mann MY . Semin Perinatol 2010 34 (2) 105-20 Newborn screening (NBS) reaches approximately all of the 4 million newborns in the United States each year and has been effective in significantly reducing the morbidity and mortality that results from certain congenital conditions. The comprehensive NBS system can be divided into preanalytic (education and screening), analytic (laboratory testing), and postanalytic (reporting, short-term follow-up/tracking, diagnosis, treatment/management, ancillary services, and outcome evaluation) activities. To monitor and improve the screening system, there has been increasing emphasis on evaluation models. Federal sponsorship of a model performance evaluation and assessment scheme (PEAS) has resulted in a comprehensive listing of quality indicators for system self-assessment. We review the PEAS evolution process in an effort to illustrate the necessary infrastructure considerations in a well-functioning NBS system. Readers are encouraged to identify their role in the system and to interact appropriately at the local level. The comprehensive PEAS indicator list is provided as an Appendix. |
The evolution of early hearing detection and intervention programs in the United States
White KR , Forsman I , Eichwald J , Munoz K . Semin Perinatol 2010 34 (2) 170-9 Identifying and treating children with congenital hearing loss during the first few months of life is a relatively new concept. To assist states in the development of statewide Early Hearing Detection and Intervention programs, the federal government provides grants and/or cooperative agreements to almost all states and has established "National Goals, Program Objectives and Performance Measures" to guide the development and implementation of those systems. This article reviews the history of newborn hearing screening programs in the United States, summarizes the content of legislation and regulations passed by states related to universal newborn hearing screening, and describes how well each National Goal has been addressed. Although substantial progress has been made in the percentage of infants screened for hearing loss before hospital discharge, significant improvement is needed with respect to the availability of pediatric audiologists, implementation of effective tracking and data management systems, program evaluation and quality assurance, availability of appropriate early intervention programs, and linkages with medical home providers. |
Content analysis of continuing medical education for cervical cancer screening
Roland KB , Larkins TL , Benard VB , Berkowitz Z , Saraiya M . J Womens Health (Larchmt) 2010 19 (4) 651-7 BACKGROUND: Since 2003, newer cervical cancer screening guidelines that include human papillomavirus (HPV) testing with cytology (HPV co-testing) call for extension of screening intervals in women who are cytology normal and HPV negative. Continuing medical education (CME) may help increase knowledge and appropriate adoption of new technologies and guidelines. However, there are concerns that industry support of CME may bias messages favoring newer technologies without emphasizing the updated guidelines, especially less frequent testing recommendations. Our objectives were to assess availability and accuracy of web-based CME activities describing cervical cancer screening guidelines, screening intervals, and HPV testing. METHODS: We identified 20 web-based CME activities available between 2006 and 2008 and evaluated the content for messages related to HPV and natural history, cervical cancer screening guidelines, management of HPV abnormalities, and counseling tips for patients. In addition to content, we noted funding source, credit offered, and dates available. RESULTS: Most activities (80%) discussed the updated screening guidelines with HPV co-testing for eligible women. Twelve activities (60%) referenced professional organization support of the extended screening interval with the HPV co-test, and three (15%) discussed the justification for extension of intervals for eligible women. Eight activities (40%) were funded by industry, seven of which included accurate, updated screening guidelines about extension of screening intervals. CONCLUSIONS: Web-based CME activities generally support updated guidance for HPV co-testing and extended screening intervals but need more information on counseling patients and acceptability of extending screening intervals. |
Crosswalking public health and health education competencies: implications for professional preparation and practice
Woodhouse LD , Auld ME , Miner K , Alley KB , Lysoby L , Livingood WC . J Public Health Manag Pract 2010 16 (3) E20-E28 This article highlights similarities and differences between the public health competencies recently developed by the Association of Schools of Public Health (ASPH) and one public health specialty, health education (HE), which has used competencies in its quality assurance systems for more than 20 years. Based on a crosswalk methodology developed for this analysis, some 50 percent to 61 percent of the HE and ASPH competencies had similarities of varying degrees; 18 percent were deemed matches due to sameness in skill or content. Most similarities were found between the ASPH social and behavioral sciences competencies and the HE competencies. Significant domains of "no match" were found between the HE and ASPH competencies in the areas of Systems Thinking, Leadership, and Public Health Biology. The study results have implications for academic programs related to curricula review and revision, continuing education providers who are developing training agendas for the workforce, employers anticipating competencies in new job hires, and prospective students and practitioners who are considering a form of certification. Qualitative insights from the study related to professional culture, purpose, age, and consistency of the scope or depth of the two competency sets, as well as the crosswalk methodology itself, may be useful to those comparing other competency sets. |
Health care utilization among adults aged 55-64 years: how has it changed over the past 10 years?
Freid VM , Bernstein AB . NCHS Data Brief 2010 (32) 1-8 KEY FINDINGS: The percentage of physician office and hospital outpatient department (OPD) visits during which an MRI/CT/PET scan was ordered doubled, to 4%, and the percentage of hospital emergency department visits with an MRI/CT scan more than tripled, to 16%. The percentage of physician office and OPD visits with at least five drugs prescribed more than doubled, to 25%. Inpatient hospitalization rates were similar in 2006 and 1996, but the types of procedures and surgeries performed have changed. Hospitalization rates for coronary artery stent insertions, hip replacements, and knee replacements rose sharply, while rates for some other procedures declined. Ambulatory surgery visit rates were almost twice as high in 2006 as in 1994-1996, and for some types of ambulatory procedures, such as colonoscopies, the increase was even greater. |
Trichomonas vaginalis prevalence, incidence, risk factors and antibiotic-resistance in an adolescent population
Krashin JW , Koumans EH , Bradshaw-Sydnor AC , Braxton JR , Secor WE , Sawyer MK , Markowitz LE . Sex Transm Dis 2010 37 (7) 440-4 OBJECTIVE: To determine the prevalence and incidence of trichomoniasis, risk factors for infection, and the prevalence of metronidazole- and tinidazole-resistant Trichomonas vaginalis in female adolescents. METHODS: Nonpregnant, HIV-seronegative, sexually active females (13-19 years) visiting an inner city public primary care clinic were tested for T. vaginalis by wet mount and culture, and interviewed about risk-taking behavior every 6 months. Infected patients were treated with a 2 g oral dose of metronidazole. Isolates from positive T. vaginalis cultures were tested for in vitro resistance to metronidazole and tinidazole. RESULTS: Among 467 study participants, 67 (14.4%; 95% confidence interval, 11.3-17.5) were diagnosed with trichomoniasis at first T. vaginalis culture. Significant risk factors for T. vaginalis infection were having an older sex partner and concurrent Neisseria gonorrhoeae infection. The incidence was 22.1 cases per 100 person-years. Among 42 participants who had a prevalent infection and returned for follow-up, 13 (31.0%) had at least one more episode of trichomoniasis. Resistance testing was completed for 78 isolates: 37 at first visit and 41 during follow-up. One (2.7%; 95% confidence interval, 0.07-14.2) of the 37 first-visit isolates was moderately resistant to metronidazole (minimal lethal concentration = 200 mug/mL). Of the 41 follow-up visit isolates, 1 was moderately resistant to metronidazole and 2 had borderline resistance (minimal lethal concentration = 50 mug/mL). The prevalence of tinidazole resistance was 0% (0.0%-9.5%). CONCLUSION: The study population had high prevalence and incidence of trichomoniasis. The prevalence of antibiotic-resistant T. vaginalis among female adolescents was low. |
Folic acid intake among U.S. women aged 15-44 years, National Health and Nutrition Examination Survey, 2003-2006
Tinker SC , Cogswell ME , Devine O , Berry RJ . Am J Prev Med 2010 38 (5) 534-42 BACKGROUND: In 1998, the IOM recommended all women capable of becoming pregnant consume 400 mug of folic acid daily to prevent neural tube defects (NTDs). PURPOSE: This paper aims to describe how different sources of folic acid contribute to achieving the recommended usual daily intake. METHODS: Data on 2617 nonpregnant U.S. women aged 15-44 years from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys were analyzed in 2009. The usual daily folic acid intake from diet and supplements accounting for measurement error; the proportion of women consuming the recommended usual intake; and the adjusted associations of recommended intake with multiple characteristics were estimated. RESULTS: Overall, 24% of nonpregnant U.S. women of childbearing age consumed the recommended usual intake (95% CI=20%, 27%). Intake was highest among non-Hispanic white women (30%), followed by Mexican-American (17%) and non-Hispanic black women (9%). Among women who used supplements with folic acid, 72% (95% CI=65%, 79%) consumed the recommended usual intake. Use of supplements was the strongest determinant (unadjusted prevalence ratio [PR]: 10.2, 95% CI=7.1, 14.7) of recommended intake, mediating associations of other characteristics. Among the 68% of women who did not use supplements, consumption of cereals with folic acid and having diabetes were the strongest determinants of recommended usual intake (PRs=20.2 and 0.10, respectively). CONCLUSIONS: Given that consumption of folic acid is an important public health goal to prevent NTDs, an evaluation of strategies, beyond recommendations that women consume supplements, is needed. |
Future directions for positive youth development as a strategy to promote adolescent sexual and reproductive health
Catalano RF , Gavin LE , Markham CM . J Adolesc Health 2010 46 S92-6 PYD has tremendous potential to promote not only ASRH but adolescent health more broadly. This review has identified 15 tested, effective models that have demonstrated impact on ASRH; most also affected other youth outcomes, and several produced long-lasting, sustainable effects. These model programs should be prepared for broader dissemination, replication, and effectiveness trials. Broader dissemination will entail investments in developing training, technical assistance, and monitoring models that will aid in ensuring and sustaining implementation with fidelity and tracking program adaptations in broad settings. Evaluations of existing national youth-serving organizations and existing PYD programs that are unevaluated should be encouraged if they are evaluable, address the most strongly supported PYD constructs, have a clearly developed logic model that connects program elements to youth development constructs and outcomes, and program manuals are developed. Support is also provided here for the impact of youth development constructs on later ASRH outcomes, suggesting that new PYD programs, especially those targeting PYD constructs with longitudinal evidence of promotive or protective effects, should be developed and evaluated to identify long-term results. There is much work to be done on examining the ability of PYD constructs to impact ASRH. While there is sufficient evidence for a number of PYD constructs, more longitudinal research is needed. We have argued here that investigation of existing longitudinal datasets may efficiently increase our understanding of the evidence for the promotive and protective effects of understudied constructs or those with mixed evidence. Further, there is a need for the development of standardized measures of PYD constructs and the development and use of measures of positive sexual and reproductive health outcomes. We also recommend that future studies compare the relative strength of the PYD constructs and devote more resources to understanding how these constructs work together to promote ASRH. |
Blood disorders among women: implications for preconception care
Ebrahim SH , Kulkarni R , Parker C , Atrash HK . Am J Prev Med 2010 38 S459-67 The objectives of preconception care for women with blood disorders are to provide women and their partners with information on the implications of blood disorders for pregnancy; reproductive choices; and the management of potential or future pregnancies. Advances in hematology have led to improved diagnosis and treatment of blood disorders, thereby contributing to longevity and quality of life for women who are either affected by or are carriers of blood disorders. Women with blood disorders pose unique challenges: physiologic events such as pregnancy and menstruation influence the manifestations of blood disorders; blood disorders are a risk factor for adverse pregnancy outcomes; pregnancy imposes the risk of potential genetic transmission of the blood disorder to the offspring;and medications used for treatment of blood disorders pose additional challenges to conception and pregnancy. Hence, it is crucial that women of childbearing age with blood disorders be provided proper care for their conditions and be counseled before they become pregnant, in time to prevent complications to mothers and infants related to blood disorders. The purpose of this paper is to provide a brief overview of the current knowledge related to blood disorders in women of reproductive age, the interventions needed to manage these conditions, and the implications of these conditions and their management for the health of women and their infants. |
Novel Corynebacterium diphtheriae in domestic cats
Hall AJ , Cassiday PK , Bernard KA , Bolt F , Steigerwalt AG , Bixler D , Pawloski LC , Whitney AM , Iwaki M , Baldwin A , Dowson CG , Komiya T , Takahashi M , Hinrikson HP , Tondella ML . Emerg Infect Dis 2010 16 (4) 688-91 Novel nontoxigenic Corynebacterium diphtheriae was isolated from a domestic cat with severe otitis. Contact investigation and carrier study of human and animal contacts yielded 3 additional, identical isolates from cats, although no evidence of zoonotic transmission was identified. Molecular methods distinguished the feline isolates from known C. diphtheriae. |
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