Trends in predicted 10-year risk of coronary heart disease and cardiovascular disease among US adults from 1999 to 2010
Ford ES . J Am Coll Cardiol 2013 61 (22) 2249-52 OBJECTIVE: The objective of this study was to examine trends in predicted 10-year risk for coronary heart disease (CHD) and cardiovascular disease (CVD) from 1999-2000 to 2009-2010 among adults in the United States. BACKGROUND: Examining trends in predicted risk for CHD and CVD may offer insights into the direction of cardiovascular health. METHODS: Data from 7751 fasting participants aged 30-74 years of six 2-year cycles of the National Health and Nutrition Examination Survey were used. Predicted 10-year risk for CHD and CVD was calculated using risk equations derived from data from the Framingham Heart Study. RESULTS: Mean predicted 10-year risk was 7.2% during 1999-2000 and 6.5% during 2009-2010 for CHD (plinear trend=0.005) and 9.2% during 1999-2000 and 8.7% during 2009-2010 for CVD (plinear trend=0.152). Mean predicted risk for CHD and CVD declined significantly among participants aged 40-49 years, 50-59 years, 60-74 years, and women. Mean predicted risk for CHD declined significantly among men and whites but nonsignificantly among Mexican Americans (plinear trend=0.067). Mean predicted risk increased nonsignificantly among African Americans for CHD (plinear trend=0.063) and CVD (plinear trend=0.059). Of the modifiable cardiovascular risk factors included in the risk equations, favorable trends were noted for mean systolic and diastolic blood pressure, mean concentrations of total cholesterol and high-density lipoprotein cholesterol, and smoking status. The prevalence of diabetes worsened. CONCLUSIONS: Predicted 10-year risk for CHD improved modestly. Reversing the seemingly rising trend in risk among African American adults should be a high priority. |
PML diagnostic criteria: consensus statement from the AAN Neuroinfectious Disease Section
Berger JR , Aksamit AJ , Clifford DB , Davis L , Koralnik IJ , Sejvar JJ , Bartt R , Major EO , Nath A . Neurology 2013 80 (15) 1430-1438 OBJECTIVE: To establish criteria for the diagnosis of progressive multifocal leukoencephalopathy (PML). METHODS: We reviewed available literature to identify various diagnostic criteria employed. Several search strategies employing the terms "progressive multifocal leukoencephalopathy" with or without "JC virus" were performed with PubMed, SCOPUS, and EMBASE search engines. The articles were reviewed by a committee of individuals with expertise in the disorder in order to determine the most useful applicable criteria. RESULTS: A consensus statement was developed employing clinical, imaging, pathologic, and virologic evidence in support of the diagnosis of PML. Two separate pathways, histopathologic and clinical, for PML diagnosis are proposed. Diagnostic classification includes certain, probable, possible, and not PML. CONCLUSION: Definitive diagnosis of PML requires neuropathologic demonstration of the typical histopathologic triad (demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei) coupled with the techniques to show the presence of JC virus. The presence of clinical and imaging manifestations consistent with the diagnosis and not better explained by other disorders coupled with the demonstration of JC virus by PCR in CSF is also considered diagnostic. Algorithms for establishing the diagnosis have been recommended. |
Factors associated with asthma prevalence among racial and ethnic groups-United States, 2009-2010 Behavioral Risk Factor Surveillance System
Zahran HS , Bailey C . J Asthma 2013 50 (6) 583-9 BACKGROUND: Although the causes of asthma are poorly understood, multiple factors (e.g., genetic, environmental, socioeconomic, and lifestyle) have been implicated in the development and exacerbation of the disease. OBJECTIVES: To identify potential predictive factors of current asthma and to assess if the predictive ability of some factors differ by race and ethnicity. METHODS: We used the Centers for Disease Control and Prevention's 2009-2010 Behavioral Risk Factor Surveillance System data to estimate asthma prevalence and to examine the potential predictive factors for asthma (sex, age, educational attainment, household income, obesity, smoking, physical activity, and health insurance) by race and ethnicity. RESULTS: Of the 869519 adult respondents in the survey, 8.6% reported having asthma. Overall asthma prevalence was significantly higher among adults with household income of <$15000 (13.3%; adjusted prevalence ratio [aPR] of 1.9) than those with income of ≥$75000 (6.8%). The prevalence was also higher among obese adults (11.6%; aPR=1.5) than non-obese (7.3%), current and former smokers (10.5%; aPR=1.2 and 8.5%;1.1) than non-smokers (7.8%), and adults with health insurance (8.6%; aPR=1.3) than adults without it (7.8%). However, the prevalence was lower among adults aged 65+ (7.8; aPR=0.7) than adults aged 18-24 (9.3%) and among adults who reported having leisure time physical activity (7.8%; aPR=0.8) than adults who did not report it (10.7%). When examined among race/ethnic groups, these associations were observed among whites and blacks but not for the other four race/ethnic groups. CONCLUSIONS: Predictive factors for asthma vary among racial/ethnic groups. Identifying race/ethnicity specific modifiable environmental and host-related factors (mold, pollens, house dust mites, cockroaches, animal allergens, other pollutants, education, income, obesity, smoking, physical activity, and health insurance status) can be important in developing targeted interventions to reduce the health and economic impact of asthma among disproportionately affected segments of the United States population. |
A study evaluating poliovirus antibodies and risk factors associated with polio seropositivity in low socioeconomic areas of Pakistan
Habib M , Soofi S , Ali N , Sutter RW , Palansch M , Qureshi H , Akhtar T , Molodecky NA , Okayasu H , Bhutta ZA . Vaccine 2013 31 (15) 1987-93 BACKGROUND: Seroprevalence studies provide important data on performance of immunization programs, susceptible groups and populations at-risk of future outbreaks. Identifying risk factors that affect seroconversion of the oral polio vaccine (OPV) will enable the polio eradication initiatives to increase seroprevalence. This paper describes the first population-based seroprevalence survey in Pakistan. METHODS: This study evaluated the seroprevalence of poliovirus (PV) types 1, 2, and 3 antibodies to OPV in an illustrative sample of 554 subjects 6-11 months of age in three geographic locations of Pakistan (Lahore, Karachi, and Peshawar) representing a low socioeconomic at-risk populations. Antibody titers were measured and sero protection rates and geometric median titers were compared among different geographic regions and populations, as were demographics and OPV vaccination history collected by questionnaire. Univariate and multivariate analyses were conducted on subject characteristics to assess for potential risk factors for failure to sero-convert. RESULTS: The average seroprevalence of PV1, PV2, and PV3 was 96.0%, 87.9% and 86.7%, respectively. The lowest sero protection rate for all three serotypes was for Karachi with 90.2%, 73.8%, and 78.8% for PV1, PV2, and PV3, respectively. Significant regional variation in PV3 seroprevalence was found (range: 74.2-100%). In the univariate analysis, age, total and campaign OPV doses were associated with higher seroprevalence, whereas stunting, respondent education and diarrhea in the past six months were significant risk factors for failure to sero-convert. CONCLUSIONS: These findings demonstrate consistently high levels of antibody response to PV1 and more geographically varied response to PV2 and PV3. Additionally, important risk factors affecting seropositivity were identified. |
Measles transmission during air travel, United States, December 1, 2008-December 31, 2011
Nelson K , Marienau K , Schembri C , Redd S . Travel Med Infect Dis 2013 11 (2) 81-9 BACKGROUND: Flight-related measles contact investigations in the United States are coordinated by the Centers for Disease Control and Prevention (CDC). To evaluate the efficiency of CDC's measles protocol, we analyzed data from contact investigations conducted December 2008-December 2011. METHODS: Cases were defined as travelers diagnosed with measles that were infectious at the time of the flight. Passengers seated within 2 rows of the case-traveler and all babies-in-arms were defined as contacts. Contact information obtained from airlines was distributed to US health departments; reporting of outcomes was requested. We cross-referenced the National Notifiable Diseases Surveillance System and CDC's National Center for Immunization and Respiratory Diseases to identify unreported cases in passenger-contacts and in passengers not identified as contacts. RESULTS: Our evaluation included 74 case-travelers on 108 flights. Information for 2673 (79%) of 3399 passenger-contacts was provided to health departments; 9 cases of secondary measles were reported. No additional cases were identified. CONCLUSION: Our evaluation provided evidence of measles transmission related to air travel. CDC's protocol efficiently identifies passengers most at risk of exposure and infection for flights into and within the United States. |
Hepatitis E virus infection in a liver transplant recipient in the United States: a case report
Te HS , Drobeniuc J , Kamili S , Dong C , Hart J , Sharapov UM . Transplant Proc 2013 45 (2) 810-3 BACKGROUND: Chronic infection with hepatitis E virus (HEV) has recently been recognized in immunocompromised or immunosuppressed individuals. CASE REPORT: We report a case of concurrent HEV and human herpes virus-6 (HHV-6) infection, documented by serum HEV RNA and HHV-6 DNA, in an orthotopic liver transplant (OLT) recipient in the United States, where HEV genotype 3 infection, although prevalent, is considered to be self-limited and almost always asymptomatic. The coinfection was accompanied by elevated serum aminotransaminases, liver biopsies demonstrating chronic hepatitis, and the presence of HEV RNA in the tissue. After lowering of immunosuppressive therapy and 2 courses of valganciclovir, sequential clearance of the viruses and normalization of the serum aminotransaminases were observed. CONCLUSIONS: HEV infection can lead to chronic hepatitis in OLT recipients, and evaluation of this virus should be considered in immunosuppressed individuals with unexplained liver test abnormalities. |
Aminoglycoside cross-resistance in mycobacterium tuberculosis due to mutations in the 5' untranslated region of whiB7
Reeves AZ , Campbell PJ , Sultana R , Malik S , Murray M , Plikaytis BB , Shinnick TM , Posey JE . Antimicrob Agents Chemother 2013 57 (4) 1857-65 Since the discovery of streptomycin's bactericidal activity against Mycobacterium tuberculosis, aminoglycosides have been utilized to treat tuberculosis (TB). Today, the aminoglycosides kanamycin and amikacin are used to treat multidrug-resistant (MDR) TB, and resistance to any of the second-line injectable antibiotics, including kanamycin, amikacin, or capreomycin, is a defining characteristic of extensively drug-resistant (XDR) TB. Resistance to kanamycin and streptomycin is thought to be due to the acquisition of unlinked chromosomal mutations. However, we identified eight independent mutations in the 5' untranslated region of the transcriptional activator whiB7 that confer low-level resistance to both aminoglycosides. The mutations lead to 23- to 145-fold increases in whiB7 transcripts and subsequent increased expression of both eis (Rv2416c) and tap (Rv1258c). Increased expression of eis confers kanamycin resistance in these mutants, while increased expression of tap, which encodes an efflux pump, is a previously uncharacterized mechanism of low-level streptomycin resistance. Additionally, high-level resistance to streptomycin arose at a much higher frequency in whiB7 mutants than in a wild-type (WT) strain. Although whiB7 is typically associated with intrinsic antibiotic resistance in M. tuberculosis, these data suggest that mutations in an uncharacterized regulatory region of whiB7 contribute to cross-resistance against clinically used second-line antibiotics. As drug resistance continues to develop and spread, understanding the mechanisms and molecular basis of antibiotic resistance is critical for the development of rapid molecular tests to diagnose drug-resistant TB strains and ultimately for designing regimens to treat drug-resistant cases of TB. |
Seroprevalence of Powassan virus in New England deer, 1979-2010
Nofchissey RA , Deardorff ER , Blevins TM , Anishchenko M , Bosco-Lauth A , Berl E , Lubelczyk C , Mutebi JP , Brault AC , Ebel GD , Magnarelli LA . Am J Trop Med Hyg 2013 88 (6) 1159-62 Powassan virus and its subtype, deer tick virus, are closely related tick-borne flaviviruses that circulate in North America. The incidence of human infection by these agents appears to have increased in recent years. To define exposure patterns among white-tailed deer, potentially useful sentinels that are frequently parasitized by ticks, we screened serum samples collected during 1979-2010 in Connecticut, Maine, and Vermont for neutralizing antibody by using a novel recombinant deer tick virus-West Nile virus chimeric virus. Evidence of exposure was detected in all three states. Overall our results demonstrate that seroprevalence is variable in time and space, suggesting that risk of exposure to Powassan virus is similarly variable. |
Emergence potential of sylvatic dengue virus type 4 in the urban transmission cycle is restrained by vaccination and homotypic immunity
Durbin AP , Mayer SV , Rossi SL , Amaya-Larios IY , Ramos-Castaneda J , Eong Ooi E , Jane Cardosa M , Munoz-Jordan JL , Tesh RB , Messer WB , Weaver SC , Vasilakis N . Virology 2013 439 (1) 34-41 Sylvatic dengue viruses (DENV) are both evolutionarily and ecologically distinct from human DENV and are maintained in an enzootic transmission cycle. Evidence of sylvatic human infections from West Africa and Southeast Asia suggests that sylvatic DENV come into regular contact with humans. Thus, this potential of emergence into the human transmission cycle could limit the potential for eradicating this cycle with vaccines currently in late stages of development. We assessed the likelihood of sylvatic DENV-4 emergence in the face of natural immunity to current human strains and vaccination with two DENV-4 vaccine candidates. Our data indicate homotypic neutralization of sylvatic and human DENV-4 strains by human primary convalescent and vaccinee sera but limited heterotypic immunity. These results suggest that emergence of sylvatic strains into the human cycle would be limited by homotypic immunity mediated by virus neutralizing antibodies produced by natural infection or vaccination. |
Detailed molecular epidemiologic characterization of HIV-1 infection in Bulgaria reveals broad diversity and evolving phylodynamics.
Ivanov IA , Beshkov D , Shankar A , Hanson DL , Paraskevis D , Georgieva V , Karamacheva L , Taskov H , Varleva T , Elenkov I , Stoicheva M , Nikolova D , Switzer WM . PLoS One 2013 8 (3) e59666 Limited information is available to describe the molecular epidemiology of HIV-1 in Bulgaria. To better understand the genetic diversity and the epidemiologic dynamics of HIV-1 we analyzed 125 new polymerase (pol) sequences from Bulgarians diagnosed through 2009 and 77 pol sequences available from our previous study from persons infected prior to 2007. Epidemiologic and demographic information was obtained from each participant and phylogenetic analysis was used to infer HIV-1 evolutionary histories. 120 (59.5%) persons were infected with one of five different HIV-1 subtypes (A1, B, C, F1 and H) and 63 (31.2%) persons were infected with one of six different circulating recombinant forms (CRFs; 01_AE, 02_AG, 04_cpx, 05_DF, 14_BG, and 36_cpx). We also for the first time identified infection with two different clusters of unique A-like and F-like sub-subtype variants in 12 persons (5.9%) and seven unique recombinant forms (3.5%), including a novel J/C recombinant. While subtype B was the major genotype identified and was more prevalent in MSM and increased between 2000-2005, most non-B subtypes were present in persons ≥45 years old. CRF01_AE was the most common non-B subtype and was higher in women and IDUs relative to other risk groups combined. Our results show that HIV-1 infection in Bulgaria reflects the shifting distribution of genotypes coincident with the changing epidemiology of the HIV-1 epidemic among different risk groups. Our data support increased public health interventions targeting IDUs and MSM. Furthermore, the substantial and increasing HIV-1 genetic heterogeneity, combined with fluctuating infection dynamics, highlights the importance of sustained and expanded surveillance to prevent and control HIV-1 infection in Bulgaria. |
Using a state cancer registry to recruit young breast cancer survivors and high-risk relatives: protocol of a randomized trial testing the efficacy of a targeted versus a tailored intervention to increase breast cancer screening.
Katapodi MC , Northouse LL , Schafenacker AM , Duquette D , Duffy SA , Ronis DL , Anderson B , Janz NK , McLosky J , Milliron KJ , Merajver SD , Duong LM , Copeland G . BMC Cancer 2013 13 97 BACKGROUND: The Michigan Prevention Research Center, the University of Michigan Schools of Nursing, Public Health, and Medicine, and the Michigan Department of Community Health propose a multidisciplinary academic-clinical practice three-year project to increase breast cancer screening among young breast cancer survivors and their cancer-free female relatives at greatest risk for breast cancer. METHODS/DESIGN: The study has three specific aims: 1) Identify and survey 3,000 young breast cancer survivors (diagnosed at 20-45 years old) regarding their breast cancer screening utilization. 2) Identify and survey survivors' high-risk relatives regarding their breast cancer screening utilization. 3) Test two versions (Targeted vs. Enhanced Tailored) of an intervention to increase breast cancer screening among survivors and relatives. Following approval by human subjects review boards, 3,000 young breast cancer survivors will be identified through the Michigan Cancer Registry and mailed an invitation letter and a baseline survey. The baseline survey will obtain information on the survivors': a) current breast cancer screening status and use of genetic counseling; b) perceived barriers and facilitators to screening; c) family health history. Based on the family history information provided by survivors, we will identify up to two high-risk relatives per survivor. Young breast cancer survivors will be mailed consent forms and baseline surveys to distribute to their selected high-risk relatives. Relatives' baseline survey will obtain information on their: a) current breast cancer screening status and use of genetic counseling; and b) perceived barriers and facilitators to screening. Young breast cancer survivors and high-risk relatives will be randomized as a family unit to receive two versions of an intervention aiming to increase breast cancer screening and use of cancer genetic services. A follow-up survey will be mailed 9 months after the intervention to survivors and high-risk relatives to evaluate the efficacy of each intervention version on: a) use of breast cancer screening and genetic counseling; b) perceived barriers and facilitators to screening; c) self-efficacy in utilizing cancer genetic and screening services; d) family support related to screening; e) knowledge of breast cancer genetics; and f) satisfaction with the intervention. DISCUSSION: The study will enhance efforts of the state of Michigan surrounding cancer prevention, control, and public health genomics. TRIAL REGISTRATION: NCT01612338. |
Sickle cell disease incidence among newborns in New York State by maternal race/ethnicity and nativity.
Wang Y , Kennedy J , Caggana M , Zimmerman R , Thomas S , Berninger J , Harris K , Green NS , Oyeku S , Hulihan M , Grant AM , Grosse SD . Genet Med 2013 15 (3) 222-8 PURPOSE: Sickle cell disease is estimated to occur in 1:300-400 African-American births, with higher rates among immigrants from Africa and the Caribbean, and is less common among Hispanic births. This study determined sickle cell disease incidence among New York State newborns stratified by maternal race/ethnicity and nativity. METHODS: Newborns with confirmed sickle cell disease born to New York State residents were identified by the New York State newborn screening program for the years 2000-2008 and matched to birth records to obtain birth and maternal information. Annual incidence rates were computed and bivariate analyses were conducted to examine associations with maternal race/ethnicity and nativity. RESULTS: From 2000 to 2008, 1,911 New York State newborns were diagnosed with sickle cell disease and matched to the birth certificate files. One in every 1,146 live births was diagnosed with sickle cell disease. Newborns of non-Hispanic black mothers accounted for 86% of sickle cell disease cases whereas newborns of Hispanic mothers accounted for 12% of cases. The estimated incidence was 1:230 live births for non-Hispanic black mothers, 1:2,320 births for Hispanic mothers, and 1:41,647 births for non-Hispanic white mothers. Newborns of foreign-born non-Hispanic black mothers had a twofold higher incidence of sickle cell disease than those born to US-born non-Hispanic black mothers (P < 0.001). CONCLUSION: This study provides the first US estimates of sickle cell disease incidence by maternal nativity. Women born outside the United States account for the majority of children with sickle cell disease born in New York State. Such findings identify at-risk populations and inform outreach activities that promote ongoing, high-quality medical management to affected children. (Genet Med 2013:15(3):222-228.) |
Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults
Reichard A , Fox MH . Disabil Health J 2013 6 (2) 75-86 BACKGROUND: Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these program's populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization. OBJECTIVE/HYPOTHESIS: Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population. METHODS: This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000-2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability. RESULTS: For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram. CONCLUSIONS: A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles. |
Neuraminidase inhibitor susceptibility surveillance of influenza viruses circulating worldwide during the 2011 Southern Hemisphere season
Okomo-Adhiambo M , Sleeman K , Lysen C , Nguyen HT , Xu X , Li Y , Klimov AI , Gubareva LV . Influenza Other Respir Viruses 2013 7 (5) 645-58 BACKGROUND: Neuraminidase (NA) inhibitors (NAIs) are currently the only antivirals effective against influenza infections due to widespread resistance to M2 inhibitors. METHODS: Influenza A and B viruses (n = 1079) collected worldwide between April 01, 2011, and September 30, 2011, were assessed for susceptibility to FDA-approved NAIs, oseltamivir and zanamivir, and investigational peramivir, using the fluorescent-based NA-Fluor Influenza Neuraminidase Assay Kit. A subset of viruses (n = 98) were tested for susceptibility to the investigational NAI, laninamivir. RESULTS: Influenza A(H1N1)pdm09 viruses (n = 326) were sensitive to all NAIs, except for two (0.6%) with H275Y (N1 numbering; H274Y in N2 numbering) substitution, which exhibited elevated IC50 s for oseltamivir and peramivir, and a third with previously unreported N325K substitution, exhibiting reduced susceptibility to oseltamivir. Influenza A(H3N2) viruses (n = 407) were sensitive to all NAIs. Influenza B viruses (n = 346) were sensitive to all NAIs, except two (0.6%) with H273Y (N1 numbering; H274Y in N2 numbering) substitution, exhibiting reduced susceptibility to oseltamivir and peramivir, and one with previously unreported G140R and N144K substitutions, exhibiting reduced susceptibility to oseltamivir, zanamivir, and peramivir. All influenza A and B viruses were sensitive to laninamivir. It is unknown whether substitutions N325K, G140R, and N144K were present in the virus prior to culturing because clinical specimens were unavailable for testing. CONCLUSIONS: This study summarizes NAI susceptibility of influenza viruses circulating worldwide during the 2011 Southern Hemisphere (SH) season, assessed using the NA-Fluor Kit. Despite low resistance to NAIs among tested influenza viruses, constant surveillance of influenza virus susceptibility to NAIs should be emphasized. |
The effect of multiple primary rules on population-based cancer survival
Weir HK , Johnson CJ , Thompson TD . Cancer Causes Control 2013 24 (6) 1231-42 PURPOSE: Different rules for registering multiple primary (MP) cancers are used by cancer registries throughout the world, making international data comparisons difficult. This study evaluates the effect of Surveillance, Epidemiology, and End Results (SEER) and International Association of Cancer Registries (IACR) MP rules on population-based cancer survival estimates. METHODS: Data from five US states and six metropolitan area cancer registries participating in the SEER Program were used to estimate age-standardized relative survival (RS%) for first cancers-only and all first cancers matching the selection criteria according to SEER and IACR MP rules for all cancer sites combined and for the top 25 cancer site groups among men and women. RESULTS: During 1995-2008, the percentage of MP cancers (all sites, both sexes) increased 25.4 % by using SEER rules (from 14.6 to 18.4 %) and 20.1 % by using IACR rules (from 13.2 to 15.8 %). More MP cancers were registered among females than among males, and SEER rules registered more MP cancers than IACR rules (15.8 vs. 14.4 % among males; 17.2 vs. 14.5 % among females). The top 3 cancer sites with the largest differences were melanoma (5.8 %), urinary bladder (3.5 %), and kidney and renal pelvis (2.9 %) among males, and breast (5.9 %), melanoma (3.9 %), and urinary bladder (3.4 %) among females. Five-year survival estimates (all sites combined) restricted to first primary cancers-only were higher than estimates by using first site-specific primaries (SEER or IACR rules), and for 11 of 21 sites among males and 11 of 23 sites among females. SEER estimates are comparable to IACR estimates for all site-specific cancers and marginally higher for all sites combined among females (RS 62.28 vs. 61.96 %). CONCLUSION: Survival after diagnosis has improved for many leading cancers. However, cancer patients remain at risk of subsequent cancers. Survival estimates based on first cancers-only exclude a large and increasing number of MP cancers. To produce clinically and epidemiologically relevant and less biased cancer survival estimates, data on all cancers should be included in the analysis. The multiple primary rules (SEER or IACR) used to identify primary cancers do not affect survival estimates if all first cancers matching the selection criteria are used to produce site-specific survival estimates. |
GeoSentinel surveillance of illness in returned travelers, 2007-2011
Leder K , Torresi J , Libman MD , Cramer JP , Castelli F , Schlagenhauf P , Wilder-Smith A , Wilson ME , Keystone JS , Schwartz E , Barnett ED , von Sonnenburg F , Brownstein JS , Cheng AC , Sotir MJ , Esposito DH , Freedman DO . Ann Intern Med 2013 158 (6) 456-68 BACKGROUND: International travel continues to increase, particularly to Asia and Africa. Clinicians are increasingly likely to be consulted for advice before travel or by ill returned travelers. OBJECTIVE: To describe typical diseases in returned travelers according to region, travel reason, and patient demographic characteristics; describe the pattern of low-frequency travel-associated diseases; and refine key messages for care before and after travel. DESIGN: Descriptive, using GeoSentinel records. SETTING: 53 tropical or travel disease units in 24 countries. PATIENTS: 42,173 ill returned travelers seen between 2007 and 2011. MEASUREMENTS: Frequencies of demographic characteristics, regions visited, and illnesses reported. RESULTS: Asia (32.6%) and sub-Saharan Africa (26.7%) were the most common regions where illnesses were acquired. Three quarters of travel-related illness was due to gastrointestinal (34.0%), febrile (23.3%), and dermatologic (19.5%) diseases. Only 40.5% of all ill travelers reported pretravel medical visits. The relative frequency of many diseases varied with both travel destination and reason for travel, with travelers visiting friends and relatives in their country of origin having both a disproportionately high burden of serious febrile illness and very low rates of advice before travel (18.3%). Life-threatening diseases, such as Plasmodium falciparum malaria, melioidosis, and African trypanosomiasis, were reported. LIMITATIONS: Sentinel surveillance data collected by specialist clinics do not reflect healthy returning travelers or those with mild or self-limited illness. Data cannot be used to infer quantitative risk for illness. CONCLUSION: Many illnesses may have been preventable with appropriate advice, chemoprophylaxis, or vaccination. Clinicians can use these 5-year GeoSentinel data to help tailor more efficient pretravel preparation strategies and evaluate possible differential diagnoses of ill returned travelers according to destination and reason for travel. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention. |
Incorporating the service multiplier method in respondent-driven sampling surveys to estimate the size of hidden and hard-to-reach populations: case studies from around the world
Johnston LG , Prybylski D , Raymond HF , Mirzazadeh A , Manopaiboon C , McFarland W . Sex Transm Dis 2013 40 (4) 304-10 BACKGROUND: Estimating the sizes of populations at highest risk for HIV is essential for developing and monitoring effective HIV prevention and treatment programs. We provide several country examples of how service multiplier methods have been used in respondent-driven sampling surveys and provide guidance on how to maximize this method's use. METHODS: Population size estimates were conducted in 4 countries (Mauritius- intravenous drug users [IDU] and female sex workers [FSW]; Papua New Guinea-FSW and men who have sex with men [MSM]; Thailand-IDU; United States-IDU) using adjusted proportions of population members reporting attending a service, project or study listed in a respondent-driven sampling survey, and the estimated total number of population members who visited one of the listed services, projects, or studies collected from the providers. RESULTS: The median population size estimates were 8866 for IDU and 667 for FSW in Mauritius. Median point estimates for FSW were 4190 in Port Moresby and 8712 in Goroka, Papua New Guinea, and 2,126 for MSM in Port Moresby and 4200 for IDU in Bangkok, Thailand. Median estimates for IDU were 1050 in Chiang Mai, Thailand, and 15,789 in 2005 and 15,554 in 2009 in San Francisco. CONCLUSION: Our estimates for almost all groups in each country fall within the range of other regional and national estimates, indicating that the service multiplier method, assuming all assumptions are met, can produce informative estimates. We suggest using multiple multipliers whenever possible, garnering program data from the widest possible range of services, projects, and studies. A median of several estimates is likely more robust to potential biases than a single estimate. |
An outbreak of foodborne illness among attendees of a wedding reception in Wisconsin likely caused by Arcobacter butzleri
Lappi V , Archer JR , Cebelinski E , Leano F , Besser JM , Klos RF , Medus C , Smith KE , Fitzgerald C , Davis JP . Foodborne Pathog Dis 2013 10 (3) 250-5 BACKGROUND: Arcobacter species, primarily Arcobacter butzleri, are widely distributed among animals, infrequently isolated from humans, and previously not associated with outbreaks of foodborne illness. We report results of an investigation of a foodborne outbreak that occurred among attendees of a wedding reception in Wisconsin, United States, and was likely caused by A. butzleri. METHODS: We conducted a case-control study among reception attendees and a laboratory investigation to determine the extent, source, and cause of the outbreak. A clinical case was defined as diarrhea in an attendee with illness onset ≤7 days following the wedding reception. RESULTS: The case-control study included 47 of 51 case patients and 43 non-ill attendees. Results demonstrated that consuming broasted chicken was the only factor significantly associated with illness (odds ratio 10.51; 95% confidence interval 1.28, 476.4). Five patients provided stool specimens. Comprehensive culture and polymerase chain reaction (PCR) testing did not detect common bacterial or viral pathogens. Subsequent testing with PCRs targeting 16S/23S rDNA of the three most clinically relevant Arcobacter spp. and the rpoB/C gene of A. butzleri provided products confirmed as A. butzleri (four patients) and A. cryaerophilus (one patient) by sequence analysis. CONCLUSIONS: The results of this investigation suggest that A. butzleri should be considered an agent that can cause outbreaks of foodborne illness. Rigorous investigation of outbreaks of undetermined etiology is valuable for incrementally increasing our understanding of emerging agents causing foodborne illnesses. |
Campylobacter jejuni infections associated with unpasteurized milk -- multiple states, 2012
Longenberger AH , Palumbo A , Chu A , Moll M , Weltman A , Ostroff S . Clin Infect Dis 2013 57 (2) 263-6 In 2012, a multistate outbreak of Campylobacter infections associated with unpasteurized milk resulted in 148 illnesses. A dairy with a Pennsylvania Department of Agriculture unpasteurized milk permit and minimal deficiencies identified during inspection was the outbreak source, demonstrating the ongoing hazards of unpasteurized dairy. |
Relationships between selected gene polymorphisms and blood pressure sensitivity to weight loss in elderly persons with hypertension.
Kostis WJ , Cabrera J , Hooper WC , Whelton PK , Espeland MA , Cosgrove NM , Cheng JQ , Deng Y , De Staerck C , Pyle M , Maruthur N , Reyes I , Anderson CA , Liu J , Kostis JB . Hypertension 2013 61 (4) 857-63 Salt sensitivity, the heterogeneity in the response of blood pressure (BP) to alterations in sodium intake, has been studied extensively, whereas weight sensitivity, the heterogeneity in BP response to weight change, has received scant attention. We examined the relationship of 21 gene polymorphisms previously found to be associated with hypertension, diabetes mellitus, or obesity, with weight sensitivity in the Trial of Nonpharmacologic Interventions in the Elderly, where participants with hypertension were randomized to receive intensive dietary intervention of sodium reduction, weight loss, both, or attention control, whereas pharmacological therapy was kept constant. After correcting for multiplicity, we identified significant associations of 3 polymorphisms with weight sensitivity of systolic BP (rs4646994, rs2820037, and rs1800629) and 3 polymorphisms for diastolic BP (rs4646994, rs2820037, and rs5744292). A recursive partitioning algorithm selected the combination of rs4646994, rs1800629, rs1982073, and rs1800896 as the set associated with the highest weight sensitivity. Polymorphisms related to hypertension, obesity, and diabetes mellitus are associated with weight sensitivity of BP. |
Mutation of the dengue virus type 2 envelope protein heparan sulfate binding sites or the domain III lateral ridge blocks replication in Vero cells prior to membrane fusion.
Roehrig JT , Butrapet S , Liss NM , Bennett SL , Luy BE , Childers T , Boroughs KL , Stovall JL , Calvert AE , Blair CD , Huang CY . Virology 2013 441 (2) 114-25 Using an infectious cDNA clone we engineered seven mutations in the putative heparan sulfate- and receptor-binding motifs of the envelope protein of dengue virus serotype 2, strain 16681. Four mutant viruses, KK122/123EE, E202K, G304K, and KKK305/307/310EEE, were recovered following transfection of C6/36 cells. A fifth mutant, KK291/295EE, was recovered from C6/36 cells with a compensatory E295V mutation. All mutants grew in and mediated fusion of virus-infected C6/36 cells, but three of the mutants, KK122/123EE, E202K, G304K, did not grow in Vero cells without further modification. Two Vero cell lethal mutants, KK291/295EV and KKK307/307/310EEE, failed to replicate in DC-SIGN-transformed Raji cells and did not react with monoclonal antibodies known to block DENV attachment to Vero cells. Additionally, both mutants were unable to initiate negative-strand vRNA synthesis in Vero cells by 72h post-infection, suggesting that the replication block occurred prior to virus-mediated membrane fusion. |
Dietary sodium intake: knowledge, attitudes and practices in Shandong Province, China, 2011
Zhang J , Xu AQ , Ma JX , Shi XM , Guo XL , Engelgau M , Yan LX , Li Y , Li YC , Wang HC , Lu ZL , Zhang JY , Liang XF . PLoS One 2013 8 (3) e58973 OBJECTIVE: To investigate the knowledge, attitudes and practices (KAP) for dietary sodium intake among adult residents of Shandong Province, China. METHODS: In 2011, we conducted a cross sectional survey among a representative sample of 15,350 adults aged 18 to 69 years using a standardized questionnaire to assess their KAP for sodium. Variation in the KAPs by gender, and residence location were compared using the Chi-square tests. Predictors for the 'intention to' and 'currently taking action to' reduce sodium intake were determined by multivariate logistic regression with adjustment for confounding factors. RESULTS: KAPs for dietary sodium intake among urban residents was generally more favorable than among rural residents. Women were likely to have more favorable KAPs than men. About four fifth of subjects reported that they favored a low sodium diets. However, 31% reported that consumption of less sodium results in less physical strength. Overall, 70% indicated their intention to reduce sodium intake, although only 39% reported that they had taken action to reduce sodium. Multiple logistic regression analyses indicated that favorable actions to dietary sodium reduction were more likely to occur among those who were aware of the link between sodium and hypertension, and less likely among those who had unfavorable attitudes towards dietary sodium reduction. CONCLUSION: Increasing knowledge levels about the benefits of sodium reduction will be a key success factor for effective sodium reduction initiatives and is linked to favorable behavioral change. Emphasis should be placed on the rural area. |
Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-using men who have sex with men (SUMSM) in San Francisco
Santos GM , Coffin PO , Das M , Matheson T , Demicco E , Raiford JL , Vittinghoff E , Dilley JW , Colfax G , Herbst JH . J Acquir Immune Defic Syndr 2013 63 (4) 540-4 We evaluated the relationship between frequency and number of substances used and HIV risk (i.e. serodiscordant unprotected anal intercourse [SDUAI]) among 3173 HIV-negative substance-using MSM. Compared to non-users, the adjusted odds ratio(AOR) for SDUAI among episodic and at least weekly users, respectively, was 3.31(95%CI 2.55-4.28) and 5.46(3.80-7.84) for methamphetamine, 1.86(1.51-2.29) and 3.13(2.12-4.63) for cocaine, and 2.08(1.68-2.56) and 2.54(1.85-3.48) for poppers. Heavy alcohol drinkers reported more SDUAI than moderate drinkers (AOR=1.90(1.43-2.51)). Compared to non-users, AORs for using one, two, and ≥ three substances were 16.81(12.25-23.08), 27.31(18.93-39.39), and 46.38(30.65-70.19), respectively. High-risk sexual behaviors were strongly associated with frequency and number of substances used. |
Real-time treatment guidelines: considerations during the Exserohilum rostratum outbreak in the United States
Pappas PG , Kontoyiannis DP , Perfect JR , Chiller TM . Antimicrob Agents Chemother 2013 57 (4) 1573-6 In this issue of Antimicrobial Agents and Chemotherapy, Stevens offers his reflections on the therapeutic approach to the ongoing outbreak of Exserohilum infections related to contaminated methylprednisolone injections (1). As of 24 January 2012, there have been 678 cases reported from 19 states and 44 associated deaths. Early in the epidemic, other fungi were implicated as possibly related to this outbreak based on the isolation of Aspergillus fumigatus from the index case (2, 3), but all other proven infections have been related to Exserohilum rostratum (2–5). For the purposes of this discussion, only E. rostratum will be considered as the etiologic agent in question. | In response to the potential public health consequences to almost 14,000 exposed individuals in the United States, the CDC, working with state and local health departments, developed a rapid and coordinated approach to the outbreak. After identifying the contaminated products and exposed patients, the CDC coordinated the effort to contact these persons to assess the need for clinical evaluation. In addition, cases needed to be rapidly identified, and case definitions were developed, as well as a reporting system for states and health care providers. This unprecedented event required the CDC to take a very proactive approach toward developing guidance on the diagnosis and management of potentially infected patients related to this epidemic. Because of the complicated nature of these infections and the lack of extensive experience in the management of this rare condition, the CDC, with input from the Infectious Diseases Society of America, established an advisory group constituted of experts in clinical mycology. Their purpose was to assimilate the available knowledge, to provide input to the CDC and practitioners who are managing these patients, and to develop and continuously review specific recommendations pertaining to the treatment of fungal infections associated with the outbreak. The opinions which have been put forth by these clinical experts are based on the best available knowledge at the time, and these recommendations are fluid and continue to evolve as more data become available (6, 7). As such, the recommendations from this expert panel are imprecise but openly discussed and well reasoned and allow for a consistent therapeutic approach. In considering treatment approaches for these patients, the advisory group considered in vitro susceptibility of the key pathogen (E. rostratum), the pharmacokinetic features of each potential agent, potential toxicity, the collective experience of those who work with animal models, and most importantly, the experience of those managing these infections in humans. |
Unintentional transfer of vaccinia virus associated with smallpox vaccines: ACAM2000 (R) compared with Dryvax (R)
Tack DM , Karem KL , Montgomery JR , Collins L , Bryant-Genevier MG , Tiernan R , Cano M , Lewis P , Engler RJ , Damon IK , Reynolds MG . Hum Vaccin Immunother 2013 9 (7) 1489-96 BACKGROUND: Routine vaccination against smallpox (variola) ceased in the US in 1976. However, in 2002 limited coverage for military personnel and some healthcare workers was reinstituted. In March 2008, ACAM2000(R) replaced Dryvax(R) as the vaccine used in the United States against smallpox. Unintentional transfer of vaccinia virus from a vaccination site by autoinoculation or contact transmission, can have significant public health implications. We summarize unintentional virus transfer AEs associated with ACAM2000(R) since March 2008 and compare with Dryvax(R). RESULTS: We identified 309 reports for ACAM2000(R) with skin or ocular involvement, of which 93 were autoinoculation cases and 20 were contact transmission cases. The rate for reported cases of autoinoculation was 20.6 per 100,000 vaccinations and for contact transmission was 4.4 per 100,000 vaccinations. Eighteen contact transmission cases could be attributed to contact during a sporting activity (45%) or intimate contact (45%). Of the 113 unintentional transfer cases, 6 met the case definition for ocular vaccinia. The most common locations for all autoinoculation and contact cases were arm/elbow/shoulder (35/113; 31%) and face (24/113; 21%). METHODS: We reviewed 753 reports associated with smallpox in the Vaccine Adverse Event Reporting System and CDC Poxvirus consultation log, reported from March 2008 to August 2010. Reports were classified into categories based upon standard case definitions. CONCLUSION: Overall, unintentional transfer events for ACAM2000(R) and Dryvax(R) are similar. We recommend continued efforts to prevent transfer events and continuing education for healthcare providers focused on recognition of vaccinia lesions, proper sample collection, and laboratory testing to confirm diagnosis. |
Vaccination for typhoid fever in sub-Saharan Africa
Slayton RB , Date KA , Mintz ED . Hum Vaccin Immunother 2013 9 (4) 903-6 New data on the epidemiologic, clinical and microbiologic aspects of typhoid fever in sub-Saharan Africa call for new strategies and new resources to bring the regional epidemic under control. Areas with endemic disease at rates approaching those in south Asia have been identified; large, prolonged and severe outbreaks are occurring more frequently; and resistance to antimicrobial agents, including fluoroquinolones is increasing. Surveillance for typhoid fever is hampered by the lack of laboratory resources for rapid diagnosis, culture confirmation and antimicrobial susceptibility testing. Nonetheless, in 2010, typhoid fever was estimated to cause 725 incident cases and 7 deaths per 100,000 person years in sub-Saharan Africa. Efforts for prevention and outbreak control are challenged by limited access to safe drinking water and sanitation and by a lack of resources to initiate typhoid immunization. A comprehensive approach to typhoid fever prevention including laboratory and epidemiologic capacity building, investments in water, sanitation and hygiene and reconsideration of the role of currently available vaccines could significantly reduce the disease burden. Targeted vaccination using currently available typhoid vaccines should be considered as a short- to intermediate-term risk reduction strategy for high-risk groups across sub-Saharan Africa. |
2012 HIV Diagnostics Conference: the molecular diagnostics perspective.
Branson BM , Pandori M . Expert Rev Mol Diagn 2013 13 (3) 243-5 2012 HIV Diagnostic Conference Atlanta, GA, USA, 12-14 December 2012. This report highlights the presentations and discussions from the 2012 National HIV Diagnostic Conference held in Atlanta (GA, USA), on 12-14 December 2012. Reflecting changes in the evolving field of HIV diagnostics, the conference provided a forum for evaluating developments in molecular diagnostics and their role in HIV diagnosis. In 2010, the HIV Diagnostics Conference concluded with the proposal of a new diagnostic algorithm which included nucleic acid testing to resolve discordant screening and supplemental antibody test results. The 2012 meeting, picking up where the 2010 meeting left off, focused on scientific presentations that assessed this new algorithm and the role played by RNA testing and new developments in molecular diagnostics, including detection of total and integrated HIV-1 DNA, detection and quantification of HIV-2 RNA, and rapid formats for detection of HIV-1 RNA. |
Increased recognition of non-O157 Shiga toxin-producing Escherichia coli infections in the United States during 2000-2010: epidemiologic features and comparison with E. coli O157 infections
Gould LH , Mody RK , Ong KL , Clogher P , Cronquist AB , Garman KN , Lathrop S , Medus C , Spina NL , Webb TH , White PL , Wymore K , Gierke RE , Mahon BE , Griffin PM . Foodborne Pathog Dis 2013 10 (5) 453-60 BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) are an important cause of diarrhea and the major cause of postdiarrheal hemolytic uremic syndrome. Non-O157 STEC infections are being recognized with greater frequency because of changing laboratory practices. METHODS: Foodborne Diseases Active Surveillance Network (FoodNet) site staff conducted active, population-based surveillance for laboratory-confirmed STEC infections. We assessed frequency and incidence of STEC infections by serogroup and examined and compared demographic factors, clinical characteristics, and frequency of international travel among patients. RESULTS: During 2000-2010, FoodNet sites reported 2006 cases of non-O157 STEC infection and 5688 cases of O157 STEC infections. The number of reported non-O157 STEC infections increased from an incidence of 0.12 per 100,000 population in 2000 to 0.95 per 100,000 in 2010; while the rate of O157 STEC infections decreased from 2.17 to 0.95 per 100,000. Among non-O157 STEC, six serogroups were most commonly reported: O26 (26%), O103 (22%), O111 (19%), O121 (6%), O45 (5%), and O145 (4%). Non-O157 STEC infections were more common among Hispanics, and infections were less severe than those caused by O157 STEC, but this varied by serogroup. Fewer non-O157 STEC infections were associated with outbreaks (7% versus 20% for O157), while more were associated with international travel (14% versus 3% for O157). CONCLUSIONS: Improved understanding of the epidemiologic features of non-O157 STEC infections can inform food safety and other prevention efforts. To detect both O157 and non-O157 STEC infections, clinical laboratories should routinely and simultaneously test all stool specimens submitted for diagnosis of acute community-acquired diarrhea for O157 STEC and for Shiga toxin and ensure that isolates are sent to a public health laboratory for serotyping and subtyping. |
Assessment of hydroxylated metabolites of polychlorinated biphenyls as potential xenoestrogens: a QSAR comparative analysis
Ruiz P , Myshkin E , Quigley P , Faroon O , Wheeler JS , Mumtaz MM , Brennan RJ . SAR QSAR Environ Res 2013 24 (5) 393-416 Alternative methods, including quantitative structure-activity relationships (QSAR), are being used increasingly when appropriate data for toxicity evaluation of chemicals are not available. Approximately 40 mono-hydroxylated polychlorinated biphenyls (OH-PCBs) have been identified in humans. They represent a health and environmental concern because some of them have been shown to have agonist or antagonist interactions with human hormone receptors. This could lead to modulation of steroid hormone receptor pathways and endocrine system disruption. We performed QSAR analyses using available estrogenic activity (human estrogen receptor ER alpha) data for 71 OH-PCBs. The modelling was performed using multiple molecular descriptors including electronic, molecular, constitutional, topological, and geometrical endpoints. Multiple linear regressions and recursive partitioning were used to best fit descriptors. The results show that the position of the hydroxyl substitution, polarizability, and meta adjacent un-substituted carbon pairs at the phenolic ring contribute towards greater estrogenic activity for these chemicals. These comparative QSAR models may be used for predictive toxicity, and identification of health consequences of PCB metabolites that lack empirical data. Such information will help prioritize such molecules for additional testing, guide future basic laboratory research studies, and help the health/risk assessment community understand the complex nature of chemical mixtures. |
Comparison of dried blood spot to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein
Lacher DA , Berman LE , Chen TC , Porter KS . Clin Chim Acta 2013 422 54-8 BACKGROUND: Compared to venipuncture, dried blood spots (DBS) can be collected by non-phlebotomists in non-clinical settings, is relatively inexpensive, more easily transported and stored conveniently. Disadvantages of DBS include difficult assay development and validation. This study compared dried blood spot to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein. METHODS: Dried blood spot collection and venipuncture were performed on 401 participants. The DBS were collected on Whatman 903 protein saver card. For analysis, 3.2 mm blood punches were placed into a 96-well microtiter plate for elution and then analyzed. RESULTS: The Pearson squared correlation coefficients were high for hemoglobin A1c (0.92), CRP (0.84) and glucose (0.81) and low for total cholesterol (0.34) and HDL cholesterol (0.30). Sensitivity (>82%) and specificity (>90%) were high for CRP, glucose and hemoglobin A1c at selected clinical cut-points. Low sensitivity (<41%) and high specificity (>87%) were seen for total and HDL cholesterol. CONCLUSIONS: The hemoglobin A1c, glucose and CRP correlated well between DBS and venous methods (r2>0.80), but there was a poor correlation for total and HDL cholesterol (r2<0.34). This resulted in low sensitivity of DBS methods for total and HDL cholesterol. |
Dietary supplement use and smoking are important correlates of biomarkers of water-soluble vitamin status after adjusting for sociodemographic and lifestyle variables in a representative sample of U.S. adults
Pfeiffer CM , Sternberg MR , Schleicher RL , Rybak ME . J Nutr 2013 143 (6) 957S-65S Biochemical indicators of water-soluble vitamin (WSV) status were measured in a nationally representative sample of the U.S. population in NHANES 2003-2006. To examine whether demographic differentials in nutritional status were related to and confounded by certain variables, we assessed the association of sociodemographic (age, sex, race-ethnicity, education, income) and lifestyle (dietary supplement use, smoking, alcohol consumption, BMI, physical activity) variables with biomarkers of WSV status in adults (aged ≥20 y): serum and RBC folate, serum pyridoxal-5'-phosphate (PLP), serum 4-pyridoxic acid, serum total cobalamin (vitamin B-12), plasma total homocysteine (tHcy), plasma methylmalonic acid (MMA), and serum ascorbic acid. Age (except for PLP) and smoking (except for MMA) were generally the strongest significant correlates of these biomarkers (|r| ≤ 0.43) and together with supplement use explained more of the variability compared with the other covariates in bivariate analysis. In multiple regression models, sociodemographic and lifestyle variables together explained from 7 (vitamin B-12) to 29% (tHcy) of the biomarker variability. We observed significant associations for most biomarkers (≥6 of 8) with age, sex, race-ethnicity, supplement use, smoking, and BMI and for some biomarkers with PIR (5 of 8), education (1 of 8), alcohol consumption (4 of 8), and physical activity (5 of 8). We noted large estimated percentage changes in biomarker concentrations between race-ethnic groups (from -24 to 20%), between supplement users and nonusers (from -12 to 104%), and between smokers and nonsmokers (from -28 to 8%). In summary, age, sex, and race-ethnic differentials in biomarker concentrations remained significant after adjusting for sociodemographic and lifestyle variables. Supplement use and smoking were important correlates of biomarkers of WSV status. |
Pulmonary toxicity and fibrogenic response of carbon nanotubes
Manke A , Wang L , Rojanasakul Y . Toxicol Mech Methods 2013 23 (3) 196-206 Carbon nanotubes (CNTs) have been a subject of intensive research for a wide range of applications. However, because of their extremely small size and light weight, CNTs are readily inhaled into human lungs resulting in increased rates of pulmonary disorders, most notably fibrosis. Several studies have demonstrated the fibrogenic effects of CNTs given their ability to translocate into the surrounding areas in the lung causing granulomatous lesions and interstitial and sub-pleural fibrosis. However, the mechanisms underlying the disease process remain obscure due to the lack of understanding of the cellular interactions and molecular targets involved. Interestingly, certain physicochemical properties of CNTs have been shown to affect their respiratory toxicity, thereby becoming significant determinants of fibrogenesis. CNT-induced fibrosis involves a multitude of cell types and is characterized by the early onset of inflammation, oxidative stress and accumulation of extracellular matrix. Increased reactive oxygen species activate various cytokine/growth factor signaling cascades resulting in increased expression of inflammatory and fibrotic genes. Profibrotic growth factors and cytokines contribute directly to fibroblast proliferation and collagen production. Given the role of multiple players during the pathogenesis of CNT-induced fibrosis, the objective of this review is to summarize the key findings and discuss major cellular and molecular events governing pulmonary fibrosis. We also discuss the physicochemical properties of CNTs and their effects on pulmonary toxicities as well as various biological factors contributing to the development of fibrosis. |
Adiposity, muscle, and physical activity: predictors of perturbations in heart rate variability
Andrew ME , Shengqiao L , Wactawski-Wende J , Dorn JP , Mnatsakanova A , Charles LE , Fekedulegn D , Miller DB , Violanti JM , Burchfiel CM , Sharp DS . Am J Hum Biol 2013 25 (3) 370-7 OBJECTIVES: This study examines cross-sectional associations of indices of adiposity, lean body mass, and physical activity, with heart rate variability (HRV), a marker for parasympathetic cardiac vagal control. METHODS: The study population consists of 360 officers from the Buffalo New York Police Department. Indices of adiposity include body mass index, waist circumference, and a fat-mass index taken from dual-energy X-ray absorptiometry (DEXA) measurements. Lean body mass indices were derived from DEXA measurements of trunk mass and extremity lean mass. Physical activity was measured using a 7-day self-report questionnaire. HRV was obtained from 5-min electrocardiogram measurements by means of parametric spectral analysis resulting in estimates for high-frequency (HF) and low-frequency (LF) HRV. RESULTS: Both HF and LF HRV were significantly associated with markers for adiposity, two components of lean mass and physical activity with all associations being in the expected direction except that for trunk lean mass. This unexpected result is explained by the possibility that trunk mass is a marker for visceral adiposity rather than lean mass. Body mass index did not explain any additional variance in HRV above and beyond waist circumference and the DEXA indices. CONCLUSIONS: Higher levels of physical activity, lower levels of markers for central adiposity and higher lean mass in the extremities predict higher levels of HRV in this population of police officers. This association between modifiable risk factors and markers for autonomic function suggest possible interventions that may improve health and performance. (Am. J. Hum. Biol., 2013. (c) 2013 Wiley Periodicals, Inc.) |
Assessment of ALS mortality in a cohort of formaldehyde-exposed garment workers
Pinkerton LE , Hein MJ , Meyers A , Kamel F . Amyotroph Lateral Scler Frontotemporal Degener 2013 14 353-5 The etiology of ALS is unknown. Although some investigators have evaluated the role of occupational exposures (1), their role is poorly understood. | Among subjects with known exposure duration in the American Cancer Society’s Cancer Prevention Study II cohort (~1 million subjects), the ALS mortality rate was more than two times higher for subjects with self-reported formaldehyde exposure, compared to unexposed subjects (rate ratio 2.47, 95% confidence interval (CI) 1.58-3.86, 1120 unexposed and 22 exposed cases), and strongly associated with exposure duration (2). Compared to unexposed subjects, the rate ratios were 1.5, 2.1, and 4.1 for subjects with < 4, 4–10, and > 10 years of self-reported formaldehyde exposure, respectively. In contrast, formaldehyde exposure (inferred from occupation) was not associated with ALS in a small case-control study (109 cases, 253 controls) by Fang and colleagues (1). In this study, no association was observed with weighted exposure duration although an imprecise 3-fold increase of ALS, based on four cases, was observed among a sub-group of the highest exposure tertile. | We evaluated ALS mortality among a cohort of formaldehyde-exposed garment workers (3–5). |
Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives
Kavanaugh ML , Frohwirth L , Jerman J , Popkin R , Ethier K . J Pediatr Adolesc Gynecol 2013 26 (2) 86-95 STUDY OBJECTIVE: To describe and explore provider- and patient-level perspectives regarding long-acting reversible contraception (LARC) for teens and young adults (ages 16-24). METHODS: Data collection occurred between June and December 2011. We first conducted telephone interviews with administrative directors at 20 publicly funded facilities that provide family planning services. At 6 of these sites, we conducted a total of 6 focus group discussions (FGDs) with facility staff and 48 in-depth interviews (IDIs) with facility clients ages 16-24. RESULTS: Staff in the FGDs did not generally equate being a teen with ineligibility for IUDs. In contrast to staff, one-quarter of the young women did perceive young age as rendering them ineligible. Clients and staff agreed that the "forgettable" nature of the methods and their duration were some of LARC's most significant advantages. They also agreed that fear of pain associated with both insertion and removal and negative side effects were disadvantages. Some aspects of IUDs and implants were perceived as advantages by some clients but disadvantages by others. Common challenges to providing LARC-specific services to younger patients included extra time required to counsel young patients about LARC methods, outdated clinic policies requiring multiple visits to obtain IUDs, and a perceived higher removal rate among young women. The most commonly cited strategy for addressing many of these challenges was securing supplementary funding to support the provision of these services to young patients. CONCLUSION: Incorporating young women's perspectives on LARC methods into publicly funded family planning facilities' efforts to provide these methods to a younger population may increase their use among young women. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Laboratory Sciences
- Nutritional Sciences
- Occupational Safety and Health
- Reproductive Health
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure