"ALS reversals": demographics, disease characteristics, treatments, and co-morbidities
Harrison D , Mehta P , van Es MA , Stommel E , Drory VE , Nefussy B , van den Berg LH , Crayle J , Bedlack R . Amyotroph Lateral Scler Frontotemporal Degener 2018 19 1-5 OBJECTIVE: To identify differences in demographics, disease characteristics, treatments, and co-morbidities between patients with "amyotrophic lateral sclerosis (ALS) reversals" and those with typically progressive ALS. METHODS: Cases of possible ALS reversals were found in prior publications, in the Duke ALS clinic, through self-referral or referral from other Neurologists, and on the internet. Of 89 possible reversals identified, 36 cases were included because chart or literature review confirmed their diagnosis and a robust, sustained improvement in at least one objective measure. Controls were participants in the Pooled Resource Open-Access ALS Clinical Trials database and the National ALS Registry. Cases and controls were compared using descriptive statistics. RESULTS: ALS reversals were more likely to be male, have limb onset disease, and initially progress faster. The prevalences of myasthenia gravis (MG) and purely lower motor neuron disease in cases were higher than estimates of these prevalences in the general population. The odds of taking curcumin, luteolin, cannabidiol, azathioprine, copper, glutathione, vitamin D, and fish oil were greater for cases than controls. CONCLUSIONS: When compared to patients with typically progressive ALS, patients with reversals differed in their demographics, disease characteristics, and treatments. While some of these patients may have had a rare antibody-mediated ALS mimicker, such as atypical myasthenia gravis, details of their exams, EMGs and family histories argue that this was unlikely. Instead, our data suggest that ALS reversals warrant evaluation for mechanisms of disease resistance and that treatments associated with multiple ALS reversals deserve further study. |
Factors associated with hypertension control in U.S. adults using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999-2016
Ostchega Y , Zhang G , Hughes J , Nwankwo T . Am J Hypertens 2018 31 (8) 886-894 Background: Factors and trends associated with hypertension control (BP <130/<80 mm Hg) and mean blood pressure (BP) among hypertensive adults (BP >/=130/80 mm Hg or medicated for hypertension). Method: Data on 22,911 hypertensive US adults from the 1999-2016 National Health and Nutrition Examination Survey. Results: For men, hypertension control prevalence increased from 8.6% in 1999-2000 to 16.2% in 2003-2004 (P<0.001), and continued the increasing trend afterwards to 23.2% in 2011-2012 (P<0.001) and then plateaued. For women, hypertension control prevalence increased from 1999-2000 to 2009-2010 (10.8% to 26.3%, P<0.001) and then plateaued. For men with hypertension, systolic BP decreased from 1999-2000 to 2011-2012 (135.7 mmHg to 132.8 mmHg, P<0.001) and then increased to 135.3 mmHg in 2015-2016 (P<0.001). For women with hypertension, systolic BP decreased from 1999-2000 to 2009-2010 (139.7 mmHg to 131.9 mmHg; p<.001) and then increased to 134.4 mmHg in 2015-2016 (P = 0.003). Diastolic BP decreased from 1999-2000 to 2015-2016 (men 79.1 mmHg to 75.5 mmHg and women 76.4 mmHg to 73.7 mmHg, P<.001 for both). In 2011 to 2016, hypertension control was 22.0% for men and 25.2% for women. The adjusted prevalence ratio (PR) of hypertension control were lower for non-Hispanic black men and women (PR=0.72, 95%C I=0.61-0.86; PR=0.83, 95%CI=0.70-0.99, respectively; non-Hispanic white (NHW) as reference), Hispanic and non-Hispanic Asian men (PR=0.70, 95%CI=0.54-0.92; PR=0.59, 95%CI=0.39-0.86; respectively; NHW as reference). Conclusion: Hypertension control significantly increased from 1999-2000 to 2011-2012(men) and 2009-2010 (women) and then plateaued. About a quarter of US adults with hypertension were controlled in 2011-2016. |
Epidemiology and molecular characterization of Neisseria lactamica carried in 11-19 years old students in Salvador, Brazil.
Moura Arss , Kretz CB , Ferreira IE , Nunes Ampb , de Filippis I , de Moraes JC , Reis MG , McBride AJA , Wang X , Campos LC . Int J Med Microbiol 2018 308 (4) 454-458 Neisseria lactamica is a nonpathogenic commensal bacterium that is potentially associated with the development of natural immunity against N. meningitidis. However, the genetic variation present in natural populations of N. lactamica has not been fully investigated. To better understand its epidemiology and genetic variation, we studied N. lactamica carriage in 1200 students aged 11-19 years old in Salvador, Brazil. The carriage prevalence was 4.5% (54/1200), with no statistical difference among sex and age, although we observed a trend towards higher carriage prevalence among 11-year-old individuals. Whole genome sequence analysis revealed a high genetic diversity among the isolates, with the presence of 32 different STs, 28 (87.5%) of which were new. A total of 21/50 (42%) isolates belonged to three different clonal complexes. While none of the isolates contained nadA or fHpb alleles, we detected 21 FetA variants, 20 NhbA variants and two variants of PorB. The data provide detailed information on circulating N. lactamica isolates in adolescents in Brazil and are complementary to studies in other countries. |
Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States.
Rolfes MA , Millman AJ , Talley P , Elbadawi LI , Kramer NA , Barnes JR , Blanton L , Davis JP , Cole S , Dreisig JJ , Garten R , Haupt T , Jackson MA , Kocharian A , Leifer D , Lynfield R , Martin K , McHugh L , Robinson S , Turabelidze G , Webber LA , Pearce Weinberg M , Wentworth DE , Finelli L , Jhung MA . Clin Infect Dis 2018 67 (4) 485-492 Background: During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods: During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results: Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions: Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season. |
Adult female syphilis prevalence, congenital syphilis case incidence and adverse birth outcomes, Mongolia 2000-2016: Estimates using the Spectrum STI tool
Enkhbat E , Korenromp EL , Badrakh J , Zayasaikhan S , Baya P , Orgiokhuu E , Jadambaa N , Munkhbaatar S , Khishigjargal D , Khad N , Mahiane G , Ishikawa N , Jagdagsuren D , Taylor MM . Infect Dis Model 2018 3 13-22 Introduction: Mongolia's health ministry prioritizes control of Sexually Transmitted Infections, including syphilis screening and treatment in antenatal care (ANC). Methods: Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool, using data from ANC surveys and routine screening over 1997-2016. Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis (CS) and CS-attributable adverse birth outcomes (ABO), which we compared with CS case reports. Results: Syphilis prevalence in pregnant women was estimated at 1.7% in 2000 and 3.0% in 2016. We estimated 652 CS cases, of which 410 ABO, in 2016. Far larger, annually increasing numbers of CS cases and ABO were estimated to have been prevented: 1654 cases, of which 789 ABO in 2016 - thanks to increasing coverages of ANC (99% in 2016), ANC-based screening (97% in 2016) and treatment of women diagnosed (81% in 2016). The 42 CS cases reported nationally over 2016 (liveborn infants only) represented 27% of liveborn infants with clinical CS, but only 7% of estimated CS cases among women found syphilis-infected in ANC, and 6% of all estimated CS cases including those born to women with undiagnosed syphilis. Discussion/Conclusion: Mongolia's ANC-based syphilis screening program is reducing CS, but maternal prevalence remains high. To eliminate CS (target: <50 cases per 100,000 live births), Mongolia should strengthen ANC services, limiting losses during referral for treatment, and under-diagnosis of CS including still-births and neonatal deaths, and expand syphilis screening and prevention programs. |
Creating innovative sexually transmitted infection testing options for university students: The impact of an STI self-testing program
Habel MA , Brookmeyer KA , Oliver-Veronesi R , Haffner MM . Sex Transm Dis 2018 45 (4) 272-277 BACKGROUND: National-level data suggest that sexually transmitted infection (STI) testing rates among young adults are low. The purpose of this study was to evaluate the acceptability of an STI self-testing program at a university health center. Few evaluations on the acceptability of collegiate self-testing programs and their effect on testing uptake have been conducted. METHODS: To assess acceptability and uptake of self-testing (urine and self-collected vaginal swab), we conducted a brief self-administered survey of students accessing a large US-based university health center from January to December 2015. RESULTS: In 2015, University Health Services experienced a 28.5% increase in chlamydia (CT)/gonorrhea (GC) testing for male individuals and 13.7% increase in testing for female students compared to 2013 (baseline). In 2015, 12.4% of male students and 4.8% of female students tested positive for CT/GC via clinician testing, whereas 12.9% of male students and 12.4% of female students tested positive via self-testing. Female students were more likely to test positive for CT/GC when electing to test via self-test versus a clinician test (chi(1, N = 3068) = 36.54, P < 0.01); no significant difference in testing type was observed for male students. Overall, 22.5% of students who opted for the self-test option completed the acceptability survey; 63% reported that their main reason for testing was unprotected sex. In the past year, 42% reported 4 or more partners. The majority were very satisfied and likely to use the service again (82%). CONCLUSIONS: Self-testing may be an efficient and effective way to provide STI testing for students and increase testing uptake. Self-reports of multiple partners, unprotected sex, and detected infections suggest that at-risk students are using the service. |
Deaths from pneumonia - New York City, 1999-2015
Cordoba E , Maduro G , Huynh M , Varma JK , Vora NM . Open Forum Infect Dis 2018 5 (2) ofy020 Background. "Pneumonia and influenza" are the third leading cause of death in New York City. Since 2012, pneumonia and influenza have been the only infectious diseases listed among the 10 leading causes of death in NYC. Most pneumonia and influenza deaths in NYC list pneumonia as the underlying cause of death, not influenza. We therefore analyzed death certificate data for pneumonia in NYC during 1999-2015. Methods. We calculated annualized pneumonia death rates (overall and by sociodemographic subgroup) and examined the etiologic agent listed. Results. There were 41 400 pneumonia deaths during the study period, corresponding to an annualized age-adjusted death rate of 29.7 per 100 000 population. Approximately 17.5% of pneumonia deaths specified an etiologic agent. Age-adjusted pneumonia death rate declined over the study period and across each borough. Males had an annualized age-adjusted pneumonia death rate 1.5 (95% confidence interval [CI], 1.5-1.5) times that of females. Non-Hispanic blacks had an annualized age-adjusted pneumonia death rate 1.2 (95% CI, 1.2-1.2) times that of non-Hispanic whites. The annualized pneumonia death rate increased with age group above 5-24 years and neighborhood-level poverty. Staten Island had an annualized age-adjusted pneumonia death rate 1.3 (95% CI, 1.2-1.3) times that of Manhattan. In the multivariable analysis, pneumonia deaths were more likely to occur among males, non-Hispanic blacks, persons aged ≥65 years, residents of neighborhoods with higher poverty levels, and in Staten Island. Conclusions. While the accuracy of death certificates is unknown, investigation is needed to understand why certain populations are disproportionately recorded as dying from pneumonia in NYC. |
Hospitalized bacteremic melioidosis in rural Thailand; 2009-2013
Jatapai A , Gregory CJ , Thamthitiwat S , Tanwisaid K , Bhengsri S , Baggett HC , Sangwichian O , Jorakate P , MacArthur JR . Am J Trop Med Hyg 2018 98 (6) 1585-1591 Melioidosis incidence and mortality have reportedly been increasing in endemic areas of Thailand, but little population-based data on culture-confirmed Burkholderia pseudomallei infections exist. We provide updated estimates of melioidosis bacteremia incidence and in-hospital mortality rate using integration of two population-based surveillance databases in Nakhon Phanom, Thailand, since automated blood culture became available in 2005. From 2009 to 2013, 564 hospitalized bacteremic melioidosis patients were identified. The annual incidence of bacteremic melioidosis ranged from 14 to 17 per 100,000 persons, and average population mortality rate was 2 per 100,000 persons per year. In-hospital mortality rate declined nonsignificantly from 15% (15/102) to 13% (15/118). Of 313 (56%) bacteremic melioidosis patients who met criteria for acute lower respiratory infection and were included in the hospital-based pneumonia surveillance system, 65% (202/313) had a chest radiograph performed within 48 hours of admission; 46% (92/202) showed radiographic evidence of pneumonia. Annual incidence of bacteremic melioidosis with pneumonia was 2.4 per 100,000 persons (95% confidence intervals; 1.9-2.9). In-hospital death was more likely among bacteremic melioidosis patients with pneumonia (34%; 20/59) compared with non-pneumonia patients (18%; 59/321) (P-value = 0.007). The overall mortality could have been as high as 46% (257/564) if patients with poor clinical condition at the time of discharge had died. The continued high incidence of bacteremic melioidosis, pneumonia, and deaths in an endemic area highlights the need for early diagnosis and treatment and additional interventions for the prevention and control for melioidosis. |
Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015
Jalloh MF , Li W , Bunnell RE , Ethier KA , O'Leary A , Hageman KM , Sengeh P , Jalloh MB , Morgan O , Hersey S , Marston BJ , Dafae F , Redd JT . BMJ Glob Health 2018 3 (2) e000471 Background: The mental health impact of the 2014-2016 Ebola epidemic has been described among survivors, family members and healthcare workers, but little is known about its impact on the general population of affected countries. We assessed symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population in Sierra Leone after over a year of outbreak response. Methods: We administered a cross-sectional survey in July 2015 to a national sample of 3564 consenting participants selected through multistaged cluster sampling. Symptoms of anxiety and depression were measured by Patient Health Questionnaire-4. PTSD symptoms were measured by six items from the Impact of Events Scale-revised. Relationships among Ebola experience, perceived Ebola threat and mental health symptoms were examined through binary logistic regression. Results: Prevalence of any anxiety-depression symptom was 48% (95% CI 46.8% to 50.0%), and of any PTSD symptom 76% (95% CI 75.0% to 77.8%). In addition, 6% (95% CI 5.4% to 7.0%) met the clinical cut-off for anxiety-depression, 27% (95% CI 25.8% to 28.8%) met levels of clinical concern for PTSD and 16% (95% CI 14.7% to 17.1%) met levels of probable PTSD diagnosis. Factors associated with higher reporting of any symptoms in bivariate analysis included region of residence, experiences with Ebola and perceived Ebola threat. Knowing someone quarantined for Ebola was independently associated with anxiety-depression (adjusted OR (AOR) 2.3, 95% CI 1.7 to 2.9) and PTSD (AOR 2.095% CI 1.5 to 2.8) symptoms. Perceiving Ebola as a threat was independently associated with anxiety-depression (AOR 1.69 95% CI 1.44 to 1.98) and PTSD (AOR 1.86 95% CI 1.56 to 2.21) symptoms. Conclusion: Symptoms of PTSD and anxiety-depression were common after one year of Ebola response; psychosocial support may be needed for people with Ebola-related experiences. Preventing, detecting, and responding to mental health conditions should be an important component of global health security efforts. |
National incidence of pediatric mastoiditis in the United States, 2000-2012: Creating a baseline for public health surveillance
King LM , Bartoces M , Hersh AL , Hicks LA , Fleming-Dutra KE . Pediatr Infect Dis J 2018 38 (1) e14-e16 Between 2000-2012, the national estimated incidence rate of pediatric mastoiditis, a rare but serious complication of acute otitis media (AOM), was highest in 2006 (2.7 per 100,000 population) and lowest in 2012 (1.8 per 100,000 population). This measure provides a baseline for public health surveillance in the pneumococcal conjugate vaccine era as stewardship efforts target antibiotic use in AOM. |
Non-mumps viral parotitis during the 2014-2015 influenza season in the United States
Elbadawi LI , Talley P , Rolfes MA , Millman AJ , Reisdorf E , Kramer NA , Barnes JR , Blanton L , Christensen J , Cole S , Danz T , Dreisig JJ , Garten R , Haupt T , Isaac BM , Jackson MA , Kocharian A , Leifer D , Martin K , McHugh L , McNall RJ , Palm J , Radford KW , Robinson S , Rosen JB , Sakthivel SK , Shult P , Strain AK , Turabelidze G , Webber LA , Weinberg MP , Wentworth DE , Whitaker BL , Finelli L , Jhung MA , Lynfield R , Davis JP . Clin Infect Dis 2018 67 (4) 493-501 Background: During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods: NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results: Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, >/=2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions: Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks. |
Preventive behaviors adults report using to avoid catching or spreading influenza, United States, 2015-16 influenza season
Srivastav A , Santibanez TA , Lu PJ , Stringer MC , Dever JA , Bostwick M , Kurtz MS , Qualls NL , Williams WW . PLoS One 2018 13 (3) e0195085 INTRODUCTION: Influenza vaccination can prevent influenza and potentially serious influenza-related complications. Although the single best way to prevent influenza is annual vaccination, everyday preventive actions, including good hygiene, health, dietary, and social habits, might help, too. Several preventive measures are recommended, including: avoiding close contact with people who are sick; staying home when sick; covering your mouth and nose when coughing or sneezing; washing your hands often; avoiding touching your eyes, nose, and mouth; and practicing other good health habits like cleaning and disinfecting frequently touched surfaces, getting plenty of sleep, and drinking plenty of fluids. Understanding public acceptance and current usage of these preventive behaviors can be useful for planning both seasonal and pandemic influenza prevention campaigns. This study estimated the percentage of adults in the United States who reported practicing preventive behaviors to avoid catching or spreading influenza, and explored associations of reported behaviors with sociodemographic factors. METHODS: We analyzed data from 2015 National Internet Flu Survey, a nationally representative probability-based Internet panel survey of the non-institutionalized U.S. population >/=18 years. The self-reported behaviors used to avoid catching or spreading influenza were grouped into four and three non-mutually exclusive subgroups, respectively. Weighted proportions were calculated. Multivariable logistic regression models were used to calculate adjusted prevalence differences and to determine independent associations between sociodemographic characteristics and preventive behavior subgroups. RESULTS: Common preventive behaviors reported were: 83.2% wash hands often, 80.0% cover coughs and sneezes, 78.2% stay home if sick with a respiratory illness, 64.4% avoid people sick with a respiratory illness, 51.7% use hand sanitizers, 50.2% get treatment as soon as possible, and 49.8% report getting the influenza vaccination. Race/ethnicity, gender, age, education, income, region, receipt of influenza vaccination, and household size were associated with use of preventive behaviors after controlling for other factors. CONCLUSION: Many adults in the United States reported using preventive behaviors to avoid catching or spreading influenza. Though vaccination is the most important tool available to prevent influenza, the addition of preventive behaviors might play an effective role in reducing or slowing transmission of influenza and complement prevention efforts. |
A randomized controlled trial to assess the impact of ceramic water filters on prevention of diarrhea and cryptosporidiosis in infants and young children - Western Kenya, 2013
Morris JF , Murphy J , Fagerli K , Schneeberger C , Jaron P , Moke F , Juma J , Ochieng JB , Omore R , Roellig D , Xiao L , Priest JW , Narayanan J , Montgomery J , Hill V , Mintz E , Ayers TL , O'Reilly CE . Am J Trop Med Hyg 2018 98 (5) 1260-1268 Cryptosporidium is a leading cause of diarrhea among Kenyan infants. Ceramic water filters (CWFs) are used for household water treatment. We assessed the impact of CWFs on diarrhea, cryptosporidiosis prevention, and water quality in rural western Kenya. A randomized, controlled intervention trial was conducted in 240 households with infants 4-10 months old. Twenty-six weekly household surveys assessed infant diarrhea and health facility visits. Stool specimens from infants with diarrhea were examined for Cryptosporidium. Source water, filtered water, and filter retentate were tested for Cryptosporidium and/or microbial indicators. To estimate the effect of CWFs on health outcomes, logistic regression models using generalized estimating equations were performed; odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Households reported using surface water (36%), public taps (29%), or rainwater (17%) as their primary drinking water sources, with no differences in treatment groups. Intervention households reported less diarrhea (7.6% versus 8.9%; OR: 0.86 [0.64-1.16]) and significantly fewer health facility visits for diarrhea (1.0% versus 1.9%; OR: 0.50 [0.30-0.83]). In total, 15% of intervention and 12% of control stools yielded Cryptosporidium (P = 0.26). Escherichia coli was detected in 93% of source water samples; 71% of filtered water samples met World Health Organization recommendations of < 1 E. coli/100 mL. Cryptosporidium was not detected in source water and was detected in just 2% of filter rinses following passage of large volumes of source water. Water quality was improved among CWF users; however, the short study duration and small sample size limited our ability to observe reductions in cryptosporidiosis. |
Rapid increases in syphilis in reproductive-aged women in Japan: A warning for other countries
Kamb ML , Taylor MM , Ishikawa N . Sex Transm Dis 2018 45 (3) 144-146 In this issue of Sexually Transmitted Diseases, Arima et al.1 report on a rapid and large increase in heterosexual syphilis in Japan, with an especially concerning rate of rise among young women of reproductive age. As is true in many industrialized countries, Japan has experienced a marked upsurge in syphilis over the past 2 decades, and national surveillance since 2012 has found an increasing proportion of primary and secondary (P&S)—that is, incident—syphilis cases each year demonstrated by a 4-fold increase in case rates, from 0.7 per 100,000 in 2012 to 3.6 per 100,000 in 2016. However, unlike most high-income countries where most P&S syphilis cases are in men who have sex with men (MSM), P&S cases in Japan are most frequently reported among men who self-report only having sex with women (MSW; 48.6% of cases), followed by women (23.2%) and MSM (22.2%). On the surface, this might suggest underreporting of male homosexual contact. However, the relatively modest increase in syphilis case rates among MSM, compared with the concurrent and similarly steep rises in case rates among both MSW and women beginning in 20131 (See Arima et al, Figs. 1A, B), suggests that heterosexual syphilis is indeed on the rise in Japan. |
Social support networks: An underutilized resource for the prevention of HIV and other sexually transmitted diseases among Hispanic/Latino migrants and immigrants
Painter TM . J Health Care Poor Underserved 2018 29 (1) 44-57 Hispanic/Latino migrants and immigrants are vulnerable to infection by HIV and other sexually transmitted diseases (STDs). Participation in social support networks helps them cope with circumstances in the U.S. Studies of Hispanic/Latino migrants suggest that participation may also be protective against HIV/STD infection. However the studies do not satisfactorily explain how participation leads to protective actions, and recommend externally-induced interventions for HIV/STD prevention rather than incorporating the spontaneously occurring forms of social support they describe. Given the potential protective effects of support networks, a database search was conducted to ascertain the extent to which published HIV/STD prevention interventions for these populations incorporate their support networks. Very few interventions were identified and fewer still incorporate support networks. This commentary calls for research to understand more fully how support networks affect HIV/STD risks among Hispanic/Latino migrants and immigrants and identifies potential benefits of incorporating these networks in HIV/STD prevention for these vulnerable populations. |
Trends in testing algorithms used to diagnose HIV infection, 2011-2015, United States and 6 dependent areas
Peruski AH , Dong X , Selik RM . J Clin Virol 2018 103 19-24 BACKGROUND: In 2014 the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) issued updated laboratory testing recommendations for the diagnosis of HIV infection. OBJECTIVES: To examine trends in the use of HIV diagnostic testing algorithms, and determine whether the use of different algorithms is associated with selected patient characteristics and linkage to HIV medical care. STUDY DESIGN: Analysis of HIV infection diagnoses during 2011-2015 reported to the National HIV Surveillance System through December 2016. Algorithm classification: traditional=initial HIV antibody immunoassay followed by a Western blot or immunofluorescence antibody test; recommended=initial HIV antibody IA followed by HIV-1/2 type-differentiating antibody test; rapid=two CLIA-waived rapid tests on same date. RESULTS: During 2011-2015, the percentage of HIV diagnoses made using the traditional algorithm decreased from 84% to 16%, the percentage using the recommended algorithm increased from 0.1% to 64%, and the percentage using the rapid testing algorithm increased from 0.1% to 2%. The percentage of persons linked to care within 30days after HIV diagnosis in 2015 was higher for diagnoses using the recommended algorithm (59%) than for diagnoses using the traditional algorithm (55%) (p<0.05). CONCLUSIONS: During 2011-2015, the percentage of HIV diagnoses reported using the recommended and rapid testing algorithms increased while the use of the traditional algorithm decreased. In 2015, persons with HIV diagnosed using the recommended algorithm were more promptly linked to care than those with diagnosis using the traditional algorithm. |
Genome Sequence of Coxiella-Like Endosymbiont Strain CLE-RmD, a Bacterial Agent in the Cattle Tick (Rhipicephalus microplus) Deutsch Strain.
Ramaiah A , Dasch GA . Genome Announc 2018 6 (13) We report a partial genome sequence for the Coxiella-like endosymbiont strain CLE-RmD, assembled from metagenomics data obtained from the southern cattle tick (Rhipicephalus microplus) Deutsch strain. |
Determining raptor species and tissue sensitivity for improved West Nile virus surveillance
Kritzik KL , Kratz G , Panella NA , Burkhalter K , Clark RJ , Biggerstaff BJ , Komar N . J Wildl Dis 2018 54 (3) 528-533 Raptors are a target sentinel species for West Nile virus (WNV) because many are susceptible to WNV disease, they are easily sighted because of their large size, and they often occupy territories near human settlements. Sick and dead raptors accumulate at raptor and wildlife rehabilitation clinics. However, investigations into species selection and specimen type for efficient detection of WNV are lacking. Accordingly, we evaluated dead raptors from north-central Colorado and SE Wyoming over a 4-yr period. Nonvascular mature feathers ("quill"), vascular immature feathers ("pulp"), oropharyngeal swabs, cloacal swabs, and kidney samples were collected from raptor carcasses at the Rocky Mountain Raptor Program in Colorado from 2013 through 2016. We tested the samples using real-time reverse transcriptase-PCR. We found that 11% (53/482) of raptor carcasses tested positive for WNV infection. We consistently detected positive specimens during a 12-wk span between the second week of July and the third week of September across all years of the study. We detected WNV RNA most frequently in vascular feather pulp from Cooper's Hawk ( Accipiter cooperii). North American avian mortality surveillance for WNV using raptors can obviate necropsies by selecting Cooper's Hawk and Red-tailed Hawk ( Buteo jamaicensis) as sentinels and targeting feather pulp as a substrate for viral detection. |
A web-based review of environmental health vector control services in the United States
Ruiz A , Vanover C , Parale A , Gerding J . J Environ Health 2018 80 (8) 36-38 The authors provide insights and information about environmental health programs, trends, issues, and resources. Topics discussed include the need and significance for mosquito control in local jurisdictions, the role of environmental health professionals in influencing the scope of vector control services in the U.S., and environmental health vector control opportunities. |
Zika virus MB16-23 in mosquitoes, Miami-Dade County, Florida, USA, 2016
Mutebi JP , Hughes HR , Burkhalter KL , Kothera L , Vasquez C , Kenney JL . Emerg Infect Dis 2018 24 (4) 808-10 We isolated a strain of Zika virus, MB16-23, from Aedes aegypti mosquitoes collected in Miami Beach, Florida, USA, on September 2, 2016. Phylogenetic analysis suggests that MB16-23 most likely originated from the Caribbean region. |
Antibiotic stewardship grows up
Srinivasan A . Jt Comm J Qual Patient Saf 2018 44 (2) 65-67 The Joint Commission’s antibiotic stewardship accreditation standard, Medication Management (MM) Standard MM.09.01.01, effective January 1, 2017,1,2 is transforming efforts to improve antibiotic use in hospitals in the United States. In 2016 the Centers for Medicare & Medicaid Services proposed a similar requirement in the hospital Conditions of Participation.3 Data supporting the effectiveness of hospital antibiotic stewardship programs (ASPs) have been long-standing and voluminous. Many studies during the past three decades have shown that these programs can improve patient outcomes and reduce antibiotic resistance while saving money at the same time.4,5 |
Childhood and adolescent phenol and phthalate exposure and the age of menarche in Latina girls
Binder AM , Corvalan C , Calafat AM , Ye X , Mericq V , Pereira A , Michels KB . Environ Health 2018 17 (1) 32 BACKGROUND: The age of menarche has been associated with metabolic and cardiovascular disease, as well as cancer risk. The decline in menarcheal age over the past century may be partially attributable to increased exposure to endocrine disrupting chemicals (EDCs). METHODS: We assessed the influence of 26 phenol and phthalate biomarkers on the timing of menarche in a longitudinal cohort of Chilean girls. These EDCs were quantified in urine collected prior to the onset of breast development (Tanner 1; B1), and during adolescence (Tanner 4; B4). Multivariable accelerated failure time (AFT) models were used to analyze associations between biomarker concentrations and the age of menarche adjusting for body mass index (BMI) Z-score and maternal education, accounting for within-subject correlation. RESULTS: Several biomarkers were significantly associated with the age at menarche; however, these associations were dependent on the timing of biomarker assessment. A log(ng/ml) increase in B1 concentrations of di(2-ethylhexyl) phthalate biomarkers was associated with later menarche (hazard ratio (HR): 0.77; 95% CI: 0.60, 0.98), whereas higher B1 concentrations of 2,5-dichlorophenol and benzophenone-3 were associated with earlier menarche (HR: 1.13; 95% CI: 1.01, 1.27; HR: 1.17; 95% CI: 1.06, 1.29, respectively). Elevated B4 concentrations of monomethyl phthalate were similarly associated with earlier menarche (HR: 1.30; 95% CI: 1.10, 1.53). The impact of monoethyl phthalate and triclosan concentrations on pubertal timing were significantly modified by BMI Z-score. Higher monoethyl phthalate and triclosan concentrations were associated with earlier menarche among overweight or obese girls, but not among those that were normal weight. CONCLUSIONS: This study identifies modulation of sexual maturation by specific EDC biomarkers in Latina girls. |
Loud noise: Too loud, too long!
Eichwald J , Carroll Y , Breysse P . J Environ Health 2018 80 (8) 34-35 The article discusses the relationship between exposure to hazardous substances in the environment and their impact on human health and how to protect public health. Topics mentioned include a hearing loss campaign launched by the U.S. Centers for Disease Control and Prevention in February 2017, the National Health and Nutrition Examination Survey, and the 1999 Guidelines for Community Noise by the World Health Organization. |
Maternal urinary phthalate metabolites during pregnancy and thyroid hormone concentrations in maternal and cord sera: The HOME Study
Romano ME , Eliot MN , Zoeller RT , Hoofnagle AN , Calafat AM , Karagas MR , Yolton K , Chen A , Lanphear BP , Braun JM . Int J Hyg Environ Health 2018 221 (4) 623-631 BACKGROUND: Phthalates, endocrine-disrupting chemicals that are commonly found in consumer products, may adversely affect thyroid hormones, but findings from prior epidemiologic studies are inconsistent. OBJECTIVES: In a prospective cohort study, we investigated whether maternal urinary phthalate metabolite concentrations and phthalate mixtures measured during pregnancy were associated with thyroid hormones among pregnant women and newborns. METHODS: We measured nine phthalate metabolites [monoethyl phthalate (MEP), mono-n-butyl phthalate, mono-isobutyl phthalate, monobenzyl phthalate (MBzP), and four monoesthers of di(2-ethylhexyl) phthalate] in urine collected at approximately 16 and 26 weeks' gestation among women in the Health Outcomes and Measures of the Environment Study (2003-2006, Cincinnati, Ohio). Thyroid stimulating hormone (TSH) and free and total thyroxine and triiodothyronine were measured in maternal serum at 16 weeks' gestation (n=202) and cord serum at delivery (n=276). We used multivariable linear regression to assess associations between individual urinary phthalate metabolites and concentrations of maternal or cord serum thyroid hormones. We used weighted quantile sum regression (WQS) to create a phthalate index describing combined concentrations of phthalate metabolites and to investigate associations of the phthalate index with individual thyroid hormones. RESULTS: With each 10-fold increase in 16-week maternal urinary MEP, maternal serum total thyroxine (TT4) decreased by 0.52mug/dL (95% CI: -1.01, -0.03). For each 10-fold increase in average (16- and 26-week) maternal urinary MBzP, cord serum TSH decreased by 19% (95% CI: -33.1, -1.9). Among mothers, the phthalate index was inversely associated with maternal serum TT4 (WQS beta=-0.60; 95% CI: -1.01, -0.18). Among newborns, the phthalate index was inversely associated with both cord serum TSH (WQS beta=-0.11; 95% CI: -0.20, -0.03) and TT4 (WQS beta=-0.53; 95% CI: -0.90, -0.16). CONCLUSION: Our results suggest that co-exposure to multiple phthalates was inversely associated with certain thyroid hormones (TT4 in pregnant women and newborns, and TSH in newborns) in this birth cohort. These findings highlight the need to study chemical mixtures in environmental epidemiology. |
Organizational characteristics of local health departments and environmental health services and activities
Banerjee SN , Gerding JA , Sarisky J . J Environ Health 2018 80 (8) 20-29 The main objective of this research was to ascertain the association between organizational characteristics of local health departments (LHDs) and environmental health (EH) services rendered in the community. Data used for the analysis were collected from LHDs by the National Association of County and City Health Officials for its 2013 national profile study of LHDs. We analyzed the data during 2016. Apart from understanding basic characteristics of LHDs in the nation, we introduced new measures of these characteristics, including "EH full-time equivalents" per 100,000 population and "other revenue" (revenues from fees and fines) per capita. The association of these and other organizational characteristics with EH services were measured using likelihood ratio §² and t-tests. Out of 34 EH services considered, LHDs directly provided an average of 12 different services. As many as 41% of the 34 EH services were not available in more than 10% of the communities served by LHDs. About 70% of communities received some services from organizations other than LHDs. All the available organizational characteristics of LHDs had association with some of the EH services. Although we might assume an increase in per capita expenditure could result in an increase in LHDs' direct involvement in providing EH services, we found it to be true only for five (15%) of the EH services. The variation of EH services provided in communities could be explained by a combination of factors such as fee generation, community needs, type of governance, and population size. |
Rapid identification of a cooling tower-associated Legionnaires' disease outbreak supported by polymerase chain reaction testing of environmental samples, New York City, 2014-2015
Benowitz I , Fitzhenry R , Boyd C , Levy M , Ying L , Passaretti T , Rakeman J , Saylors A , Shamoonian E , Smith T , Balter S . J Environ Health 2018 80 (8) 8-12 We investigated an outbreak of eight Legionnaires' disease cases among persons living in an urban residential community of 60,000 people. Possible environmental sources included two active cooling towers (air-conditioning units for large buildings) <1 km from patient residences, a market misting system, a community-wide water system used for heating and cooling, and potable water. To support a timely public health response, we used real-time polymerase chain reaction (PCR) to identify Legionella DNA in environmental samples within hours of specimen collection. We detected L. pneumophila serogroup 1 DNA only at a power plant cooling tower, supporting the decision to order remediation before culture results were available. An isolate from a power plant cooling tower sample was indistinguishable from a patient isolate by pulsed-field gel electrophoresis, suggesting the cooling tower was the outbreak source. PCR results were available <1 day after sample collection, and culture results were available as early as 5 days after plating. PCR is a valuable tool for identifying Legionella DNA in environmental samples in outbreak settings. |
Silicone wristbands compared with traditional polycyclic aromatic hydrocarbon exposure assessment methods
Dixon HM , Scott RP , Holmes D , Calero L , Kincl LD , Waters KM , Camann DE , Calafat AM , Herbstman JB , Anderson KA . Anal Bioanal Chem 2018 410 (13) 3059-3071 Currently there is a lack of inexpensive, easy-to-use technology to evaluate human exposure to environmental chemicals, including polycyclic aromatic hydrocarbons (PAHs). This is the first study in which silicone wristbands were deployed alongside two traditional personal PAH exposure assessment methods: active air monitoring with samplers (i.e., polyurethane foam (PUF) and filter) housed in backpacks, and biological sampling with urine. We demonstrate that wristbands worn for 48 h in a non-occupational setting recover semivolatile PAHs, and we compare levels of PAHs in wristbands to PAHs in PUFs-filters and to hydroxy-PAH (OH-PAH) biomarkers in urine. We deployed all samplers simultaneously for 48 h on 22 pregnant women in an established urban birth cohort. Each woman provided one spot urine sample at the end of the 48-h period. Wristbands recovered PAHs with similar detection frequencies to PUFs-filters. Of the 62 PAHs tested for in the 22 wristbands, 51 PAHs were detected in at least one wristband. In this cohort of pregnant women, we found more significant correlations between OH-PAHs and PAHs in wristbands than between OH-PAHs and PAHs in PUFs-filters. Only two comparisons between PAHs in PUFs-filters and OH-PAHs correlated significantly (rs = 0.53 and p = 0.01; rs = 0.44 and p = 0.04), whereas six comparisons between PAHs in wristbands and OH-PAHs correlated significantly (rs = 0.44 to 0.76 and p = 0.04 to <0.0001). These results support the utility of wristbands as a biologically relevant exposure assessment tool which can be easily integrated into environmental health studies. Graphical abstract PAHs detected in samples collected from urban pregnant women. |
Efficacy of human botulism immune globulin for the treatment of infant botulism: The first 12 years post licensure
Payne JR , Khouri JM , Jewell NP , Arnon SS . J Pediatr 2018 193 172-177 OBJECTIVES: To report the efficacy of Human Botulism Immune Globulin Intravenous (BIG-IV) in the first 12 years following its licensure in 2003 and to characterize its use nationwide in treating patients with infant botulism. STUDY DESIGN: Medical records and billing information were collected for US patients treated with BIG-IV from 2003 to 2015. Length of hospital stay (LOS) and hospital charge information for treated patients were compared with the BIG-IV Pivotal Clinical Trial Placebo Group to quantify decreases in LOS and hospital charges. RESULTS: The use of BIG-IV reduced mean LOS from 5.7 to 2.2 weeks. This shortened hospital stay resulted in a mean decrease in hospital charges of $88 900 per patient. For all US patients 2003-2015, total decreases in LOS and hospital charges were 66.9 years and $86.2 million, respectively. The decrease in mean LOS was time dependent: BIG-IV treatment on hospital days 0-3 reduced mean LOS by 3.7 weeks (P <.001 vs the BIG-IV Pivotal Clinical Trial Placebo Group), on hospital days 4-7 by 2.6 weeks (P <.001 vs the BIG-IV Pivotal Clinical Trial Placebo Group) and on hospital days 8-10 by just 1 week (P = NS). Since licensure, 1192 patients in 48 states and Washington, DC, have been treated with BIG-IV. CONCLUSIONS: The use of BIG-IV since its licensure in 2003 treated approximately 93% of US patients with laboratory-confirmed infant botulism, and prevented >65 years in hospital stay and >$85 million in hospital charges from occurring. The greatest LOS reduction was achieved when BIG-IV was administered soon after hospital admission. Effective and appropriate use of BIG-IV in the US has continued in the postlicensure period. |
Prevalence of human noroviruses in commercial food establishment bathrooms
Leone CM , Dharmasena M , Tang C , Di Caprio E , Ma Y , Araud E , Bolinger H , Rupprom K , Yeargin T , Li J , Schaffner D , Jiang X , Sharp J , Vinje J , Fraser A . J Food Prot 2018 81 (5) 719-728 Although transmission of human norovirus in food establishments is commonly attributed to consumption of contaminated food, transmission via contaminated environmental surfaces, such as those in bathrooms, may also play a role. Our aim was to determine the prevalence of human norovirus on bathroom surfaces in commercial food establishments in New Jersey, Ohio, and South Carolina under nonoutbreak conditions and to determine characteristics associated with the presence of human norovirus. Food establishments (751) were randomly selected from nine counties in each state. Four surfaces (underside of toilet seat, flush handle of toilet, inner door handle of stall or outer door, and sink faucet handle) were swabbed in male and female bathrooms using premoistened macrofoam swabs. A checklist was used to collect information about the characteristics, materials, and mechanisms of objects in bathrooms. In total, 61 (1.5%) of 4,163 swabs tested were presumptively positive for human norovirus, 9 of which were confirmed by sequencing. Some factors associated with the presence of human norovirus included being from South Carolina (odd ratio [OR], 2.4; 95% confidence interval [CI], 1.2 to 4.9; P < 0.05) or New Jersey (OR, 1.7; 95% CI, 0.9 to 3.3; 0.05 < P < 0.10), being a chain establishment (OR, 1.9; 95% CI, 1.1 to 3.3; P < 0.05), being a unisex bathroom (versus male: OR, 2.0; 95% CI, 0.9 to 4.1; 0.05 < P < 0.10; versus female: OR, 2.6; 95% CI, 1.2 to 5.7; P < 0.05), having a touchless outer door handle (OR, 3.3; 95% CI, 0.79 to 13.63; 0.05 < P < 0.10), and having an automatic flush toilet (OR, 2.5, 95% CI, 1.1 to 5.3; 0.05 < P < 0.10). Our findings confirm that the presence of human norovirus on bathroom surfaces in commercial food establishments under nonoutbreak conditions is a rare event. Therefore, routine environmental monitoring for human norovirus contamination during nonoutbreak periods is not an efficient method of monitoring norovirus infection risk. |
Genome Sequence of the Amphotericin B-Resistant Candida duobushaemulonii Strain B09383.
Chow NA , Gade L , Batra D , Rowe LA , Juieng P , Loparev VN , Litvintseva AP . Genome Announc 2018 6 (13) Candida duobushaemulonii is a drug-resistant yeast that can cause invasive candidiasis. Here, we report the first genome sequence of C. duobushaemulonii, isolate B09383, generated using PacBio sequencing technology. The estimated genome size was 12.5 Mb with a GC content of 46.84%. |
Genomic Analysis of a Pan-Resistant Isolate of Klebsiella pneumoniae , United States 2016.
de Man TJB , Lutgring JD , Lonsway DR , Anderson KF , Kiehlbauch JA , Chen L , Walters MS , Sjolund-Karlsson M , Rasheed JK , Kallen A , Halpin AL . mBio 2018 9 (2) Antimicrobial resistance is a threat to public health globally and leads to an estimated 23,000 deaths annually in the United States alone. Here, we report the genomic characterization of an unusual Klebsiella pneumoniae, nonsusceptible to all 26 antibiotics tested, that was isolated from a U.S. PATIENT: The isolate harbored four known beta-lactamase genes, including plasmid-mediated blaNDM-1 and blaCMY-6, as well as chromosomal blaCTX-M-15 and blaSHV-28, which accounted for resistance to all beta-lactams tested. In addition, sequence analysis identified mechanisms that could explain all other reported nonsusceptibility results, including nonsusceptibility to colistin, tigecycline, and chloramphenicol. Two plasmids, IncA/C2 and IncFIB, were closely related to mobile elements described previously and isolated from Gram-negative bacteria from China, Nepal, India, the United States, and Kenya, suggesting possible origins of the isolate and plasmids. This is one of the first K. pneumoniae isolates in the United States to have been reported to the Centers for Disease Control and Prevention (CDC) as nonsusceptible to all drugs tested, including all beta-lactams, colistin, and tigecycline.IMPORTANCE Antimicrobial resistance is a major public health threat worldwide. Bacteria that are nonsusceptible or resistant to all antimicrobials available are of major concern to patients and the public because of lack of treatment options and potential for spread. A Klebsiella pneumoniae strain that was nonsusceptible to all tested antibiotics was isolated from a U.S. PATIENT: Mechanisms that could explain all observed phenotypic antimicrobial resistance phenotypes, including resistance to colistin and beta-lactams, were identified through whole-genome sequencing. The large variety of resistance determinants identified demonstrates the usefulness of whole-genome sequencing for detecting these genes in an outbreak response. Sequencing of isolates with rare and unusual phenotypes can provide information on how these extremely resistant isolates develop, including whether resistance is acquired on mobile elements or accumulated through chromosomal mutations. Moreover, this provides further insight into not only detecting these highly resistant organisms but also preventing their spread. |
Contents, followers, and retweets of the Centers for Disease Control and Prevention's Office of Advanced Molecular Detection (@CDC_AMD) Twitter profile: Cross-sectional study
Fung IC , Jackson AM , Mullican LA , Blankenship EB , Goff ME , Guinn AJ , Saroha N , Tse ZTH . JMIR Public Health Surveill 2018 4 (2) e33 BACKGROUND: The Office of Advanced Molecular Detection (OAMD), Centers for Disease Control and Prevention (CDC), manages a Twitter profile (@CDC_AMD). To our knowledge, no prior study has analyzed a CDC Twitter handle's entire contents and all followers. OBJECTIVE: This study aimed to describe the contents and followers of the Twitter profile @CDC_AMD and to assess if attaching photos or videos to tweets posted by @CDC_AMD would increase retweet frequency. METHODS: Data of @CDC_AMD were retrieved on November 21, 2016. All followers (N=809) were manually categorized. All tweets (N=768) were manually coded for contents and whether photos or videos were attached. Retweet count for each tweet was recorded. Negative binomial regression models were applied to both the original and the retweet corpora. RESULTS: Among the 809 followers, 26.0% (210/809) were individual health professionals, 11.6% (94/809) nongovernmental organizations, 3.3% (27/809) government agencies' accounts, 3.3% (27/809) accounts of media organizations and journalists, and 0.9% (7/809) academic journals, with 54.9% (444/809) categorized as miscellaneous. A total of 46.9% (360/768) of @CDC_AMD's tweets referred to the Office's website and their current research; 17.6% (135/768) referred to their scientists' publications. Moreover, 80% (69/86) of tweets retweeted by @CDC_AMD fell into the miscellaneous category. In addition, 43.4% (333/768) of the tweets contained photos or videos, whereas the remaining 56.6% (435/768) did not. Attaching photos or videos to original @CDC_AMD tweets increases the number of retweets by 37% (probability ratio=1.37, 95% CI 1.13-1.67, P=.002). Content topics did not explain or modify this association. CONCLUSIONS: This study confirms CDC health communicators' experience that original tweets created by @CDC_AMD Twitter profile sharing images or videos (or their links) received more retweets. The current policy of attaching images to tweets should be encouraged. |
Increasing transparency while using the source of payment typology data standard
Rudolph B , Khan H , Ledbetter S . J AHIMA 2018 89 (3) 30-33 The article discusses the development of the Source of Payment Typology data standard and U.S. states' use of data standards. Topics covered include the Payer Typology code set, user's guide, states' implementation of the code set in administrative data systems, and its major classifications and subclassifications. Also noted are states' possible improvement of data use in analyzing the Affordable Care Act's (ACA) impact, and the type of payers that may impact cost, quality, and care access. |
Social Security income and health care spending: Evidence from the Social Security notch
Tsai Y . Scand J Econ 2018 120 (2) 440-464 The paper exploits Social Security legislation changes to identify the causal effect of Social Security income on out-of-pocket medical expenditures of the elderly. Using the 1986-1994 Consumer Expenditure Survey and an instrumental variables strategy, the empirical results show that health care expenditures are responsive to changes in Social Security income for elderly individuals with less than a high school education. The estimated income elasticities are between 1.41 and 3.47 depending on the outcome measures and are statistically significant at conventional levels. The findings are in contrast to existing studies that find a small income elasticity at the individual/household level. |
Incidence and outbreak of healthcare-onset healthcare-associated Clostridioides difficile infections among intensive care patients in a large teaching hospital in China
Li C , Li Y , Huai Y , Liu S , Meng X , Duan J , Klena JD , Rainey JJ , Wu A , Rao CY . Front Microbiol 2018 9 566 Background: Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality among hospitalized patients. In China, however, hospital staffdo not routinely test for CDI, leading to under-diagnosis and poor patient outcomes. Locally generated CDI data can help assess the magnitude of the problem and strengthen approaches for CDI prevention and control. Methods: We prospectively monitored hospital-onset hospital-associated (HOHA) CDI in four intensive care units (ICUs) from June 2013 to September 2014 in a large teaching hospital in China. We collected clinical information from all ICU patients with ≥ 3 episodes of diarrhea occurring within a 24-h period at least 48 h following admission (suspect case definition). Stool specimens were collected from all suspect cases of CDI and cultured for C. difficile. Polymerase chain reaction (PCR) was used to detect toxin genes from positive isolates; multi-locus sequence typing (MLST) was used for typing and identifying novel strains. We estimated the incidence rate as the number of HOHA CDI cases per 10,000 patient days; 95% confidence intervals were generated to assess rate differences between the four ICUs. Results: A total of 593 hospital-onset diarrhea patients met the suspect case definition during the study period. Of these, 47 patients (8%) were positive for C. difficile and toxin genes. The HOHA-CDI incidence rate was 14.1 cases per 10,000 patient days (95% CI: 10.5-18.6). Six patients with HOHA CDI died. ST54 (n = 14, 20%) was the most common type of HOHA-CDI strain circulating in the hospital during the study period and was linked to a temporal cluster (outbreak) involving two (NICU and GICU) of the four ICUs. Conclusion: HOHA-CDI occurs among ICU patients at this teaching hospital, supporting the importance of routine testing for CDI. Information on strain distribution can help detect CDI outbreaks. Detection of ST54 strain in a temporal cluster suggests possible gaps in infection control practices that should be investigated and addressed as needed. |
Notes from the field: Nontuberculous mycobacteria infections in U.S. medical tourists associated with plastic surgery - Dominican Republic, 2017
Gaines J , Poy J , Musser KA , Benowitz I , Leung V , Carothers B , Kauerauf J , Mollon N , Duwell M , Henschel K , De Jesus A , Head SK , Lee K , Arboleda N , Esposito DH . MMWR Morb Mortal Wkly Rep 2018 67 (12) 369-370 Since 2013, CDC has received reports and investigated serious complications among medical tourists (i.e., persons whose primary purpose for international travel is medical care) upon their return to the United States (1). On May 1, 2017, the New York City Department of Health and Mental Hygiene informed CDC of three patients with nontuberculous mycobacteria (NTM) surgical site infections (SSI), all of whom had undergone cosmetic surgical procedures by a single surgeon at Centro Internacional de Cirugía Plástica Avanzada (CIPLA) in the Dominican Republic (2). | | To identify additional patients, calls for cases were issued via CDC’s Epidemic Information Exchange (Epi-X), state-based health alert systems, the Infectious Diseases Society of America’s Emerging Infections Network, and the American Society of Plastic Surgeons’ email distribution list. State and local health department staff members interviewed reported patients to collect information about medical care received abroad, symptoms, and treatment received after their original surgical procedures. A confirmed case of cosmetic surgery–associated NTM infection was defined as a diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017. |
Assessing potential confounding and misclassification bias when studying the safety of the childhood immunization schedule
Daley MF , Shoup JA , Newcomer SR , Jackson ML , Groom HC , Jacobsen SJ , McLean HQ , Klein NP , Weintraub ES , McNeil MM , Glanz JM . Acad Pediatr 2018 18 (7) 754-762 OBJECTIVES: Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to: 1) examine risk of misclassification of vaccination status in electronic health record (EHR) data; and 2) assess potential for confounding if asthma risk factors varied by vaccination status. METHODS: A survey was conducted among parents of children 19-35 months old at 6 medical organizations within the Vaccine Safety Datalink. Parents of children in 4 vaccination groups were surveyed: 1) no vaccines by 12 months of age and a diagnosis of parental vaccine refusal; 2) consistent vaccine-limiting (</=2 vaccines per visit); 3) not consistently vaccine-limiting, but otherwise under-vaccinated with a vaccine refusal diagnosis; and 4) fully vaccinated with no delays and no vaccine refusal. Parents were surveyed about their child's vaccination status and whether asthma risk factors existed. RESULTS: Among a survey sample of 2043 parents, 1209 (59.2%) responded. For receiving no vaccines, the observed agreement between parent report and EHR data was 94.0% (kappa 0.79); for receiving all vaccines with no delays, the observed agreement was 87.3% (kappa 0.73). Although most asthma risk factors (allergic rhinitis; eczema; food allergies; family asthma history) reported by parents did not differ significantly between children in the vaccination groups studied, several factors (aeroallergen sensitivity; breastfeeding) differed significantly between groups. CONCLUSIONS: Measurement and control of disease risk factors should be carefully considered in observational studies of the safety of the immunization schedule. |
Challenges in conducting a community-based influenza vaccine trial in a rural community in northern India
Kumar R , Amarchand R , Narayan VV , Saha S , Lafond KE , Kapoor SK , Dar L , Jain S , Krishnan A . Hum Vaccin Immunother 2018 14 (8) 1-19 Evidence on influenza vaccine effectiveness from low and middle countries (LMICs) is limited due to limited institutional capacities; lack of adequate resources; and lack of interest by ministries of health for influenza vaccine introduction. There are concerns that the highest ethical standards will be compromised during trials in LMICs leading to mistrust of clinical trials. These factors pose regulatory and operational challenges to researchers in these countries. We conducted a community-based vaccine trial to assess the efficacy of live attenuated influenza vaccine and inactivated influenza vaccine in rural north India. Key regulatory challenges included obtaining regulatory approvals, reporting of adverse events, and compensating subjects for trial-related injuries; all of which were required to be completed in a timely fashion. Key operational challenges included obtaining audio-visual consent; maintaining a low attrition rate; and administering vaccines during a narrow time period before the influenza season, and under extreme heat. We overcame these challenges through advanced planning, and sustaining community engagement. We adapted the trial procedures to cope with field conditions by conducting mock vaccine camps; and planned for early morning vaccination to mitigate threats to the cold chain. These lessons may help investigators to confront similar challenges in other LMICs. |
Effectiveness of 13-pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal disease in children in the Dominican Republic
Tomczyk S , Lessa FC , Sanchez J , Pena C , Fernandez J , Gloria Carvalho M , Pimenta F , Cedano D , Whitney CG , Verani JR , Coradin H , Garib Z , De Oliveira LH , Feris-Iglesias J . BMC Infect Dis 2018 18 (1) 152 BACKGROUND: Limited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naive populations. The Dominican Republic introduced PCV13 in September 2013 using a 2 + 1 schedule (2, 4, and 12 months) without a catch-up campaign. We evaluated PCV13 effectiveness against vaccine-type (VT) invasive pneumococcal disease (IPD) among children in the Dominican Republic. METHODS: We conducted a matched case-control study. A case-patient was defined as VT-IPD identified by culture or polymerase chain reaction (PCR) from a normally sterile-site in a hospitalized child who was age-eligible to have received >/=1 PCV13 dose. Four age- and neighborhood-matched controls were enrolled for each case-patient. We collected demographic, vaccination history, and risk factor data. Conditional logistic regression was performed. Vaccine effectiveness was calculated as (1- adjusted matched odds ratio for vaccination) X 100%. RESULTS: We enrolled 39 case-patients and 149 matched-controls. Most case-patients had pneumonia with pleural effusion (64%), followed by meningitis (28%) and septicemia (13%). The most common pneumococcal serotypes identified included 14 (18%), 3 (13%), 19A (10%), and 1 (8%). Fewer case-patients had >/=1 PCV13 dose as compared to controls (61.5% vs. 80.0%; p = 0.006). Adjusting for malnutrition and socioeconomic status, VE of >/=1 PCV13 dose compared to no doses was 67.2% (95% CI: 2.3% to 90.0%). Only 44% of controls were up-to-date for PCV13, suggesting low vaccine coverage in the population. CONCLUSIONS: We found that PCV13 provided individual protection against VT-IPD in this resource-poor setting with a PCV-naive population, despite low PCV13 coverage. Expanding vaccination coverage might increase PCV13 impact. |
Hepatitis B vaccination coverage among adults aged 18 years traveling to a country of high or intermediate endemicity, United States, 2015
Lu PJ , O'Halloran AC , Williams WW , Nelson NP . Vaccine 2018 36 (18) 2471-2479 BACKGROUND: Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. PURPOSE: To assess hepatitis B vaccination coverage among adults>/=18years traveling to a country of high or intermediate endemicity from the United States. METHODS: Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (>/=1 dose) and series completion (>/=3 doses) among persons aged>/= 18years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. RESULTS: In 2015, hepatitis B vaccination coverage (>/=1 dose) among adults aged>/=18years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (>/=3 doses) was 31.7% and 21.2%, respectively (P<0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (>/=1 dose, and>/=3 doses) among travelers included age, race/ethnicity, educational level, duration of U.S. residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. CONCLUSIONS: Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination. |
Knowledge, attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China
Wendlandt R , Cowling BJ , Chen Y , Havers F , Shifflett P , Song Y , Zhang R , Iuliano D , Xu C , Yu H , Zhang J , Zhang H , Tang F , Thompson M . Vaccine 2018 36 (19) 2673-2682 BACKGROUND: This study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine. METHODS: A prospective cohort of 1506 older adults (aged >/=60years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated. RESULTS: One in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least "a little" knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least "a little" knowledge of the vaccine was 2.9-fold (95% CI=1.6-5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they "worry about getting the flu this season." Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least "a little". CONCLUSIONS: If and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment. |
A description and evaluation of the concussion education application HEADS UP Rocket Blades
Daugherty J , Miles I , Sarmiento K , Sansone C , Kroshus E , Bethea B . Health Promot Pract 2018 20 (1) 1524839918764670 BACKGROUND: Concussions are responsible for numerous emergency department visits and hospitalizations among children annually. However, there remains a great deal of confusion about how to prevent and manage concussions in youth. To teach children aged 6 to 8 years about concussion safety, the Centers for Disease Control and Prevention (CDC) created a mobile gaming application called HEADS UP Rocket Blades. This report introduces the game and presents findings on its evaluation. METHODS: The aim of the game is to teach children what a concussion is, its commons signs and symptoms, how to prevent one, and what to do if one occurs. An early version of the game went through two rounds of usability testing with children and parents to obtain initial impressions and make improvements. RESULTS: The first round of usability testing focused on the mechanics of the game. Based on feedback from this session, CDC and the developers simplified the messaging and adjusted the game's level of difficulty. The second round focused on the gaming experience. The children indicated that they enjoyed playing, and nearly all were able to relay at least one learning objective. CONCLUSIONS: Parents and children rated Rocket Blades as a good learning tool and indicated that they would download it for personal use. |
The epidemiology of unintentional and violence-related injury morbidity and mortality among children and adolescents in the United States
Ballesteros MF , Williams DD , Mack KA , Simon TR , Sleet DA . Int J Environ Res Public Health 2018 15 (4) Injuries and violence among young people have a substantial emotional, physical, and economic toll on society. Understanding the epidemiology of this public health problem can guide prevention efforts, help identify and reduce risk factors, and promote protective factors. We examined fatal and nonfatal unintentional injuries, injuries intentionally inflicted by other (i.e., assaults and homicides) among children ages 0-19, and intentionally self-inflicted injuries (i.e., self-harm and suicides) among children ages 10-19. We accessed deaths (1999-2015) and visits to emergency departments (2001-2015) for these age groups through the Centers for Disease Control and Prevention's (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS), and examined trends and differences by age, sex, race/ethnicity, rural/urban status, and injury mechanism. Almost 13,000 children and adolescents age 0-19 years died in 2015 from injury and violence compared to over 17,000 in 1999. While the overall number of deaths has decreased over time, there were increases in death rates among certain age groups for some categories of unintentional injury and for suicides. The leading causes of injury varied by age group. Our results indicate that efforts to reduce injuries to children and adolescents should consider cause, intent, age, sex, race, and regional factors to assure that prevention resources are directed at those at greatest risk. |
Variations in mechanisms of injury for children with concussion
Haarbauer-Krupa J , Arbogast KB , Metzger KB , Greenspan AI , Kessler R , Curry AE , Bell JM , DePadilla L , Pfeiffer MR , Zonfrillo MR , Master CL . J Pediatr 2018 197 241-248 e1 Objectives: To assess the distribution of injury mechanisms and activities among children with concussions in a large pediatric healthcare system. Study design: All patients, age 0-17 years, who had at least 1 clinical encounter with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of concussion in the Children's Hospital of Philadelphia's electronic health record system from July 1, 2012 to June 30, 2014, were selected (N = 8233) and their initial concussion-related visit identified. Approximately, 20% of the patients (n = 1625) were randomly selected for manual record review to examine injury mechanisms and activities. Results: Overall, 70% of concussions were sports related; however, this proportion varied by age. Only 18% of concussions sustained by children aged 0-4 were sports related, compared with greater proportions for older children (67% for age 5-11, 77% for age 12-14, and 73% for age 15-17). When the concussion was not sports related, the primary mechanisms of injury were struck by an object (30%) and falls (30%). Conclusions: Sports-related injuries in children older than 6 years of age contributed to the majority of concussions in this cohort; however, it is important to note that approximately one-third of concussions were from non–sports-related activities. Although there is increased participation in community and organized sports activities among children, a focus on prevention efforts in other activities where concussions occur is needed. |
Susceptibility of Brazilian influenza A(H1N1)pdm09 viruses to neuraminidase inhibitors in the 2014-2016 seasons: Identification of strains bearing mutations associated with reduced inhibition profile.
Matos AR , Resende PC , Miranda MD , Garcia CC , Caetano BC , Lopes JCO , Debur MC , Cury ALF , Vianna LA , Lima MC , Schirmer M , Gubareva L , Hurt AC , Brown DW , Siqueira MM . Antiviral Res 2018 154 35-43 Neuraminidase inhibitors (NAIs) are the main class of antivirals currently used for the treatment of influenza infections. As influenza viruses are constantly evolving, drug-resistance can emerge resulting in reduced effectiveness of treatment. This study evaluated the presence of molecular markers associated with NAI susceptibility in 724 influenza A(H1N1)pdm09 positive samples from Brazilian surveillance system from the 2014-2016 seasons, including 76 isolates tested for oseltamivir (OST) susceptibility and 23 isolates also tested for zanamivir, peramivir and laninamivir susceptibility. We identified the H275Y (n=3) and I223K (n=1) NA substitutions, associated with reduced inhibition (RI) by the NAIs. Noteworthy, no epidemiological links were identified among the patients infected with the mutant viruses. Phylogenetic analysis from NA and hemagglutinin genes showed that mutant viruses were not clustered. All mutant virus strains carried the permissive substitutions V241I and N369K, in addition to the N386K, which has been shown to destabilize the NA structure. Functional NA analysis of one virus containing the H275Y mutation confirmed its highly RI profile to OST and peramivir and demonstrated that it had decreased viral replication and NA thermostability compared to the wild type virus. The remaining tested isolates presented normal inhibition profile to the NAIs tested. In conclusion, the overall frequency of influenza A(H1N1)pdm09 viruses bearing mutations associated with NAI RI was 0.6%, similar to what has been observed in recent global studies. |
Automated generation and ensemble-learned matching of X-ray absorption spectra
Zheng C , Mathew K , Chen C , Chen Y , Tang H , Dozier A , Kas JJ , Vila FD , Rehr JJ , Piper LFJ , Persson KA , Ong SP . NPJ Computational Materials 2018 4 (1) X-ray absorption spectroscopy (XAS) is a widely used materials characterization technique to determine oxidation states, coordination environment, and other local atomic structure information. Analysis of XAS relies on comparison of measured spectra to reliable reference spectra. However, existing databases of XAS spectra are highly limited both in terms of the number of reference spectra available as well as the breadth of chemistry coverage. In this work, we report the development of XASdb, a large database of computed reference XAS, and an Ensemble-Learned Spectra IdEntification (ELSIE) algorithm for the matching of spectra. XASdb currently hosts more than 800,000 K-edge X-ray absorption near-edge spectra (XANES) for over 40,000 materials from the open-science Materials Project database. We discuss a high-throughput automation framework for FEFF calculations, built on robust, rigorously benchmarked parameters. FEFF is a computer program uses a real-space Green's function approach to calculate X-ray absorption spectra. We will demonstrate that the ELSIE algorithm, which combines 33 weak "learners" comprising a set of preprocessing steps and a similarity metric, can achieve up to 84.2% accuracy in identifying the correct oxidation state and coordination environment of a test set of 19 K-edge XANES spectra encompassing a diverse range of chemistries and crystal structures. The XASdb with the ELSIE algorithm has been integrated into a web application in the Materials Project, providing an important new public resource for the analysis of XAS to all materials researchers. Finally, the ELSIE algorithm itself has been made available as part of veidt, an open source machine-learning library for materials science. © 2018 The Author(s). |
Comparison of PCR methods for Onchocerca volvulus detection in skin snip biopsies from the Tshopo Province, Democratic Republic of the Congo
Prince-Guerra J , Cama V , Wilson N , Thiele EA , Likwela J , Gyamba NN , Muzinga Wa Muzinga J , Ayebazibwe N , Ndjakani YD , Pitchouna NA , Ngoyi DM , Tshefu AK , Ogawa G , Cantey PT . Am J Trop Med Hyg 2018 98 (5) 1427-1434 Defining the optimal diagnostic tools for evaluating onchocerciasis elimination efforts in areas co-endemic for other filarial nematodes is imperative. This study compared three published PCR methods: the Onchocerca volvulus-specific qPCR-O150, the pan-filarial qPCR melt curve analysis (MCA), and the O150-PCR ELISA currently used for vector surveillance in skin snip biopsies (skin snips) collected from the Democratic Republic of the Congo. The pan-filarial qPCR-MCA was compared with species-specific qPCRs for Loa loa and Mansonella perstans. Among the 471 skin snips, 47.5%, 43.5%, and 27% were O. volvulus positive by qPCR-O150, qPCR-MCA, and O150-PCR ELISA, respectively. Using qPCR-O150 as the comparator, the sensitivity and specificity of qPCR-MCA were 89.3% and 98%, respectively, whereas for O150-PCR ELISA, they were 56.7% and 100%, respectively. Although qPCR-MCA identified the presence of L. loa and Mansonella spp. in skin snips, species-specific qPCRs had greater sensitivity and were needed to identify M. perstans. Most of the qPCR-MCA misclassifications occurred in mixed infections. The reduced sensitivity of O150-PCR ELISA was associated with lower microfilaria burden and with lower amounts of O. volvulus DNA. Although qPCR-MCA identified most of the O. volvulus-positive skin snips, it is not sufficiently robust to be used for stop-mass drug administration (MDA) evaluations in areas co-endemic for other filariae. Because O150-PCR ELISA missed 43.3% of qPCR-O150-positive skin snips, the qPCR-O150 assay is more appropriate for evaluating skin snips of OV-16 + children in stop-MDA assessments. Although improving the sensitivity of the O150-PCR ELISA as an alternative to qPCR might be possible, qPCR-O150 offers distinct advantages aside from increased sensitivity. |
Potent 1,2,4-triazino[5,6 b]indole-3-thioether inhibitors of the kanamycin resistance enzyme Eis from Mycobacterium tuberculosis
Ngo HX , Green KD , Gajadeera CS , Willby MJ , Holbrook SYL , Hou C , Garzan A , Mayhoub AS , Posey JE , Tsodikov OV , Garneau-Tsodikova S . ACS Infect Dis 2018 4 (6) 1030-1040 A common cause of resistance to kanamycin (KAN) in tuberculosis is overexpression of the enhanced intracellular survival (Eis) protein. Eis is an acetyltransferase that multiacetylates KAN and other aminoglycosides, rendering them unable to bind the bacterial ribosome. By high-throughput screening, a series of substituted 1,2,4-triazino[5,6 b]indole-3-thioether molecules were identified as effective Eis inhibitors. Herein, we purchased 17 and synthesized 22 new compounds, evaluated their potency, and characterized their steady-state kinetics. Four inhibitors were found not only to inhibit Eis in vitro, but also to act as adjuvants of KAN and partially restore KAN sensitivity in a Mycobacterium tuberculosis KAN-resistant strain in which Eis is upregulated. A crystal structure of Eis in complex with a potent inhibitor and CoA shows that the inhibitors bind in the aminoglycoside binding site snugly inserted into a hydrophobic cavity. These inhibitors will undergo preclinical development as novel KAN adjuvant therapies to treat KAN-resistant tuberculosis. |
Susceptibility of paramyxoviruses and filoviruses to inhibition by 2'-monofluoro- and 2'-difluoro-4'-azidocytidine analogs
Lo MK , Jordan PC , Stevens S , Tam Y , Deval J , Nichol ST , Spiropoulou CF . Antiviral Res 2018 153 101-113 Ebolaviruses, marburgviruses, and henipaviruses are zoonotic pathogens belonging to the Filoviridae and Paramyxoviridae families. They exemplify viruses that continue to spill over into the human population, causing outbreaks characterized by high mortality and significant clinical sequelae in survivors of infection. There are currently no approved small molecule therapeutics for use in humans against these viruses. In this study, we evaluated the antiviral activity of the nucleoside analog 4'-azidocytidine (4'N3-C, R1479) and its 2'-monofluoro- and 2'-difluoro-modified analogs (2'F-4'N3-C and 2'diF-4'N3-C) against representative paramyxoviruses (Nipah virus, Hendra virus, measles virus, and human parainfluenza virus 3) and filoviruses (Ebola virus, Sudan virus, and Ravn virus). We observed enhanced antiviral activity against paramyxoviruses with both 2'diF-4'N3-C and 2'F-4'N3-C compared to R1479. On the other hand, while R1479 and 2'diF-4'N3-C inhibited filoviruses similarly to paramyxoviruses, we observed 10-fold lower filovirus inhibition by 2'F-4'N3-C. To our knowledge, this is the first study to compare the susceptibility of paramyxoviruses and filoviruses to R1479 and its 2'-fluoro-modified analogs. The activity of these compounds against negative-strand RNA viruses endorses the development of 4'-modified nucleoside analogs as broad-spectrum therapeutics against zoonotic viruses of public health importance. |
A review of global literature on using administrative data to estimate prevalence of intellectual and developmental disabilities
Friedman DJ , Gibson Parrish R , Fox MH . J Policy Pract Intellect Disabil 2018 15 (1) 43-62 As understanding of health deficits among people with intellectual and developmental disabilities (IDD) increases, concerns grow about how to develop comprehensive, sustainable surveillance systems to reliably monitor the health of this population over time. This study reviews literature from 12 countries in which retrospective administrative data have been used to estimate population-based prevalence of IDD, identifies promising practices in that literature, and discusses the feasibility of applying those promising practices to other countries. Administrative data sources can be used to identify the number of people with IDD (numerators) in the presence of population estimates from which people with IDD are drawn (denominators) for discrete geographic locations. Case ascertainment methods, age groupings, data years captured, and other methods vary, contributing to a wide variation in prevalence rates. Six methods are identified from five countries that appear to offer the greatest likelihood of expanded applications. Approaches in which administrative data collections are linked with other population-based data sources appear promising as a means of estimating the size and characteristics of populations living with IDD in defined geographic locations. They offer the potential for sustainability, timeliness, accuracy, and efficiency. |
Epigenetic impacts of stress priming of the neuroinflammatory response to sarin surrogate in mice: a model of Gulf War illness.
Ashbrook DG , Hing B , Michalovicz LT , Kelly KA , Miller JV , de Vega WC , Miller DB , Broderick G , O'Callaghan JP , McGowan PO . J Neuroinflammation 2018 15 (1) 86 BACKGROUND: Gulf War illness (GWI) is an archetypal, medically unexplained, chronic condition characterised by persistent sickness behaviour and neuroimmune and neuroinflammatory components. An estimated 25-32% of the over 900,000 veterans of the 1991 Gulf War fulfil the requirements of a GWI diagnosis. It has been hypothesised that the high physical and psychological stress of combat may have increased vulnerability to irreversible acetylcholinesterase (AChE) inhibitors leading to a priming of the neuroimmune system. A number of studies have linked high levels of psychophysiological stress and toxicant exposures to epigenetic modifications that regulate gene expression. Recent research in a mouse model of GWI has shown that pre-exposure with the stress hormone corticosterone (CORT) causes an increase in expression of specific chemokines and cytokines in response to diisopropyl fluorophosphate (DFP), a sarin surrogate and irreversible AChE inhibitor. METHODS: C57BL/6J mice were exposed to CORT for 4 days, and exposed to DFP on day 5, before sacrifice 6 h later. The transcriptome was examined using RNA-seq, and the epigenome was examined using reduced representation bisulfite sequencing and H3K27ac ChIP-seq. RESULTS: We show transcriptional, histone modification (H3K27ac) and DNA methylation changes in genes related to the immune and neuronal system, potentially relevant to neuroinflammatory and cognitive symptoms of GWI. Further evidence suggests altered proportions of myelinating oligodendrocytes in the frontal cortex, perhaps connected to white matter deficits seen in GWI sufferers. CONCLUSIONS: Our findings may reflect the early changes which occurred in GWI veterans, and we observe alterations in several pathways altered in GWI sufferers. These close links to changes seen in veterans with GWI indicates that this model reflects the environmental exposures related to GWI and may provide a model for biomarker development and testing future treatments. |
Effectiveness of a vacuum lifting system in reducing spinal load during airline baggage handling
Lu ML , Dufour JS , Weston EB , Marras WS . Appl Ergon 2018 70 247-252 Information on spinal loading for using lift assist systems for airport baggage handling is lacking. We conducted a laboratory study to evaluate a vacuum lift system for reducing lumbar spinal loads during baggage loading/unloading tasks. Ten subjects performed the tasks using the industry average baggage weight of 14.5 kg on a typical two-shelved baggage cart with or without using the lift system (i.e. lifting technique). Repeated measures analysis of variance (2 tasks x 2 shelf heights x 2 techniques) was used. Spinal loads were estimated by an electromyography-driven biomechanical model. On average, the vacuum lift system reduced spinal compressive forces on the lumbar spine by 39% and below the 3400 N damage threshold. The system also resulted in a 25% reduction in the anterior-posterior shear force at the L5/S1 inferior endplate level. This study provides evidence for the potential to reduce spinal loads when using a vacuum lift system. |
Expanding the paradigm of occupational safety and health: A new framework for worker well-being
Chari R , Chang CC , Sauter SL , Sayers ELP , Cerully JL , Schulte P , Schill AL , Uscher-Pines L . J Occup Environ Med 2018 60 (7) 589-593 OBJECTIVE: This article describes the National Institute for Occupational Safety and Health's (NIOSH) development of a conceptual framework for worker well-being. While well-being research is growing, there is a need to translate theoretical concepts into practical models for measurement and action. METHODS: Multidisciplinary literature reviews informed development of the worker well-being framework and major domains and subdomains. An expert panel helped prioritize constructs for measurement. RESULTS: The framework includes five domains and twenty subdomains and conceptualizes worker well-being as a subjective and objective phenomenon inclusive of experiences both within and beyond work contexts. CONCLUSIONS: Well-being is a positive and unifying concept that captures multiple factors that contribute to workers' health and quality of life. This work lays the foundation for larger well-being measurement efforts and will provide tools for NIOSH partners to help workers flourish. |
Implications of applying cumulative risk assessment to the workplace
Fox MA , Spicer K , Chosewood LC , Susi P , Johns DO , Dotson GS . Environ Int 2018 115 230-238 Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health. |
Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures
Dale AM , Ekenga CC , Buckner-Petty S , Merlino L , Thiese MS , Bao S , Meyers AR , Harris-Adamson C , Kapellusch J , Eisen EA , Gerr F , Hegmann KT , Silverstein B , Garg A , Rempel D , Zeringue A , Evanoff BA . Occup Environ Med 2018 75 (7) 501-506 BACKGROUND: There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. OBJECTIVE: This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. METHODS: 2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. RESULTS: Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose-response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. CONCLUSION: Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the 'gold standard' method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures. |
Use of the kurtosis statistic in an evaluation of the effects of noise and solvent exposures on the hearing thresholds of workers: An exploratory study
Fuente A , Qiu W , Zhang M , Xie H , Kardous CA , Campo P , Morata TC . J Acoust Soc Am 2018 143 (3) 1704 The aim of this exploratory study was to examine whether the kurtosis metric can contribute to investigations of the effects of combined exposure to noise and solvents on human hearing thresholds. Twenty factory workers exposed to noise and solvents along with 20 workers of similar age exposed only to noise in eastern China were investigated using pure-tone audiometry (1000-8000 Hz). Exposure histories and shift-long noise recording files were obtained for each participant. The data were used in the calculation of the cumulative noise exposure (CNE) and CNE adjusted by the kurtosis metric for each participant. Passive samplers were used to measure solvent concentrations for each worker exposed to solvents over the full work shift. Results showed an interaction between noise exposure and solvents for the hearing threshold at 6000 Hz. This effect was observed only when the CNE level was adjusted by the kurtosis metric. |
Using a modified theory of planned behavior to examine adolescents' workplace safety and health knowledge, perceptions, and behavioral intention: A structural equation modeling approach
Guerin RJ , Toland MD , Okun AH , Rojas-Guyler L , Bernard AL . J Youth Adolesc 2018 47 (8) 1595-1610 Work, a defining feature of adolescence in the United States, has many benefits. Work also has risks, as adolescents experience a higher rate of serious job-related injuries compared to adults. Talking Safety, a free curriculum from the National Institute for Occupational Safety and Health, is one tool educators may adopt to provide teens with essential workplace safety and health education. Adolescents (N = 2503; female, 50.1%; Hispanic, 50.0%) in a large urban school district received Talking Safety from their eighth-grade science teachers. This study used a modified theory of planned behavior (which included a knowledge construct), to examine students' pre- and post-intervention scores on workplace safety and health knowledge, attitude, self-efficacy, and behavioral intention to enact job safety skills. The results from confirmatory factor analyses indicate three unique dimensions reflecting the theory, with a separate knowledge factor. Reliability estimates are omega >/= .83. The findings from the structural equation models demonstrate that all paths, except pre- to posttest behavioral intention, are statistically significant. Self-efficacy is the largest contributor to the total effect of these associations. As hypothesized, knowledge has indirect effects on behavioral intention. Hispanic students scored lower at posttest on all but the behavioral intention measure, possibly suggesting the need for tailored materials to reach some teens. Overall the findings support the use of a modified theory of planned behavior to evaluate the effectiveness of a foundational workplace safety and health curriculum. This study may inform future efforts to ensure that safe and healthy work becomes integral to the adolescent experience. |
Work-related nonfatal injuries in Alaska's aviation industry, 2000-2013
Case SL , Moller KM , Nix NA , Lucas DL , Snyder EH , O'Connor MB . Saf Sci 2018 104 239-245 Aviation is a critical component of life in Alaska, connecting communities off the road system across the state. Crash-related fatalities in the state are well understood and many intervention efforts have been aimed at reducing aircraft crashes and resulting fatalities; however, nonfatal injuries among workers who perform aviation-related duties have not been studied in Alaska. This study aimed to characterize hospitalized nonfatal injuries among these workers using data from the Alaska Trauma Registry. During 2000-2013, 28 crash-related and 89 non-crash injuries were identified, spanning various occupational groups. Falls were a major cause of injuries, accounting for over half of non-crash injuries. Based on the study findings, aviation stakeholders should review existing policies and procedures regarding aircraft restraint systems, fall protection, and other injury prevention strategies. To supplement these findings, further study describing injuries that did not result in hospitalization is recommended. |
Efficacy and safety of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in three provinces in Angola, 2017.
Davlantes E , Dimbu PR , Ferreira CM , Florinda Joao M , Pode D , Felix J , Sanhangala E , Andrade BN , Dos Santos Souza S , Talundzic E , Udhayakumar V , Owens C , Mbounga E , Wiesner L , Halsey ES , Martins JF , Fortes F , Plucinski MM . Malar J 2018 17 (1) 144 BACKGROUND: The Angolan government recommends three artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DP). Due to the threat of emerging anti-malarial drug resistance, it is important to periodically monitor the efficacy of artemisinin-based combination therapy (ACT). This study evaluated these medications' therapeutic efficacy in Benguela, Lunda Sul, and Zaire Provinces. METHODS: Enrollment occurred between March and July 2017. Study participants were children with P. falciparum monoinfection from each provincial capital. Participants received a 3-day course of a quality-assured artemisinin-based combination and were monitored for 28 (AL and ASAQ arms) or 42 days (DP arm). Each ACT was assessed in two provinces. The primary study endpoints were: (1) follow-up without complications and (2) failure to respond to treatment or development of recurrent P. falciparum infection. Parasites from each patient experiencing recurrent infection were genotyped to differentiate new infection from recrudescence of persistent parasitaemia. These parasites were also analysed for molecular markers associated with ACT resistance. RESULTS: Of 608 children enrolled in the study, 540 (89%) reached a primary study endpoint. Parasitaemia was cleared within 3 days of medication administration in all participants, and no early treatment failures were observed. After exclusion of reinfections, the corrected efficacy of AL was 96% (91-100%, 95% confidence interval) in Zaire and 97% (93-100%) in Lunda Sul. The corrected efficacy of ASAQ was 100% (97-100%) in Benguela and 93% (88-99%) in Zaire. The corrected efficacy of DP was 100% (96-100%) in Benguela and 100% in Lunda Sul. No mutations associated with artemisinin resistance were identified in the pfk13 gene in the 38 cases of recurrent P. falciparum infection. All 33 treatment failures in the AL and ASAQ arms carried pfmdr1 or pfcrt mutations associated with lumefantrine and amodiaquine resistance, respectively, on day of failure. CONCLUSIONS: AL, ASAQ, and DP continue to be efficacious against P. falciparum malaria in these provinces of Angola. Rapid parasite clearance and the absence of genetic evidence of artemisinin resistance are consistent with full susceptibility to artemisinin derivatives. Periodic monitoring of in vivo drug efficacy remains a priority routine activity for Angola. |
Anti-schistosome responses after four annual treatments
Ndombi EM , Abudho B , Kittur N , Carter JM , Korir H , Riner DK , Ochanda H , Lee YM , Secor WE , Karanja DM , Colley DG . Parasite Immunol 2018 40 (6) e12530 AIM: This study evaluated potential changes in anti-schistosome immune responses in children from schools that received four rounds of annual mass drug administration (MDA) of praziquantel (PZQ). METHODS: In a repeated cross-sectional study design, 210 schistosome egg-positive children were recruited at baseline from schools in western Kenya (baseline group). Another 251 children of the same age range were recruited from the same schools and diagnosed for schistosome infection by microscopy (post-MDA group). In-vitro schistosome-specific cytokines and plasma antibody levels were measured by ELISA and compared between the two groups of children. RESULTS: Schistosome soluble egg antigen (SEA) and soluble worm antigen preparation (SWAP) stimulated higher IL-5 production by egg-negative children in the post-MDA group compared to the baseline group. Similarly, anti-SEA IgE levels were higher in egg negative children in the post-MDA group compared to the baseline group. Anti-SEA and anti-SWAP IgG4 levels were lower in egg negative children in the post-MDA group compared to baseline. This resulted in higher anti-SEA IgE/IgG4 ratios for children in the post-MDA group compared to baseline. CONCLUSION: These post-MDA immunological changes are compatible with the current paradigm that treatment shifts immune responses to higher anti-schistosome IgE:IgG4 ratios in parallel with a potential increase in resistance to reinfection. This article is protected by copyright. All rights reserved. |
Treatment of uncomplicated and severe malaria during pregnancy
D'Alessandro U , Hill J , Tarning J , Pell C , Webster J , Gutman J , Sevene E . Lancet Infect Dis 2018 18 (4) e133-e146 Over the past 10 years, the available evidence on the treatment of malaria during pregnancy has increased substantially. Owing to their relative ease of use, good sensitivity and specificity, histidine rich protein 2 based rapid diagnostic tests are appropriate for symptomatic pregnant women; however, such tests are less appropriate for systematic screening because they will not detect an important proportion of infections among asymptomatic women. The effect of pregnancy on the pharmacokinetics of antimalarial drugs varies greatly between studies and class of antimalarial drugs, emphasising the need for prospective studies in pregnant and non-pregnant women. For the treatment of malaria during the first trimester, international guidelines are being reviewed by WHO. For the second and third trimester of pregnancy, results from several trials have confirmed that artemisinin-based combination treatments are safe and efficacious, although tolerability and efficacy might vary by treatment. It is now essential to translate such evidence into policies and clinical practice that benefit pregnant women in countries where malaria is endemic. Access to parasitological diagnosis or appropriate antimalarial treatment remains low in many countries and regions. Therefore, there is a pressing need for research to identify quality improvement interventions targeting pregnant women and health providers. In addition, efficient and practical systems for pharmacovigilance are needed to further expand knowledge on the safety of antimalarial drugs, particularly in the first trimester of pregnancy. |
Percentage of deaths associated with inadequate physical activity in the United States
Carlson SA , Adams EK , Yang Z , Fulton JE . Prev Chronic Dis 2018 15 E38 INTRODUCTION: Current physical activity guidelines recommend that adults participate weekly in at least 150 minutes of moderate-intensity equivalent aerobic physical activity to achieve substantial health benefits. We used a nationally representative sample of data of US adults to estimate the percentage of deaths attributable to levels of physical activity that were inadequate to meet the aerobic guideline. METHODS: Data from the 1990 to 1991 National Health Interview Survey for adults aged 25 years or older were linked with mortality data up until December 31, 2011, from the National Death Index (N = 67,762 persons and 18,796 deaths). Results from fully adjusted Cox proportional hazards models were used to estimate hazard ratios and population attributable fractions for inadequate levels of physical activity (ie, less than 150 minutes per week of moderate-intensity equivalent aerobic activity). RESULTS: Overall, 8.3% (95% confidence interval [CI], 6.4-10.2) of deaths were attributed to inadequate levels of physical activity. The percentage of deaths attributed to inadequate levels was not significant for adults aged 25 to 39 years (-0.2%; 95% CI, -8.8% to 7.7%) but was significant for adults aged 40 to 69 years (9.9%; 95% CI, 7.2%-12.6%) and adults aged 70 years or older (7.8%; 95% CI, 4.9%-10.7%). CONCLUSIONS: A significant portion of deaths was attributed to inadequate levels of physical activity. Increasing adults' physical activity levels to meet current guidelines is likely one way to reduce the risk of premature death in the United States. |
Differences in the utilization of gestational surrogacy between states in the U.S
Perkins KM , Boulet SL , Levine AD , Jamieson DJ , Kissin DM . Reprod Biomed Soc Online 2018 5 1-4 Gestational surrogacy policy in the USA varies by state, but information on state differences is lacking. This study used data from the National Assisted Reproductive Technology Surveillance System from 2010 to 2014 to calculate state differences in gestational carrier cycle characteristics. Of the 662,165 in-vitro fertilization cycles in the USA between 2010 and 2014, 16,148 (2.4%) used gestational carriers. Non-USA residents accounted for 18.3% of gestational carrier cycles, and 29.1% of gestational carrier cycles by USA residents were performed in a state other than the state of residence of the intended parent. USA gestational surrogacy practice varies by state, potentially impacting patients’ access to surrogacy services. |
Health care provider perceptions of the safety of IUDs for women with HIV
Simmons KB , Zapata L , Curtis KM . Perspect Sex Reprod Health 2018 50 (2) 67-73 CONTEXT: Women who are living with HIV use IUDs at a lower rate than the general population, and it is unclear whether health care providers' misconceptions about IUD safety contribute to this disparity. METHODS: A 2013-2014 nationwide survey of 1,998 U.S. family planning providers assessed perceptions of IUD safety for women with HIV or other medical conditions. Multivariable logistic regression was used to examine associations between provider characteristics and whether individuals believed IUDs were safe for HIV-positive women. Data from public-sector providers and office-based physicians were analyzed separately. RESULTS: Seven in 10 providers considered IUDs safe for women with HIV, and there were no differences by provider type. Among public-sector providers, some of the characteristics associated with believing that IUDs were unsafe for seropositive women were working at a clinic without Title X funding (odds ratio, 1.5), not being trained in IUD insertion (2.1) and not using the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) for clinical guidance (1.8). Office-based physicians who did not use the guidelines also had an increased likelihood of believing that IUDs were unsafe for women with HIV (2.9), and physicians who had completed training 25 or more years ago were more likely than those who had done so less than five years ago to consider IUDs unsafe (3.3). CONCLUSIONS: Greater use of evidence-based contraceptive guidance such as the U.S. MEC may help inform provider perceptions of IUD safety and hence contribute to increased contraceptive choice for women with HIV. |
Solution to Detect, Classify, and Report Illicit Online Marketing and Sales of Controlled Substances via Twitter: Using Machine Learning and Web Forensics to Combat Digital Opioid Access.
Mackey T , Kalyanam J , Klugman J , Kuzmenko E , Gupta R . J Med Internet Res 2018 20 (4) e10029 BACKGROUND: On December 6-7, 2017, the U.S. Department of Health and Human Services hosted its first Code-a-Thon event aimed at leveraging technology and data-driven solutions to help combat the opioid epidemic. Authors, comprised of an interdisciplinary team from academia, the private sector, and the U.S. Centers for Disease Control and Prevention, participated in the Code-a-Thon as part of the "Prevention" track. OBJECTIVE: To develop and deploy a methodology using machine learning to accurately detect the marketing and sale of opioids by illicit online sellers via Twitter as part of participation at the HHS Opioid Code-a-Thon event. METHODS: Tweets were collected from the Twitter public API stream filtered for common prescription opioid keywords in conjunction with participation in the Code-a-Thon from November 15 - December 5, 2017. An unsupervised machine learning-based approach was developed and used during the Code-a-Thon competition (24 hours) to obtain a summary of the content of the Tweets to isolate those clusters associated with illegal online marketing and sale using a Biterm Topic Model (BTM). After isolating relevant tweets, hyperlinks associated with these tweets were reviewed to assess characteristics of illegal online sellers. RESULTS: We collected and analyzed 213K tweets over the course of the Code-a-Thon containing keywords codeine, percocet, vicodin, oxycontin, oxycodone, fentanyl and hydrocodone. Using BTM, 692 (0.3%) tweets were identified as being associated with illegal online marketing and sale of prescription opioids. After removing duplicates and dead links, we identified 34 unique "live" tweets with 15 (44.1%) directing consumers to illicit online pharmacies, 11 (32.4%) linked to individual drug sellers, and 7 (20.6%) used by marketing affiliates. In addition to offering the "no prescription" sale of opioids, many of these vendors also sold other controlled substances and illicit drugs. CONCLUSIONS: Results of this study confirm prior studies that have identified social media platforms, including Twitter, as a potential conduit for supply and sale of illicit opioids. To translate these results into action, authors also developed a prototype wireframe for the purposes of detecting, classifying, and reporting illicit online pharmacy tweets selling controlled substances illegally to the U.S. Food and Drug Administration and U.S. Drug Enforcement Agency. Further development of solutions based on these methods has the potential to proactively alert regulators and law enforcement agencies of illegal opioid sales, while also making the online environment safer for the public. CLINICALTRIAL: not applicable. |
Policy approaches for regulating alcohol marketing in a global context: A public health perspective
Esser MB , Jernigan DH . Annu Rev Public Health 2018 39 385-401 Alcohol consumption is responsible for 3.3 million deaths globally or nearly 6% of all deaths. Alcohol use contributes to both communicable and noncommunicable diseases, as well as violence and injuries. The purpose of this review is to discuss, in the context of the expansion of transnational alcohol corporations and harms associated with alcohol use, policy options for regulating exposure to alcohol marketing. We first provide an overview of the public health problem of harmful alcohol consumption and describe the association between exposure to alcohol marketing and alcohol consumption. We then discuss the growth and concentration of global alcohol corporations and their marketing practices in low- and middle-income countries, as well as in higher-income societies. We review the use and effectiveness of various approaches for regulating alcohol marketing in various countries before discussing challenges and opportunities to protect public health. |
Risk for interspecies transmission of zoonotic pathogens during poultry processing and pork production in Peru: A qualitative study
Carnero AM , Kitayama K , Diaz DA , Garvich M , Angulo N , Cama VA , Gilman RH , Bayer AM . Zoonoses Public Health 2018 65 (5) 528-539 Interspecies transmission of pathogens is an unfrequent but naturally occurring event and human activities may favour opportunities not previously reported. Reassortment of zoonotic pathogens like influenza A virus can result from these activities. Recently, swine and birds have played a central role as "mixing vessels" for epidemic and pandemic events related to strains like H1N1 and H5N1. Unsafe practices in poultry markets and swine farms can lead to interspecies transmission, favouring the emergence of novel strains. Thus, understanding practices that lead to interspecies interactions is crucial. This qualitative study aimed to evaluate poultry processing practices in formal and informal markets and the use of leftovers by swine farmers in three Peruvian cities: Lima (capital), Tumbes (coastal) and Tarapoto (jungle). We conducted 80 direct observations at formal and informal markets and interviewed 15 swine farmers. Processors slaughter and pluck chickens and vendors and/or processors eviscerate chickens. Food safety and hygiene practices were suboptimal or absent, although some heterogeneity was observed between cities and chicken vendors versus processors. Both vendors (76%) and processors (100%) sold the chicken viscera leftovers to swine farmers, representing the main source of chicken viscera for swine farms (53%). Swine farmers fed the chicken viscera to their swine. Chicken viscera cooking times varied widely and were insufficient in some cases. Non-abattoired poultry leads to the sale of poultry leftovers to small-scale swine farms, resulting in indirect but frequent interspecies contacts that can lead to interspecies transmission of bacterial pathogens or the reassortment of influenza A viruses. These interactions are exacerbated by suboptimal safety and hygiene conditions. People involved in these activities constitute an at-risk population who could play a central role in preventing the transmission of pathogens between species. Educational interventions on hygiene and food safety practices will be important for reducing the risk of interspecies influenza transmission. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Food Safety
- Genetics and Genomics
- Health Communication and Education
- Health Economics
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Military Medicine and Health
- Occupational Safety and Health
- Parasitic Diseases
- Physical Activity
- Reproductive Health
- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
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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.
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