Timeliness of cervical cancer diagnosis and initiation of treatment in the National Breast and Cervical Cancer Early Detection Program
Benard VB , Howe W , Royalty J , Helsel W , Kammerer W , Richardson LC . J Womens Health (Larchmt) 2012 21 (7) 776-82 OBJECTIVES: To examine time intervals from cervical cancer screening to diagnosis and treatment initiation among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) during two consecutive time periods. METHODS: We analyzed NBCCEDP data for women with abnormal Pap tests (n=100,167), from which 1,417 invasive cervical cancers were diagnosed. We examined two time intervals for this study: diagnostic interval (time from abnormal Pap test to the date of definitive diagnosis) and treatment initiation interval (time from definitive diagnosis to treatment initiation) for two time periods: 1996-2002 and 2003-2009. We compared median time intervals for diagnostic and treatment initiation using the Kruskal-Wallis test. Adjusted proportions (predicted marginals) were calculated using logistic regression to examine diagnosis and treatment within program benchmarks (≤60 days). RESULTS: Median diagnostic intervals decreased overall by 6 days (54 vs. 48 days, p<0.001). This decrease in the median diagnostic interval was noted for all variables examined. The median treatment initiation intervals remained stable over the two time periods. CONCLUSIONS: Women screened by the NBCCEDP receive diagnostic follow-up and initiate treatment within preestablished program guidelines. |
United States national prevalence of electrocardiographic abnormalities in black and white middle-age (45- to 64-year) and older (≥65-year) adults (from the Reasons for Geographic and Racial Differences in Stroke study)
Prineas RJ , Le A , Soliman EZ , Zhang ZM , Howard VJ , Ostchega Y , Howard G . Am J Cardiol 2012 109 (8) 1223-8 A United States national sample of 20,962 participants (57% women, 44% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study provided general population estimates for electrocardiographic (ECG) abnormalities among black and white men and women. The participants were recruited from 2003 to 2007 by random selection from a commercially available nationwide list, with oversampling of blacks and those from the stroke belt, with a cooperation rate of 49%. The measurement of risk factors and 12-lead electrocardiograms (centrally coded using Minnesota code criteria) showed 28% had ≥1 major ECG abnormality. The prevalence of abnormalities was greater (≥35%) for those ≥65 years old, with no differences between blacks and whites. However, among men <65 years, blacks had more major abnormalities than whites, most notably for atrial fibrillation, major Q waves, and left ventricular hypertrophy. Men generally had more ECG abnormalities than women. The most common ECG abnormalities were T-wave abnormalities. The average heart rate-corrected QT interval was longer in women than in men, similar in whites and blacks, and increased with age. However, the average heart rate was greater in women than in men and in blacks than in whites and decreased with age. The prevalence of ECG abnormalities was related to the presence of hypertension, diabetes, blood pressure, and age. In conclusion, black men and women in the United States have a significantly greater prevalence of ECG abnormalities than white men and women at age 45 to 64 years; however, these proportions, although larger, tended to equalize or reverse after age 65. |
Respiratory syncytial virus in Indonesian children
Armstrong GL . Pediatr Infect Dis J 2012 31 (5) 539 Globally, respiratory syncytial virus (RSV) is estimated to cause between 66,000 and 199,000 deaths among young children every year.1 Several factors, including a better understanding of RSV disease burden, improvements and vaccine technology and the remarkable success of vaccines such as rotavirus vaccines, have led to a renaissance in interest in RSV vaccine development. Currently, there are more than a dozen RSV vaccine candidates in preclinical or early clinical development. | One of the critical questions about RSV vaccines is whether they can be effective early enough in life to prevent the most severe disease. Studies in industrialized as well as developing nations suggest that the highest incidence of hospitalization for RSV is in the first 6 months of life, and in particular, during the second and third month of life.2–5 Developing vaccines to induce active immunity at such a young age would be challenging. | The study by Simões et al6 in September’s Pediatric Infectious Disease Journal presents an intriguing finding from a study conducted in Indonesia a decade earlier—that fewer than 5% of cases of RSV lower respiratory infection among periurban and semirural Sundanese infants occur in the first 6 months of life. If true, and if this pattern occurs in other developing world settings, this opens the possibility that an RSV vaccine that does not become effective until age 6 months could prevent the bulk of serious RSV-related disease in those settings. |
Risk factors for hospitalization with lower respiratory tract infections in children in rural Alaska
Bulkow LR , Singleton RJ , Debyle C , Miernyk K , Redding G , Hummel KB , Chikoyak L , Hennessy TW . Pediatrics 2012 129 (5) e1220-7 OBJECTIVE: Lower respiratory tract infections (LRTIs) are a major cause of morbidity for children worldwide and particularly for children from developing and indigenous populations. In this study, we evaluated risk factors for hospitalization with LRTI in a region in southwest Alaska. METHODS: The study was conducted from October 1, 2006, to September 30, 2007, in the Yukon Kuskokwim Delta region of Alaska. Cases were recruited from children <3 years of age hospitalized with LRTI. Controls were recruited during visits to the surrounding communities in the region and matched posthoc to cases on the basis of subregion, season, and age. Parents were interviewed for potential risk factors, and medical records were reviewed. Participants had a nasopharyngeal swab sample taken for polymerase chain reaction (PCR) testing for a panel of respiratory viruses. Samples positive for respiratory syncytial virus, human metapneumovirus, or parainfluenza type 3 were quantitated by reverse transcriptase real-time quantitative PCR. RESULTS: One hundred twenty-eight cases were matched to 186 controls. In a multivariable conditional logistic regression model, significantly (P < .05) increased risk of hospitalization was associated with medically high-risk status, having a woodstove in the house, being bottle fed, and vomiting after feeding; living in a house that had 2 or more rooms with sinks was a protective factor. Viral loads in hospitalized cases were significantly higher than those in controls, but a strict cutoff level was not observed. CONCLUSIONS: Several risk factors for LRTI hospitalization were identified in this high risk population. Some factors are amenable to environmental and behavioral interventions. |
Low rates of hepatitis screening and vaccination of HIV-infected MSM in HIV clinics
Hoover KW , Butler M , Workowski KA , Follansbee S , Gratzer B , Hare CB , Johnston B , Theodore JL , Tao G , Smith BD , Chorba T , Kent CK . Sex Transm Dis 2012 39 (5) 349-353 BACKGROUND: HIV-infected men who have sex with men (MSM) are at increased risk of viral hepatitis because of similar behavioral risk factors for acquisition of these infections. Our objective was to estimate adherence to HIV management guidelines that recommend screening HIV-infected persons for hepatitis A, B, and C infection, and vaccinating for hepatitis A and B if susceptible. METHODS: We evaluated hepatitis prevention services received by a random sample of HIV-infected MSM in 8 HIV clinics in 6 US cities. We abstracted medical records of all visits made by the patients to the clinic during the period from 2004 to 2007, to estimate hepatitis screening and vaccination rates overall and by clinic site. RESULTS: Medical records of 1329 patients who had 14,831 visits from 2004 to 2006 were abstracted. Screening rates for hepatitis A, B, and C were 47%, 52%, and 54%, respectively. Among patients who were screened and found to be susceptible, 29% were vaccinated for hepatitis A and 25% for hepatitis B. The percentage of patients screened and vaccinated varied significantly by clinic. CONCLUSIONS: Awareness of hepatitis susceptibility and hepatitis coinfection status in HIV-infected patients is essential for optimal clinical management. Despite recommendations for hepatitis screening and vaccination of HIV-infected MSM, rates were suboptimal at all clinic sites. These low rates highlight the importance of routine review of adherence to recommended clinical services. Such reviews can prompt the development and implementation of simple and sustainable interventions to improve the quality of care. |
Prevalence of methicillin-resistant Staphylococcus aureus as an etiology of community-acquired pneumonia
Moran GJ , Krishnadasan A , Gorwitz RJ , Fosheim GE , Albrecht V , Limbago B , Talan DA . Clin Infect Dis 2012 54 (8) 1126-1133 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown. METHODS: We prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter-spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed. RESULTS: Of 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%-5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department. CONCLUSIONS: Methicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation. (See the Editorial Commentary by Mandell and Wunderink, on pages 1134-6.) |
Effects of screening and partner notification on Chlamydia positivity in the United States: a modeling study
Kretzschmar M , Satterwhite C , Leichliter J , Berman S . Sex Transm Dis 2012 39 (5) 325-31 OBJECTIVES: Model impact of increasing screening and partner notification (PN) on chlamydia positivity. METHODS: We used a stochastic simulation model describing pair formation and dissolution in an age-structured heterosexual population. The model accounts for steady, casual, and concurrent partnerships and a highly sexually active core group. The model used existing sexual behavior data from the United States and was validated using chlamydia positivity data from Region X (Alaska, Idaho, Oregon, Washington). A screening program with a coverage rate of 20% was implemented among women aged 15 to 24 years. After 10 years, we increased screening coverage to 35%, 50%, and 65% and partner treatment rates from 20% to 40% and 55%. Finally, we included male screening (aged 15-24, screening coverage: 20% and 35%, partner treatment: 25% and 40%). We analyzed the effects on chlamydia positivity in women and the frequency of reinfection 6 months after treatment. RESULTS: The model described the decline in positivity observed from 1988 to 1997 in Region X, given screening coverage of 20% and a 25% partner treatment rate. Increasing screening coverage from 35% to 65% resulted in incremental decreases in positivity as did increasing the PN rate; a 23% reduction in positivity was achieved by either increasing screening by 3-fold or PN by 2-fold. Adding male screening to the program had less impact than increasing screening coverage or PN among women. Increased PN and treatment reduced reinfection rates considerably. CONCLUSIONS: Increasing efforts in PN may contribute at least as much to control of chlamydia infection as increasing screening coverage rates. |
How can this be? Preventing death in patients with HIV-associated tuberculosis
Marston BJ , De Cock KM . Int J Tuberc Lung Dis 2012 16 (5) 569-70 In 2010, some 350 000 deaths occurred worldwide among the 1 100 000 persons afflicted with both tuberculosis (TB) and human immunodeficiency virus (HIV) infection,1 despite the fact that we have effective treatments for both. How can this be? It was recognized early on in the AIDS (acquired immunedeficiency syndrome) pandemic that outcomes of TB treatment were substantially worse for people infected with HIV, and that those who were most immunosuppressed had the worst prognosis.2 The past few years have seen a steady surge of new information, which should reduce this inequity, regarding more effective diagnostic tools and optimal use of antiretroviral therapy (ART). Achieving public health impact, however, is more difficult, and in this issue of the Journal, Kumar and others examine the 15% mortality rate among persons with co-infection under India’s TB control program.3 | What are the options for preventing death among persons with co-infection? Much can be done before the onset of disease—both early ART and provision of isoniazid preventive therapy (IPT) to persons with HIV reduce the risk of developing active TB. Once a diagnosis of HIV-associated TB is made, three key interventions are available: treatment for TB (with any needed modifications of treatment regimens specific for those with co-infection), treatment for additional co-morbidities, and treatment for HIV. As high mortality in co-infected patients is driven by advancing immunodeficiency, ART has to be considered a critical part of the response. And because ART is the only intervention that directly affects underlying pathogenesis by restoring immune function, other interventions have to be re-examined in the context of provision of ART. |
IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults
Chow AW , Benninger MS , Brook I , Brozek JL , Goldstein EJ , Hicks LA , Pankey GA , Seleznick M , Volturo G , Wald ER , File TM Jr . Clin Infect Dis 2012 54 (8) e72-e112 Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed. |
Influenza and pregnancy in the United States: before, during, and after 2009 H1N1
Rasmussen SA , Jamieson DJ . Clin Obstet Gynecol 2012 55 (2) 487-97 Because pregnant women were recognized to be at increased risk for influenza-associated complications, special considerations for this population were included as part of preparedness efforts before the 2009 H1N1 pandemic. We review data available before the pandemic on influenza and its treatment and prevention during pregnancy. We also review pandemic preparedness efforts aimed at pregnant women and how these efforts served as a foundation for recommendations during the pandemic. Data on 2009 H1N1 influenza in pregnant women and their infants are summarized, and the application of these data to recommendations for pregnant women in future influenza seasons and pandemics is discussed. |
Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States
Rice TW , Rubinson L , Uyeki TM , Vaughn FL , John BB , Miller RR 3rd , Higgs E , Randolph AG , Smoot BE , Thompson BT . Crit Care Med 2012 40 (5) 1487-1498 OBJECTIVES: The contribution of bacterial coinfection to critical illness associated with 2009 influenza A virus infection remains uncertain. The objective of this study was to determine whether bacterial coinfection increased the morbidity and mortality of 2009 influenza A. DESIGN: Retrospective and prospective cohort study. SETTING: Thirty-five adult U.S. intensive care units over the course of 1 yr. PATIENTS: Six hundred eighty-three critically ill adults with confirmed or probable 2009 influenza A. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A confirmed or probable case was defined as a positive 2009 influenza A test result or positive test for influenza A that was otherwise not subtyped. Bacterial coinfection was defined as documented bacteremia or any presumed bacterial pneumonia with or without positive respiratory tract culture within 72 hrs of intensive care unit admission. The mean age was 45 +/- 16 yrs, mean body mass index was 32.5 +/- 11.1 kg/m, and mean Acute Physiology and Chronic Health Examination II score was 21 +/- 9, with 76% having at least one comorbidity. Of 207 (30.3%) patients with bacterial coinfection on intensive care unit admission, 154 had positive cultures with Staphylococcus aureus (n = 57) and Streptococcus pneumoniae (n = 19), the most commonly identified pathogens. Bacterial coinfected patients were more likely to present with shock (21% vs. 10%; p = .0001), require mechanical ventilation at the time of intensive care unit admission (63% vs. 52%; p = .005), and have longer duration of intensive care unit care (median, 7 vs. 6 days; p = .05). Hospital mortality was 23%; 31% in bacterial coinfected patients and 21% in patients without coinfection (p = .002). Immunosuppression (relative risk 1.57; 95% confidence interval 1.20 -2.06; p = .0009) and Staphylococcus aureus at admission (relative risk 2.82; 95% confidence interval 1.76-4.51; p < .0001) were independently associated with increased mortality. CONCLUSIONS: Among intensive care unit patients with 2009 influenza A, bacterial coinfection diagnosed within 72 hrs of admission, especially with Staphylococcus aureus, was associated with significantly higher morbidity and mortality. |
Transmission dynamics of an insect-specific flavivirus in a naturally infected Culex pipiens laboratory colony and effects of co-infection on vector competence for West Nile virus
Bolling BG , Olea-Popelka FJ , Eisen L , Moore CG , Blair CD . Virology 2012 427 (2) 90-7 We established a laboratory colony of Culex pipiens mosquitoes from eggs collected in Colorado and discovered that mosquitoes in the colony are naturally infected with Culex flavivirus (CxFV), an insect-specific flavivirus. In this study we examined transmission dynamics of CxFV and effects of persistent CxFV infection on vector competence for West Nile virus (WNV). We found that vertical transmission is the primary mechanism for persistence of CxFV in Cx. pipiens, with venereal transmission potentially playing a minor role. Vector competence experiments indicated possible early suppression of WNV replication by persistent CxFV infection in Cx. pipiens. This is the first description of insect-specific flavivirus transmission dynamics in a naturally infected mosquito colony and the observation of delayed dissemination of superinfecting WNV suggests that the presence of CxFV may impact the intensity of enzootic transmission of WNV and the risk of human exposure to this important pathogen. |
"Review of the epidemiologic literature on residential exposure to perchloroethylene" by John A. Bukowski
Storm JE , Mazor KA , Aldous KM , Blount BC , Brodie SE , Serle JB . Crit Rev Toxicol 2012 42 (4) 314-7 We read with interest the recent article by John A. Bukowski “Review of the epidemiologic literature on residential exposure to perchloroethylene” (CitationBukowski, 2011). We were especially interested in his review of neurobehavioral studies as we anticipated description and interpretation of our study “Tetrachloroethylene (perc) exposure and visual contrast sensitivity (VCS) test performance in adults and children residing in buildings with or without a dry cleaner” (CitationNew York State Department of Health [NYS DOH], 2010). | Unfortunately, in his review, Dr. Bukowski claims that confidence in our study findings that elevated residential perc exposure may alter children’s VCS is undermined by (i) low response rates presumably leading to selection bias resulting in over representation of “exposed” subjects, (ii) “selective reporting” such that “negative” study findings that are contrary to our “positive” findings are marginalized, (iii) confounding between lower socioeconomic status and exposure limiting our ability to associate perc exposure and VCS, and (iv) inconsistency of our findings with available literature. We strongly disagree with these characterizations of our study and note in detail below why they are unfounded and do not undermine confidence in our findings. |
Public health performance management: opportunities for environmental public health
Gerding J , Price J . J Environ Health 2012 74 (8) 30-31 NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature a column from the Environmental Health Services Branch (EHSB) of the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In this column, EHSB and guest authors from across CDC will highlight a variety of concerns, opportunities, challenges, and successes that we all share in environmental public health. EHSB's objective is to strengthen the role of state, local, and national environmental health programs and professionals to anticipate, identify, and respond to adverse environmental exposures and the consequences of these exposures for human health. The services being developed through EHSB include access to topical, relevant, and scientific information; consultation; and assistance to environmental health specialists, sanitarians, and environmental health professionals and practitioners. |
The role of public health institutions in global health system strengthening efforts: the US CDC's perspective
Bloland P , Simone P , Burkholder B , Slutsker L , De Cock KM . PLoS Med 2012 9 (4) e1001199 Peter Bloland and colleagues from the US CDC lay out the agency's priorities for health systems strengthening efforts. |
Human papillomavirus vaccine discussions: an opportunity for mothers to talk with their daughters about sexual health
McRee AL , Gottlieb SL , Reiter PL , Dittus PJ , Tucker Halpern C , Brewer NT . Sex Transm Dis 2012 39 (5) 394-401 PURPOSE: Mother-daughter communication about sex is associated with healthier behavior during adolescence. We sought to characterize mothers' communication with their daughters about human papillomavirus (HPV) vaccine and the potential for these discussions to provide an opportunity for talking about sexual health. METHODS: During December 2009, we conducted an online survey with a nationally representative sample of US mothers of girls aged 11 to 14 years (n = 900; response rate = 66%). We used 3 complimentary approaches to assess HPV vaccine as an opportunity for mother-daughter communication about sex. Estimates are weighted. RESULTS: Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have also talked with their daughters about sex (92% vs. 74%, OR = 3.25, CI = 1.57-6.68, P < 0.05), in multivariate analyses. Among mothers who talked about sex when they talked about HPV vaccine, many felt that HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%). CONCLUSIONS: HPV vaccine discussions provide a cue to mother-daughter communication about sex that is as important as some more widely recognized cues. Discussions about HPV vaccine are an acceptable opportunity for mothers to talk with their daughters at an age when communication about sex is most influential. It may be possible for parents to capitalize on HPV vaccine discussions already happening in many families to promote sexual health. |
Perspectives of pulmonologists on the 2009-2010 H1N1 vaccination effort
Clark SJ , Cowan AE , Wortley PM . Pulm Med 2012 2012 306207 Persons with high-risk conditions such as asthma were a target group for H1N1 vaccine recommendations. We conducted a mailed survey of a national sample of pulmonologists to understand their participation in the 2009-2010 H1N1 vaccine campaign. The response rate was 59%. The majority of pulmonologists strongly recommended H1N1 vaccine for children (73%) and adults aged 25-64 years (51%). Only 60% of respondents administered H1N1 vaccine in their practice compared to 87% who offered seasonal influenza vaccine. Other than vaccine supply, respondents who provided H1N1 vaccine reported few logistical problems. Two-thirds of respondents would be very likely to vaccinate during a future influenza pandemic; this rate was higher among those who provided H1N1 vaccine and/or seasonal flu vaccine. In total, the H1N1 vaccine-related experiences of pulmonologists seemed to be positive. However, additional efforts are needed to increase participation in future pandemic vaccination campaigns. |
Immunosenescence and challenges of vaccination against influenza in the aging population
Reber AJ , Chirkova T , Kim JH , Cao W , Biber R , Shay DK , Sambhara S . Aging Dis 2012 3 (1) 68-90 Influenza is an important contributor to morbidity and mortality worldwide. Accumulation of genetic mutations termed antigenic drift, allows influenza viruses to inflict yearly epidemics that may result in 250,000 to 500,000 deaths annually. Over 90% of influenza-related deaths occur in the older adult population. This is at least in part a result of increasing dysregulation of the immune system with age, termed immunosenescence. This dysregulation results in reduced capacity to cope with infections and decreased responsiveness to vaccination. The older adult population is in dire need of improved vaccines capable of eliciting protective responses in the face of a waning immune system. This review focuses on the status of immunity, responses to influenza vaccination, and strategies that are currently being explored to elicit enhanced immune responses in this high risk population. |
Family context, victimization, and child trauma symptoms: variations in safe, stable, and nurturing relationships during early and middle childhood
Turner HA , Finkelhor D , Ormrod R , Hamby S , Leeb RT , Mercy JA , Holt M . Am J Orthopsychiatry 2012 82 (2) 209-19 Based on a nationally representative sample of 2,017 children age 2-9 years, this study examines variations in "safe, stable, and nurturing" relationships (SSNRs), including several forms of family perpetrated victimization, and documents associations between these factors and child trauma symptoms. Findings show that many children were exposed to multiple forms of victimization within the family (such as physical or sexual abuse, emotional maltreatment, child neglect, sibling victimization, and witnessing family violence), as evidenced by substantial intercorrelations among the different forms of victimization. Moreover, victimization exposure was significantly associated with several indices of parental dysfunction, family adversity, residential instability, and problematic parenting practices. Of all SSNR variables considered, emotional abuse and inconsistent or hostile parenting emerged as having the most powerful independent effects on child trauma symptoms. Also, findings supported a cumulative risk model, whereby trauma symptom levels increased with each additional SSNR risk factor to which children were exposed. Implications for research and practice are discussed. |
Fulfilling a promise: the national action plan for child injury prevention
Baldwin G , Sleet D , Gilchrist J , Degutis L . Inj Prev 2012 18 (3) 207 For many of us, the passion we feel for our work in injury prevention is driven by a fundamental belief that we should do everything in our power every day to protect families and communities from harm. This commitment to safety is even stronger when it comes to protecting children—especially if you are a parent. The loss of a child to an injury is often needless and always tragic. We know injuries are preventable. Widespread adoption of known, effective programmes and policies offers the opportunity to reduce injuries and death among those who are the most vulnerable and the least able to control their own environment. | In 2009, more than 9000 children and adolescents 0–19 years old in the USA died from an unintentional injury—with the main causes of these injuries being motor vehicle crashes, suffocation, drowning, poisoning, fire and falls.1 For every child injury death, more than 1000 children are treated for a non-fatal injury.2 While child injury death rates declined by 29% from 2000 to 2009, the annual number of deaths (9143 in 2009) remains unacceptably high.1 | A recent study by the Centers for Disease Control and Prevention (CDC) identified a 54% increase in suffocation death rates among infants (under age 1) from 2000 (13.8 per 100 000) to 2009 (21.3 per 100 000).1 Even more striking, the same study showcased the near doubling of the poisoning death rate for 15–19 year olds from 1.7 per 100 000 to 3.3 per 100 000—driven largely by an increase in prescription drug overdose-related deaths.1 The sixfold variation in state death rates (MA and NJ <5 per 100 000 vs MS and SC >23 per 100 000) underscores the uneven implementation and uptake of science-based programmes and policies across the USA.1 In context, the USA is lagging behind other developed countries—ranking near the bottom of all Organisation for Economic Cooperation and Development (OECD) countries—with a death rate four times that of the top performing countries like the Netherlands and Sweden.3 While sobering, this statistic sets a high benchmark for what is achievable if wider adoption of known, effective programmes and polices occurs. |
Dried blood spot specimens are a suitable alternative sample type for HIV-1 viral load measurement and drug resistance genotyping in patients receiving first-line antiretroviral therapy.
Rottinghaus EK , Ugbena R , Diallo K , Bassey O , Azeez A , Devos J , Zhang G , Aberle-Grasse J , Nkengasong J , Yang C . Clin Infect Dis 2012 54 (8) 1187-95 BACKGROUND: Antiretroviral therapy (ART) is being administered in developing nations at unprecedented numbers following the World Health Organization's (WHO) development of standardized first-line drug regimens. To ensure continued efficacy of these drug regimens, WHO recommends monitoring virological responses and development of human immunodeficiency virus (HIV) drug resistance (HIVDR) in HIV-infected patients in a prospective cohort. The current study compared dried fluid spot specimens with the reference standard plasma specimens as a practical tool for viral load (VL) and HIVDR genotyping in resource-limited settings. METHODS: Dried blood spot (DBS), dried plasma spot (DPS), and plasma specimens were collected from 173 -patients receiving ART at 2 hospital sites in Abuja, Nigeria. HIV-1 VL analysis was performed using NucliSENS EasyQ HIV-1 v1.1 RUO test kits. Genotyping of the HIV-1 pol gene was performed using a broadly sensitive in-house assay. RESULTS: Direct comparison of VL levels showed that DBS specimens, and not DPS specimens, gave results comparable to those of plasma specimens (P = .0619 and .0007, respectively); however, both DBS and DPS specimens had excellent correlation with plasma specimens in predicting virological failure (VL, ≥1000 copies/mL) in patients (kappa = 0.78 and 0.83, respectively). Of the 18 specimens with a plasma VL ≥1000 copies/mL, HIVDR genotyping rates were 100% in DBS and 38.9% in DPS specimens, and DBS specimens identified 61 of 65 HIVDR mutations (93.8%) identified in plasma specimens. CONCLUSIONS: Our results indicate that DBS specimens could be used for surveys to monitor HIVDR prevention failure in resource-limited settings. |
UC781 microbicide gel retains anti-HIV activity in cervicovaginal lavages collected following twice daily vaginal application
Haaland RE , Evans-Strickfaden T , Holder A , Pau CP , McNicholl JM , Chaikummao S , Chonwattana W , Hart CE . Antimicrob Agents Chemother 2012 56 (7) 3592-6 The potent non-nucleoside reverse transcriptase inhibitor UC781 has been safety tested as a vaginal microbicide gel formulation for prevention of HIV-1 sexual transmission. To investigate whether UC781 retained anti-infective activity following exposure to the female genital tract, we conducted an ex vivo analysis of the UC781 levels and antiviral activity in cervicovaginal lavages (CVL) from 25 Thai women enrolled in a 14-day safety trial of twice-daily vaginal application of two concentrations of UC781 microbicide gel. CVL samples were collected from women in 0.1% (n=5), 0.25% (n=15) and placebo (n=5) gel arms following the first application of gel (T(15min)) and 8-24 hours after the final application (T(8-24hr)), and separated into cell-free (CVL-s) and pelletable fractions (CVL-p). As UC781 is highly hydrophobic, there were significantly higher levels of UC781 in the CVL-p samples compared to CVL-s for the UC781 gel arms. In T(8-24hr) CVL-p samples, 2/5 and 13/15 samples collected from the 0.1% and 0.25% UC781 gel arms, respectively, efficiently blocked infection with ≥4 log(10) TCID(50) of a CCR5-tropic CRF01_AE HIV-1 virus stock. Independent of arm, the 11 CVL-p samples with UC781 levels ≥5 mcg/CVL reduced infectious HIV ≥4 log(10) TCID(50). Our results suggest that the levels and anti-infective activity of UC781 gel formulations are likely to be associated with a cellular or pelletable component in CVL samples. Therefore, cellular and pelletable fractions should be assayed for drug levels and anti-infective activity in preclinical studies of candidate microbicides. |
Laboratory-based surveillance of non-typhoidal Salmonella infections in Guangdong Province, China
Deng X , Ran L , Wu S , Ke B , He D , Yang X , Zhang Y , Ke C , Klena JD , Yan M , Feng Z , Kan B , Liu X , Mikoleit M , Varma JK . Foodborne Pathog Dis 2012 9 (4) 305-12 Salmonella is one of the most common foodborne pathogens in humans. Laboratory-based surveillance for non-typhoidal Salmonella infection was conducted in Guangdong Province, China to improve understanding about the disease burden and detection of dispersed outbreaks. Salmonella isolated from patients with diarrhea were sent from 16 sentinel hospitals to local public health laboratories for confirmation, serotyping, antimicrobial susceptibility testing, and pulsed-field gel electrophoresis (PFGE). PFGE patterns were analyzed to identify clusters representing potential outbreaks. Between September 2009 and October 2010, 352 (4%) Salmonella isolates were obtained from 9167 stool specimens. Salmonella enterica serotype Typhimurium (45%) and Salmonella enterica serotype Enteritidis (13%) were the most common serotypes, and multidrug resistance was high, especially in Salmonella Typhimurium isolates. PFGE patterns of obtained Salmonella isolates were found to be diverse, but a unique PFGE pattern comprising 53 Salmonella Typhimurium isolates were found to occur almost exclusively in infants. Epidemiologic studies are ongoing to determine whether a common exposure is the source of the Salmonella Typhimurium strain frequently isolated from infants. |
Mechanisms of carbon nanotube-induced toxicity: focus on oxidative stress
Shvedova AA , Pietroiusti A , Fadeel B , Kagan VE . Toxicol Appl Pharmacol 2012 261 (2) 121-33 Nanotechnologies are emerging as highly promising technologies in many sectors in the society. However, the increasing use of engineered nanomaterials also raises concerns about inadvertent exposure to these materials and the potential for adverse effects on human health and the environment. Despite several years of intensive investigations, a common paradigm for the understanding of nanoparticle-induced toxicity remains to be firmly established. Here, the so-called oxidative stress paradigm is scrutinized. Does oxidative stress represent a secondary event resulting inevitably from disruption of biochemical processes and the demise of the cell, or a specific, non-random event that plays a role in the induction of cellular damage e.g. apoptosis? The answer to this question will have important ramifications for the development of strategies for mitigation of adverse effects of nanoparticles. Recent examples of global lipidomics studies of nanoparticle-induced tissue damage are discussed along with proteomics and transcriptomics approaches to achieve a comprehensive understanding of the complex and interrelated molecular changes in cells and tissues exposed to nanoparticles. We also discuss instances of non-oxidative stress-mediated cellular damage resulting from direct physical interference of nanomaterials with cellular structures. |
Multiple virus infection alters rotavirus replication and expression of cytokines and toll-like receptors in intestinal epithelial cells
Wang H , Moon S , Wang Y , Jiang B . Virus Res 2012 167 (1) 48-55 Two live oral rotavirus vaccines have shown to be effective in protecting young children from severe illness in developed and middle income countries, but their efficacy is significantly lower in low income countries. One of the reasons for this lower efficacy may be mixed virus infection in the gut that is commonly encountered among infants in the developing world. We investigated whether multiple virus infection interferes with rotavirus replication and alters host response by comparing single and mixed enteric virus infections in Caco-2 cells. We observed a dramatic reduction in rotavirus replication and growth in mixed rotavirus, astrovirus and enterovirus infection compared to single rotavirus infection. By contrast, the levels of astrovirus and enterovirus RNA in mixed infection remained unchanged when compared to those of the corresponding single virus infection. We then examined cells with single or multiple virus infections for the expression of 10 cytokine genes and demonstrated elevated expressions for 7 (IFN-alpha, IFN-beta, IFN-gamma, TNF-alpha, IL-6, IL-8, and IL-17) in dual rotavirus and enterovirus or triple rotavirus, enterovirus and astrovirus-infected cells but only 3 (IFN-beta, TNF-alpha, and IL-8) in dual rotavirus and astrovirus-infected cells. We further observed elevated levels of TLR4, TLR5, TLR7 and TLR9 mRNAs in cells with rotavirus and enterovirus or rotavirus, enterovirus and astrovirus infections when compared to single rotavirus infections. Our data suggest that rotavirus infection is susceptible to interference by other enteric viruses in the gut, which could result in reduced virus replication and contribute to lower immunogenicity and efficacy of oral rotavirus vaccines in low income countries. |
Alternatives to retroorbital blood collection in hispid cotton rats (Sigmodon hispidus)
Ayers JD , Rota PA , Collins ML , Drew CP . J Am Assoc Lab Anim Sci 2012 51 (2) 239-245 Cotton rats (Sigmodon hispidus) are a valuable animal model for many human viral diseases, including polio virus, measles virus, respiratory syncytial virus, and herpes simplex virus. Although cotton rats have been used in research since 1939, few publications address handling and sampling techniques for this species, and the retroorbital sinus remains the recommended blood sampling site. Here we assessed blood sampling methods that are currently used in other species and a novel subzygomatic sampling site for their use in S. hispidus. The subzygomatic approach accesses a venous sinus that possibly is unique to this species and that lies just below the zygomatic arch of the maxilla and deep to the masseter muscle. We report that both the novel subzygomatic approach and the sublingual vein method can be used effectively in cotton rats. |
Analysis of a kinetic multi-segment foot model part I: model repeatability and kinematic validity
Bruening DA , Cooney KM , Buczek FL . Gait Posture 2012 35 (4) 529-34 Kinematic multi-segment foot models are still evolving, but have seen increased use in clinical and research settings. The addition of kinetics may increase knowledge of foot and ankle function as well as influence multi-segment foot model evolution; however, previous kinetic models are too complex for clinical use. In this study we present a three-segment kinetic foot model and thorough evaluation of model performance during normal gait. In this first of two companion papers, model reference frames and joint centers are analyzed for repeatability, joint translations are measured, segment rigidity characterized, and sample joint angles presented. Within-tester and between-tester repeatability were first assessed using 10 healthy pediatric participants, while kinematic parameters were subsequently measured on 17 additional healthy pediatric participants. Repeatability errors were generally low for all sagittal plane measures as well as transverse plane Hindfoot and Forefoot segments (median<3 degrees ), while the least repeatable orientations were the Hindfoot coronal plane and Hallux transverse plane. Joint translations were generally less than 2mm in any one direction, while segment rigidity analysis suggested rigid body behavior for the Shank and Hindfoot, with the Forefoot violating the rigid body assumptions in terminal stance/pre-swing. Joint excursions were consistent with previously published studies. |
Analysis of a kinetic multi-segment foot model part II: kinetics and clinical implications
Bruening DA , Cooney KM , Buczek FL . Gait Posture 2012 35 (4) 535-40 Kinematic multi-segment foot models have seen increased use in clinical and research settings, but the addition of kinetics has been limited and hampered by measurement limitations and modeling assumptions. In this second of two companion papers, we complete the presentation and analysis of a three segment kinetic foot model by incorporating kinetic parameters and calculating joint moments and powers. The model was tested on 17 pediatric subjects (ages 7-18 years) during normal gait. Ground reaction forces were measured using two adjacent force platforms, requiring targeted walking and the creation of two sub-models to analyze ankle, midtarsal, and 1st metatarsophalangeal joints. Targeted walking resulted in only minimal kinematic and kinetic differences compared with walking at self selected speeds. Joint moments and powers were calculated and ensemble averages are presented as a normative database for comparison purposes. Ankle joint powers are shown to be overestimated when using a traditional single-segment foot model, as substantial angular velocities are attributed to the mid-tarsal joint. Power transfer is apparent between the 1st metatarsophalangeal and mid-tarsal joints in terminal stance/pre-swing. While the measurement approach presented here is limited to clinical populations with only minimal impairments, some elements of the model can also be incorporated into routine clinical gait analysis. |
Cell permeability, migration, and reactive oxygen species induced by multiwalled carbon nanotubes in human microvascular endothelial cells
Pacurari M , Qian Y , Fu W , Schwegler-Berry D , Ding M , Castranova V , Guo NL . J Toxicol Environ Health A 2012 75 (3) 129-47 Multiwalled carbon nanotubes (MWCNT) have elicited great interest in biomedical applications due to their extraordinary physical, chemical, and optical properties. Intravenous administration of MWCNT-based medical imaging agents and drugs in animal models was utilized. However, the potential harmful health effects of MWCNT administration in humans have not yet been elucidated. Furthermore, to date, there are no apparent reports regarding the precise mechanisms of translocation of MWCNT into target tissues and organs from blood circulation. This study demonstrates that exposure to MWCNT leads to an increase in cell permeability in human microvascular endothelial cells (HMVEC). The results obtained from this study also showed that the MWCNT-induced rise in endothelial permeability is mediated by reactive oxygen species (ROS) production and actin filament remodeling. In addition, it was found that MWCNT promoted cell migration in HMVEC. Mechanistically, MWCNT exposure elevated the levels of monocyte chemoattractant protein-1 (MCP-1) and intercellular adhesion molecule 1 (ICAM-1) in HMVEC. Taken together, these results provide new insights into the bioreactivity of MWCNT, which may have implications in the biomedical application of MWCNT in vascular targeting, imaging, and drug delivery. The results generated from this study also elucidate the potential adverse effects of MWCNT exposure on humans at the cellular level. |
Comparison of artificial neural network (ANN) and partial least squares (PLS) regression models for predicting respiratory ventilation: an exploratory study
Lin MI , Groves W , Freivalds A , Lee E , Harper M . Eur J Appl Physiol 2012 112 (5) 1603-1611 The objective of this study was to assess the potential for using artificial neural networks (ANN) to predict inspired minute ventilation during exercise activities. Six physiological/kinematic measurements obtained from a portable ambulatory monitoring system, along with individual’s anthropometric and demographic characteristics, were employed as input variables to develop and optimize the ANN configuration with respect to reference values simultaneously measured using a pneumotachograph (PT). The generalization ability of the resulting two-hidden-layer ANN model was compared with a linear predictive model developed through partial least squares (PLS) regression, as well as other inspired minute ventilation predictive models proposed in the literature. Using an independent dataset recorded from nine 80-min step tests, the results showed that the ANN-estimated inspired minute ventilation was highly correlated (R2 = 0.88) with inspired minute ventilation measured by the PT, with a mean difference of approximately 0.9%. In contrast, the PLS and other regression-based models resulted in larger average errors ranging from 7 to 34%. In addition, the ANN model yielded estimates of cumulative total volume that were on average within 1% of reference PT measurements. Compared with established statistical methods, the proposed ANN model demonstrates the potential to provide improved prediction of respiratory ventilation in workplace applications for which the use of traditional laboratory-based instruments is not feasible. Further research should be conducted to investigate the performance of ANNs for different types of physical activity in larger and more varied worker populations. |
Dermal absorption of finite doses of volatile compounds
Frasch HF . J Pharm Sci 2012 101 (7) 2616-9 Laplace domain solutions to a previously published finite dose skin diffusion model are presented. The purpose of the current analysis is to derive a simple algebraic expression quantifying the total mass that is systemically absorbed at infinite time after exposure, relative to the applied mass. The resulting expression is a function of two dimensionless parameters: f, the fractional depth within the skin surface through which the permeant is initially deposited, and chi, the ratio of maximum evaporation flux to maximum dermal flux. The result may be useful for dermal risk assessment as well as in the evaluation of cosmetic and pharmaceutical product performance. ((c) 2012 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci.) |
Evidence-based path to newborn screening for Duchenne muscular dystrophy.
Mendell JR , Shilling C , Leslie ND , Flanigan KM , Al-Dahhak R , Gastier-Foster J , Kneile K , Dunn DM , Duval B , Aoyagi A , Hamil C , Mahmoud M , Roush K , Bird L , Rankin C , Lilly H , Street N , Chandrasekar R , Weiss RB . Ann Neurol 2012 71 (3) 304-13 OBJECTIVE: Creatine kinase (CK) levels are increased on dried blood spots in newborns related to the birthing process. As a marker for newborn screening, CK in Duchenne muscular dystrophy (DMD) results in false-positive testing. In this report, we introduce a 2-tier system using the dried blood spot to first assess CK with follow-up DMD gene testing. METHODS: A fluorometric assay based upon the enzymatic transphosphorylation of adenosine diphosphate to adenosine triphosphate was used to measure CK activity. Preliminary studies established a population-based range of CK in newborns using 30,547 deidentified anonymous dried blood spot samples. Mutation analysis used genomic DNA extracted from the dried blood spot followed by whole genome amplification with assessment of single-/multiexon deletions/duplications in the DMD gene using multiplex ligation-dependent probe amplification. RESULTS: DMD gene mutations (all exonic deletions) were found in 6 of 37,649 newborn male subjects, all of whom had CK levels >2,000U/l. In 3 newborns with CK >2,000U/l in whom DMD gene abnormalities were not found, we identified limb-girdle muscular dystrophy gene mutations affecting DYSF, SGCB, and FKRP. INTERPRETATION: A 2-tier system of analysis for newborn screening for DMD has been established. This path for newborn screening fits our health care system, minimizes false-positive testing, and uses predetermined levels of CK on dried blood spots to predict DMD gene mutations. |
Occupational coccidioidomycosis in California: outbreak investigation, respirator recommendations, and surveillance findings
Das R , McNary J , Fitzsimmons K , Dobraca D , Cummings K , Mohle-Boetani J , Wheeler C , McDowell A , Iossifova Y , Bailey R , Kreiss K , Materna B . J Occup Environ Med 2012 54 (5) 564-71 OBJECTIVE: To describe the investigation of a 2007 occupational coccidioidomycosis outbreak in California, recommend prevention measures, and assess statewide disease burden. METHODS: We evaluated the worksite, observed work practices, interviewed the workers and employer, reviewed medical records, provided prevention recommendations including risk-based respirator selection, and analyzed statewide workers' compensation claims. RESULTS: Ten of 12 workers developed acute pulmonary coccidioidomycosis; none used respiratory protection. We recommended engineering, work practice, and administrative controls, powered air-purifying respirator use, and medical care. Occupational coccidioidomycosis incidence nearly quadrupled in California from 2000 to 2006, with the highest rates in construction and agricultural workers. CONCLUSIONS: Construction workers are at risk for occupational coccidioidomycosis. The high attack rate in this outbreak was due to lack of awareness, rainfall patterns, soil disruption, and failure to use appropriate controls. Multiple risk-based measures are needed to control occupational coccidioidomycosis in endemic areas. |
Occupational safety and health in the USA: now and the future
Howard J , Hearl F . Ind Health 2012 50 (2) 80-3 In the USA, national worker protection legislation was enacted in 1970. The legislation required that research, recommendations and guidance be developed to aid employers and workers, that workplace health and safety standards be adopted, that employer comply with those rules and that the government police employer compliance, and that assistance be offered to employers and workers to help them maintain a safe and healthful workplace. In the 40 yr since passage of the Occupational Safety and Health Act of 1970, worker injury, illness and fatalities have declined but not been eliminated. Efforts to accelerate the standards adoption process are much discussed in the USA along with how to protect workers from emerging hazards like nanotechnology. New strategies which seek to eliminate not only the causes of work-related injury and illness, but also more broadly, worker injury and illness, are on the horizon. |
An investigation on the dynamic stability of scissor lift
Dong RG , Pan CS , Hartsell JJ , Welcome DE , Lutz T , Brumfield A , Harris JR , Wu JZ , Wimer B , Mucino V , Means K . Open J Saf Sci Technnol 2012 2 (1) 8-15 The tip-over of scissor lifts in operation has frequently resulted in the death and/or severe injuries of workers. The objective of this study is to enhance the understanding of its major mechanisms and factors influencing scissor lift stability. Both experimental and modeling approaches were used in this study. Two series of experiments were performed under possible tip-over scenarios: curb impact and pothole depression. Based on the dynamic characteristics identified from the experimental results, a lumped-parameter model of the scissor lift was developed. It was applied to investigate the effect of scissor structure flexibility on the tip-over potential of the lift, to understand tip-over mechanisms, and to explore preventive strategies. This study found that the fundamental natural frequencies of the lift were generally in a range of 0.30 - 2.08 Hz, which are likely related to the tip-over. Increasing flexibility of the lift structure generally increased the tip-over potential. The tip-over threshold was also a function of both ground slope and tilt speed of the lift. The results suggest that the lift should not be elevated on largely deformable and/or uneven surfaces such as bridged wood board or a soft soil base. The worker on the lift platform should avoid any large continuous periodic movement or forceful action in the horizontal plane, especially when the lift is fully elevated. Besides the tilt angle of the lift, the tilt speed should be monitored to help prevent the tip-over. |
A case for using A-weighted equivalent energy as a damage risk criterion for impulse noise exposure
Murphy WJ , McKinley RL . J Acoust Soc Am 2012 131 (4) 3532 Damage risk criteria (DRCs) for continuous noise rely upon epidemiologic analyses of populations of persons exposed over several years to noise in occupational environments. In 2006, the U.S. Army proposed to update the MIL-STD 1474D to use the Auditory Hazard Assessment Algorithm for Humans (AHAAH) and discontinue using the peak sound pressure level, envelope duration and number of impulses. The National Institute for Occupational Safety and Health has conducted two separate evaluations of the data used to justify the AHAAH methodology and found that the use of the A-weighted equivalent energy L(Aeq8) was more suitable for the purposes of predicting the effects of temporary threshold shifts (TTS) both in humans and in chinchillas. The L(Aeq8) method provided best fit for the TTS outcomes and demonstrated the greatest discrimination (ability to predict TTS) when compared to AHAAH, MIL-STD 1474D and two other proposed DRCs. Similarly, L(Aeq8) was found to give the best-fit and greatest discrimination for the chinchilla impulse noise exposures. The L(Aeq8) affords the best sensitivity and specificity for discrimination of potential hazards and has the greatest level of integration with present occupational exposure standards and prospective hearing protection labeling regulations. |
A visual warning system to reduce struck-by or pinning accidents involving mobile mining equipment
Sammarco J , Gallagher S , Mayton A , Srednicki J . Appl Ergon 2012 43 (6) 1058-65 This paper describes an experiment to examine whether a visual warning system can improve detection of moving machine hazards that could result in struck-by or pinning accidents. Thirty-six participants, twelve each in one of three age groups, participated in the study. A visual warning system capable of providing four different modes of warning was installed on a continuous mining machine that is used to mine coal. The speed of detecting various machine movements was recorded with and without the visual warning system. The average speed of detection for forward and reverse machine movements was reduced by 75% when using the flashing mode of the visual warning system. This translated to 0.485 m of machine travel for the fast speed condition of 19.8 m/min, which is significant in the context of the confined spaces of a mine. There were no statistically significant differences among age groups in the ability to detect machine movements for the visual warning modes in this study. The visual warning system shows promise as a safety intervention for reducing struck-by or pinning accidents involving continuous mining machines. The methods and results of this study could be applied to other moving machinery used in mining or other industries where moving machinery poses struck-by or pinning hazards. |
Albendazole therapy and enteric parasites in United States-bound refugees
Swanson SJ , Phares CR , Mamo B , Smith KE , Cetron MS , Stauffer WM . N Engl J Med 2012 366 (16) 1498-507 BACKGROUND: Beginning on May 1, 1999, the Centers for Disease Control and Prevention (CDC) recommended presumptive treatment of refugees for intestinal parasites with a single dose of albendazole (600 mg), administered overseas before departure for the United States. METHODS: We conducted a retrospective cohort study involving 26,956 African and Southeast Asian refugees who were screened by means of microscopical examination of stool specimens for intestinal parasites on resettlement in Minnesota between 1993 and 2007. Adjusted prevalence ratios for intestinal nematodes, schistosoma species, giardia, and entamoeba were calculated among refugees who migrated before versus those who migrated after the CDC recommendation of presumptive predeparture albendazole treatment. RESULTS: Among 4370 untreated refugees, 20.8% had at least one stool nematode, most commonly hookworm (in 9.2%). Among 22,586 albendazole-treated refugees, only 4.7% had one or more nematodes, most commonly trichuris (in 3.9%). After adjustment for sex, age, and region, albendazole-treated refugees were less likely than untreated refugees to have any nematodes (prevalence ratio, 0.19), ascaris (prevalence ratio, 0.06), hookworm (prevalence ratio, 0.07), or trichuris (prevalence ratio, 0.27) but were not less likely to have giardia or entamoeba. Schistosoma ova were identified exclusively among African refugees and were less prevalent among those treated with albendazole (prevalence ratio, 0.60). After implementation of the albendazole protocol, the most common pathogens among 17,011 African refugees were giardia (in 5.7%), trichuris (in 5.0%), and schistosoma (in 1.8%); among 5575 Southeast Asian refugees, only giardia remained highly prevalent (present in 17.2%). No serious adverse events associated with albendazole use were reported. CONCLUSIONS: Presumptive albendazole therapy administered overseas before departure for the United States was associated with a decrease in the prevalence of intestinal nematodes among newly arrived African and Southeast Asian refugees. |
Case-crossover analysis of condom use and herpes simplex virus type 2 acquisition
Stanaway JD , Wald A , Martin ET , Gottlieb SL , Magaret AS . Sex Transm Dis 2012 39 (5) 388-93 BACKGROUND: Although growing evidence suggests that condoms offer moderate protection against herpes simplex virus type 2 (HSV-2), inability to control for unknown or unmeasured confounders associated with sexual activity may reduce the accuracy of the estimates. The case-crossover design offers increased control of individual-level confounders, and was thus used with the aim of producing a more accurate estimate of the effect of condom use on HSV-2 acquisition. METHODS: Data were pooled from 6 prospective studies that measured HSV-2 status at enrollment and over follow-up, and included periodic self-reported condom use and sexual activity. Sexual activity contemporaneous with acquisition was assigned to a case period; earlier sexual activity was assigned to a control period. Conditional logistic regression was used to assess differences in behavior during the case and control periods. RESULTS: One hundred ninety-one eligible participants acquired HSV-2 during follow-up. This approach detected a 3.6% increase in the odds of HSV-2 acquisition with each unprotected act (odds ratio = 1.036; 95% confidence interval: 1.021-1.052), but no increase in the odds of acquisition associated with protected acts (odds ratio = 1.008; 95% confidence interval: 0.987-1.030). CONCLUSIONS: This analysis suggests that condoms offer significant protection against HSV-2 transmission. |
Binge drinking intensity and health-related quality of life among US adult binge drinkers
Wen XJ , Kanny D , Thompson WW , Okoro CA , Town M , Balluz LS . Prev Chronic Dis 2012 9 E86 INTRODUCTION: Binge drinking (men, ≥5 drinks, women, ≥4 on an occasion) accounts for more than half of the 79,000 annual deaths due to excessive alcohol use in the United States. The frequency of binge drinking is associated with poor health-related quality of life (HRQOL), but the association between binge drinking intensity and HRQOL is unknown. Our objective was to examine this association. METHODS: We used 2008-2010 Behavioral Risk Factor Surveillance System data and multivariate linear regression models to examine the association between binge drinking intensity (largest number of drinks consumed on any occasion) among US adult binge drinkers and 2 HRQOL indicators: number of physically and mentally unhealthy days. RESULTS: Among binge drinkers, the highest-intensity binge drinkers (women consuming ≥7 drinks and men consuming ≥8 drinks on any occasion) were more likely to report poor HRQOL than binge drinkers who reported lower levels of intensity (women who consumed 4 drinks and men who consumed 5 drinks on any occasion). On average, female binge drinkers reported more physically and mentally unhealthy days (2.8 d and 5.1 d, respectively) than male binge drinkers (2.5 d and 3.6 d, respectively). After adjustment for confounding factors, women who consumed ≥7 drinks on any occasion reported more mentally unhealthy days (6.3 d) than women who consumed 4 drinks (4.6 d). Compared with male binge drinkers across the age groups, female binge drinkers had a significantly higher mean number of mentally unhealthy days. CONCLUSION: Our findings underscore the importance of implementing effective population-level strategies to prevent binge drinking and improve HRQOL. |
Common occurrence of a unique Cryptosporidium ryanae variant in zebu cattle and water buffaloes in the buffer zone of the Chitwan National Park, Nepal
Feng Y , Raj Karna S , Dearen TK , Singh DK , Adhikari LN , Shrestha A , Xiao L . Vet Parasitol 2012 185 309-14 There are very few studies on the diversity and public health significance of Cryptosporidium species in zebu cattle and water buffaloes in developing countries. In this study, PCR-restriction fragment length polymorphism and DNA sequence analyses of the small-subunit (SSU) rRNA gene were used to genotype Cryptosporidium specimens from 12 zebu cattle calves, 16 water buffalo calves, and four swamp deer (Cervus duvaucelii) collected from the buffer zone of the Chitwan National Park, Nepal. All Cryptosporidium specimens from cattle and buffaloes belonged to Cryptosporidium ryanae, whereas those from deer belonged to Cryptosporidium ubiquitum. Comparison of the SSU rRNA gene sequences obtained with those from earlier studies has identified a nucleotide substitution unique to all C. ryanae isolates from Nepal, in addition to some sequence heterogeneity among different copies of the gene. The finding of the dominance of a unique C. ryanae variant in both zebu cattle and water buffaloes in Nepal indicates that there is unique cryptosporidiosis transmission in bovine animals in the study area, and cross-species transmission of some Cryptosporidium spp. can occur between related animal species sharing the same habitats. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Global Health
- Health Communication and Education
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Reproductive Health
- Substance Use and Abuse
- Veterinary Medicine
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure