Attitudes of primary care providers and recommendations of home blood pressure monitoring-DocStyles, 2010
Tirabassi J , Fang J , Ayala C . J Clin Hypertens (Greenwich) 2013 15 (4) 224-9 To assess primary care providers' (PCPs) opinions related to recommending home blood pressure monitoring (HBPM) for their hypertensive patients, the authors analyzed a Web-based 2010 DocStyles survey, which included PCPs' demographics, health-related behaviors, recommendations on HBPM, views of patient knowledge, and use of continuing medical education. Of the 1254 PCPs who responded, 539 were family practitioners, 461 were internists, and 254 were nurse practitioners; 32% recommended HBPM to ≥90% of their patients and 26% recommended it to ≤40% of their patients. Nurse practitioners were significantly more likely to recommend HBPM than were internists (odds ratio, 0.55; 95% confidence interval, 0.40-0.78). The top reasons for not recommending HBPM were "patient can't afford it" and "patient doesn't need it." A total of 20% of PCPs indicated that their patients were poor to lower middle class; these PCPs were less likely to recommend HBPM to their patients than were those PCPs with most patients in higher economic classes. Additional efforts are needed to provide education to providers, especially physicians, about the benefits of HBPM in improved and cost-effective blood pressure control in the United States. |
Dental care among young adults with intellectual disability
Kancherla V , Van Naarden-Braun K , Yeargin-Allsopp M . Res Dev Disabil 2013 34 (5) 1630-1641 Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer young adults with ID (45%) visited a dentist at least once per year, compared with those without ID (58%). ID severity and the presence of co-occurring developmental disabilities predicted dental care use. Sociodemographics, daily functioning, societal participation, dental services, and dental health factors were examined as predictors of dental care frequency. Our findings can help focus efforts toward improving the frequency of dental care visits among young adults with ID. |
What are the reasons for poor uptake of HIV testing among patients with TB in an eastern India district?
Bishnu B , Bhaduri S , Kumar AM , Click ES , Chadha VK , Satyanarayana S , Nair SA , Gupta D , Ahmed QT , Sarkar S , Paul D , Dewan P . PLoS One 2013 8 (3) e55229 BACKGROUND: National policy in India recommends HIV testing of all patients with TB. In West Bengal state, only 28% of patients with TB were tested for HIV between April-June, 2010. We conducted a cross-sectional survey to understand patient, provider and health system related factors associated with low uptake of HIV testing among patients with TB. METHODS: We reviewed TB and HIV program records to assess the HIV testing status of patients registered for anti-TB treatment from July-September 2010 in South-24-Parganas district, West Bengal, assessed availability of HIV testing kits and interviewed a random sample of patients with TB and providers. RESULTS: Among 1633 patients with TB with unknown HIV status at the time of diagnosis, 435 (26%) were tested for HIV within the intensive phase of TB treatment. Patients diagnosed with and treated for TB at facilities with co-located HIV testing services were more likely to get tested for HIV than at facilities without [RR = 1.27, (95% CI 1.20-3.35)]. Among 169 patients interviewed, 67 reported they were referred for HIV testing, among whom 47 were tested. During interviews, providers attributed the low proportion of patients with TB being referred and tested for HIV to inadequate knowledge among providers about the national policy, belief that patients will not test for HIV even if they are referred, shortage of HIV testing kits, and inadequate supervision by both programs. DISCUSSION: In West Bengal, poor uptake of HIV testing among patients with TB was associated with absence of HIV testing services at sites providing TB care services and to poor referral practices among providers. Comprehensive strategies to change providers' beliefs and practices, decentralization of HIV testing to all TB care centers, and improved HIV test kit supply chain management may increase the proportion of patients with TB who are tested for HIV. |
The effect of opportunistic illness on HIV RNA viral load and CD4+ T cell count among HIV-positive adults taking antiretroviral therapy
Ekwaru JP , Campbell J , Malamba S , Moore DM , Were W , Mermin J . J Int AIDS Soc 2013 16 (1) 17355 INTRODUCTION: HIV RNA viral load (VL) has been shown to increase during opportunistic illnesses (OIs), suggesting active HIV replication in response to infection among patients not taking antiretroviral therapy (ART). We assessed the effects of OIs on HIV RNA VL and CD4+ T cell counts among patients on ART with initially suppressed VL. METHODS: Between 2003 and 2007, we enrolled and followed 1094 HIV-1-infected adults who initiated ART and had quarterly blood draws for VL and CD4+ T cell count. In VL/CD4+ T cell measurement intervals following undetectable VL, we compared the elevation in VL to detectable levels and CD4+ T cell count changes between intervals when participants had episodes of OIs and intervals when they did not have OIs. RESULTS: VL was more likely to be detectable if participants had OIs in the prior three months compared to when they did not (OR=4.0 (95% CI=1.9-8.6)). The CD4+ T cell counts declined 24.1 cells/microL per three months in intervals where the participants had OIs compared to an increase of 21.3 cells/microL per three months in intervals where they did not have OIs (adjusted difference in the rate of CD4+ T cell count change of 61.7 cells/microL per three months (95% CI=13.7-109.7), P value=0.012). The rate of CD4+ T cell count increase was 25.6 cells/microL per three months (95% CI=11.6-39.6) higher for females compared to males (p value=<0.001), 1.4 cells/microL per three months lower per one year increase in age (p value=0.046) and 4 cells/microL per three months lower per 10 cells/microL increase in the starting CD4+ T cell count value (p value=<0.001). CONCLUSION: Episodes of opportunistic infections among patients taking ART with undetectable VL were associated with elevation of HIV RNA VL to detectable levels and decline in CD4+ T cell counts. CLINICAL TRIAL NUMBER: NCT00119093. |
Antimicrobial use in outpatient hemodialysis units
Snyder GM , Patel PR , Kallen AJ , Strom JA , Tucker JK , D'Agata EM . Infect Control Hosp Epidemiol 2013 34 (4) 349-57 OBJECTIVE:To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis. DESIGN: Retrospective and prospective observational study. SETTING: Two outpatient hemodialysis units. PATIENTS: All patients receiving chronic hemodialysis. METHODS: The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met. RESULTS: Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins. CONCLUSIONS: Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use. (See the commentary by Malani and Heung, on pages 358-360.) |
A cluster-randomized trial of insecticide-treated curtains for dengue vector control in Thailand
Lenhart A , Trongtokit Y , Alexander N , Apiwathnasorn C , Satimai W , Vanlerberghe V , Van der Stuyft P , McCall PJ . Am J Trop Med Hyg 2013 88 (2) 254-9 The efficacy of insecticide-treated window curtains (ITCs) for dengue vector control was evaluated in Thailand in a cluster-randomized controlled trial. A total of 2,037 houses in 26 clusters was randomized to receive the intervention or act as control (no treatment). Entomological surveys measured Aedes infestations (Breteau index, house index, container index, and pupae per person index) and oviposition indices (mean numbers of eggs laid in oviposition traps) immediately before and after intervention, and at 3-month intervals over 12 months. There were no consistent statistically significant differences in entomological indices between intervention and control clusters, although oviposition indices were lower (P < 0.01) in ITC clusters during the wet season. It is possible that the open housing structures in the study reduced the likelihood of mosquitoes making contact with ITCs. ITCs deployed in a region where this house design is common may be unsuitable for dengue vector control. |
Socioeconomic disparities in indoor air, breath, and blood perchloroethylene level among adult and child residents of buildings with or without a dry cleaner
Storm JE , Mazor KA , Shost SJ , Serle J , Aldous KM , Blount BC . Environ Res 2013 122 88-97 In many cities, dry cleaners using perchloroethylene are frequently located in multifamily residential buildings and often cause elevated indoor air levels of perchloroethylene throughout the building. To assess individual perchloroethylene exposures associated with co-located dry cleaners, we measured perchloroethylene in residential indoor air, and in blood and breath of adults and children residing in buildings with a dry cleaner as part of the New York City (NYC) Perc Project. We also measured perchloroethylene in indoor air, and in blood and breath of residents of buildings without a dry cleaner for comparison. Here, we evaluate whether an environmental disparity in perchloroethylene exposures is present. Study participants are stratified by residential building type (dry cleaner or reference) and socioeconomic characteristics (race/ethnicity and income); measures of perchloroethylene exposure are examined; and, the influence of stratified variables and other factors on perchloroethylene exposure is assessed using multivariate regression. All measures of perchloroethylene exposure for residents of buildings with a dry cleaner indicated a socioeconomic disparity. Mean indoor air perchloroethylene levels were about five times higher in minority (82.5ug/m(3)) than in non-minority (16.5ug/m(3)) households, and about six times higher in low-income (105.5ug/m(3)) than in high income (17.8ug/m(3)) households. Mean blood perchloroethylene levels in minority children (0.27ng/mL) and adults (0.46ng/mL) were about two and three times higher than in non-minority children (0.12ng/mL) and adults (0.15ng/mL), respectively. Mean blood perchloroethylene levels in low income children (0.34ng/mL) and adults (0.62ng/mL) were about three and four times higher than in high income children (0.11ng/mL) and adults (0.14ng/mL), respectively. A less marked socioeconomic disparity was observed in perchloroethylene breath levels with minority and low income residents having slightly higher levels than non-minority and high income residents. Multivariate regression affirmed that indoor air perchloroethylene level in dry cleaner buildings was the single most important factor determining perchloroethylene in blood and breath. Neither age, gender, nor socioeconomic status significantly influenced perchloroethylene levels in breath or blood. We previously reported that increased indoor air, breath, and blood perchloroethylene levels among NYC Perc Project child participants were associated with an increased risk for slightly altered vision. Thus, the disproportionately elevated perchloroethylene exposures of minority and low-income child residents of buildings with a dry cleaner shown here constitutes an environmental exposure disparity with potential public health consequences. Among residents of buildings without a dry cleaner, we observed some small increases in perchloroethylene breath and blood levels among non-minority or high income residents compared to minority or low income residents. These differences were not attributable to differences in indoor air levels of perchloroethylene which did not differ across socioeconomic categories, but appear to be associated with more frequent exposures dry cleaned garments. |
Urinary concentrations of bisphenol A in an urban minority birth cohort in New York City, prenatal through age 7 years
Hoepner LA , Whyatt RM , Just AC , Calafat AM , Perera FP , Rundle AG . Environ Res 2013 122 38-44 BACKGROUND: Despite growing concern over potential health effects associated with exposures to the endocrine disruptor, bisphenol A (BPA), insufficient information is available on determinants of BPA concentrations among minority populations in the US. OBJECTIVES: To describe concentrations and predictors of BPA in an inner-city longitudinal birth cohort. METHODS: We analyzed spot urines for total BPA collected during pregnancy and child ages 3, 5, and 7 years from African Americans and Dominicans (n=568) enrolled in the Columbia Center for Children's Environmental Health birth cohort and residing in Northern Manhattan and the South Bronx. Adjusting for specific gravity, generalized estimating equations were used to compare BPA concentrations across paired samples and linear regression analyses were used to determine relationships between BPA, season of sample collection, socio-demographic variables and urinary concentrations of phthalate metabolites. RESULTS: BPA was detected in ≥94% of samples. Prenatal concentrations were significantly lower than postnatal concentrations. Geometric means were higher among African Americans compared to Dominicans in prenatal (p=0.008), 5 year (p<0.001) and 7 year (p=0.017) samples. Geometric means at 5 and 7 years were higher (p=0.021, p=0.041 respectively) for children of mothers never married compared to mothers ever married at enrollment. BPA concentrations were correlated with phthalate metabolite concentrations at prenatal, 3, 5 and 7 years (p-values <0.05). Postnatal BPA concentrations were higher in samples collected during the summer. CONCLUSIONS: This study shows widespread BPA exposure in an inner-city minority population. BPA concentration variations were associated with socio-demographic characteristics and other xenobiotics. |
Worldwide transmission and seasonal variation of pandemic influenza A(H1N1)2009 virus activity during the 2009-2010 pandemic
Storms AD , Van Kerkhove MD , Azziz-Baumgartner E , Lee WK , Widdowson MA , Ferguson NM , Mounts AW . Influenza Other Respir Viruses 2013 7 (6) 1328-35 BACKGROUND: Seasonal influenza activity varies with geography and time of year. OBJECTIVE: To describe how pandemic influenza A(H1N1)2009 [A(H1N1)pdm09] activity varied during the 2009-2010 pandemic. METHODS: We analyzed influenza virological data compiled by the World Health Organization from June 2009-August 2010. We calculated weekly proportions of A(H1N1)pdm09-positive specimens out of all A(H1N1)pdm09-positive specimens detected during the study period for each country. We compared parameters of pandemic activity (e.g., peak A[H1N1]pdm09 weekly proportion [peak activity], number of weeks between the 5th and 95th percentiles of A(H1N1)pdm09 cumulative weekly proportion [duration of activity]) between countries in temperate and tropical-subtropical regions. We quantified the proportion of A(H1N1)pdm09 out of all influenza A specimens by country and correlated it with countries' central latitudes. RESULTS: We analyzed data from 80 countries (47 temperate, 33 tropical-subtropical). The median proportion of cases identified during the peak week was higher in temperate (0.12) than in tropical-subtropical (0.09) regions (P < 0.01). The median duration of activity was longer in tropical-subtropical (27 weeks) than in temperate countries (20 weeks) (P < 0.01). In most temperate countries (98%), peak pandemic activity occurred during the fall-winter period. There was a positive correlation between country central latitude and proportion of A(H1N1)pdm09 out of all influenza A specimens (r: 0.76; P < 0.01). CONCLUSIONS: The transmission of A(H1N1)pdm09 exhibited similarities with seasonal influenza transmission in that activity varied between temperate and tropical-subtropical countries and by time of year. Our findings suggest the potential utility of accounting for these factors during future pandemic planning. |
Prostate cancer screening in men ages 75 and older fell by 8 percentage points after task force recommendation
Howard DH , Tangka FK , Guy GP , Ekwueme DU , Lipscomb J . Health Aff (Millwood) 2013 32 (3) 596-602 In 2008 the US Preventive Services Task Force recommended against screening men ages 75 and older for prostate cancer. Using Medicare Current Beneficiary Survey Access to Care files and linked claims, we compared trends in prostate-specific antigen (PSA) testing rates between men ages 75 and older and men ages 65-74. We estimate that the revised recommendation led to a 7.9-percentage-point decline in annual PSA testing rates over two years among men ages 75 and older. Although 42 percent of men in this age group continue to receive PSA tests, our results highlight the potential of guidelines with negative recommendations to reduce the use of low-value medical care. |
Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data
Newman L , Kamb M , Hawkes S , Gomez G , Say L , Seuc A , Broutet N . PLoS Med 2013 10 (2) e1001396 BACKGROUND: The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. METHODS AND FINDINGS: Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. CONCLUSIONS: Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary. |
Human papillomavirus vaccine coverage among females aged 11 to 17 in Texas counties: an application of multilevel, small area estimation
Eberth JM , Hossain MM , Tiro JA , Zhang X , Holt JB , Vernon SW . Womens Health Issues 2013 23 (2) e131-41 BACKGROUND: Local data are often used to plan and evaluate public health interventions and policy. With increasingly fewer public resources to collect sufficient data to support direct estimation of local outcomes, methods for deriving small area estimates are vital. The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among adolescent females in Texas using multilevel small area estimation. METHODS: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (≥1 dose Gardasil) from the 2008 Behavioral Risk Factor Surveillance System. Using the parameter estimates from the final model, we simulated 10,000 data sets for each regression coefficient from the normal distribution and applied them to the logit model to estimate HPV vaccine coverage in each county. RESULTS: County-level coverage estimates ranged from 7% to 29%, compared with the state average of 18% (95% confidence interval [CI], 13.59-21.88). Many Southwestern border and metropolitan counties exhibited high coverage estimates. Low coverage estimates were noted in the Panhandle, Southeastern border region, and Northeast. Significant correlations were observed between HPV vaccination and Hispanic ethnicity, county poverty, and public health region poverty. CONCLUSION: Harnessing the flexibility of multilevel small area models to estimate HPV vaccine coverage at the county level, we have provided data that may inform the development of health education programs/policies, the provision of health services, and the planning of new research studies. Additionally, we have provided a framework for modeling other health outcomes at the county level using national survey data. |
Molecular evolution of viruses of the family Filoviridae based on 97 whole-genome sequences.
Carroll SA , Towner JS , Sealy TK , McMullan LK , Khristova ML , Burt FJ , Swanepoel R , Rollin PE , Nichol ST . J Virol 2013 87 (5) 2608-16 Viruses in the Ebolavirus and Marburgvirus genera (family Filoviridae) have been associated with large outbreaks of hemorrhagic fever in human and nonhuman primates. The first documented cases occurred in primates over 45 years ago, but the amount of virus genetic diversity detected within bat populations, which have recently been identified as potential reservoir hosts, suggests that the filoviruses are much older. Here, detailed Bayesian coalescent phylogenetic analyses are performed on 97 whole-genome sequences, 55 of which are newly reported, to comprehensively examine molecular evolutionary rates and estimate dates of common ancestry for viruses within the family Filoviridae. Molecular evolutionary rates for viruses belonging to different species range from 0.46 x 10(-4) nucleotide substitutions/site/year for Sudan ebolavirus to 8.21 x 10(-4) nucleotide substitutions/site/year for Reston ebolavirus. Most recent common ancestry can be traced back only within the last 50 years for Reston ebolavirus and Zaire ebolavirus species and suggests that viruses within these species may have undergone recent genetic bottlenecks. Viruses within Marburg marburgvirus and Sudan ebolavirus species can be traced back further and share most recent common ancestors approximately 700 and 850 years before the present, respectively. Examination of the whole family suggests that members of the Filoviridae, including the recently described Lloviu virus, shared a most recent common ancestor approximately 10,000 years ago. These data will be valuable for understanding the evolution of filoviruses in the context of natural history as new reservoir hosts are identified and, further, for determining mechanisms of emergence, pathogenicity, and the ongoing threat to public health. |
Historical shifts in Brazilian P. falciparum population structure and drug resistance alleles.
Griffing SM , Viana GM , Mixson-Hayden T , Sridaran S , Alam MT , de Oliveira AM , Barnwell JW , Escalante AA , Povoa MM , Udhayakumar V . PLoS One 2013 8 (3) e58984 Previous work suggests that Brazilian Plasmodium falciparum has limited genetic diversity and a history of bottlenecks, multiple reintroductions due to human migration, and clonal expansions. We hypothesized that Brazilian P. falciparum would exhibit clonal structure. We examined isolates collected across two decades from Amapa, Rondonia, and Para state (n = 190). By examining more microsatellites markers on more chromosomes than previous studies, we hoped to define the extent of low diversity, linkage disequilibrium, bottlenecks, population structure, and parasite migration within Brazil. We used retrospective genotyping of samples from the 1980s and 1990s to explore the population genetics of SP resistant dhfr and dhps alleles. We tested an existing hypothesis that the triple mutant dhfr mutations 50R/51I/108N and 51I/108N/164L developed in southern Amazon from a single origin of common or similar parasites. We found that Brazilian P. falciparum had limited genetic diversity and isolation by distance was rejected, which suggests it underwent bottlenecks followed by migration between sites. Unlike Peru, there appeared to be gene flow across the Brazilian Amazon basin. We were unable to divide parasite populations by clonal lineages and pairwise FST were common. Most parasite diversity was found within sites in the Brazilian Amazon, according to AMOVA. Our results challenge the hypothesis that triple mutant alleles arose from a single lineage in the Southern Amazon. SP resistance, at both the double and triple mutant stages, developed twice and potentially in different regions of the Brazilian Amazon. We would have required samples from before the 1980s to describe how SP resistance spread across the basin or describe the complex internal migration of Brazilian parasites after the colonization efforts of past decades. The Brazilian Amazon basin may have sufficient internal migration for drug resistance reported in any particular region to rapidly spread to other parts of basin under similar drug pressure. |
Recent advances in research of HIV infection: implications of viral and host genetics on treatment and prevention.
Haaland RE , Johnson JA , Tang J . Public Health Genomics 2013 16 31-6 The genetic diversity among human immunodeficiency virus (HIV) subtypes as well as the variability of viral sequences found in HIV-infected individuals presents a number of difficult obstacles for the development of universally effective HIV treatment and prevention methods. Here, we present a brief summary of recent developments in the analysis of viral genetics and human genomics to provide insight into future methods for HIV treatment and prevention. Recent studies have mined viral sequences found in newly infected individuals to identify common features of all transmitted viruses that could provide potential targets for HIV vaccine development. Analysis of human immunogenetics has identified specific alleles associated with reduced virus loads in HIV-infected individuals providing valuable information that may influence individual responses to treatment and prevention methods. Increased sensitivity of antiretroviral drug resistance testing has improved the detection of hidden drug resistant virus but also highlighted the potential for drug resistant viruses to reduce the effectiveness of clinical treatment regimens. The rapidly expanding amount of data generated by studies of viral genetics and human immunogenetics will provide valuable information to guide the design of new strategies to improve clinical treatment and enhance HIV vaccine development. |
Malaria diagnostics and surveillance in the post-genomic era.
Lucchi NW , Oberstaller J , Kissinger JC , Udhayakumar V . Public Health Genomics 2013 16 37-43 Genome sequences are available for 3 human-infecting malaria parasites, Plasmodium falciparum, P. vivax and P. knowlesi, and population genomics data are available for many endemic regions. This review summarizes how genomic data have been used to develop new, species-specific molecular targets for better malaria diagnosis. The combination of bioinformatics and genomics has been used to identify new sequence targets suitable for diagnostic applications and assess their viability within the context of global Plasmodium sequence variation. The selection criteria maximized the sensitivity and specificity of the novel targets. At least one target from each species was found to be suitable for molecular diagnosis of malaria with some advantages over existing molecular methods. The promise of using genome sequence data to develop sensitive, genus- or species-specific diagnostic methods for other pathogens of public health interest is strong. This undertaking together with what we envision as the future of malaria diagnosis in the 'omic' era is discussed. |
Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 1: US-bound migrants evaluated by comprehensive protocol-based health assessment
Barnett ED , Weld LH , McCarthy AE , So H , Walker PF , Stauffer W , Cetron M . Clin Infect Dis 2013 56 (7) 913-24 BACKGROUND: Many nations are struggling to develop structured systems and guidelines to optimize the health of new arrivals, but there is currently no international consensus about the best approach. METHODS: Data on 7792 migrants who crossed international borders for the purpose of resettlement and underwent a protocol-based health assessment were collected from the GeoSentinel Surveillance network. Demographic and health characteristics of a subgroup of these migrants seen at 2 US-based GeoSentinel clinics for protocol-based health assessments are described. RESULTS: There was significant variation over time in screened migrant populations and in their demographic characteristics. Significant diagnoses identified in all migrant groups included latent tuberculosis, found in 43% of migrants, eosinophilia in 15%, and hepatitis B infection in 6%. Variation by region occurred for select diagnoses such as parasitic infections. Notably absent were infectious tuberculosis, soil-transmitted helminths, and malaria. Although some conditions would be unfamiliar to clinicians in receiving countries, universal health problems such as dental caries, anemia, ophthalmologic conditions, and hypertension were found in 32%, 11%, 10%, and 5%, respectively, of screened migrants. CONCLUSIONS: Data from postarrival health assessments can inform clinicians about screening tests to perform in new immigrants and help communities prepare for health problems expected in specific migrant populations. These data support recommendations developed in some countries to screen all newly arriving migrants for some specific diseases (such as tuberculosis) and can be used to help in the process of developing additional screening recommendations that might be applied broadly or focused on specific at-risk populations. |
Spectrum of illness in international migrants seen at GeoSentinel clinics in 1997-2009, part 2: migrants resettled internationally and evaluated for specific health concerns
McCarthy AE , Weld LH , Barnett ED , So H , Coyle C , Greenaway C , Stauffer W , Leder K , Lopez-Velez R , Gautret P , Castelli F , Jenks N , Walker PF , Loutan L , Cetron M . Clin Infect Dis 2013 56 (7) 925-33 BACKGROUND: Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants. METHODS:Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared. RESULTS: A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19-39 years; 11% were children. Most (58%) were seen >1 year after arrival; 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%); 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas). CONCLUSIONS: Eliciting a migration history is important at every encounter; migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants. |
Sexual risk taking in relation to sexual identification, age, and education in a diverse sample of African American men who have sex with men (MSM) in New York City
Hampton M , Halkitis P , Storholm E , Kupprat S , Siconolfi D , Jones D , Steen J , Gillen S , McCree D . AIDS Behav 2013 17 (3) 931-938 HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education,and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types,unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate. |
Prevalence and predictors of drug use among adolescents with HIV infection acquired perinatally or later in life
Conner LC , Wiener J , Lewis JV , Phill R , Peralta L , Chandwani S , Koenig LJ . AIDS Behav 2013 17 (3) 976-86 We examined the prevalence and predictors of drug use among a diverse group of adolescents living with HIV infection acquired perinatally or through sexual risk behaviors ("behaviorally acquired"). Adolescents ages 13-21 (n = 166) who were receiving care at one of five pediatric/adolescent HIV clinics in three US cities (Baltimore MD, Washington DC, and New York NY) and were enrolled in a behavioral intervention were interviewed at baseline regarding lifetime drug use experiences and depression symptoms. A majority of study participants reported using alcohol (57.2%) and marijuana (51.2%); 48.8% reported tobacco/cigarette use. The mean age of onset of use for each type of drug was 14 years or younger. A larger proportion of participants with behaviorally acquired HIV than adolescents with perinatally acquired HIV reported lifetime use of alcohol (76.1 vs. 44.4%), marijuana (73.1 vs. 36.4%), tobacco (70.2 vs. 34.3%), and club drugs (22.4 vs. 3%) (all p < 0.001). |
National Healthcare Safety Network report, data summary for 2011, device-associated module
Dudeck MA , Horan TC , Peterson KD , Allen-Bridson K , Morrell G , Anttila A , Pollock DA , Edwards JR . Am J Infect Control 2013 41 (4) 286-300 This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2011 and reported to the Centers for Disease Control and Prevention (CDC) by August 1, 2012. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 This report complements other NHSN reports, including national and state-specific reports of standardized infection ratios (SIRs) for select healthcare-associated infections (HAIs).2,3,4 | NHSN data collection, reporting, and analysis are organized into three components: Patient Safety, Healthcare Personnel Safety, and Biovigilance, and use standardized methods and definitions in accordance with specific module protocols.5,6,7 Institutions may use modules singly or simultaneously, but once selected, they must be used for a minimum of one calendar month for the data to be included in CDC analyses. All infections are categorized using standard CDC definitions that include laboratory and clinical criteria.7 The DA Module may be used by facilities other than hospitals, including outpatient dialysis centers. A report of data from this module for outpatient dialysis centers was published separately.8 NHSN facilities contributing HAI surveillance data to this report did so voluntarily, in response to state mandatory reporting requirements or in compliance with the Centers for Medicare and Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting (IQR) Program. CDC aggregated these data into a single national database for 2011, consistent with the stated purposes of NHSN, which were to: | Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and healthcare personnel. | Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of these adverse events. | Analyze and report collected data to permit recognition of trends. | Provide facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement activities. | Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and healthcare worker safety problems and prompt intervention with appropriate measures. | Conduct collaborative research studies with NHSN member facilities (e.g., describe the epidemiology of emerging healthcare-associated infection [HAI] and pathogens, assess the importance of potential risk factors, further characterize HAI pathogens and their mechanisms of resistance, and evaluate alternative surveillance and prevention strategies). | Comply with legal requirements – including but not limited to state or federal laws, regulations, or other requirements – for mandatory reporting of healthcare facility-specific adverse event, prevention practice adherence, and other public health data. | Enable healthcare facilities to report HAI and prevention practice adherence data via NHSN to the U.S. Centers for Medicare and Medicaid Services (CMS) in fulfillment of CMS’s quality measurement reporting requirements for those data. | Provide state departments of health with information that identifies the healthcare facilities in their state that participate in NHSN. | Provide to state agencies, at their request, facility-specific, NHSN patient safety component and healthcare personnel safety component adverse event and prevention practice adherence data for surveillance, prevention, or mandatory public reporting. | Patient- and facility-specific data reported to CDC are kept confidential in accordance with sections 304, 306, and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)). |
U.S. postlicensure safety surveillance for adolescent and adult tetanus, diphtheria and acellular pertussis vaccines: 2005-2007
Chang S , O'Connor PM , Slade BA , Woo EJ . Vaccine 2013 31 (10) 1447-52 BACKGROUND: Pre-licensure clinical trials for two U.S. licensed tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccines did not reveal any major safety concerns. However, routine use in large adolescent and adult populations could reveal rare and potentially serious adverse events (AEs). METHODS: To characterize reported AEs following Tdap vaccination and identify potential safety concerns warranting further evaluation, we analyzed data from the Vaccine Adverse Event Reporting System (VAERS) and assessed the frequency and proportions of AEs and reporting rates (reports per 100,000 vaccine doses distributed). RESULTS: A total of 2090 reports (7% were serious; 55% listed Tdap alone) involving Tdap vaccines were submitted to VAERS May 2005-June 2007. The crude reporting rate was 10.2 per 100,000 vaccine doses distributed. The median age of vaccinees was 22 years, and the female to male ratio was about 2 to 1. The majority of reports described common local and systemic signs and symptoms, such as injection site reactions, fever, and headache. Rarely reported AEs included myopericarditis, demyelinating diseases of the central nervous system, Guillain-Barre Syndrome, syncope, encephalopathy/encephalitis, seizure, Bell's palsy, anaphylaxis, and thrombocytopenia. CONCLUSIONS: Because adolescents and adults were not routinely vaccinated against pertussis in the past, this surveillance summary provides important - and reassuring - information about the use of Tdap in these age groups. Although subject to the limitations of passive surveillance, the findings of this VAERS review support the pre-licensure clinical trial data with regard to the safety of the U.S. licensed Tdap vaccines. Continued monitoring of clinically significant AEs that are temporally associated with Tdap vaccination and further assessment of such events using controlled observational studies may provide additional information about the safety of these vaccines. |
A population-based cohort study of undervaccination in 8 managed care organizations across the United States
Glanz JM , Newcomer SR , Narwaney KJ , Hambidge SJ , Daley MF , Wagner NM , McClure DL , Xu S , Rowhani-Rahbar A , Lee GM , Nelson JC , Donahue JG , Naleway AL , Nordin JD , Lugg MM , Weintraub ES . JAMA Pediatr 2013 167 (3) 274-81 OBJECTIVES: To examine patterns and trends of undervaccination in children aged 2 to 24 months and to compare health care utilization rates between undervaccinated and age-appropriately vaccinated children. DESIGN: Retrospective matched cohort study. SETTING: Eight managed care organizations of the Vaccine Safety Datalink. PARTICIPANTS: Children born between 2004 and 2008. MAIN EXPOSURE: Immunization records were used to calculate the average number of days undervaccinated. Two matched cohorts were created: 1 with children who were undervaccinated for any reason and 1 with children who were undervaccinated because of parental choice. For both cohorts, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex. MAIN OUTCOME MEASURES: Rates of undervaccination, specific patterns of undervaccination, and health care utilization rates. RESULTS: Of 323,247 children born between 2004 and 2008, 48.7% were undervaccinated for at least 1 day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time (P < .001). In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with children who were age-appropriately vaccinated (incidence rate ratio [IRR], 0.89; 95% CI, 0.89- 0.90). In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children (IRR, 1.21; 95% CI, 1.18-1.23). In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits (IRR, 0.94; 95% CI, 0.93-0.95) and emergency department encounters (IRR, 0.91; 95% CI, 0.88-0.94) than age-appropriately vaccinated children. CONCLUSIONS: Undervaccination appears to be an increasing trend. Undervaccinated children appear to have different health care utilization patterns compared with age-appropriately vaccinated children. |
Factors associated with receipt of 2009 pandemic influenza A (H1N1) monovalent and seasonal influenza vaccination among school-aged children: Maricopa County, Arizona, 2009-2010 influenza season
Baty SA , Ayala A , Odish M , Cadwell BL , Schumacher M , Sunenshine RH . J Public Health Manag Pract 2013 19 (5) 436-43 CONTEXT: To target school-aged children (SAC), who were identified as a priority for pandemic 2009 Influenza A (pH1N1) vaccination, Maricopa County (MC) initiated school-based influenza vaccination in 69% of its 706 schools during the 2009-2010 influenza season. OBJECTIVE: To determine factors associated with receipt of pH1N1 monovalent and 2009-2010 seasonal influenza vaccination among SAC and evaluate the association of school-based vaccination with vaccination status of SAC. DESIGN: Random-digit dialing was used to survey 600 MC households with willing adult participants and children grades K-12. Logistic regression was used to identify factors associated with pH1N1 and seasonal vaccine receipt. SETTING: Arizona. PARTICIPANTS: Household adults with children grades K-12. MAIN OUTCOME MEASURE: Characteristics of children, parents, and households were obtained. RESULTS: Among 909 SAC, 402 (44%) received pH1N1 and 436 (48%) received seasonal vaccination. Factors associated with pH1N1 vaccination included vaccine availability at school (adjusted odds ratio [AOR]: 1.6; 95% confidence interval [CI]: 1.0-2.7), high-risk medical condition in child (AOR: 2.4; 95% CI: 1.4-4.0), elementary versus high school attendance (AOR: 1.6; 95% CI: 1.0-2.7), and seasonal influenza vaccination (AOR: 10.0; 95% CI: 6.4-15.6). Factors associated with seasonal vaccination included Hispanic ethnicity (AOR: 2.2; 95% CI: 1.1-4.2), health insurance coverage (AOR: 4.8; 95% CI: 1.7-13.7), elementary versus high school attendance (AOR: 1.5; 95% CI: 1.0-2.5), and pH1N1 vaccination (AOR: 10.5; 95% CI: 6.7-16.6). CONCLUSIONS: Availability of pH1N1 vaccine at school was independently associated with pH1N1 vaccination of MC school-aged children. School-based influenza vaccination campaigns should be considered to increase vaccination among this population. |
Combined effects of antenatal receipt of influenza vaccine by mothers and pneumococcal conjugate vaccine receipt by infants: results from a randomized, blinded, controlled trial
Omer SB , Zaman K , Roy E , Arifeen SE , Raqib R , Noory L , Seib K , Breiman RF , Steinhoff MC . J Infect Dis 2013 207 (7) 1144-7 A 2 x 2 factorial trial was performed to determine the efficacy of antennal influenza vaccination of mothers plus pneumococcal conjugate vaccination of their infants against respiratory illness during early infancy. The efficacy of trivalent inactivated influenza vaccine (TIV; delivered to mothers) plus 7-valent pneumococcal vaccine (PCV7; delivered to infants) was higher than the efficacy of TIV alone or PCV7 alone. During the period of the study in which influenza was circulating, the efficacy of TIV plus PCV7 was 72.4% (95% confidence interval, 30.2%-89.1%) against febrile respiratory illness and 66.4% (95% CI, 14.3%-86.9%) against medically attended acute respiratory illness. CLINICAL TRIALS REGISTRATION: NCT00142389. |
The role of economic factors and economic support in preventing and escaping from intimate partner violence
Matjasko JL , Niolon PH , Valle LA . J Policy Anal Manage 2013 32 (1) 122-128 This paper discusses the role of economic factors and economic support in preventing and escaping from intimate partner violence. Intimate partner violence (IPV) includes physical violence, sexual violence, threats of physical or sexual violence, stalking, and psychological aggression by a current or former intimate partner. There is substantial variability in the strength of the relationship between different risk factors and IPV perpetration and victimization. Economic support can be defined as assistance in helping families provide for their basic needs of food, shelter, health, and clothing, and alleviating stressors associated with living in poverty. We suggest that interventions and programs that increase economic independence and reduce economic hardship and stress that leads to conflict and potentially to violence have the potential to prevent situational couple violence (SCV). Although economic policies may be less related to the perpetration of intimate terrorism (IT), they are likely very relevant if they assist victims of IT in escaping violent relationships. Future research on economic intervention policies should explicitly consider whether their results are generalizable to all or only certain typologies of IPV so that we can better tailor interventions to address the specific economic needs of those in different types of intimate relationships. (PsycINFO Database Record (c) 2013 APA, all rights reserved). |
A systematic qualitative review of risk and protective factors for sexual violence perpetration
Tharp AT , Degue S , Valle LA , Brookmeyer KA , Massetti GM , Matjasko JL . Trauma Violence Abuse 2013 14 (2) 133-67 The current review summarized results of 191 published empirical studies that examined the risk and protective factors for sexual violence perpetration. Studies in the review examined factors for perpetration by and against adolescents and adults, by male and female perpetrators, and by those who offended against individuals of the same sex or opposite sex. Factors associated with child sexual abuse (CSA) perpetration were not included. In all, 2 societal and community factors, 23 relationship factors, and 42 individual-level factors were identified. Of these 67 factors, consistent significant support for their association with SV was found for 35, nonsignificant effects were found for 10, 7 factors had limited or sample-specific evidence that they were associated with SV but were in need of further study, and 15 demonstrated mixed results. The factors identified in the review underscore the need for comprehensive prevention programs that target multiple risk and protective factors as well as factors that occur across the social ecology. Moreover, we identified two domains of factors-the presence and acceptance of violence and unhealthy sexual behaviors, experiences, or attitudes-that had consistent significant associations with SV but are not typically addressed in prevention programs. Therefore, SV prevention may also benefit from learning from effective strategies in other areas of public health, namely sexual health and youth violence prevention. |
Different types of intimate partner violence likely require different types of approaches to prevention: a response to Buzawa and Buzawa
Matjasko JL , Niolon PH , Valle LA . J Policy Anal Manage 2013 32 (1) 137-139 Comments on an article by Eve S. Buzawa & Carl G. Buzawa (see record 2013-00130-009). Buzawa and Buzawa assert that there are different typologies of intimate partner violence (IPV) defined by the extent to which the violence is part of a general pattern of coercive control. They center their discussion on batterers, who are understood to be responsible for the most severe forms of abuse and injury. Economic factors are believed to be "only a weak predictor of violence" in these cases. Thus, they argue that, in the face of severe budget constraints, there is a need to focus on the chronically violent offender and support-coordinated services for IPV victims. Buzawa and Buzawa state that the best programs are those that address fragmentation and lack of coordinated services and cite coordinated community response and Family Justice Centers as examples. In sum, evidence suggests that economic factors may play different roles in preventing and intervening in the different forms of IPV, so it is unlikely that one approach will suffice. (PsycINFO Database Record (c) 2013 APA, all rights reserved). |
Poor immune responses of newborn rhesus macaques to measles virus DNA vaccines expressing the hemagglutinin and fusion glycoproteins.
Polack FP , Lydy SL , Lee SH , Rota PA , Bellini WJ , Adams RJ , Robinson HL , Griffin DE . Clin Vaccine Immunol 2013 20 (2) 205-10 A vaccine that would protect young infants against measles could facilitate elimination efforts and decrease morbidity and mortality in developing countries. However, immaturity of the immune system is an important obstacle to the development of such a vaccine. In this study, DNA vaccines expressing the measles virus (MeV) hemagglutinin (H) protein or H and fusion (F) proteins, previously shown to protect juvenile macaques, were used to immunize groups of 4 newborn rhesus macaques. Monkeys were inoculated intradermally with 200 mcg of each DNA at birth and at 10 months of age. As controls, 2 newborn macaques were similarly vaccinated with DNA encoding the influenza virus H5, and 4 received one dose of the current live attenuated MeV vaccine (LAV) intramuscularly. All monkeys were monitored for development of MeV-specific neutralizing and binding IgG antibody and cytotoxic T lymphocyte (CTL) responses. These responses were poor compared to the responses induced by LAV. At 18 months of age, all monkeys were challenged intratracheally with a wild-type strain of MeV. Monkeys that received the DNA vaccine encoding H and F, but not H alone, were primed for an MeV-specific CD8(+) CTL response but not for production of antibody. LAV-vaccinated monkeys were protected from rash and viremia, while DNA-vaccinated monkeys developed rashes, similar to control monkeys, but had 10-fold lower levels of viremia. We conclude that vaccination of infant macaques with DNA encoding MeV H and F provided only partial protection from MeV infection. |
The receptor-binding site of the measles virus hemagglutinin protein itself constitutes a conserved neutralizing epitope
Tahara M , Ohno S , Sakai K , Ito Y , Fukuhara H , Komase K , Brindley MA , Rota PA , Plemper RK , Maenaka K , Takeda M . J Virol 2013 87 (6) 3583-6 Here, we provide direct evidence that the receptor-binding site of measles virus (MV) hemagglutinin protein itself forms an effective conserved neutralizing epitope (CNE). Several receptor-interacting residues constitute the CNE. Thus, viral escape from neutralization has to be associated with loss of receptor-binding activity. Since interactions with both the signaling lymphocyte activation molecule (SLAM) and nectin4 are critical for MV pathogenesis, its escape, which results from loss of receptor-binding activity, should not occur in nature. |
Tropism and infectivity of influenza virus, including highly pathogenic avian H5N1 virus, in ferret tracheal differentiated primary epithelial cell cultures
Zeng H , Goldsmith CS , Maines TR , Belser JA , Gustin KM , Pekosz A , Zaki SR , Katz JM , Tumpey TM . J Virol 2013 87 (5) 2597-607 Tropism and adaptation of influenza viruses to new hosts is partly dependent on the distribution of the sialic acid (SA) receptors to which the viral hemagglutinin (HA) binds. Ferrets have been established as a valuable in vivo model of influenza virus pathogenesis and transmission because of similarities to humans in the distribution of HA receptors and in clinical signs of infection. In this study, we developed a ferret tracheal differentiated primary epithelial cell culture model that consisted of a layered epithelium structure with ciliated and nonciliated cells on its apical surface. We found that human-like (alpha2,6-linked) receptors predominated on ciliated cells, whereas avian-like (alpha2,3-linked) receptors, which were less abundant, were presented on nonciliated cells. When we compared the tropism and infectivity of three human (H1 and H3) and two avian (H1 and H5) influenza viruses, we observed that the human influenza viruses primarily infected ciliated cells and replicated efficiently, whereas a highly pathogenic avian H5N1 virus (A/Vietnam/1203/2004) replicated efficiently within nonciliated cells despite a low initial infection rate. Furthermore, compared to other influenza viruses tested, VN/1203 virus replicated more efficiently in cells isolated from the lower trachea and at a higher temperature (37 degrees C) compared to a lower temperature (33 degrees C). VN/1203 virus infection also induced higher levels of immune mediator genes and cell death, and virus was recovered from the basolateral side of the cell monolayer. This ferret tracheal differentiated primary epithelial cell culture system provides a valuable in vitro model for studying cellular tropism, infectivity, and the pathogenesis of influenza viruses. |
Molecular determinants of mouse neurovirulence and mosquito infection for Western equine encephalitis virus
Mossel EC , Ledermann JP , Phillips AT , Borland EM , Powers AM , Olson KE . PLoS One 2013 8 (3) e60427 Western equine encephalitis virus (WEEV) is a naturally occurring recombinant virus derived from ancestral Sindbis and Eastern equine encephalitis viruses. We previously showed that infection by WEEV isolates McMillan (McM) and IMP-181 (IMP) results in high ( approximately 90-100%) and low (0%) mortality, respectively, in outbred CD-1 mice when virus is delivered by either subcutaneous or aerosol routes. However, relatively little is known about specific virulence determinants of WEEV. We previously observed that IMP infected Culex tarsalis mosquitoes at a high rate (app. 80%) following ingestion of an infected bloodmeal but these mosquitoes were infected by McM at a much lower rate (10%). To understand the viral role in these phenotypic differences, we characterized the pathogenic phenotypes of McM/IMP chimeras. Chimeras encoding the E2 of McM on an IMP backbone (or the reciprocal) had the most significant effect on infection phenotypes in mice or mosquitoes. Furthermore, exchanging the arginine, present on IMP E2 glycoprotein at position 214, for the glutamine present at the same position on McM, ablated mouse mortality. Curiously, the reciprocal exchange did not confer mouse virulence to the IMP virus. Mosquito infectivity was also determined and significantly, one of the important loci was the same as the mouse virulence determinant identified above. Replacing either IMP E2 amino acid 181 or 214 with the corresponding McM amino acid lowered mosquito infection rates to McM-like levels. As with the mouse neurovirulence, reciprocal exchange of amino acids did not confer mosquito infectivity. The identification of WEEV E2 amino acid 214 as necessary for both IMP mosquito infectivity and McM mouse virulence indicates that they are mutually exclusive phenotypes and suggests an explanation for the lack of human or equine WEE cases even in the presence of active transmission. |
Emergence of a norovirus GII.4 strain correlates with changes in evolving blockade epitopes
Lindesmith LC , Costantini V , Swanstrom J , Debbink K , Donaldson EF , Vinje J , Baric RS . J Virol 2013 87 (5) 2803-13 The major capsid protein of norovirus GII.4 strains is evolving rapidly, resulting in epidemic strains with altered antigenicity. GII.4.2006 Minerva strains circulated at pandemic levels in 2006 and persisted at lower levels until 2009. In 2009, a new GII.4 variant, GII.4.2009 New Orleans, emerged and since then has become the predominant strain circulating in human populations. To determine whether changes in evolving blockade epitopes correlate with the emergence of the GII.4.2009 New Orleans strains, we compared the antibody reactivity of a panel of mouse monoclonal antibodies (MAbs) against GII.4.2006 and GII.4.2009 virus-like particles (VLPs). Both anti-GII.4.2006 and GII.4.2009 MAbs effectively differentiated the two strains by VLP-carbohydrate ligand blockade assay. Most of the GII.4.2006 MAbs preferentially blocked GII.4.2006, while all of the GII.4.2009 MAbs preferentially blocked GII.4.2009, although 8 of 12 tested blockade MAbs blocked both VLPs. Using mutant VLPs designed to alter predicted antigenic epitopes, binding of seven of the blockade MAbs was impacted by alterations in epitope A, identifying residues 294, 296, 297, 298, 368, and 372 as important antigenic sites in these strains. Convalescent-phase serum collected from a GII.4.2009 outbreak confirmed the immunodominance of epitope A, since alterations of epitope A affected serum reactivity by 40%. These data indicate that the GII.4.2009 New Orleans variant has evolved a key blockade epitope, possibly allowing for at least partial escape from protective herd immunity and provide epidemiological support for the utility of monitoring changes in epitope A in emergent strain surveillance. |
Evaluation of an indirect rapid immunohistochemistry test for the differentiation of rabies virus variants
Dyer JL , Niezgoda M , Orciari LA , Yager PA , Ellison JA , Rupprecht CE . J Virol Methods 2013 190 29-33 Cost effective diagnostic tests are needed in rabies virus (RABV) enzootic areas to study the prevalence, distribution, and transmission of rabies virus among reservoir hosts. To reduce the associated costs of acquiring and maintaining specialized laboratory equipment, an indirect rapid immunohistochemistry test (IRIT), for the detection and differentiation of RABV variants, was evaluated by traditional light microscopy. The IRIT utilizes fresh frozen brain touch impressions or cell culture monolayers fixed in buffered formalin, a panel of murine anti-nucleoprotein monoclonal antibodies (mAb-N) and commercially available biotin- labeled goat anti-mouse antibody. In this study, 96 RABV isolates, representing 20 RABV variants previously determined by antigenic typing using a panel of mAb-N and the indirect fluorescent antibody test (IFA), and genetic sequence analysis were characterized by IRIT and the results compared. The IRIT results revealed distinct reactivity patterns associated with current and historical RABV reservoir hosts similar to IFA test and genetic sequence analysis. Evaluation of suspected RABV samples through IRIT does not require specialized equipment and is possible to perform in a field setting. Additionally, commercially available labeled secondary antibodies permit the use of a standard panel of unlabeled primary mAbs, without the need for fluorescence microscopy, and should augment existing attempts at antigenic characterization during canine rabies elimination campaigns in developed and developing countries. These results are useful in studying the epizootiology of rabies and inferring the source of infection when unknown. |
Acid-soluble internal capsules for closed-face cassette elemental sampling and analysis of workplace air
Harper M , Ashley K . J Occup Environ Hyg 2013 10 (6) 297-306 Airborne particles that are collected using closed-face filter cassettes (CFCs), which are used widely in the sampling of workplace aerosols, can deposit in places other than on the filter and thereby may not be included in the ensuing analysis. A technique for ensuring that internal non-filter deposits are included in the analysis is to collect airborne particles within an acid-soluble internal capsule that, following sampling, can be dissolved along with the filter for subsequent elemental analysis. An interlaboratory study (ILS) was carried out to evaluate the use of cellulosic CFC capsule inserts for their suitability in the determination of trace elements in airborne samples. The ILS was performed in accordance with an applicable ASTM International standard practice, ASTM E691, which describes statistical procedures for investigating interlaboratory precision. Performance evaluation materials consisted of prototype cellulose acetate capsules attached to mixed-cellulose ester filters. Batches of capsules were dosed with Pb-containing materials (standard aqueous solutions, and certified reference material soil and paint). Also, aerosol samples containing nine target analyte elements (As, Cd, Co, Cr, Cu, Fe, Pb, Mn, and Ni) were generated using a multiport sampler; various concentrations and sampling times were employed to yield samples fortified at desired loading levels. Triplicates of spiked capsules at three different loadings were conveyed to each volunteer laboratory; loading levels were unknown to the participants. The laboratories were asked to prepare the samples by acid dissolution and to analyze aliquots of extracted samples by atomic spectrometry in accordance with applicable ASTM International Standards. Participants were asked to report their results in units of mcg of each target element per sample. For the elements investigated, inter-laboratory precision and recovery estimates from the participating laboratories demonstrated the utility of the cellulosic capsule inserts for the measurement of sampled trace elements. |
Characterization of nuclear localization signal in the N terminus of integrin-linked kinase-associated phosphatase (ILKAP) and its essential role in the down-regulation of RSK2 protein signaling
Zhou W , Cao H , Yang X , Cong K , Wang W , Chen T , Yin H , Wu Z , Cai X , Liu T , Xiao J . J Biol Chem 2013 288 (9) 6259-71 Integrin-linked kinase-associated phosphatase (ILKAP) is a serine/threonine (S/T) phosphatase that belongs to the protein phosphatase 2C (PP2C) family. Many previous studies have demonstrated that ILKAP plays key roles in the regulation of cell survival and apoptosis. Researchers have thus far considered ILKAP a cytoplasmic protein that negatively regulates integrin signaling by interacting with and phosphorylating integrin-linked kinase 1 (ILK1). In this study, we found that both endogenous and tagged ILKAP mainly localize to the nucleus and that the nuclear transport of ILKAP is nuclear localization signal (NLS) importin-mediated. The ILKAP protein interacts directly with importin alpha1, alpha3, and alpha5. The NLS in ILKAP is located in the N-terminal region between amino acids 71 and 86, and the NLS-deleted ILKAP protein was distributed in the cytoplasm. In addition, we show that Lys-78 and Arg-79 are critical for the binding of ILKAP to importin alpha. We also found that nuclear ILKAP interacts with ribosomal protein S6 kinase-2 (RSK2) and induces apoptosis by inhibiting RSK2 activity and down-regulating the expression level of the RSK2 downstream substrate cyclin D1. These results indicate that ILKAP is a nuclear protein that regulates cell survival and apoptosis through the regulation of RSK2 signaling. |
Weighing for results: assessing the effect of IPTp
Gutman J , Eckert E , Mangiaterra V , Bardaji A , Aponte JJ , Menendez C , Nahlen B , Slutsker L . Lancet Infect Dis 2013 13 (4) 292 Although earlier studies showed that intermittent preventive therapy in pregnancy (IPTp) with sulfadoxine–pyrimethamine provides substantial benefit to pregnant women and their infants, the spread of resistance raises questions about how long the therapy is efficient for.1 In their meta-analysis, Thomas Eisele and colleagues2 show that IPTp with sulfadoxine–pyrimethamine continues to provide substantial benefits, resulting in a 26% reduction in low birthweight and a 16% reduction in neonatal mortality under programme conditions. How ever, the absence of exact birthweight data in many of the surveys is an important limitation. Mothers tend to overestimate weight; therefore, the prevalence of low birthweight is underestimated.3 The effect of IPTp with sulfadoxine–pyrimethamine and insecticide-treated nets (ITNs) on low birthweight can be underestimated when mothers’ perception of weight is used as a proxy for measured birthweight. Despite this limitation, the study shows how useful birthweight data from cross-sectional surveys are to monitor effectiveness of interventions nationally, and emphasises the importance of obtaining accurate birthweight information on all infants. | The authors suggest that the effect of IPTp on neonatal mortality could be explained by increased birthweight. However, a clinical trial of IPTp with sulfadoxine–pyrimethamine found a marked reduction (61·3%) in neonatal mortality without an effect on birthweight, suggesting that the treatment affects neonatal survival through mechanisms independent of increased birthweight.4 In the study by Eisele and colleagues, the effect of ITN use during pregnancy was probably underestimated because household ownership was used as a proxy for use and because of the overlapping definitions of full and partial coverage. Other studies have provided indisputable evidence that ITNs protect against the adverse effects of malaria in pregnancy; therefore, this intervention should not be discounted on the basis of the results of this study.5 The uptake of IPTp with sulfadoxine–pyrimethamine has been slow in many countries and substantial improvement in IPTp coverage is needed. Collaboration between national malaria control and reproductive health programmes is needed to improve the delivery of IPTp. The recent WHO guidelines calling for administration of IPTp with sulfadoxine–pyrimethamine at each scheduled antenatal care visit starting in second trimester will hopefully improve coverage.6 |
Micronutrient supplementation and pregnancy outcomes: double-blind randomized controlled trial in China
Liu JM , Mei Z , Ye R , Serdula MK , Ren A , Cogswell ME . JAMA Intern Med 2013 173 (4) 276-82 BACKGROUND: Beyond perinatal folic acid supplementation, the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear. We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia. METHODS: In this randomized double-blind controlled trial, 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 mcg) (control), folic acid-iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery. Primary outcome was perinatal mortality. Secondary outcomes included neonatal and infant mortality, preterm delivery, birth weight, birth length, gestational duration, and maternal hemoglobin concentration and anemia. RESULTS: A total of 92.7% of women consumed 80% to 100% of supplements as instructed. On average, women consumed 177 supplements. Compared with daily prenatal folic acid, supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality (8.8, 8.7, and 8.3, respectively) per 1000 births, and relative risks (RRs) were 1.00 (95% CI, 0.68-1.46; P = .99) and 0.94 (95% CI, 0.64-1.39; P = .76), respectively. Risk of other adverse maternal and infant outcomes also did not differ, except that RRs for third-trimester maternal anemia were 0.72 (95% CI, 0.63-0.83; P < .001) and 0.71 (95% CI, 0.62-0.82; P <.001), respectively. CONCLUSION: Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00133744. |
Patterns of body composition among HIV-infected, pregnant Malawians and the effects of famine season
Ramlal RT , Tembo M , Soko A , Chigwenembe M , Tohill BC , Kayira D , King CC , Chasela C , Jamieson D , van der Horst C , Bentley ME , Adair LS . Matern Child Health J 2013 17 (2) 265-73 We describe change in weight, midupper arm circumference (MUAC), arm muscle area (AMA) and arm fat area (AFA) in 1130 pregnant HIV-infected women with CD4 counts > 200 as part of the BAN Study ( www.thebanstudy.org ), a randomized, controlled clinical trial to evaluate antiretroviral and nutrition interventions to reduce mother-to-child transmission of HIV during breast feeding. In a longitudinal analysis, we found a linear increase in weight with a mean rate of weight gain of 0.27 kgs/week, from baseline (12 to 30 weeks gestation) until the last follow-up visit (32-38 weeks). Analysis of weight gain showed that 17.1% of the intervals between visits resulted in a weight loss. In unadjusted models, MUAC and AMA increased and AFA declined during late pregnancy. Based on multivariable regression analysis, exposure to the famine season resulted in larger losses in AMA [-0.08, 95% CI -0.14, -0.02; p = 0.01] while AFA losses occurred irrespective of season [-0.55, 95%: -0.95, -0.14, p = 0.01]. CD4 was associated with AFA [0.21, 95% CI 0.01, 0.41, p = .04]. Age was positively associated with MUAC and AMA. Wealth was positively associated with MUAC, AFA, and weight. While patterns of anthropometric measures among HIV-infected, pregnant women were found to be similar to those reported for uninfected women in sub-Saharan Africa, effects of the famine season among undernourished, Malawian women are of concern. Strategies to optimize nutrition during pregnancy for these women appear warranted. |
Prechewing and prewarming food for HIV-exposed children: a prospective cohort experience from Latin America
Gaur AH , Cohen RA , Read JS , Hance LF , Dominguez K , Alarcon JO , Menezes J , Peixoto MF , Mussi-Pinhata MM , Coelho DF , Mitchell C , Siberry GK . AIDS Patient Care STDS 2013 27 (3) 142-5 Gaur et al.1 reported HIV infection in three children in the United States from infected adults feeding them prechewed food. This practice is common among HIV-infected care providers around the world.2–6 Prechewing involves chewing food before feeding it to a child. Prewarming (or precooling) involves holding food in the mouth to adjust the temperature before offering it to a child. These practices may expose the child to blood from the mouth of an HIV-infected adult. The context of these practices and the efficiency of related HIV transmission have not been described. We previously surveyed HIV-infected pregnant women in Latin America about these practices and advised against them.3 We now follow up on this sensitized cohort, characterize the frequency and context of these practices through 18 months postpartum, and assess the risk of HIV transmission. | Women were enrolled at 12 sites (Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative [NISDI] Longitudinal Study in Latin American Countries7 [LILAC]) in Argentina, Brazil, and Peru, and followed for 18 months postpartum. At study visits (antepartum and 6, 12, and 18 months postpartum), enrolled mothers (or alternative providers) were interviewed using a standardized questionnaire about prechewing/prewarming. Information about factors influencing risk of HIV transmission, including symptoms of disrupted oral mucosal integrity in the child or the adult and the HIV/hepatitis B/hepatitis C infection status of the adult, were collected. At the end of each interview, a scripted statement was read to respondents regarding the potential risk of HIV transmission associated with these practices and advising against them. |
Effects of maternal smokeless tobacco use on selected pregnancy outcomes in Alaska Native women: a case-control study
England LJ , Kim SY , Shapiro-Mendoza CK , Wilson HG , Kendrick JS , Satten GA , Lewis CA , Tucker MJ , Callaghan WM . Acta Obstet Gynecol Scand 2013 92 (6) 648-55 OBJECTIVE: To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes. DESIGN: A population-based, case-control study using a retrospective medical record review. POPULATION: Singleton deliveries 1997-2005 to Alaska Native women residing in western Alaska. METHODS: Hospital discharge codes were used to identify potential case deliveries and a random control sample. Data on tobacco use and confirmation of pregnancy outcomes were abstracted from medical records for 1123 deliveries. Logistic regression was used to examine associations between tobacco use and pregnancy outcomes. Adjusted odds ratios (OR), 95% confidence intervals (95% CI), and p-values were calculated. MAIN OUTCOMES MEASURES: Preterm delivery, pregnancy-associated hypertension, and placental abruption. RESULTS: In unadjusted analysis, smokeless tobacco use was not significantly associated with preterm delivery (OR 1.44, 95% CI 0.97-2.15). After adjustment for parity, pre-pregnancy body mass index, and maternal age, the point estimate was attenuated and remained non-significant. No significant associations were observed between smokeless tobacco use and pregnancy-associated hypertension (adjusted OR 0.92, 95% CI 0.56-1.51) or placental abruption (adjusted OR 1.11, 95% CI 0.53-2.33). CONCLUSIONS: Prenatal smokeless tobacco use does not appear to reduce risk of pregnancy-associated hypertension or to substantially increase risk of abruption. An association between smokeless tobacco and preterm delivery could not be ruled out. Components in tobacco other than nicotine likely play a major role in decreased pre-eclampsia risk in smokers. Nicotine adversely affects fetal neurodevelopment and our results should not be construed to mean that smokeless tobacco use is safe during pregnancy. |
Why US adults use dietary supplements
Bailey RL , Gahche JJ , Miller PE , Thomas PR , Dwyer JT . JAMA Intern Med 2013 173 (5) 355-61 BACKGROUND: Dietary supplements are used by more than half of adults, although to our knowledge, the reasons motivating use have not been previously examined in US adults using nationally representative data. The purpose of this analysis was to examine motivations for dietary supplement use, characterize the types of products used for the most commonly reported motivations, and to examine the role of physicians and health care practitioners in guiding choices about dietary supplements. METHODS: Data from adults (≥20 years; n = 11 956) were examined in the 2007-2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional, population-based survey. RESULTS: The most commonly reported reasons for using supplements were to "improve" (45%) or "maintain" (33%) overall health. Women used calcium products for "bone health" (36%), whereas men were more likely to report supplement use for "heart health or to lower cholesterol" (18%). Older adults (≥60 years) were more likely than younger individuals to report motivations related to site-specific reasons like heart, bone and joint, and eye health. Only 23% of products were used based on recommendations of a health care provider. Multivitamin-mineral products were the most frequently reported type of supplement taken, followed by calcium and omega-3 or fish oil supplements. Supplement users are more likely to report very good or excellent health, have health insurance, use alcohol moderately, eschew cigarette smoking, and exercise more frequently than nonusers. CONCLUSIONS: Supplement users reported motivations related to overall health more commonly than for supplementing nutrients from food intakes. Use of supplements was related to more favorable health and lifestyle choices. Less than a quarter of supplements used by adults were recommended by a physician or health care provider. |
Perceived competence and comfort in respiratory protection: results of a nationwide survey of occupational health nurses
Burgel BJ , Novak D , Burns CM , Byrd A , Carpenter H , Gruden M , Lachat A , Taormina D . Workplace Health Saf 2013 61 (3) 103-15 In response to the Institute of Medicine (2011) report Occupational Health Nurses and Respiratory Protection: Improving Education and Training, a nationwide survey was conducted in May 2012 to assess occupational health nurses' educational preparation, roles, responsibilities, and training needs in respiratory protection. More than 2,000 occupational health nurses responded; 83% perceived themselves as competent, proficient, or expert in respiratory protection, reporting moderate comfort with 12 respiratory program elements. If occupational health nurses had primary responsibility for the respiratory protection program, they were more likely to perceive higher competence and more comfort in respiratory protection, after controlling for occupational health nursing experience, highest education, occupational health nursing certification, industry sector, Association of Occupational Health Professionals in Healthcare membership, taking a National Institute for Occupational Safety and Health spirometry course in the prior 5 years, and perceiving a positive safety culture at work. These survey results document high perceived competence and comfort in respiratory protection. These findings support the development of targeted educational programs and interprofessional competencies for respiratory protection. |
Proper use of surgical n95 respirators and surgical masks in the OR
Benson SM , Novak DA , Ogg MJ . AORN J 2013 97 (4) 457-70 Proper adherence to infection control precautions, including appropriate selection and use of personal protective equipment (PPE), is of significant importance to the health and well-being of perioperative personnel. Surgical masks are intended for use as a barrier to protect the wearer's face from large droplets and splashes of blood and other body fluids; however, surgical and high-filtration surgical laser masks do not provide enough protection to be considered respiratory PPE. Potential exposure to airborne contaminants and infectious agents, including those present in surgical smoke, necessitates the use of respiratory PPE, such as a surgical N95 particulate filtering facepiece respirator. Filtering facepiece respirators greatly reduce a wide size range of particles from entering the wearer's breathing zone and are designed to protect the user from both droplet and airborne particles. Every health care worker who must use a respirator to control hazardous exposures in the workplace must be trained to properly use the respirator and pass a fit test before using it in the workplace. |
Making strides toward active living: the policy research perspective
Eyler AA , Brownson RC , Schmid TL . J Public Health Manag Pract 2013 19 S5-7 Physical activity has been promoted to improve health for decades.1 A summary of the health benefits and physical activity recommendations gained national support in the 1996 landmark publication of the Surgeon General’s Report on Physical Activity and Health.2 Specific physical activity recommendations have evolved from vigorous exercise for cardiovascular fitness to an accumulation of moderately intense activities (e.g., brisk walking) for general health benefits.3 The current recommendations make it easier and more appropriate for the general population to achieve them, but less than half of the adults in the US meet these criteria.3, 4 Despite public health efforts, about 25% of adults report no leisure-time physical activity at all.5 There is also growing concern over the amount of daily sedentary time, as evidence points to detrimental health effects independent of physical activity.6 | Many strategies have been attempted to improve population physical activity prevalence.3, 7 However, there is evidence indicating that interventions targeting individuals to change physical activity behavior are not significantly effective or sustainable.8 Motivating people to be physically active can be difficult, and made even more challenging by environments where few opportunities to be physically active exist.9 Because physical activity is a behavior influenced by factors ranging from individual motivation to community policies, a socio-ecological approach to interventions is recommended.10 Specifically, more effective intervention strategies include policy and environmental changes that are designed to provide opportunities, support, and cues to help people be more physically active.8, 11 |
Physical activity and screen-time viewing among elementary school-aged children in the United States from 2009 to 2010
Fakhouri TH , Hughes JP , Brody DJ , Kit BK , Ogden CL . JAMA Pediatr 2013 167 (3) 223-9 OBJECTIVES: To describe the percentage of children who met physical activity and screen-time recommendations and to examine demographic differences. Recommendations for school-aged children include 60 minutes of daily moderate-to-vigorous physical activity and no more than 2 hours per day of screen-time viewing. DESIGN: Cross-sectional study. SETTING: Data from the 2009-2010 National Health and Nutrition Examination Survey, a representative sample of the US population. PARTICIPANTS: Analysis included 1218 children 6 to 11 years of age. MAIN EXPOSURES: Age, race/ethnicity, sex, income, family structure, and obesity status. MAIN OUTCOME MEASURES: Proxy-reported adherence to physical activity and screen-time recommendations, separately and concurrently. RESULTS: Based on proxy reports, overall, 70% of children met physical activity recommendations, and 54% met screen-time viewing recommendations. Although Hispanics were less likely to meet physical activity recommendations (adjusted odds ratio [aOR], 0.60 [95% CI, 0.38-0.95]), they were more likely to meet screen-time recommendations compared with non-Hispanic whites (aOR, 1.69 [95% CI, 1.18-2.43]). Only 38% met both recommendations concurrently. Age (9-11 years vs 6-8 years: aOR, 0.57 [95% CI, 0.38-0.85]) and obesity (aOR, 0.53 [95% CI, 0.38-0.73]) were inversely associated with concurrent adherence to both recommendations. CONCLUSIONS: Fewer than 4 in 10 children met both physical activity and screen-time recommendations concurrently. The prevalence of sedentary behavior was higher in older children. Low levels of screen-time viewing may not necessarily predict higher levels of physical activity. |
Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel
Sarmiento K , Eckstein D , Zambon A . Health Promot Pract 2013 14 (2) 174-80 In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community. |
Analysis of state obesity legislation from 2001 to 2010
Lankford T , Hardman D , Dankmeyer C , Schmid T . J Public Health Manag Pract 2013 19 S114-8 OBJECTIVE: The prevalence of obesity has increased significantly since the 1950s. Currently, more than one-third of adults are obese. This study includes the review of 611 bills that were introduced over the past 10 years for the purpose of reducing obesity. DESIGN: Bills were obtained from state legislature Web sites and Centers for Disease Control and Prevention's (CDC's) Division of Nutrition, Physical Activity, and Obesity legislative database. Full text of bills was read and summed by year and the following categories: (a) Taskforce, (b) School, (c) Community, and (d) Health care. Bills were then coded according to strategies outlined in the Institute of Medicine publication, Accelerating Progress in Obesity Prevention. RESULTS: Of the 611 obesity-specific bills proposed over the last decade, 93 (15.2%) passed and represented 30 states. The largest number of bills ("n") introduced was in the School category (n = 276), followed by Community (n = 126), Health care (n = 117), and Taskforce (n = 92). Percentages of bills passed were as follows: Taskforce (28%), Health care (16%), Schools (14%), and Community (7%). Institute of Medicine strategies were identified in most state legislations. CONCLUSION: Overall, 15% of obesity bills passed from 2001 to 2010. Legislation can be an important first step to change society and institutional norms to encourage and support people to develop healthier behaviors. Public health practitioners may find the Institute of Medicine guidance and the legislative database useful resources to further efforts in obesity prevention. |
Communities of practice foster collaboration across public health
Mabery MJ , Gibbs-Scharf L , Bara D . J Knowl Manag 2013 17 (2) 226-236 PURPOSE: The complexity and responsibilities of public health make collaboration across multiple levels of government critical. The Centers for Disease Control and Prevention (CDC) effectively uses communities of practice (CoPs) to bring its staff together with partners to share, learn, and address public health problems. This paper aims to focus on CoPs. DESIGN/METHODOLOGY/APPROACH: The paper assesses the value of CoPs to individual members, their organizations, and their public health domains; assesses whether the CoP Program has improved CDC's relationship with participants in various CoPs; and identifies barriers to participation or success factors that could be applied to the development of new CoPs. Responses from a random sample of active CoP members were analyzed using qualitative data analysis software to identify themes and answer research questions. FINDINGS: The results reveal clear benefits to individual members, their organizations, and public health disciplines including daily work efficiencies, expanded infrastructure, and enhanced relationships between CDC and its public health partners. RESEARCH LIMITATIONS/IMPLICATIONS: This qualitative research analyzed a small number of communities of practice spanning their launch through year 2; further study of a larger sample of public health CoPs, including sustainability factors, would build on this case study's implications. PRACTICAL IMPLICATIONS: Public health practitioners seeking a collaborative approach to problem solving will find in this study some useful lessons learned from CDC; readers will be introduced to CDC's CoP Resource Kit and a public health collaboration portal, phConnect. ORIGINALITY/VALUE: Well-facilitated, member-driven, and highly participative CoPs are valuable tools for fostering collaboration essential to improving the public health system, and should be used more broadly across public health. |
In their own words: romantic relationships and the sexual health of young African American women
Murray CC , Hatfield-Timajchy K , Kraft JM , Bergdall AR , Habel MA , Kottke M , Diclemente RJ . Public Health Rep 2013 128 Suppl 1 33-42 OBJECTIVE: We assessed young African American women's understanding of "dual protection" (DP) (i.e., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods. METHODS: We conducted 10 focus groups with African American women (n=51) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP. RESULTS: From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP. Social influences (e.g., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships. CONCLUSIONS: Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women. |
Condom use with serious and casual heterosexual partners: findings from a community venue-based survey of young adults
Hock-Long L , Henry-Moss D , Carter M , Hatfield-Timajchy K , Erickson PI , Cassidy A , Macauda M , Singer M , Chittams J . AIDS Behav 2013 17 (3) 900-13 Given the racial/ethnic disparities that characterize STI trends and recent increases in heterosexually transmitted HIV infection in the US, an understanding of factors underlying condom use among young adults in minority communities is vitally important. To this end, this paper presents findings from a community venue-based survey examining the influence of motivations, heuristics, and relationship factors on condom behaviors with serious and casual heterosexual partners in a sample of urban African American and Puerto Rican males and females ages 18-25 (n = 380). Condom use rates at time of last sex were considerably higher with casual partners (n = 87) than with serious (n = 313) partners, 77.9% vs. 38.7%. While dual pregnancy/STI prevention was the most frequently cited reason for use at last sex with casual partners, pregnancy prevention was the most frequently cited reason for use with serious partners. Bivariate conditional logistic regression analyses found two factors to be associated with condom use at last sex with casual partners: use at first sex with the partner and belief that neighborhood peers worried some/a lot about HIV. In contrast, such factors as condom heuristics (e.g., nonuse symbolizes trust), contraceptive status, and markers of emotional intimacy were associated with condom use with serious partners in both bivariate and multivariable analyses. |
Quality-adjusted life expectancy (QALE) loss due to smoking in the United States
Jia H , Zack MM , Thompson WW , Dube SR . Qual Life Res 2013 22 (1) 27-35 PURPOSE: Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. METHODS: Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. RESULTS: In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. CONCLUSIONS: This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE--especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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