Invasive cancer incidence - United States, 2010
Henley JS , Singh S , King J , Wilson R , Ryerson B . MMWR Morb Mortal Wkly Rep 2014 63 (12) 253-9 Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV. |
Cervical cancer-related knowledge, attitudes, and practices of health professionals working in Brazil's network of primary care units
Stormo AR , de Moura L , Saraiya M . Oncologist 2014 19 (4) 375-82 INTRODUCTION: Brazil's national strategy for cervical cancer screening includes using the Papanicolaou (Pap) test every 3 years among women aged 25-64 years. Comprehensive primary care services are provided through a network of primary health units, but little is known about cervical cancer-related knowledge, attitudes, and practices among health professionals and coordinators working in these facilities. METHODS: In 2011, we conducted a cross-sectional nationally representative phone survey of 1,600 primary health care units to interview one unit coordinator and one health care professional per unit (either nurse, physician, or community health worker). Responses were obtained from 1,251 coordinators, 182 physicians, 347 nurses, and 273 community health workers. Questionnaires were administered to assess health units' characteristics and capacity for cervical cancer-related services as well as health professionals' perceived effectiveness of the Pap test, preparedness to talk to women about cervical cancer, adherence with screening guidelines, and willingness to recommend human papillomavirus (HPV) vaccination to females. RESULTS: Most units conducted screening (91.9%), used home visits to conduct recruitment and outreach (83.4%), and provided follow-up to women who did not return to discuss Pap test results (88.1%). Approximately 93% of health professionals stated that Pap testing was effective in decreasing death rates from cervical cancer and 65% stated that national guidelines for cervical cancer screening are very influential; 93% of nurses and physicians reported screening women annually and 75% reported beginning to screen women younger than 25 years old. Regarding HPV vaccination, almost 90% of nurses and physicians would recommend the HPV vaccine to their females patients if it were available. A larger proportion of physicians and nurses recommended the HPV vaccine to older girls (13-18 years) and women (19-26 years and even older than 26 years) than to younger girls (12 years or younger). CONCLUSION: Although Brazil's network of primary care units has significantly increased access to cervical cancer screening, effective strategies are needed to ensure that women get screened at the appropriate ages and intervals. Additionally, this study's baseline data on HPV vaccination may be useful as Brazil embarks on a national HPV vaccination program in 2014. |
Current cervical cancer screening knowledge, awareness, and practices among U.S. Affiliated Pacific Island providers: opportunities and challenges
Townsend JS , Stormo AR , Roland KB , Buenconsejo-Lum L , White S , Saraiya M . Oncologist 2014 19 (4) 383-93 BACKGROUND: Cervical cancer is a leading cause of cancer mortality in nearly all U.S. Affiliated Pacific Island Jurisdictions (USAPIJ); however, most jurisdictions are financially and geographically limited in their capacity to deliver routine screening. METHODS: We conducted a cross-sectional survey of 72 health care providers from five of the six USAPIJ in 2011 to assess knowledge, beliefs, practices, and perceived barriers regarding routine cervical cancer screening. We compared the responses of providers from jurisdictions that were funded by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with those that were not funded. RESULTS: Most providers reported cervical cancer prevention as a priority in their clinical practices (90.3%) and use the Papanicolaou test for screening (86.1%). Many providers reported knowledge of screening guidelines (76.4%); however, more than half reported that annual screening is most effective (56.9%). Providers in non-NBCCEDP-funded jurisdictions reported greater acceptance of visual inspection with acetic acid (93.9%) and self-sampling for human papillomavirus testing (48.5%) compared with NBCCEDP-funded jurisdictions (15.4% and 30.8% respectively). Providers from non-NBCCEDP-funded jurisdictions reported inadequate technological resources for screening women (42.4%), and approximately 25% of providers in both groups believed that screening was cost-prohibitive. CONCLUSION: Although cervical cancer screening is a priority in clinical practice, beliefs about annual screening, costs associated with screening, and varying levels of support for alternative screening tests pose barriers to providers throughout the USAPIJ. Further exploration of using evidence-based, lower cost, and sustainable screening technologies is warranted in addition to emphasizing timely follow-up of all positive cases. |
Relationship between level of hepatitis B virus DNA and liver disease: a population-based study of hepatitis B e antigen-negative persons with hepatitis B.
McMahon BJ , Bulkow L , Simons B , Zhang Y , Negus S , Homan C , Spradling P , Teshale E , Lau D , Snowball M , Livingston SE . Clin Gastroenterol Hepatol 2014 12 (4) 701-706.e3 BACKGROUND & AIMS: There is little information on the proportion of persons with chronic hepatitis B virus (HBV) infection with active hepatitis. We aimed to determine the proportion of persons with hepatitis B e antigen-negative chronic HBV infection who develop immune-active HBV infection over time and the relationship between demographic and viral factors on severity of disease on liver biopsy. METHODS: We performed a longitudinal population-based cohort study of 754 Alaska Native patients with chronic HBV infection. Levels of alanine aminotransferase (ALT) were measured every 6 months, and levels of HBV DNA were measured at study entry and whenever ALT levels exceeded the upper limit of normal (ULN). Immune-active chronic HBV infection was defined as levels of ALT ≥30 U/L in men and >20 U/L in women and levels of HBV DNA >2000 IU/mL at 1 or more time points from 2001-2008. Liver biopsies were scored by using the modified histology activity index score of Knodell and the Ishak fibrosis score. RESULTS: Of the study participants, 186 (25%) met the criteria for immune-active HBV, 56% of these initially and 44% later during follow up. Of the 38 patients with liver biopsy results, only 1 of 16 with ALT levels consistently below twice the ULN and 1 of 19 with HBV DNA between 2000 and 20,000 IU/mL, vs 12 of 22 (55%) with ALT > twice ULN (P = .002) and 11 of 18 (61%) with 1 or more measurements of HBV DNA >20,000 IU/mL (P < .001), had moderate or severe hepatitis or fibrosis. CONCLUSIONS: In a cohort of Alaska Natives with chronic HBV infection, 25% met criteria for immune-active HBV. There is a low probability of advanced fibrosis if levels of HBV DNA never exceed 20,000 IU/mL. |
Risk factors for treatment default in close contacts with latent tuberculous infection
Fiske CT , Yan FX , Hirsch-Moverman Y , Sterling TR , Reichler MR . Int J Tuberc Lung Dis 2014 18 (4) 421-7 OBJECTIVE: 1) To characterize risk factors for non-completion of latent tuberculous infection treatment (LTBIT), and 2) to assess the impact of LTBIT regimens on subsequent risk of tuberculosis (TB). METHODS: Close contacts of adults aged ≥15 years with pulmonary TB were prospectively enrolled in a multi-center study in the United States and Canada from January 2002 to December 2006. Close contacts of TB patients were screened and cross-matched with TB registries to identify those who developed active TB. RESULTS: Of 3238 contacts screened, 1714 (53%) were diagnosed with LTBI. Preventive treatment was recommended in 1371 (80%); 1147 (84%) initiated treatment, of whom 723 (63%) completed it. In multivariate analysis, study site, initial interview sites other than a home or health care setting and isoniazid preventive treatment (IPT) were significantly associated with non-completion of LTBIT. Fourteen TB cases were identified in contacts, all of whom initiated IPT: two TB cases among persons who received 6 months of IPT (66 cases/100 000 person-years [py]), and nine among those who received 0-5 months (median 2 months) of IPT (792 cases/100 000 py, P < 0.001); data on duration of IPT were not available for three cases. CONCLUSION: Only 53% (723/1371) of close contacts for whom IPT was recommended actually completed treatment. Close contacts were significantly less likely to complete LTBIT if they took IPT. Less than 6 months of IPT was associated with increased risk of active TB. |
Subjective social status predicts wintertime febrile acute respiratory illness among women healthcare personnel
Thompson MG , Naleway A , Ball S , Henkle EM , Sokolow LZ , Williams J , Reynolds S , Spencer S , Shay DK , Brennan B , Gaglani MJ . Health Psychol 2014 33 (3) 282-91 OBJECTIVE: We ask whether subjective social status (SSS) predicts rates of wintertime febrile acute respiratory illness (ARI). METHODS: 1,373 women and 346 men were enrolled from September 1 through November 30, 2010 as part of a prospective cohort study of health care personnel (HCP) at two medical centers. A questionnaire was completed at enrollment followed by 20 weeks of surveillance. ARI was an illness with fever and cough self-reported via weekly telephone or Internet-based surveillance. RESULTS: For both sexes, lower SSS was associated with younger age, less education, lower neighborhood household income, being unmarried, lower occupational status, working in outpatient settings, and poorer self-rated health status. Demographic and occupational covariates explained 23% and 42% of the variance (R(2)) in SSS among women and men, respectively. Smoking, exercise frequency, and sleep quality were also associated with SSS, but these factors explained little additional variance (3-4%). Among women HCP, lower SSS at enrollment was associated with higher rates of subsequent ARI (unadjusted beta = -.21 [+/-.05], p < .001 for ordinal data). Adjusting for all covariates reduced the effect size of the SSS minimally (adjusted beta = -.19 [+/-.06], p < .001). Among men HCP, there was no univariate SSS-ARI association and after adjusting for all covariates the effect was opposite of our hypothesis (adjusted beta = .33 [+/-.17], p < .05). CONCLUSIONS: Women (but not men) with lower SSS were more likely to report an ARI during surveillance, and the SSS-ARI association was independent of demographics, occupational status, health, and health behaviors. |
Tuberculosis in human immunodeficiency virus-infected children starting antiretroviral therapy in Cote d'Ivoire
Auld AF , Tuho MZ , Ekra KA , Kouakou J , Shiraishi RW , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . Int J Tuberc Lung Dis 2014 18 (4) 381-7 SETTING: In Cote d'Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008. OBJECTIVES: To estimate tuberculosis (TB) incidence and determinants among ART enrollees. DESIGN: A nationally representative retrospective cohort study among 2110 children starting ART during 2004-2008 at 29 facilities. RESULTS: At ART initiation, the median age was 5.1 years; 82% had World Health Organization Stage III/IV, median CD4% was 11%, 42% were severely undernourished (weight-for-age Z-score [WAZ] <-3), and 150 (7%) were taking anti-tuberculosis treatment. Documentation of TB screening before ART declined from 63% to 46% during 2004-2008. Children taking anti-tuberculosis treatment at ART enrollment had a lower median CD4% (9.0% vs. 11.0%, P = 0.037) and a higher prevalence of WAZ <-3 (59% vs. 40%, P < 0.001). Among children considered TB-free at ART enrollment, TB incidence was 6.28/100 child-years during days 0-90 of ART, declining to 0.56/100 child-years after 180 days. Children with one unit higher WAZ at ART enrollment had 13% lower TB incidence (adjusted HR 0.87, 95%CI 0.77-1.00, P= 0.047). CONCLUSIONS: Ensuring clinician compliance with TB screening before ART and ensuring earlier ART initiation before children suffer from advanced HIV disease and nutritional compromise might reduce TB morbidity during ART. |
Excess burden of depression among HIV-infected persons receiving medical care in the United States: data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System
Do AN , Rosenberg ES , Sullivan PS , Beer L , Strine TW , Schulden JD , Fagan JL , Freedman MS , Skarbinski J . PLoS One 2014 9 (3) e92842 BACKGROUND: With increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population. METHODS AND FINDINGS: We used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5. CONCLUSIONS: Depression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden. |
Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe
Imanishi M , Kweza P , Slayton RB , Urayai T , Ziro O , Mushayi W , Chizororo M , Kuonza L , Ayers T , Freeman M , Govore E , Duri C , Chonzi P , Zinyowera S , Manangazira P , Kilmarx PH , Mintz E , Lantagne D . Am J Trop Med Hyg 2014 90 (5) 945-54 Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011-April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs. |
Importance of tuberculosis control to address child survival
Graham SM , Sismanidis C , Menzies HJ , Marais BJ , Detjen AK , Black RE . Lancet 2014 383 (9928) 1605-7 Tuberculosis commonly affects young children (<5 years) in countries that have high rates of child mortality.1 The global public health focus to control tuberculosis has traditionally aimed to reduce transmission through early case-finding and effective treatment of the most infectious cases. Young children have historically been excluded from this focus, since their contribution to tuberculosis transmission is believed to be small. In the past decade, national tuberculosis programmes in high-burden settings have given increased attention to the challenges of childhood tuberculosis.2 In 2012, World TB Day focused on children for the first time. This attention is likely to increase further as the WHO Global Tuberculosis Programme’s ambitious post-2015 tuberculosis control strategy seeks to engage the entire health sector, including maternal and child health. | Within the Millennium Developmental Goal (MDG) framework, tuberculosis control and its related targets are framed within MDG 6, and yet are also relevant to MDGs 4 and 5 (child and maternal mortality) and MDG 1 (undernutrition). Improvement of child survival is a major global health priority but tuberculosis is not regarded as important in that context. However, we believe that the relevance of tuberculosis to child survival will become increasingly apparent over the next decade, especially in countries where tuberculosis control remains difficult and high rates of Mycobacterium tuberculosis transmission are sustained. Recognition of the relevance and challenges of tuberculosis to child survival is growing.3 |
The burden of influenza-like illness in the US workforce
Tsai Y , Zhou F , Kim IK . Occup Med (Lond) 2014 64 (5) 341-7 BACKGROUND: The disease burden of influenza-like illnesses (ILIs) on the working population has been documented in the literature, but statistical evidence of ILI-related work absenteeism in the USA is limited due to data availability. AIMS: To assess work absenteeism due to ILIs among privately insured employees in the USA in 2007-8 and 2008-9. METHODS: We used the 2007-9 MarketScan(R) research databases. Full-time employees aged 18-64 years, with the ability to incur work absence and continuously enroled in the same insurance plan during each season were included. We identified ILI episodes using ICD-9 codes for influenza and pneumonia (480-487). For each season, we calculated the mean work-loss hours per ILI episode and the proportion of employees who had at least one ILI episode. Work-loss hours and ILI rates were examined by subgroups. RESULTS: The mean number of work hours lost per ILI episode was 23.6 in 2007-8 and 23.9 in 2008-9. The proportion of employees with at least one ILI was 1.7% in 2007-8 and 1.2% in 2008-9. In both seasons, the proportion with ILI was higher among older (2.1 and 1.5%) and hourly workers (2.0 and 1.3%), workers in the southern region (1.9 and 1.3%) and those in oil, gas or mining industries (1.9 and 1.4%). CONCLUSIONS: Our results indicate that the disease burden associated with ILIs in the working population is not trivial and deserves attention from policymakers and health care professionals to design effective strategies to reduce this burden. |
The level of submicron fungal fragments in homes with asthmatic children
Seo S , Choung JT , Cehn BT , Lindsley WG , Kim KY . Environ Res 2014 131c 71-76 OBJECTIVES: Much scientific evidence indicates a positive association between moldy environments and respiratory illnesses and/or symptoms (e.g., asthma). Recently, submicron fungal fragments (<1.0mum) have been suggested as a potential contributor to adverse health effects due to their biological composition (e.g., antigens, mycotoxins, and (1,3)-beta-d-glucan) as well as their small size. However, the contribution of exposure to fine fungal particles on adverse health outcomes has been poorly characterized, particularly in homes with asthmatic children. We characterized the airborne level of smaller-sized fungal particles between homes with and without asthmatic children. METHODS: We visited 29 homes with (n=15) and without (n=14) an asthmatic child and sampled submicron fungal fragments in a living room and childs bedroom, along with outdoor sampling, using the NIOSH two-stage sampler. (1,3)-beta-d-glucan of fungal fragments analyzed by Limulus Amebocyte lysate assay (LAL) was used for quantifying their exposure. RESULTS: Overall, the geometric mean (GM) concentration of (1,3)-beta-d-glucan in submicron fungal fragments in indoor air was two-fold higher in homes with asthmatic children (50.9pg/m3) compared to homes with non-asthmatic children (26.7pg/m3) (P<0.001). The GM concentration of these particles in childs bedroom in homes with an asthmatic child (66.1pg/m3) was about three times higher than that in homes with non-asthmatic children (23.0pg/m3) (P<0.001). The relative humidity had a negative correlation with the concentration of (1,3)-beta-d-glucan in submicron fungal fragments (Pearson coefficient=-0.257, P=0.046). CONCLUSIONS: Our findings indicate that homes with asthmatic children have a higher concentration of submicron fungal fragments compared to homes with non-asthmatic children. A greater exposure to smaller-sized fungal particles may occur in homes with an asthmatic child as relative humidity decreases. The very careful control of relative humidity in indoor air is necessary for reducing exposure to fine fungal particles and inhibiting the growth of microorganisms in homes with allergic diseases. |
Evaluation of mortality among marines and navy personnel exposed to contaminated drinking water at USMC base Camp Lejeune: a retrospective cohort study
Bove FJ , Ruckart PZ , Maslia M , Larson TC . Environ Health 2014 13 (1) 10 BACKGROUND: Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985. METHODS: We conducted a retrospective cohort mortality study of Marine and Naval personnel who began service during 1975-1985 and were stationed at Camp Lejeune or Camp Pendleton, California during this period. Camp Pendleton's drinking water was uncontaminated. Mortality follow-up was 1979-2008. Standardized Mortality Ratios were calculated using U.S. mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune (N = 154,932) and Camp Pendleton (N = 154,969) cohorts and assess effects of cumulative exposures to contaminants within the Camp Lejeune cohort. Models estimated monthly contaminant levels at residences. Confidence intervals (CIs) indicated precision of effect estimates. RESULTS: There were 8,964 and 9,365 deaths respectively, in the Camp Lejeune and Camp Pendleton cohorts. Compared to Camp Pendleton, Camp Lejeune had elevated mortality hazard ratios (HRs) for all cancers (HR = 1.10, 95% CI: 1.00, 1.20), kidney cancer (HR = 1.35, 95% CI: 0.84, 2.16), liver cancer (HR = 1.42, 95% CI: 0.92, 2.20), esophageal cancer (HR = 1.43 95% CI: 0.85, 2.38), cervical cancer (HR = 1.33, 95% CI: 0.24, 7.32), Hodgkin lymphoma (HR = 1.47, 95% CI: 0.71, 3.06), and multiple myeloma (HR = 1.68, 95% CI: 0.76, 3.72). Within the Camp Lejeune cohort, monotonic categorical cumulative exposure trends were observed for kidney cancer and total contaminants (HR, high cumulative exposure = 1.54, 95% CI: 0.63, 3.75; log10 beta = 0.06, 95% CI: -0.05, 0.17), Hodgkin lymphoma and trichloroethylene (HR, high cumulative exposure = 1.97, 95% CI: 0.55, 7.03; beta = 0.00005, 95% CI: -0.00003, 0.00013) and benzene (HR, high cumulative exposure = 1.94, 95% CI: 0.54, 6.95; beta = 0.00203, 95% CI: -0.00339, 0.00745). Amyotrophic Lateral Sclerosis (ALS) had HR = 2.21 (95% CI: 0.71, 6.86) at high cumulative vinyl chloride exposure but a non-monotonic exposure-response relationship (beta = 0.0011, 95% CI: 0.0002, 0.0020). CONCLUSION: The study found elevated HRs at Camp Lejeune for several causes of death including cancers of the kidney, liver, esophagus, cervix, multiple myeloma, Hodgkin lymphoma and ALS. CIs were wide for most HRs. Because <6% of the cohort had died, long-term follow-up would be necessary to comprehensively assess effects of drinking water exposures at the base. |
Household air quality risk factors associated with childhood pneumonia in urban Dhaka, Bangladesh
Ram PK , Dutt D , Silk BJ , Doshi S , Rudra CB , Abedin J , Goswami D , Fry AM , Brooks WA , Luby SP , Cohen AL . Am J Trop Med Hyg 2014 90 (5) 968-75 To inform interventions to reduce the high burden of pneumonia in urban settings such as Kamalapur, Bangladesh, we evaluated household air quality risk factors for radiographically confirmed pneumonia in children. In 2009-2010, we recruited children < 5 years of age with pneumonia and controls from a population-based surveillance for respiratory and febrile illnesses. Piped natural gas was used by 85% of 331 case and 91% of 663 control households. Crowding, a tin roof in the living space, low socioeconomic status, and male sex of the child were risk factors for pneumonia. The living space in case households was 28% less likely than in control households to be cross-ventilated. Particulate matter concentrations were not significantly associated with pneumonia. With increasing urbanization and supply of improved cooking fuels to urban areas, the high burden of respiratory illnesses in urban populations such as Kamalapur may be reduced by decreasing crowding and improving ventilation in living spaces. |
Age and sex differences in childhood and adulthood obesity association with phthalates: analyses of NHANES 2007-2010
Buser MC , Murray HE , Scinicariello F . Int J Hyg Environ Health 2014 217 (6) 687-94 BACKGROUND: Exposure to environmental chemicals may play a role in the development of obesity. Evidence suggests phthalate exposure may be associated with obesity in children and adults. OBJECTIVE: To examine the association of ten urinary phthalate metabolites mono-n-butyl phthalate (MnBP), mono-ethyl phthalate (MEP), mono-isobutyl phthalate (MiBP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-2-ethylhexyl phthalate (MEHP), mono-benzyl phthalate (MBzP), mono-(carboxylnonyl) phthalate (MCNP), and mono-(carboxyoctyl) phthalate (MCOP) grouped by molecular weight of their parent compounds with body weight outcomes in children, adolescent and adult participants in the National Health and Nutrition Examination Survey (NHANES) 2007-2010. METHODS: We performed multinomial logistic regression to analyze the association between obesity and urinary phthalate metabolite concentrations in children and adolescents and adults. RESULTS: Low molecular weight (LMW) phthalate metabolites (MnBP, MEP and MiBP) are significantly (p<0.05) associated with higher odds for obesity in male children and adolescents. High molecular weight (HMW) phthalate metabolites (MECPP, MEHHP, MEOHP, MEHP, MBzP, MCNP, and MCOP) and di-2-ethylhexyl phthalate (DEHP) metabolites (MEHHP, MEOHP, MEHP and MECPP) are significantly (p<0.05) associated with higher OR for obesity in all adults. Additionally, DEHP metabolites are significantly associated with obesity in all female adults; whereas DEHP and HMW metabolites are significantly associated with OR for obesity in males 60 years and older. CONCLUSIONS: We found age and sex differences in the association between urinary phthalate metabolite concentrations and body weight outcomes. Reverse causation cannot be excluded since overweight and obese people will have more fat mass, they may store more phthalates, thus leading to higher excretion concentrations. |
Thirty-day laboratory-based surveillance for carbapenem-resistant enterobacteriaceae in the Minneapolis-St. Paul metropolitan area
Pereira EC , Shaw KM , Snippes Vagnone PM , Harper JE , Kallen AJ , Limbago BM , Lynfield R . Infect Control Hosp Epidemiol 2014 35 (4) 423-5 Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in the United States. We explored the feasibility of active laboratory-based surveillance of CRE in a metropolitan area not previously considered to be an area of CRE endemicity. We provide a framework to address CRE surveillance and to monitor changes in the incidence of CRE infection over time. |
Using the National HIV Behavioral Surveillance System to inform HIV prevention efforts in the United States
Paz-Bailey G , Raymond HF , Lansky A , Mermin J . AIDS Behav 2014 18 Suppl 3 S233-6 The National HIV Behavioral Surveillance system (NHBS) was designed to monitor HIV prevalence and risk factors for infection among higher-risk individuals, i.e., sexually active men who have sex with men who attend venues, injection drug users who injected in the past 12 months, and heterosexuals living in low socioeconomic urban areas. These groups were selected as priorities for behavioral surveillance since they represent the major HIV transmission routes and the populations with the highest HIV burden. NHBS contributes to the nation's program of HIV surveillance by being the only multi-site population-based system that provides estimates on key HIV prevention measures among high-risk HIV-negative individuals, HIV-positive individuals unaware of their infection, and HIV-positive individuals aware of their infection who are in and out of care. Accurate and precise data on the behaviors in these populations are critical for tracking the epidemic, planning effective responses, and monitoring and evaluating those responses. Reports in this supplement illustrate the uses of NHBS data at the national and local level and reflect ongoing efforts to improve the system and methods. As we look to the future, behavioral surveillance remains essential for characterizing and monitoring the burden of HIV infection and sexual and behavioral risks. |
Genetic host specificity of hepatitis E virus.
Lara J , Purdy MA , Khudyakov YE . Infect Genet Evol 2014 24 127-39 Hepatitis E virus (HEV) causes epidemic and sporadic cases of hepatitis worldwide. HEV genotypes 3 (HEV3) and 4 (HEV4) infect humans and animals, with swine being the primary reservoir. The relevance of HEV genetic diversity to host adaptation is poorly understood. We employed a Bayesian network (BN) analysis of HEV3 and HEV4 to detect epistatic connectivity among protein sites and its association with the host specificity in each genotype. The data imply coevolution among approximately 70% of polymorphic sites from all HEV proteins and association of numerous coevolving sites with adaptation to swine or humans. BN models for individual proteins and domains of the nonstructural polyprotein detected the host origin of HEV strains with accuracy of 74%-93% and 63%-87%, respectively. These findings, taken together with lack of phylogenetic association to host, suggest that the HEV host specificity is a heritable and convergent phenotypic trait achievable through variety of genetic pathways (abundance), and explain a broad host range for HEV3 and HEV4. |
Full-Genome Sequence of a Rare Human G3P[9] Rotavirus Strain.
Mijatovic-Rustempasic S , Roy S , Sturgeon M , Rungsrisuriyachai K , Esona MD , Degroat D , Qin X , Cortese MM , Bowen MD . Genome Announc 2014 2 (2) This is a report of the complete genomic sequence of a rare rotavirus group A G3-P[9]-I2-R2-C2-M2-A3-N2-T1-E2-H3 strain designated RVA/Human-wt/USA/12US1134/2012/G3P[9]. |
Risk behaviors and risk factors for HIV infection among participants in the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial among people who inject drugs
Martin M , Vanichseni S , Suntharasamai P , Sangkum U , Mock PA , Leethochawalit M , Chiamwongpaet S , Gvetadze RJ , Kittimunkong S , Curlin ME , Worrajittanon D , McNicholl JM , Paxton LA , Choopanya K . PLoS One 2014 9 (3) e92809 INTRODUCTION: HIV spread rapidly among people who inject drugs in Bangkok in the late 1980s. In recent years, changes in drug use and HIV-associated risk behaviors have been reported. We examined data from the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial conducted among people who inject drugs, to assess participant risk behavior and drug use, and to identify risk factors for HIV infection. METHODS: The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. HIV status was assessed monthly and risk behavior every 3 months. We used generalized estimating equations logistic regression to model trends of injecting, needle sharing, drugs injected, incarceration, and sexual activity reported at follow-up visits; and proportional hazards models to evaluate demographic characteristics, sexual activities, incarceration, drug injection practices, and drugs injected during follow-up as predictors of HIV infection. RESULTS: The proportion of participants injecting drugs, sharing needles, and reporting sex with more than one partner declined during follow-up (p<0.001). Among participants who reported injecting at enrollment, 801 (53.2%) injected methamphetamine, 559 (37.1%) midazolam, and 527 (35.0%) heroin. In multivariable analysis, young age (i.e., 20-29 years) (p = 0.02), sharing needles (p<0.001), and incarceration in prison (p = 0.002) were associated with incident HIV infection. Participants reporting sex with an opposite sex partner, live-in partner, casual partner, or men reporting sex with male partners were not at a significantly higher risk of HIV infection compared to those who did not report these behaviors. CONCLUSION: Reports of HIV-associated risk behavior declined significantly during the trial. Young age, needle sharing, and incarceration were independently associated with HIV infection. Sexual activity was not associated with HIV infection, suggesting that the reduction in HIV incidence among participants taking daily oral tenofovir compared to those taking placebo was due to a decrease in parenteral HIV transmission. |
Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools
Pickering AJ , Blum AG , Breiman RF , Ram PK , Davis J . PLoS One 2014 9 (3) e92571 BACKGROUND: In-person structured observation is considered the best approach for measuring hand hygiene behavior, yet is expensive, time consuming, and may alter behavior. Video surveillance could be a useful tool for objectively monitoring hand hygiene behavior if validated against current methods. METHODS: Student hand cleaning behavior was monitored with video surveillance and in-person structured observation, both simultaneously and separately, at four primary schools in urban Kenya over a study period of 8 weeks. FINDINGS: Video surveillance and in-person observation captured similar rates of hand cleaning (absolute difference <5%, p = 0.74). Video surveillance documented higher hand cleaning rates (71%) when at least one other person was present at the hand cleaning station, compared to when a student was alone (48%; rate ratio = 1.14 [95% CI 1.01-1.28]). Students increased hand cleaning rates during simultaneous video and in-person monitoring as compared to single-method monitoring, suggesting reactivity to each method of monitoring. This trend was documented at schools receiving a handwashing with soap intervention, but not at schools receiving a sanitizer intervention. CONCLUSION: Video surveillance of hand hygiene behavior yields results comparable to in-person observation among schools in a resource-constrained setting. Video surveillance also has certain advantages over in-person observation, including rapid data processing and the capability to capture new behavioral insights. Peer influence can significantly improve student hand cleaning behavior and, when possible, should be exploited in the design and implementation of school hand hygiene programs. |
Mucormycosis outbreak associated with hospital linens.
Duffy J , Harris J , Gade L , Sehulster L , Newhouse E , O'Connell H , Noble-Wang J , Rao C , Balajee SA , Chiller T . Pediatr Infect Dis J 2014 33 (5) 472-6 BACKGROUND: Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections. METHODS: A case was defined as a hospital-onset illness consistent with mucormycosis, confirmed by culture or histopathology. Case-patient medical records were reviewed for clinical course and exposure to items and locations within the hospital. Environmental samples were collected from air and surfaces. Fungal isolates collected from case-patients and the environment were identified using DNA sequencing. RESULTS: Five case-patients had hospital-associated cutaneous mucormycosis over an eleven month period; all subsequently died. Three case-patients had conditions known to be associated with susceptibility to mucormycosis, while two had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas, and from one (4%) of 25 samples from non-linen-related items. Case-patients were infected with Rhizopusdelemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility. CONCLUSIONS: Hospital linens were identified as a vehicle that carried Rhizopusdelemar into contact with susceptible patients. Fungal species identification using DNA-based methods is useful for corroborating epidemiologic links in hospital outbreak investigations. Hospital linens should be laundered, packaged, shipped, and stored in a manner that minimizes exposure to environmental contaminants. |
Understanding staff perceptions about Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae control efforts in Chicago long-term acute care hospitals
Lyles RD , Moore NM , Weiner SB , Sikka M , Lin MY , Weinstein RA , Hayden MK , Sinkowitz-Cochran RL . Infect Control Hosp Epidemiol 2014 35 (4) 367-74 OBJECTIVE: To identify differences in organizational culture and better understand motivators to implementation of a bundle intervention to control Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC). DESIGN: Mixed-methods study. SETTING: Four long-term acute care hospitals (LTACHs) in Chicago. PARTICIPANTS: LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers). METHODS: Qualitative interviews or focus groups and completion of a quantitative questionnaire. RESULTS: Eighty employees (frontline, 72.5%; midlevel, 17.5%; administration, 10%) completed surveys and participated in qualitative discussions in August 2012. Although 82.3% of respondents felt that quality improvement was a priority at their LTACH, there were statistically significant differences in organizational culture between staff strata, with administrative-level having higher organizational culture scores (ie, more favorable responses) than midlevel or frontline staff. When asked to rank the success of the KPC control program, mean response was 8.0 (95% confidence interval, 7.6-8.5), indicating a high level of agreement with the perception that the program was a success. Patient safety and personal safety were reported most often as personal motivators for intervention adherence. The most convergent theme related to prevention across groups was that proper hand hygiene is vital to prevention of KPC transmission. CONCLUSIONS: Despite differences in organizational culture across 3 strata of LTACH employees, the high degree of convergence in motivation, understanding, and beliefs related to implementation of a KPC control bundle suggests that all levels of staff may be able to align perspectives when faced with a key infection control problem and quality improvement initiative. |
Multidrug-resistant Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility providing subacute care
Mortensen E , Trivedi KK , Rosenberg J , Cody SH , Long J , Jensen BJ , Vugia DJ . Infect Control Hosp Epidemiol 2014 35 (4) 406-11 OBJECTIVE: To investigate Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility (LTCF) providing subacute care (facility A). METHODS: We reviewed facility A and affiliated local hospital records for facility A residents with A. baumannii isolated during the period January 2009 through February 2010 and compared A. baumannii antimicrobial resistance patterns of residents with those of hospital patients. During March 2010, we implemented a colonization survey of facility A residents who received respiratory support or who could provide sputum samples and looked for A. baumannii colonization risks. Available clinical and survey isolates underwent pulsed-field gel electrophoresis (PFGE); PFGE strains were linked with overlapping stays to identify possible transmission. RESULTS: During the period January 2009 through February 2010, 33 facility A residents had A. baumannii isolates; all strains were multidrug resistant (MDR), which was a significantly higher prevalence of MDR strains than that found among isolates from hospital patients (81 [66%] of 122 hospital patient isolates were MDR; P < .001). The sputum survey found that 14 (20%) of 70 residents had A. baumannii colonization, which was associated with ventilator use (adjusted odds ratio, 4.24 [95% confidence interval, 1.06-16.93]); 12 (86%) of 14 isolates were MDR. Four facility A resident groups clustered with 3 PFGE strains and overlapping stays. One of these facility A residents also clustered with 3 patients at an affiliated hospital. CONCLUSIONS: We documented substantial MDR A. baumannii infections and colonization with probable intra- and interfacility spread associated with a single LTCF providing subacute care. Given the limited infection prevention and antimicrobial stewardship resources in such settings, regional collaborations among facilities across the spectrum of health care are needed to address this MDR threat. |
Multistate point-prevalence survey of health care-associated infections
Magill SS , Edwards JR , Bamberg W , Beldavs ZG , Dumyati G , Kainer MA , Lynfield R , Maloney M , McAllister-Hollod L , Nadle J , Ray SM , Thompson DL , Wilson LE , Fridkin SK . N Engl J Med 2014 370 (13) 1198-208 BACKGROUND: Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. METHODS: We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. RESULTS: Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011. CONCLUSIONS: Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections. |
Epidemiology and prevention of carbapenem-resistant Enterobacteriaceae in the United States
Guh AY , Limbago BM , Kallen AJ . Expert Rev Anti Infect Ther 2014 12 (5) 565-80 Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant organisms with few treatment options that cause infections associated with substantial morbidity and mortality. CRE outbreaks have been increasingly reported worldwide and are mainly due to the emergence and spread of strains that produce carbapenemases. In the United States, transmission of CRE is primarily driven by the spread of organisms carrying the Klebsiella pneumoniae carbapenemase enzyme, but other carbapenemase enzymes, such as the New-Delhi metallo-beta-lactamase, have also emerged. Currently recommended control strategies for healthcare facilities include the detection of patients infected or colonized with CRE and implementation of measures to prevent further spread. In addition to efforts in individual facilities, effective CRE control requires coordination across all healthcare facilities in a region. This review describes the current epidemiology and surveillance of CRE in the United States and the recommended approach to prevention. |
Population-based incidence and prevalence of systemic lupus erythematosus: the Michigan Lupus Epidemiology and Surveillance program
Somers EC , Marder W , Cagnoli P , Lewis EE , DeGuire P , Gordon C , Helmick CG , Wang L , Wing JJ , Dhar JP , Leisen J , Shaltis D , McCune WJ . Arthritis Rheumatol 2014 66 (2) 369-78 OBJECTIVE: To estimate the incidence and prevalence of systemic lupus erythematosus (SLE) in a sociodemographically diverse southeastern Michigan source population of 2.4 million people. METHODS: SLE cases fulfilling the American College of Rheumatology classification criteria (primary case definition) or meeting rheumatologist-judged SLE criteria (secondary definition) and residing in Wayne or Washtenaw Counties during 2002-2004 were included. Case finding was performed from 6 source types, including hospitals and private specialists. Age-standardized rates were computed, and capture-recapture was performed to estimate underascertainment of cases. RESULTS: The overall age-adjusted incidence and prevalence (ACR definition) per 100,000 persons were 5.5 (95% confidence interval [95% CI] 5.0-6.1) and 72.8 (95% CI 70.8-74.8). Among females, the incidence was 9.3 per 100,000 persons and the prevalence was 128.7 per 100,000 persons. Only 7 cases were estimated to have been missed by capture-recapture, adjustment for which did not materially affect the rates. SLE prevalence was 2.3-fold higher in black persons than in white persons, and 10-fold higher in females than in males. Among incident cases, the mean +/- SD age at diagnosis was 39.3 +/- 16.6 years. Black SLE patients had a higher proportion of renal disease and end-stage renal disease (ESRD) (40.5% and 15.3%, respectively) as compared to white SLE patients (18.8% and 4.5%, respectively). Black patients with renal disease were diagnosed as having SLE at younger age than white patients with renal disease (mean +/- SD 34.4 +/- 14.9 years versus 41.9 +/- 21.3 years; P = 0.05). CONCLUSION: SLE prevalence was higher than has been described in most other population-based studies and reached 1 in 537 among black female persons. There were substantial racial disparities in the burden of SLE, with black patients experiencing earlier age at diagnosis, >2-fold increases in SLE incidence and prevalence, and increased proportions of renal disease and progression to ESRD as compared to white patients. |
Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010-2012
Ferdinands JM , Olsho LE , Agan AA , Bhat N , Sullivan RM , Hall M , Mourani PM , Thompson M , Randolph AG . J Infect Dis 2014 210 (5) 674-83 BACKGROUND: No studies have examined the effectiveness of influenza vaccine against ICU admission associated with influenza virus infection among children. METHODS: In 2010-11 and 2011-12, children aged 6 months to 17 years admitted to 21 US pediatric intensive care units (PICUs) with acute severe respiratory illness and testing positive for influenza were enrolled as cases; children who tested negative were PICU controls. Community controls were children without an influenza-related hospitalization, matched to cases by comorbidities and geographic region. Vaccine effectiveness was estimated with logistic regression models. RESULTS: We analyzed data from 44 cases, 172 PICU controls, and 93 community controls. Eighteen percent of cases, 31% of PICU controls, and 51% of community controls were fully vaccinated. Compared to unvaccinated children, children who were fully vaccinated were 74% (95% CI, 19 to 91%) or 82% (95% CI, 23 to 96%) less likely to be admitted to a PICU for influenza compared to PICU controls or community controls, respectively. Receipt of one dose of vaccine among children for whom two doses were recommended was not protective. CONCLUSION: During the 2010-11 and 2011-12 US influenza seasons, influenza vaccination was associated with a three-quarters reduction in the risk of life-threatening influenza illness in children. |
CDC Grand Rounds: creating a healthier future through prevention of child maltreatment
Saul J , Valle LA , Mercy JA , Turner S , Kaufmann R , Popovic T . MMWR Morb Mortal Wkly Rep 2014 63 (12) 260-3 Child maltreatment is abuse or neglect of a child by a parent or other caregiver that results in potential or actual harm or threats of harm to a child. Maltreatment encompasses both acts of commission (abuse) and omission (neglect). Child maltreatment is divided into four types: 1) physical abuse (e.g., hitting, kicking, shaking, or burning); 2) sexual abuse (e.g., rape or fondling); 3) psychological abuse (e.g., terrorizing or belittling); and 4) neglect, which involves the failure to meet a child's basic physical, emotional, or educational needs (e.g., not providing nutrition, shelter, or medical or mental health care) or the failure to supervise the child in a way that ensures safety (e.g., not taking reasonable steps to prevent injury). In 2012, a total of 1,593 children were reported to have died as a result of maltreatment in the United States. Also in 2012, state child protective service (CPS) agencies received an estimated 3.4 million reports of alleged maltreatment, involving an estimated 6.3 million children. Following the CPS investigation or other response, nearly 700,000 children were confirmed as having been maltreated. However, many cases are never reported to authorities; the actual scope of child maltreatment is greater. For example, data from a nationally representative survey in 2011 of children and adult caregivers (usually parents) suggest that 13.8% of children are maltreated each year and 25.6% experienced maltreatment at some point during childhood. |
Whole-genome single-nucleotide-polymorphism analysis for discrimination of Clostridium botulinum group I strains.
Gonzalez-Escalona N , Timme R , Raphael BH , Zink D , Sharma SK . Appl Environ Microbiol 2014 80 (7) 2125-32 Clostridium botulinum is a genetically diverse Gram-positive bacterium producing extremely potent neurotoxins (botulinum neurotoxins A through G [BoNT/A-G]). The complete genome sequences of three strains harboring only the BoNT/A1 nucleotide sequence are publicly available. Although these strains contain a toxin cluster (HA(+) OrfX(-)) associated with hemagglutinin genes, little is known about the genomes of subtype A1 strains (termed HA(-) OrfX(+)) that lack hemagglutinin genes in the toxin gene cluster. We sequenced the genomes of three BoNT/A1-producing C. botulinum strains: two strains with the HA(+) OrfX(-) cluster (69A and 32A) and one strain with the HA(-) OrfX(+) cluster (CDC297). Whole-genome phylogenic single-nucleotide-polymorphism (SNP) analysis of these strains along with other publicly available C. botulinum group I strains revealed five distinct lineages. Strains 69A and 32A clustered with the C. botulinum type A1 Hall group, and strain CDC297 clustered with the C. botulinum type Ba4 strain 657. This study reports the use of whole-genome SNP sequence analysis for discrimination of C. botulinum group I strains and demonstrates the utility of this analysis in quickly differentiating C. botulinum strains harboring identical toxin gene subtypes. This analysis further supports previous work showing that strains CDC297 and 657 likely evolved from a common ancestor and independently acquired separate BoNT/A1 toxin gene clusters at distinct genomic locations. |
Comparative review of Francisella tularensis and Francisella novicida.
Kingry LC , Petersen JM . Front Cell Infect Microbiol 2014 4 35 Francisella tularensis is the causative agent of the acute disease tularemia. Due to its extreme infectivity and ability to cause disease upon inhalation, F. tularensis has been classified as a biothreat agent. Two subspecies of F. tularensis, tularensis and holarctica, are responsible for tularemia in humans. In comparison, the closely related species F. novicida very rarely causes human illness and cases that do occur are associated with patients who are immune compromised or have other underlying health problems. Virulence between F. tularensis and F. novicida also differs in laboratory animals. Despite this varying capacity to cause disease, the two species share ~97% nucleotide identity, with F. novicida commonly used as a laboratory surrogate for F. tularensis. As the F. novicida U112 strain is exempt from U.S. select agent regulations, research studies can be carried out in non-registered laboratories lacking specialized containment facilities required for work with virulent F. tularensis strains. This review is designed to highlight phenotypic (clinical, ecological, virulence, and pathogenic) and genomic differences between F. tularensis and F. novicida that warrant maintaining F. novicida and F. tularensis as separate species. Standardized nomenclature for F. novicida is critical for accurate interpretation of experimental results, limiting clinical confusion between F. novicida and F. tularensis and ensuring treatment efficacy studies utilize virulent F. tularensis strains. |
Rapid strategy for screening by pyrosequencing of influenza virus reassortants--candidates for live attenuated vaccines.
Shcherbik SV , Pearce NC , Levine ML , Klimov AI , Villanueva JM , Bousse TL . PLoS One 2014 9 (3) e92580 BACKGROUND: Live attenuated influenza vaccine viruses (LAIVs) can be generated by classical reassortment of gene segments between a cold adapted, temperature sensitive and attenuated Master Donor Virus (MDV) and a seasonal wild-type (wt) virus. The vaccine candidates contain hemagglutinin (HA) and neuraminidase (NA) genes derived from the circulating wt viruses and the remaining six genes derived from the MDV strains. Rapid, efficient selection of the viruses with 6ratio2 genome compositions from the large number of genetically different viruses generated during reassortment is essential for the biannual production schedule of vaccine viruses. METHODOLOGY/PRINCIPAL FINDINGS: This manuscript describes a new approach for the genotypic analysis of LAIV reassortant virus clones based on pyrosequencing. LAIV candidate viruses were created by classical reassortment of seasonal influenza A (H3N2) (A/Victoria/361/2011, A/Ohio/02/2012, A/Texas/50/2012) or influenza A (H7N9) (A/Anhui/1/2013) wt viruses with the MDV A/Leningrad/134/17/57(H2N2). Using strain-specific pyrosequencing assays, mixed gene variations were detected in the allantoic progenies during the cloning procedure. The pyrosequencing analysis also allowed for estimation of the relative abundance of segment variants in mixed populations. This semi-quantitative approach was used for selecting specific clones for the subsequent cloning procedures. CONCLUSIONS/SIGNIFICANCE: The present study demonstrates that pyrosequencing analysis is a useful technique for rapid and reliable genotyping of reassortants and intermediate clones during the preparation of LAIV candidates, and can expedite the selection of vaccine virus candidates. |
Transcriptomic characterization of the novel avian-origin influenza A (H7N9) virus: specific host response and responses intermediate between avian (H5N1 and H7N7) and human (H3N2) viruses and implications for treatment options
Josset L , Zeng H , Kelly SM , Tumpey TM , Katze MG . mBio 2014 5 (1) e01102-13 A novel avian-origin H7N9 influenza A virus (IAV) emerged in China in 2013, causing mild to lethal human respiratory infections. H7N9 originated with multiple reassortment events between avian viruses and carries genetic markers of human adaptation. Determining whether H7N9 induces a host response closer to that with human or avian IAV is important in order to better characterize this emerging virus. Here we compared the human lung epithelial cell response to infection with A/Anhui/01/13 (H7N9) or highly pathogenic avian-origin H5N1, H7N7, or human seasonal H3N2 IAV. The transcriptomic response to H7N9 was highly specific to this strain but was more similar to the response to human H3N2 than to that to other avian IAVs. H7N9 and H3N2 both elicited responses related to eicosanoid signaling and chromatin modification, whereas H7N9 specifically induced genes regulating the cell cycle and transcription. Among avian IAVs, the response to H7N9 was closest to that elicited by H5N1 virus. Host responses common to H7N9 and the other avian viruses included the lack of induction of the antigen presentation pathway and reduced proinflammatory cytokine induction compared to that with H3N2. Repression of these responses could have an important impact on the immunogenicity and virulence of H7N9 in humans. Finally, using a genome-based drug repurposing approach, we identified several drugs predicted to regulate the host response to H7N9 that may act as potential antivirals, including several kinase inhibitors, as well as FDA-approved drugs, such as troglitazone and minocycline. Importantly, we validated that minocycline inhibited H7N9 replication in vitro, suggesting that our computational approach holds promise for identifying novel antivirals. IMPORTANCE: Whether H7N9 will be the next pandemic influenza virus or will persist and sporadically infect humans from its avian reservoir, similar to H5N1, is not known yet. High-throughput profiling of the host response to infection allows rapid characterization of virus-host interactions and generates many hypotheses that will accelerate understanding and responsiveness to this potential threat. We show that the cellular response to H7N9 virus is closer to that induced by H3N2 than to that induced by H5N1, reflecting the potential of this new virus for adaptation to humans. Importantly, dissecting the host response to H7N9 may guide host-directed antiviral development. |
Estimating the effective density of engineered nanomaterials for in vitro dosimetry
Deloid G , Cohen JM , Darrah T , Derk R , Rojanasakul L , Pyrgiotakis G , Wohlleben W , Demokritou P . Nat Commun 2014 5 3514 The need for accurate in vitro dosimetry remains a major obstacle to the development of cost-effective toxicological screening methods for engineered nanomaterials. An important key to accurate in vitro dosimetry is the characterization of sedimentation and diffusion rates of nanoparticles suspended in culture media, which largely depend upon the effective density and diameter of formed agglomerates in suspension. Here we present a rapid and inexpensive method for accurately measuring the effective density of nano-agglomerates in suspension. This novel method is based on the volume of the pellet obtained by benchtop centrifugation of nanomaterial suspensions in a packed cell volume tube, and is validated against gold-standard analytical ultracentrifugation data. This simple and cost-effective method allows nanotoxicologists to correctly model nanoparticle transport, and thus attain accurate dosimetry in cell culture systems, which will greatly advance the development of reliable and efficient methods for toxicological testing and investigation of nano-bio interactions in vitro. |
High-throughput assay optimization and statistical interpolation of rubella-specific neutralizing antibody titers
Lambert ND , Pankratz VS , Larrabee BR , Ogee-Nwankwo A , Chen MH , Icenogle JP , Poland GA . Clin Vaccine Immunol 2014 21 (3) 340-6 Rubella remains a social and economic burden due to the high incidence of congenital rubella syndrome (CRS) in some countries. For this reason, an accurate and efficient high-throughput measure of antibody response to vaccination is an important tool. In order to measure rubella-specific neutralizing antibodies in a large cohort of vaccinated individuals, a high-throughput immunocolorimetric system was developed. Statistical interpolation models were applied to the resulting titers to refine quantitative estimates of neutralizing antibody titers relative to the assayed neutralizing antibody dilutions. This assay, including the statistical methods developed, can be used to assess the neutralizing humoral immune response to rubella virus and may be adaptable for assessing the response to other viral vaccines and infectious agents. |
How we determined the most reliable solid medium for studying treatment of tuberculosis
Heilig CM , Feng PJ , Joloba ML , Johnson JL , Morgan K , Gitta P , Boom WH , Mayanja-Kizza H , Eisenach KD , Bozeman L , Goldberg SV . Tuberculosis (Edinb) 2014 94 (3) 317-22 Phase 2 clinical trials for tuberculosis (TB) treatment require reliable culture methods to determine presence or absence of Mycobacterium tuberculosis (Mtb) over the course of therapy, as these trials are based primarily on bacteriological endpoints. We evaluate which of 5 solid media is most reliable: Lowenstein-Jensen (LJ) egg-base medium and 4 Middlebrook agar media (nonselective 7H10 and 7H11 and selective 7H10 and 7H11). We analyze 393 specimens from 50 HIV-negative Ugandan adults with newly-diagnosed, pulmonary TB and high acid-fast bacillus smear grade. Specimens were collected every 2-4 weeks during the first 12 weeks of therapy. We compare the results for each culture to 2 composite reference standards-one that was deemed positive if any solid culture was positive for Mtb and another based on latent-class analysis. Both reference standards established that the 2 selective Middlebrook media most reliably determine the presence or absence of Mtb (P < 0.003), largely because of their lower contamination rates. We also showed that results on Middlebrook media were similar to each other, while LJ was most frequently discordant. Contaminated results appeared more likely to be truly negative than to harbor undetected Mtb. |
Maternal smoking, xenobiotic metabolizing enzyme gene variants, and gastroschisis risk.
Jenkins MM , Reefhuis J , Gallagher ML , Mulle JG , Hoffmann TJ , Koontz DA , Sturchio C , Rasmussen SA , Witte JS , Richter P , Honein MA . Am J Med Genet A 2014 164A (6) 1454-63 Maternal smoking during pregnancy is one proposed risk factor for gastroschisis, but reported associations have been modest, suggesting that differences in genetic susceptibility might play a role. We included 108 non-Hispanic white and 62 Hispanic families who had infants with gastroschisis, and 1,147 non-Hispanic white and 337 Hispanic families who had liveborn infants with no major structural birth defects (controls) in these analyses. DNA was extracted from buccal cells collected from infants and mothers, and information on periconceptional smoking history was obtained from maternal interviews, as part of the National Birth Defects Prevention Study. We analyzed five polymorphisms in three genes that code for enzymes involved in metabolism of some cigarette smoke constituents (CYP1A1, CYP1A2, and NAT2). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) independently for maternal smoking and maternal and infant gene variants, and to assess joint associations of maternal smoking and maternal or infant gene variants with gastroschisis. In analyses adjusted for maternal age at delivery and stratified by maternal race-ethnicity, we identified three suggestive associations among 30 potential associations with sufficient numbers to calculate ORs: CYP1A1*2A for non-Hispanic white mothers who smoked periconceptionally (aOR = 0.38, 95% CI 0.15-0.98), and NAT2*6 for Hispanic non-smoking mothers (aOR = 2.17, 95% CI 1.12-4.19) and their infants (aOR = 2.11, 95% CI 1.00-4.48). This analysis does not support the occurrence of effect modification between periconceptional maternal smoking and most of the xenobiotic metabolizing enzyme gene variants assessed. |
Perinatal quality collaboratives: improving care for mothers and infants
Henderson ZT , Suchdev DB , Abe K , Johnston EO , Callaghan WM . J Womens Health (Larchmt) 2014 23 (5) 368-72 Perinatal morbidity and mortality are key indicators of a nation's health status. These measures of our nation's health are influenced by decisions made in health care facilities and by health care providers. As our health systems and health care for women and infants can be improved, there is an expectation that these measures of health will also improve. State-based perinatal quality collaboratives (PQCs) are networks of perinatal care providers including hospitals, clinicians, and public health professionals working to improve pregnancy outcomes for women and newborns through continuous quality improvement. Members of the collaborative are healthcare facilities, primarily hospitals, which identify processes of care that require improvement and then use the best available methods to effect change and improve outcomes as quickly as possible. The Division of Reproductive Health at the Centers for Disease Control and Prevention is collaborating with state-based PQCs to enhance their ability to improve perinatal care by expanding the range of neonatal and maternal health issues addressed and including higher proportions of participating hospitals in their state PQC. The work of PQCs is cross-cutting and demonstrates how partnerships can act to translate evidence-based science to clinical care. |
Predicting mortality among hospitalized children with respiratory illness in western Kenya, 2009-2012
Emukule GO , McMorrow M , Ulloa C , Khagayi S , Njuguna HN , Burton D , Montgomery JM , Muthoka P , Katz MA , Breiman RF , Mott JA . PLoS One 2014 9 (3) e92968 BACKGROUND: Pediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya. MATERIALS AND METHODS: We analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009-2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model. RESULTS: We analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3-3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7-5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6-3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2-2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5-3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1-12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores. CONCLUSIONS: A modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya. |
Individual-level influences on population data
Schoendorf KC . Paediatr Perinat Epidemiol 2014 28 (3) 179-80 Despite advances in the care of extremely preterm infants, the accurate and consistent ascertainment of population-level outcomes, such as mortality, among those infants remains difficult.1 The article by Charafeddine et al. in this issue of Paediatric and Perinatal Epidemiology sheds some light on this phenomenon from a different perspective than usually considered by the journal's audience.2 The authors undertook a survey of Lebanese paediatricians who care for extremely preterm infants, painting a somewhat subjective picture of the physicians' attitudes towards initiating resuscitation of those infants. The physicians' own opinions regarding limits of viability, predicted actions in two possible case settings, and, interestingly, an assessment of the physicians' opinions of parental preferences were ascertained. | The Charafeddine article is not the usual fare for Paediatric and Perinatal Epidemiology. It is a somewhat subjective exploration of hypothetical behaviours, rather than a descriptive analysis, an investigation of exposure-outcome relationships, or an evaluation of methodological techniques, and the findings likely are not generalisable to other populations; given the survey's response rate, they may not even be generalisable to Lebanon. However, despite – and partially because of – those factors, the paper is useful on several levels. |
Deflagration-to-detonation transition in natural gas-air mixtures
Zipf Jr RK , Gamezo VN , Mohamed KM , Oran ES , Kessler DA . Combust Flame 2014 161 (8) 2165-2176 The gas explosion test facility (GETF) previously used to study detonability of natural gas (NG)-air mixtures was modified for studies of flame acceleration and deflagration-to-detonation transition (DDT). The 73-m-long by 1.05-m-diameter tube was equipped with 15 baffles of varying blockage ratio (BR) = 0.13, 0.25, or 0.50, placed near the closed end of the tube and spaced 1.52-m apart. The remaining part of the tube was smooth. Experiments used mixtures between 5.1% and 15.0% NG-air. Ignition was achieved in NG-air mixtures over the composition range 6.1-14.1%. After passing the 15 baffles, both flame and pressure wave velocity were more than 300 m/s over this range. Flame velocity was increasing over the range 6.2-12.8% NG-air, and it reached the sound speed in the burned gases (800-1000 m/s) over the composition range 8.0-10.8% NG-air. Pressure wave velocity was increasing over the composition range 6.1-14.1% NG-air and had reached sonic velocity over the composition range 6.2-12.6% NG-air. Shock waves with magnitude greater than 1 MPa were measured in all tests over the composition range 6.5-12.4%. DDT within the baffled section of the tube and sustained detonations beyond the baffles in the smooth part of the tube were observed over the composition range 8.0-10.8% NG-air. The observed run-up length to sonic flame velocity normalized by the tube diameter, Xru/D, ranges from 16 to 23 at BR = 0.13, 10 to 21 for BR = 0.25, and 13 to 21 for BR = 0.50. The observed run-up length to DDT normalized by the tube diameter, XDDT/D, ranges from 19 to 23 at BR = 0.13, and 16 to 23 for BR = 0.25 and 0.50. Coal mine safety regulations in the US require mine seals to resist an explosion pressure-time curve that rises instantaneously to 0.8 MPa and remains at that level for 4 s. Pressure-time curves measured in these experiments show that shock waves with near-instantaneous rise time and magnitude greater than 1 MPa can develop from weak spark ignition after passing 15 turbulence-generating obstacles in test mixtures ranging from 6.5% to 12.4% NG-air. |
Prevalence of workers with shifts in hearing by industry: a comparison of OSHA and NIOSH hearing shift criteria
Masterson EA , Sweeney MH , Deddens JA , Themann CL , Wall DK . J Occup Environ Med 2014 56 (4) 446-55 OBJECTIVE: The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes. METHODS: From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry. RESULTS: Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively. CONCLUSIONS: Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss. |
Evaluation of smartphone sound measurement applications
Kardous CA , Shaw PB . J Acoust Soc Am 2014 135 (4) EL186-EL192 This study reports on the accuracy of smartphone sound measurement applications (apps) and whether they can be appropriately employed for occupational noise measurements. A representative sample of smartphones and tablets on various platforms were acquired, more than 130 iOS apps were evaluated but only 10 apps met our selection criteria. Only 4 out of 62 Android apps were tested. The results showed two apps with mean differences of 0.07 dB (unweighted) and -0.52 dB (A-weighted) from the reference values. Two other apps had mean differences within +/-2 dB. The study suggests that certain apps may be appropriate for use in occupational noise measurements. |
Gender differences in work-related asthma: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-2008
White GE , Seaman C , Filios MS , Mazurek JM , Flattery J , Harrison RJ , Reilly MJ , Rosenman KD , Lumia ME , Stephens AC , Pechter E , Fitzsimmons K , Davis LK . J Asthma 2014 51 (7) 691-702 OBJECTIVE: To characterize work-related asthma by gender. METHODS: We analyzed state-based sentinel surveillance data on confirmed work-related asthma cases collected from California, Massachusetts, Michigan, and New Jersey during 1993-2008. We used Chi-square and Fisher's Exact Test statistics to compare select characteristics between females and males. RESULTS: Of the 8239 confirmed work-related asthma cases, 60% were female. When compared to males with work-related asthma, females with work-related asthma were more likely to be identified through workers' compensation (14.8% versus 10.6%) and less likely to be identified through hospital data (14.2% versus 16.9%). Moreover, when compared to males, females were more likely to have work-aggravated asthma (24.4% versus 13.5%) and less likely to have new-onset asthma (48.0% versus 56.5%). Females were also more likely than males with work-related asthma to work in healthcare and social assistance (28.7% versus 5.2%), educational services (11.8% versus 4.2%), and retail trade (5.0% versus 3.9%) industries and in office and administrative support (20.0% versus 4.0%), healthcare practitioners and technical (13.4% versus 1.6%), and education training and library (6.2% versus 1.3%) occupations. Agent groups most frequently associated with work-related asthma were miscellaneous chemicals (20.3%), cleaning materials (15.3%), and indoor air pollutants (14.9%) in females and miscellaneous chemicals (15.7%), mineral and inorganic dusts (13.2%), and pyrolysis products (12.7%) in males. CONCLUSIONS: Among adults with work-related asthma, males and females differ in terms of workplace exposures, occupations, and industries. Physicians should consider these gender differences when diagnosing and treating asthma in working adults. |
Introduction to a special issue: eliminating health and safety inequities at work
Baron SL , Steege AL , Hughes JT Jr , Beard SD . Am J Ind Med 2014 57 (5) 493-4 In 2011, the National Institute for Occupational Safety and Health along with the National Institute of Environmental Health Sciences and in partnership with the Occupational Safety and Health Administration and the Environmental Protection Agency convened a national conference on Eliminating Health and Safety Disparities at Work (www.aoecdata.org/conferences/healthdisparities/). In this issue Steege et al. [2014] present new analyses of the Bureau of Labor Statistics data on occupational injuries and illnesses and work-related fatalities, which indicate that workers who are African American, Hispanic, immigrant, who earn low wages and who have lower levels of educational attainment are at greater risk of working in occupations where occupational injuries and illnesses occur at more than twice the national rate. These data clearly demonstrate the need for more targeted and comprehensive occupational safety and health prevention programs aimed at reducing these disparities. |
Chemical markers of occupational exposure to teak wood dust
Carrieri M , Bartolucci GB , Lee T , Barbero A , Harper M . Ann Occup Hyg 2014 58 (5) 566-78 A novel high-performance liquid chromatographic/ultraviolet method was developed to detect lapachol (LP) and deoxylapachol (DLP) in wood dust as chemical markers of teak wood (a suspected human carcinogen). The specificity of this analysis was determined by noting the absence of LP and DLP in 12 other specimens of different woods belonging to the angiosperm family. The consistency was examined by analyzing teak from three different sources, where the percentages (wt/wt) of the chemicals ranged from 0.006 to 0.261 for LP and from 0.038 to 0.497 for DLP, respectively. Although the LP and DLP components of teak varied according to source, a very high correlation coefficient (r 2 > 0.98 always) was found between the content of the two markers in the bulk specimens and in bulk dust derived from them. The method was then applied to teak dust collected on polyvinylchloride filters from aerosol in an exposure chamber in the range of mass loadings between 0.03 and 3.65mg, which corresponds to a dust exposure between 0.124 and 8.703mg m-3 for a sampling time of 2h. A field test was also carried out in a small factory where teak was used. A good correlation was confirmed between LP and DLP versus the dust collected on the filter in both cases. LP and DLP can be markers to estimate the true quantities of teak dust inhaled in a workplace with mixed wood dust, provided the results are matched to the content of LP and DLP in the bulk wood. LP and DLP have also been proposed as the agents responsible for allergic reaction to teak dust. Therefore, it would be useful to evaluate the exposure to these two substances even without a relationship to teak dust exposure. |
Insights in Public Health: strengthening the epidemiology workforce through mentorship: practicum and fellowship experiences in the Family Health Services Division at the Hawai'i Department of Health
Hayes D . Hawaii J Med Public Health 2014 73 (3) 94-7 There are significant shortages in the public health workforce and it's expected to worsen. Efforts to reduce this shortage are varied and include building the workforce by increasing exposure of students and young professionals in applied public health experiences. Providing these experiences increases productivity, and may help alleviate some of the workforce shortages in public health. This article seeks to highlight the work done at the Family Health Services Division (FHSD) in the Hawai'i Department of Health over the past 6 and half years in working with students in epidemiology practicum and fellowship experiences. |
Academic-health department collaborative relationships are reciprocal and strengthen public health practice: results from a study of academic research centers
Neri EM , Ballman MR , Lu H , Greenlund KJ , Grunbaum JA . J Public Health Manag Pract 2014 20 (3) 342-8 BACKGROUND: Collaborations between academic institutions and state and local health departments have been shown to enhance the public health core functions of Assurance by improving the public health workforce's knowledge and skills. Few studies have analyzed how academic-health department collaborations enhance Assessment and Policy Development core functions. This qualitative study explores types of collaborations between health departments and Prevention Research Centers (PRCs) and how they align with the core functions. Prevention Research Centers are academic institutions funded by the Centers for Disease Control and Prevention to conduct public health research and translate research results for policies and practices. METHODS: We reviewed each PRC's annual report from fiscal year 2011 and abstracted descriptions of PRC-health department collaborations. We identified 14 themes of PRC-health department collaborations and conducted a qualitative analysis to describe the dimensions and distribution of themes. RESULTS: Of the 37 PRCs, 36 reported 215 collaborations with 19 city, 97 county, 31 state, and 46 tribal health departments. Themes of research, survey, and surveillance aligned with the Assessment core function and evaluation, strategic planning, technical assistance, and program implementation supported the Policy Development and Assurance core functions. Overall, health departments provided on-the-ground expertise to inform PRC research, ensuring its applicability to public health practice. Reciprocally, PRCs improved data quality, increased the scientific rigor of health department processes and programs, and filled knowledge gaps within health departments. Both PRCs and health departments enhanced the relevance of public health programs and practices by grounding implementation and evaluation in community needs and views. CONCLUSION: Findings from this study demonstrate that PRC-health department collaborations often enhanced multiple core functions that could lead to implementation of evidence-based interventions and continuous quality improvement of public health administration at the local, state, and tribal levels. This study highlights the value and importance of reciprocal academic-health department partnerships. |
Models for count data with an application to healthy days measures: are you driving in screws with a hammer?
Zhou H , Siegel PZ , Barile J , Njai RS , Thompson WW , Kent C , Liao Y . Prev Chronic Dis 2014 11 E50; quiz E50 INTRODUCTION: Count data are often collected in chronic disease research, and sometimes these data have a skewed distribution. The number of unhealthy days reported in the Behavioral Risk Factor Surveillance System (BRFSS) is an example of such data: most respondents report zero days. Studies have either categorized the Healthy Days measure or used linear regression models. We used alternative regression models for these count data and examined the effect on statistical inference. METHODS: Using responses from participants aged 35 years or older from 12 states that included a homeownership question in their 2009 BRFSS, we compared 5 multivariate regression models - logistic, linear, Poisson, negative binomial, and zero-inflated negative binomial - with respect to 1) how well the modeled data fit the observed data and 2) how model selections affect inferences. RESULTS: Most respondents (66.8%) reported zero mentally unhealthy days. The distribution was highly skewed (variance = 58.7, mean = 3.3 d). Zero-inflated negative binomial regression provided the best-fitting model, followed by negative binomial regression. A significant independent association between homeownership and number of mentally unhealthy days was not found in the logistic, linear, or Poisson regression model but was found in the negative binomial model. The zero-inflated negative binomial model showed that homeowners were 24% more likely than nonowners to have excess zero mentally unhealthy days (adjusted odds ratio, 1.24; 95% confidence interval, 1.08-1.43), but it did not show an association between homeownership and the number of unhealthy days. CONCLUSION: Our comparison of regression models indicates the importance of examining data distribution and selecting models with appropriate assumptions. Otherwise, statistical inferences might be misleading. |
State Medicaid coverage for tobacco cessation treatments and barriers to coverage - United States, 2008-2014
Singleterry J , Jump Z , Lancet E , Babb S , Macneil A , Zhang L . MMWR Morb Mortal Wkly Rep 2014 63 (12) 264-9 Medicaid enrollees have a higher smoking prevalence than the general population (30.1% of adult Medicaid enrollees aged <65 years smoke, compared with 18.1% of U.S. adults of all ages), and smoking-related disease is a major contributor to increasing Medicaid costs. Evidence-based cessation treatments exist, including individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications. A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments. However, most states do not provide such coverage. To monitor trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of all evidence-based cessation treatments except telephone counseling section sign by state Medicaid programs (for a total of nine treatments), as well as data on barriers to accessing these treatments (such as charging copayments or limiting the number of covered quit attempts) from December 31, 2008, to January 31, 2014. As of 2014, all 50 states and the District of Columbia cover some cessation treatments for at least some Medicaid enrollees, but only seven states cover all nine treatments for all enrollees. Common barriers in 2014 include duration limits (40 states for at least some populations or plans), annual limits (37 states), prior authorization requirements (36 states), and copayments (35 states). Comparing 2008 with 2014, 33 states added treatments to coverage, and 22 states removed treatments from coverage; 26 states removed barriers to accessing treatments, and 29 states added new barriers. The evidence from previous analyses suggests that states could reduce smoking-related morbidity and health-care costs among Medicaid enrollees by providing Medicaid coverage for all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting the coverage, and monitoring its use. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Behavior and Risk
- Healthcare Associated Infections
- Immune System Disorders
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
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- Occupational Safety and Health
- Public Health Leadership and Management
- Statistics as Topic
- Substance Use and Abuse
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