Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis
O'Hare AM , Batten A , Burrows NR , Pavkov ME , Taylor L , Gupta I , Todd-Stenberg J , Maynard C , Rodriguez RA , Murtagh FE , Larson EB , Williams DE . Am J Kidney Dis 2012 59 (4) 513-22 BACKGROUND: Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 5,606 Veterans Affairs patients who initiated long-term dialysis in 2001-2003. PREDICTOR: Trajectory of estimated glomerular filtration rate (eGFR) during the 2-year period before initiation of long-term dialysis. OUTCOMES & MEASUREMENTS: Patient characteristics and care practices before and at the time of dialysis initiation and survival after initiation. RESULTS: We identified 4 distinct trajectories of eGFR during the 2-year period before dialysis initiation: 62.8% of patients had persistently low level of eGFR <30 mL/min/1.73 m(2) (mean eGFR slope, 7.7 +/- 4.7 [SD] mL/min/1.73 m(2) per year), 24.6% had progressive loss of eGFR from levels of approximately 30-59 ml/min/1.73 m(2) (mean eGFR slope, 16.3 +/- 7.6 mL/min/1.73 m(2) per year), 9.5% had accelerated loss of eGFR from levels >60 mL/min/1.73 m(2) (mean eGFR slope, 32.3 +/- 13.4 mL/min/1.73 m(2) per year), and 3.1% experienced catastrophic loss of eGFR from levels >60 mL/min/1.73 m(2) within 6 months or less. Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury. They were less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation. CONCLUSIONS: There is substantial heterogeneity in patterns of kidney function loss leading up to the initiation of long-term dialysis perhaps calling for a more flexible approach toward preparing for end-stage renal disease. |
Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey
Shapiro JA , Klabunde C , Thompson TD , Nadel M , Seeff LC , White A . Cancer Epidemiol Biomarkers Prev 2012 21 (6) 895-904 BACKGROUND: Recommended CRC screening tests for adults ages 50-75 include home FOBT, sigmoidoscopy with FOBT, and colonoscopy. A newer test, computed tomographic (CT) colonography, has been recommended by some, but not all, national organizations. METHODS: We analyzed 2010 National Health Interview Survey data, including new CT colonography questions, from respondents ages 50-75 (N=8952). We assessed: 1) prevalence of CRC test use overall, by test type, and by sociodemographic and health care access factors, and 2) reported reasons for not having a CRC test. RESULTS: The age-standardized percentage of respondents reporting FOBT, sigmoidoscopy or colonoscopy within recommended time intervals was 58.3% (95% CI, 57.0-59.6). Colonoscopy was the most commonly reported test (within past 10 years: 54.6% (95% CI, 53.2-55.9)). Home FOBT and sigmoidoscopy with FOBT were less frequently used (FOBT within past year: 8.8% (95% CI, 8.1-9.6); sigmoidoscopy within past 5 years with FOBT within past 3 years: 1.3% (95% CI, 1.0-1.6)). CT colonography was rare: 1.3% (95% CI, 1.0-1.7). Increasing age, education, income, having health insurance, and having a usual source of health care were associated with higher CRC test use. Test use within recommended time intervals was particularly low among individuals ages 50-64 without health insurance (21.2% (95% CI, 18.3-24.4)). The most common reason for non-use was "no reason or never thought about it." CONCLUSIONS: About 40% of Americans ages 50-75 do not meet recommendations for having CRC screening tests. Impact: Expanded health care coverage and greater awareness of CRC screening are needed to further decrease CRC mortality. |
The body adiposity index (hip circumference / height(1.5)) is not a more accurate measure of adiposity than is BMI, waist circumference, or hip circumference
Freedman DS , Thornton J , Pi-Sunyer FX , Heymsfield SB , Wang J , Pierson Jr RN , Blanck HM , Gallagher D . Obesity (Silver Spring) 2012 20 (12) 2438-44 Based on cross-sectional analyses, it was suggested that hip circumference divided by height (1.5) minus 18 (the body adiposity index, BAI), could directly estimate percent body fat without the need for further correction for sex or age. We compared the prediction of percent body fat, as assessed by dual-energy x-ray absorptiometry (PBF(DXA)), by BAI, BMI, and circumference (waist and hip) measurements among 1151 adults who had a total body scan by DXA and circumference measurements from 1993 through 2006. After accounting for sex, we found that PBF(DXA) was related similarly to BAI, BMI, waist circumference, and hip circumference. In general, BAI underestimated PBF(DXA) among men (2.5%) and overestimated PBF(DXA) among women (4%), but the magnitudes of these biases varied with the level of body fatness. The addition of covariates and quadratic terms for the body size measures in regression models substantially improved the prediction of PBF(DXA), but none of the models based on BAI could more accurately predict PBF(DXA) than could those based on BMI or circumferences. We conclude that the use of BAI as an indicator of adiposity is likely to produce biased estimates of percent body fat, with the errors varying by sex and level of body fatness. Although regression models that account for the non-linear association, as well as the influence of sex, age and race, can yield more accurate estimates of PBF(DXA), estimates based on BAI are not more accurate than those based on BMI, waist circumference, or hip circumference. |
Reaching the last one percent: progress and challenges in global polio eradication
Kew O . Curr Opin Virol 2012 2 (2) 188-98 Since its launch in 1988, the World Health Organization's Global Polio Eradication Initiative has reduced worldwide polio incidence by >99%. The most dramatic progress was achieved up to the year 2000, the original eradication target date, but subsequent years have seen only limited progress in preventing the last 1% of cases. Recent gains in India and Nigeria have been offset by continued endemicity in Pakistan and Afghanistan, and repeated reseeding of wild poliovirus into polio-free areas has led to large outbreaks and re-established transmission. Although wild poliovirus type 2 was eradicated in 1999 and wild poliovirus type 3 may be nearing eradication, the continued emergence of circulating vaccine-derived polioviruses, especially type 2, presents ongoing challenges to stopping all poliovirus transmission. |
Reasons for non-participation in an international multicenter trial of a new drug for tuberculosis treatment
Lamunu D , Chapman KN , Nsubuga P , Muzanyi G , Mulumba Y , Mugerwa MA , Goldberg S , Bozeman L , Engle M , Saukkonen J , Mastranunzio S , Mayanja-Kizza H , Johnson JL . Int J Tuberc Lung Dis 2012 16 (4) 480-485 SETTING: Clinical trials can provide a high standard of patient care and contribute to scientific knowledge; however, only a fraction of the patients screened participate and receive treatment as part of a trial. OBJECTIVE: To explore reasons why patients were not enrolled in an international tuberculosis (TB) treatment trial and to compare experiences among study sites. DESIGN: An analysis of reasons why patients were not enrolled was conducted among patients screened for a TB clinical trial at 26 sites in North and South America, Africa, and Europe. RESULTS: Staff at study sites screened 1119 potential candidates for the trial: 61% (n = 686) were not enrolled due to 1) failure to meet eligibility criteria (n = 405, 59%), 2) site's decision (n = 168, 24%), or 3) candidate's choice (n = 113, 16%). Study staff recorded a total of 144 reasons for why they believed patients chose not to participate, including concerns over research (28%), conflicts with work or school (21%), and life-style and family issues (20%). Socio-demographic and geographic factors also influenced participation. CONCLUSION: Increased evaluation of screening outcomes and of specific interventions, such as improved education and communication about trial procedures, may increase the efficiency of screening and enrollment in clinical trials. (2012 The Union.) |
The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007
Hall AJ , Curns AT , McDonald LC , Parashar UD , Lopman BA . Clin Infect Dis 2012 55 (2) 216-23 BACKGROUND: Globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus. METHODS: Gastroenteritis-associated deaths in the United States during 1999-2007 were identified from the National Center for Health Statistics multiple cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed gastroenteritis were included. Time-series regression models were used to identify cause-unspecified gastroenteritis deaths that were likely due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths. RESULTS: Gastroenteritis mortality averaged 39/1,000,000 person-years (11,255 deaths/year) over the study period, increasing from 25/1,000,000 person-years in 1999-00 to 57/1,000,000 person-years in 2006-07 (P<0.001). Adults aged ≥65 years accounted for 83% of gastroenteritis deaths (258/1,000,000 person-years). C. difficile mortality increased 5-fold from 10/1,000,000 person-years in 1999-00 to 48/1,000,000 person-years in 2006-07 (P <.001). Norovirus contributed to an estimated 797 deaths annually (3/1,000,000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains. CONCLUSION: Gastroenteritis-associated mortality has more than doubled over the past decade, primarily impacting the elderly. C. difficile is the main contributor to gastroenteritis-associated deaths, largely accounting for the increasing trend, while norovirus is likely the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development. |
Symptom screen for identification of highly infectious tuberculosis in people living with HIV in southeast Asia
Kim L , Heilig CM , McCarthy KD , Phanuphak N , Chheng P , Nong K , Quy HT , Sar B , Cain KP , Varma JK . J Acquir Immune Defic Syndr 2012 60 (5) 519-24 BACKGROUND: Tuberculosis is the leading cause of death among people living with HIV and frequently transmitted among this susceptible group. Transmission can be reduced by infection control practices. Simple, evidence-based methods to identify patients who should be isolated are not well described in the literature. We sought to identify a simple, sensitive symptom or symptom combination that healthcare providers in resource-limited settings can use to identify and isolate persons living with HIV with highly infectious TB. METHODS: Participants from eight outpatient facilities in Cambodia, Thailand, and Vietnam underwent an extensive evaluation for tuberculosis. Patients with ≥ 1 positive sputum smear and Mycobacterium tuberculosis culture growth from a pulmonary site were defined as having highly infectious tuberculosis. We calculated sensitivity and prevalence of individual symptoms and >1,000 symptom combinations. RESULTS: Of 1,980 participants, 272 (14%) had tuberculosis. Forty percent (n=109) were highly infectious. Sensitivity for detecting highly infectious tuberculosis was highest for having the following symptoms in the past month: weight loss (84%), cough (83%), fever (81%) and fatigue (78%); however, these symptoms were found in 46%-54% of all participants. Having two or three of four symptoms (prevalence, 26%-47%)-weight loss, fever, current cough, and night sweats-was 72-90% sensitive for highly infectious tuberculosis. CONCLUSIONS: The two or three of four symptom combinations of weight loss, fever, current cough, and night sweats, which are the same symptoms comprising the current World Health Organization-recommended tuberculosis diagnostic screen, are sensitive for detecting highly infectious tuberculosis in people living with HIV. |
Nocardia cyriacigeorgica infections attributable to unlicensed cosmetic procedures -- an emerging public health problem?
Apostolou A , Bolcen SJ , Dave V , Jani N , Lasker BA , Tan CG , Montana B , Brown JM , Genese CA . Clin Infect Dis 2012 55 (2) 251-3 We describe an outbreak of Nocardia cyriacigeorgica soft-tissue infections attributable to unlicensed cosmetic injections and the first report using MLST sequence data for determining Nocardia strain relatedness in an outbreak. All eight cases identified had a common source exposure and required hospitalization, surgical debridement, and prolonged antimicrobial therapy. |
Effect of HIV infection on tolerability and bacteriologic outcomes of tuberculosis treatment
Bliven-Sizemore EE , Johnson JL , Goldberg S , Burman WJ , Villarino ME , Chaisson RE , Tuberculosis Clinical Trials Consortium . Int J Tuberc Lung Dis 2012 16 (4) 473-9 SETTING: Two international, multicenter Phase 2 clinical trials examining fluoroquinolone-containing regimens in adults with smear-positive pulmonary tuberculosis (TB), conducted from July 2003 to March 2007. Both trials enrolled human immunodeficiency virus (HIV) infected participants who were not receiving antiretroviral therapy (ART) at TB treatment initiation. OBJECTIVE: To assess the impact of HIV infection on TB treatment outcomes in Phase 2 clinical trials. DESIGN: Cross-protocol analysis comparing the safety, tolerability and outcomes of anti-tuberculosis treatment by HIV status. RESULTS: Of 750 participants who received at least one dose of study treatment, 123 (16%) were HIV-infected. Treatment completion rates were similar by HIV status (81% infected vs. 85% non-infected), as were rates of week 8 culture conversion (66% infected vs. 63% non-infected), and treatment failure (5% infected vs. 3% non-infected). Among HIV-infected participants, treatment failure detected using liquid media was more frequent in those treated thrice weekly (14% thrice weekly vs. 2% daily, P = 0.03). HIV-infected participants more frequently experienced an adverse event during the intensive phase treatment than non-HIV-infected participants (30% vs. 15%, P < 0.01). CONCLUSION: HIV-infected persons not receiving ART had more adverse events during the intensive phase of anti-tuberculosis treatment, but tolerated treatment well. Failure rates were higher among HIV-infected persons treated with thrice-weekly intensive phase therapy. |
Fatal Rocky Mountain spotted fever in the United States, 1999-2007
Dahlgren FS , Holman RC , Paddock CD , Callinan LS , McQuiston JH . Am J Trop Med Hyg 2012 86 (4) 713-9 Death from Rocky Mountain spotted fever (RMSF) is preventable with prompt, appropriate treatment. Data from two independent sources were analyzed to estimate the burden of fatal RMSF and identify risk factors for fatal RMSF in the United States during 1999-2007. Despite increased reporting of RMSF cases to the Centers for Disease Control and Prevention, no significant changes in the estimated number of annual fatal RMSF cases were found. American Indians were at higher risk of fatal RMSF relative to whites (relative risk [RR] = 3.9), and children 5-9 years of age (RR = 6.0) and adults ≥ 70 years of age (RR = 3.0) were also at increased risk relative to other ages. Persons with cases of RMSF with an immunosuppressive condition were at increased risk of death (RR = 4.4). Delaying treatment of RMSF was also associated with increased deaths. These results may indicate a gap between recommendations and practice. |
In vitro characterization of a nineteenth-century therapy for smallpox
Arndt W , Mitnik C , Denzler KL , White S , Waters R , Jacobs BL , Rochon Y , Olson VA , Damon IK , Langland JO . PLoS One 2012 7 (3) e32610 In the nineteenth century, smallpox ravaged through the United States and Canada. At this time, a botanical preparation, derived from the carnivorous plant Sarracenia purpurea, was proclaimed as being a successful therapy for smallpox infections. The work described characterizes the antipoxvirus activity associated with this botanical extract against vaccinia virus, monkeypox virus and variola virus, the causative agent of smallpox. Our work demonstrates the in vitro characterization of Sarracenia purpurea as the first effective inhibitor of poxvirus replication at the level of early viral transcription. With the renewed threat of poxvirus-related infections, our results indicate Sarracenia purpurea may act as another defensive measure against Orthopoxvirus infections. |
Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan
Bloss E , Chan PC , Cheng NW , Wang KF , Yang SL , Cegielski P . Int J Tuberc Lung Dis 2012 16 (4) 462-467 SETTING: Directly observed therapy (DOT) is a core element of tuberculosis (TB) care and control efforts. In Taiwan, DOT was implemented in 2006, when the Stop TB Strategy was adopted as a national policy. OBJECTIVE: To quantify DOT among patients on anti-tuberculosis treatment and measure the association between proportion of DOT and TB treatment outcomes at a national level in Taiwan. DESIGN: We analyzed data prospectively collected on all new pulmonary TB cases reported to the national Web-based registry between 1 January 2007 and 30 June 2008. We compared treatment outcomes and proportion of DOT in multivariable analyses. RESULTS: Among 11 528 patients initiating anti-tuberculosis treatment, the proportion of days during which an official DOT observer witnessed treatment was >60% for 5150 (45%) patients and <=60% for 4601 (40%) patients, whereas for 1777 (15%) patients no days of DOT were recorded. Being older, male, having positive bacteriology results and a non-World Health Organization recommended treatment regimen at baseline were independently related to unsuccessful treatment outcomes and mortality. A dose-response effect was found between proportion of DOT and these outcomes. CONCLUSION: These findings highlight the importance of ensuring universal DOT in improving treatment outcomes among new pulmonary TB patients. (2012 The Union.) |
Development of a clinical screening index predictive of incident HIV infection among men who have sex with men (MSM) in the United States
Pals SL , Herbst JH , Shinde S , Carey JW . J Acquir Immune Defic Syndr 2012 60 (4) 421-7 BACKGROUND: To implement biomedical and other intensive HIV prevention interventions cost-effectively, busy care providers need validated, rapid, risk screening tools for identifying persons at highest risk of incident infection. METHODS: To develop and validate an index, we included behavioral and HIV test data from initially HIV-uninfected MSM who reported no injection drug use during semiannual interviews in the VaxGen VAX004 study and Project Explore HIV prevention trials. Using generalized estimating equations and logistic regression analyses, we identified significant predictors of incident HIV infection, then weighted and summed their regression coefficients to create a risk index score. RESULTS: The final logistic regression model included age, and the following behaviors reported during the past 6 months: total number of male sex partners, total number of HIV-positive male sex partners, number of times the man had unprotected receptive anal sex with a male partner of any HIV status, number of times the participant had insertive anal sex with an HIV-positive male partner, whether the participant reported using poppers, and whether they reported using amphetamines. The area under the ROC curve was 0.74, possible scores on index range from 0-47 and a score ≥10 had as sensitivity of 84% and a specificity of 45%, levels appropriate for a screening tool. CONCLUSIONS: We developed an easily administered and scored, 7-item screening index with a cutoff that is predictive of HIV seroconversion in two large prospective cohorts of U.S. MSM. The index can be used to prioritize patients for intensive HIV prevention efforts (e.g., preexposure prophylaxis). |
Existence of the rdl mutant alleles among the anopheles malaria vector in Indonesia.
Asih PB , Syahrani L , Rozi IE , Pratama NR , Marantina SS , Arsyad DS , Mangunwardoyo W , Hawley W , Laihad F , Shinta S , Sukowati S , Lobo NF , Syafruddin D . Malar J 2012 11 (1) 57 BACKGROUND: The gamma-aminobutyric acid (GABA) receptor-chloride channel complex is known to be the target site of dieldrin, a cyclodiene insecticide. GABA-receptors, with a naturally occurring amino acid substitution, A302S/G in the putative ion-channel lining region, confer resistance to cyclodiene insecticides that includes aldrin, chlordane, dieldrin, heptachlor, endrin and endosulphan. METHODS: A total of 154 mosquito samples from 10 provinces of malaria-endemic areas across Indonesia (Aceh, North Sumatra, Bangka Belitung, Lampung, Central Java, East Nusa Tenggara, West Nusa Tenggara, West Sulawesi, Molucca and North Molucca) were obtained and identified by species, using morphological characteristic. The DNA was individually extracted using chelex-ion exchanger and the DNA obtained was used for analyses using sequencing method. RESULTS: Molecular analysis indicated 11% of the total 154 Anopheles samples examined, carried Rdl mutant alleles. All of the alleles were found in homozygous form. Rdl 302S allele was observed in Anopheles vagus (from Central Java, Lampung, and West Nusa Tenggara), Anopheles aconitus (from Central Java), Anopheles barbirostris (from Central Java and Lampung), Anopheles sundaicus (from North Sumatra and Lampung), Anopheles nigerrimus (from North Sumatra), whereas the 302 G allele was only found in Anopheles farauti from Molucca. CONCLUSION: The existence of the Rdl mutant allele indicates that, either insecticide pressure on the Anopheles population in these areas might still be ongoing (though not directly associated with the malaria control programme) or that the mutant form of the Rdl allele is relatively stable in the absence of insecticide. Nonetheless, the finding suggests that integrated pest management is warranted in malaria-endemic areas where insecticides are widely used for other purposes. |
Peramivir use for treatment of hospitalized patients with influenza A(H1N1)pdm09 under Emergency Use Authorization, October 2009 - June 2010
Yu Y , Garg S , Yu PA , Kim HJ , Patel A , Merlin T , Redd S , Uyeki TM . Clin Infect Dis 2012 55 (1) 8-15 BACKGROUND: In response to the influenza A(H1N1)pdm09 [pH1N1] pandemic, peramivir, an investigational intravenous neuraminidase inhibitor, was made available for treatment of hospitalized patients with pH1N1 in the U.S. under Emergency Use Authorization (EUA). The Centers for Disease Control and Prevention (CDC) implemented a program to manage peramivir distribution to requesting clinicians under EUA. We describe results of CDC's peramivir program and three related surveys. METHODS: We analyzed data on peramivir requests made by clinicians to CDC through an electronic request system. Three surveys were administered to enhance clinician compliance with adverse event reporting, to conduct product accountability, and to collect data on peramivir-treated patients. Descriptive analyses were performed and two-source capture-recapture analysis, based upon the three surveys, was used to estimate the number of patients who received peramivir through the EUA. RESULTS: During October 23, 2009 to June 23, 2010, CDC received 1,371 clinician requests for peramivir and delivered 2,129 five-day adult treatment course equivalents of peramivir to 563 hospitals. Based on survey responses, at least 1,274 patients (median age 43 years, range 0-92 years, 49% male) received one or more doses of peramivir (median duration 6 days). Capture-recapture analysis yielded estimates for the potential total number of peramivir recipients ranging from 1,185 (95% CI: 1,076-1,293) to 1,490 (95% CI: 1,321-1,659). CONCLUSIONS: Approximately 1,274 hospitalized patients received peramivir through EUA program during the pH1N1 pandemic. Further analyses are needed to assess the clinical effectiveness of peramivir treatment of hospitalized patients with pH1N1. |
Severe outcomes are associated with genogroup 2 genotype 4 norovirus outbreaks: a systematic literature review.
Desai R , Hembree CD , Handel A , Matthews JE , Dickey BW , McDonald S , Hall AJ , Parashar UD , Leon JS , Lopman B . Clin Infect Dis 2012 55 (2) 189-93 BACKGROUND: Noroviruses are the most common cause of epidemic gastroenteritis, however, the relative impact of individual factors underlying severe illness are poorly understood. This report reviews published norovirus outbreak reports to quantify hospitalization and mortality rates and assess their relationship with outbreak setting, transmission route, and strain. METHODS: Between January 1993 and June 2011, 2435 non-duplicate articles were identified in PubMed, EMBASE, and Web of Knowledge using a string of terms related to "norovirus" and "outbreak". Inclusion criteria included outbreaks with a minimum of two ill persons with a common exposure and at least one RT-PCR-confirmed case of norovirus disease. Univariate analyses were performed and multivariable models were fitted to estimate the independent effect of each factor. RESULTS: 843 norovirus outbreaks reported in 233 published articles from 45 countries were analyzed. Based upon 71,724 illnesses, 501 hospitalizations, and 45 deaths, overall hospitalization and mortality rates were 0.54% and 0.06%, respectively. In multivariate analysis, genogroup II genotype 4 (GII.4) norovirus strains were associated with higher hospitalization (IRR: 9.4, 95% CI: 6.1 - 14.4, p < 0.001) and mortality rates (IRR: 3.1, 95% CI: 1.3 - 7.6, p=0.013); deaths were much more likely to occur in outbreaks occurring in healthcare facilities (IRR: 60, 95% CI: 6 - 109, p=0.013). CONCLUSIONS: Our review suggests that hospitalizations and deaths were more likely in outbreaks associated with GII.4 viruses, independent of other factors, and underscores the importance of developing vaccines against GII.4 viruses to prevent severe disease outcomes. |
A model-based tool to predict the propagation of infectious disease via airports
Hwang GM , Mahoney PJ , James JH , Lin GC , Berro AD , Keybl MA , Goedecke DM , Mathieu JJ , Wilson T . Travel Med Infect Dis 2012 10 (1) 32-42 Epidemics of novel or re-emerging infectious diseases have quickly spread globally via air travel, as highlighted by pandemic H1N1 influenza in 2009 (pH1N1). Federal, state, and local public health responders must be able to plan for and respond to these events at aviation points of entry. The emergence of a novel influenza virus and its spread to the United States were simulated for February 2009 from 55 international metropolitan areas using three basic reproduction numbers (R(0)): 1.53, 1.70, and 1.90. Empirical data from the pH1N1 virus were used to validate our SEIR model. Time to entry to the U.S. during the early stages of a prototypical novel communicable disease was predicted based on the aviation network patterns and the epidemiology of the disease. For example, approximately 96% of origins (R(0) of 1.53) propagated a disease into the U.S. in under 75 days, 90% of these origins propagated a disease in under 50 days. An R(0) of 1.53 reproduced the pH1NI observations. The ability to anticipate the rate and location of disease introduction into the U.S. provides greater opportunity to plan responses based on the scenario as it is unfolding. This simulation tool can aid public health officials to assess risk and leverage resources efficiently. |
Vibrio mimicus infection associated with crayfish consumption, Spokane, Washington, 2010
Kay MK , Cartwright EJ , Maceachern D , McCullough J , Barzilay E , Mintz E , Duchin JS , MacDonald K , Turnsek M , Tarr C , Talkington D , Newton A , Marfin AA . J Food Prot 2012 75 (4) 762-4 We report a cluster of severe diarrheal disease caused by Vibrio mimicus infection among four persons who had consumed leftover crayfish the day after a private crayfish boil. Gastrointestinal illness caused by Vibrio mimicus has not been reported previously in Washington State. Three cases were laboratory confirmed by stool culture; using PCR, isolates were found to have ctx genes that encode cholera toxin (CT). Two of the cases were hospitalized under intensive care with a cholera-like illness. The illnesses were most likely caused by cross-contamination of cooked crayfish with uncooked crayfish; however, V. mimicus was not isolated nor were CT genes detected by PCR in leftover samples of frozen crayfish. Clinicians should be aware that V. mimicus can produce CT and that V. mimicus infection can cause severe illness. |
F8 gene mutation type and inhibitor development in patients with severe hemophilia A: systematic review and meta-analysis.
Gouw SC , van den Berg HM , Oldenburg J , Astermark J , de Groot PG , Margaglione M , Thompson AR , van Heerde W , Boekhorst J , Miller CH , le Cessie S , van der Bom JG . Blood 2012 119 (12) 2922-34 This systematic review was designed to provide more precise effect estimates of inhibitor development for the various types of F8 gene mutations in patients with severe hemophilia A. The primary outcome was inhibitor development and the secondary outcome was high-titer-inhibitor development. A systematic literature search was performed to include cohort studies published in peer-reviewed journals with data on inhibitor incidences in the various F8 gene mutation types and a mutation detection rate of at least 80%. Pooled odds ratios (ORs) of inhibitor development for different types of F8 gene mutations were calculated with intron 22 inversion as the reference. Data were included from 30 studies on 5383 patients, including 1029 inhibitor patients. The inhibitor risk in large deletions and nonsense mutations was higher than in intron 22 inversions (pooled OR = 3.6, 95% confidence interval [95% CI], 2.3-5.7 and OR = 1.4, 95% CI, 1.1-1.8, respectively), the risk in intron 1 inversions and splice-site mutations was equal (pooled OR = 0.9; 95% CI, 0.6-1.5 and OR = 1.0; 95% CI, 0.6-1.5), and the risk in small deletions/insertions and missense mutations was lower (pooled OR = 0.5; 95% CI, 0.4-0.6 and OR = 0.3; 95% CI, 0.2-0.4, respectively). The relative risks for developing high titer inhibitors were similar. |
Prospective study of methylenetetrahydrofolate reductase (MTHFR) variant C677T and risk of all-cause and cardiovascular disease mortality among 6000 US adults.
Yang Q , Bailey L , Clarke R , Flanders WD , Liu T , Yesupriya A , Khoury MJ , Friedman JM . Am J Clin Nutr 2012 95 (5) 1245-53 BACKGROUND: The association between blood homocysteine concentration and the risk of cardiovascular disease (CVD) remains controversial, but few studies have examined the association between MTHFR C677T (a proxy for high homocysteine concentration) and death from CVD. OBJECTIVE: The objective was to examine associations of MTHFR C677T, a proxy for high homocysteine concentrations, with CVD mortality and with all-cause mortality in a national representative prospective cohort of the US adult population before the introduction of mandatory folic acid fortification of flour. DESIGN: We used Mendelian randomization to examine the association of MTHFR C677T with cause-specific mortality in 5925 participants by accessing the NHANES III (1991-1994) Linked Mortality File (through 2006). RESULTS: A comparison of homozygotes at baseline showed that individuals with a TT genotype had a 2.2-mumol/L higher homocysteine and a 1.4-ng/mL lower folate concentration, respectively, than did those with a CC genotype. The TT genotype frequency varied from 1.2% (95% CI: 0.7, 2.0) in non-Hispanic blacks and 11.6% (95% CI: 9.6, 14.0) in non-Hispanic whites to 19.4% (95% CI: 16.7, 22.3) in Mexican Americans. After adjustment for ethnic group and other CVD risk factors, the MTHFR C677T TT genotype was associated with significantly lower CVD mortality (HR: 0.69; 95% CI: 0.50, 0. 95) but had no significant effect on all-cause mortality (HR: 0.79; 95% CI: 0.59, 1.05). After stratification by period of follow-up, the inverse association of MTHFR with CVD mortality was significant only in the period after introduction of mandatory folic acid fortification. CONCLUSION: The inverse association of MTHFR with CVD mortality was unexpected and highlights the need for caution in interpretation of Mendelian randomization studies, which, like other observational studies, can be influenced by chance, bias, or confounding. |
Emergency health risk communication during the 2007 San Diego wildfires: comprehension, compliance, and recall
Sugerman DE , Keir JM , Dee DL , Lipman H , Waterman SH , Ginsberg M , Fishbein DB . J Health Commun 2012 17 (6) 698-712 In October 2007, wildfires burned nearly 300,000 acres in San Diego County, California. Emergency risk communication messages were broadcast to reduce community exposure to air pollution caused by the fires. The objective of this investigation was to determine residents' exposure to, understanding of, and compliance with these messages. From March to June 2008, the authors surveyed San Diego County residents using a 40-question instrument and random digit dialing. The 1,802 respondents sampled were predominantly 35-64 years old (65.9%), White (65.5%), and educated past high school (79.0%). Most (82.5%) lived more than 1 mile away from the fires, although many were exposed to smoky air for 5-7 days (60.7%) inside and outside their homes. Most persons surveyed reported hearing fire-related health messages (87.9%) and nearly all (97.9%) understood the messages they heard. Respondents complied with most to all of the nontechnical health messages, including staying inside the home (58.7%), avoiding outdoor exercise (88.4%), keeping windows and doors closed (75.8%), and wetting ash before cleanup (75.6%). In contrast, few (<5%) recalled hearing technical messages to place air conditioners on recirculate, use High-Efficiency Particulate Air filters, or use N-95 respirators during ash cleanup, and less than 10% of all respondents followed these specific recommendations. The authors found that nontechnical message recall, understanding, and compliance were high during the wildfires, and reported recall and compliance with technical messages were much lower. Future disaster health communication should further explore barriers to recall and compliance with technical recommendations. |
Pertussis control: time for something new?
Clark TA , Messonnier NE , Hadler SC . Trends Microbiol 2012 20 (5) 211-3 Childhood acellular pertussis vaccines were licensed and implemented in the US in the 1990s following an effort to improve on the safety profile of whole-cell vaccines. However, waning of immunity from acellular vaccines may be driving the recent resurgence of pertussis, raising the need to consider new prevention strategies. |
Impact of preexisting adenovirus vector immunity on immunogenicity and protection conferred with an adenovirus-based H5N1 influenza vaccine
Pandey A , Singh N , Vemula SV , Couetil L , Katz JM , Donis R , Sambhara S , Mittal SK . PLoS One 2012 7 (3) e33428 The prevalence of preexisting immunity to adenoviruses in the majority of the human population might adversely impact the development of adaptive immune responses against adenovirus vector-based vaccines. To address this issue, we primed BALB/c mice either intranasally (i.n.) or intramuscularly (i.m.) with varying doses of wild type (WT) human adenovirus subtype 5 (HAd5). Following the development of immunity against HAd5, we immunized animals via the i.n. or i.m. route of inoculation with a HAd vector (HAd-HA-NP) expressing the hemagglutinin (HA) and nucleoprotein (NP) of A/Vietnam/1203/04 (H5N1) influenza virus. The immunogenicity and protection results suggest that low levels of vector immunity (<520 virus-neutralization titer) induced by priming mice with up to 10(7) plaque forming units (p.f.u.) of HAd-WT did not adversely impact the protective efficacy of the vaccine. Furthermore, high levels of vector immunity (approximately 1500 virus-neutralization titer) induced by priming mice with 10(8) p.f.u. of HAd-WT were overcome by either increasing the vaccine dose or using alternate routes of vaccination. A further increase in the priming dose to 10(9) p.f.u. allowed only partial protection. These results suggest possible strategies to overcome the variable levels of human immunity against adenoviruses, leading to better utilization of HAd vector-based vaccines. |
Improved equity in measles vaccination from integrating insecticide-treated bednets in a vaccination campaign, Madagascar
Goodson JL , Kulkarni MA , Vanden Eng JL , Wannemuehler KA , Cotte AH , Desrochers RE , Randriamanalina B , Luman ET . Trop Med Int Health 2012 17 (4) 430-7 OBJECTIVE: To evaluate the effect of integrating ITN distribution on measles vaccination campaign coverage in Madagascar. METHODS: Nationwide cross-sectional survey to estimate measles vaccination coverage, nationally, and in districts with and without ITN integration. To evaluate the effect of ITN integration, propensity score matching was used to create comparable samples in ITN and non-ITN districts. Relative risks (RR) and 95% confidence intervals (CI) were estimated via log-binomial models. Equity ratios, defined as the coverage ratio between the lowest and highest household wealth quintile (Q), were used to assess equity in measles vaccination coverage. RESULTS: National measles vaccination coverage during the campaign was 66.9% (95% CI 63.0-70.7). Among the propensity score subset, vaccination campaign coverage was higher in ITN districts (70.8%) than non-ITN districts (59.1%) (RR = 1.3, 95% CI 1.1-1.6). Among children in the poorest wealth quintile, vaccination coverage was higher in ITN than in non-ITN districts (Q1; RR = 2.4, 95% CI 1.2-4.8) and equity for measles vaccination was greater in ITN districts (equity ratio = 1.0, 95% CI 0.8-1.3) than in non-ITN districts (equity ratio = 0.4, 95% CI 0.2-0.8). CONCLUSION: Integration of ITN distribution with a vaccination campaign might improve measles vaccination coverage among the poor, thus providing protection for the most vulnerable and difficult to reach children. |
Comparative tuberculosis (TB) prevention effectiveness in children of Bacillus Calmette-Guerin (BCG) vaccines from different sources, Kazakhstan
Favorov M , Ali M , Tursunbayeva A , Aitmagambetova I , Kilgore P , Ismailov S , Chorba T . PLoS One 2012 7 (3) e32567 BACKGROUND: Except during a 1-year period when BCG vaccine was not routinely administered, annual coverage of infants with Bacillus Calmette-Guerin (BCG) in Kazakhstan since 2002 has exceeded 95%. BCG preparations from different sources (Japan, Serbia, and Russia) or none were used exclusively in comparable 7-month time-frames, September through March, in 4 successive years beginning in 2002. Our objective was to assess relative effectiveness of BCG immunization. METHODS/FINDINGS: We compared outcomes of birth cohorts from the 4 time-frames retrospectively. Three cohorts received vaccine from one of three manufacturers exclusively, and one cohort was not vaccinated. Cohorts were followed for 3 years for notifications of clinical TB and of culture-confirmed TB, and for 21 months for TB meningitis notifications. Prevention effectiveness based on relative risk of TB incidence was calculated for each vaccinated cohort compared to the non-vaccinated cohort. Although there were differences in prevention effectiveness observed among the three BCG vaccines, all were protective. The Japanese vaccine (currently used in Kazakhstan), the Serbian vaccine, and the Russian vaccine respectively were 69%, 43%, and 22% effective with respect to clinical TB notifications, and 92%, 82%, and 51% effective with respect to culture confirmed TB. All three vaccines were >70% effective with respect to TB meningitis. LIMITATIONS: Potential limitations included considerations that 1) the methodology used was retrospective, 2) multiple risk factors could have varied between cohorts and affected prevention effectiveness measures, 3) most cases were clinically diagnosed, and TB culture-positive case numbers and TB meningitis case numbers were sparse, and 4) small variations in reported population TB burden could have affected relative risk of exposure for cohorts. CONCLUSIONS/SIGNIFICANCE: All three BCG vaccines evaluated were protective against TB, and prevention effectiveness varied by manufacturer. When setting national immunization policy, consideration should be given to prevention effectiveness of BCG preparations. |
Partnering strategies for childhood agricultural safety and health
Hard DL . J Agromedicine 2012 17 (2) 225-31 The National Institute for Occupational Safety and Health (NIOSH) has been the lead federal agency of the national Childhood Agricultural Injury Prevention Initiative (CAIPI) since the program's inception in 1996 and in this role, collaborated with numerous partners in childhood agricultural injury prevention activities. This collaboration has likely helped achieve the current reduction in childhood agricultural injury. The paper looks at existing groups with past and current childhood agricultural injury prevention activities for partnering strategies that could contribute to reducing the morbidity and mortality of childhood agricultural injuries. Based upon the review, suggestions are made for future partnering strategies to continue progress in this area. |
Prehospital injury deaths - strengthening the case for prevention: nationwide cohort study
Gedeborg R , Chen LH , Thiblin I , Byberg L , Melhus H , Michaelsson K , Warner M . J Trauma Acute Care Surg 2012 72 (3) 765-772 BACKGROUND: To determine the frequency and characteristics of prehospital deaths compared with hospital deaths in different subpopulations with severe injuries. METHODS: Population-based cohort study using person-based linkage of the Swedish nationwide hospital discharge register with death certificate data. In all, 28,715 injury deaths were identified among 419,137 cases of severe injury during 1998 to 2004. Prehospital deaths were defined as autopsied out-of-hospital deaths with injury as the underlying cause. Their impact on mortality prediction was assessed using the International Classification of Disease Injury Severity Score with the C statistic as a measure of discrimination. RESULTS: The majority of all injury deaths occurred either at the scene or before hospitalization. Among persons younger than 65 years, for each hospital death there were nine prehospital deaths. A high proportion of deaths from drowning, suffocation, and firearm injuries were prehospital (85, 82, and 67% of all cases, respectively). More than 90% of hospital deaths resulted from unintentional injuries, while only 43% of prehospital deaths were unintentional. The largest increase in a cause-specific case fatality risk estimate was seen for poisoning, where inclusion of prehospital deaths increased the risk estimate from 1.6% to 22.8%. Injury mortality prediction based on International Classification of Disease Injury Severity Score improved when prehospital deaths were added to hospital data (C statistic increased from 0.86 to 0.93). CONCLUSIONS: Prehospital deaths constitute the majority of trauma deaths and differ in major characteristics from hospital deaths. The high proportion of prehospital deaths among young and middle aged people highlights the potential impact of preventive efforts. LEVEL OF EVIDENCE: III. |
Educating coaches about concussion in sports: evaluation of the CDC's "Heads Up: Concussion in Youth Sports" initiative
Covassin T , Elbin RJ , Sarmiento K . J Sch Health 2012 82 (5) 233-238 BACKGROUND: Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's (CDC's) "Heads Up: Concussion in Youth Sports" materials in preventing, recognizing, and responding to concussions. METHODS: A 22-item survey was developed with questions pertaining to demographics, awareness of sports-related concussion, and the usefulness of the CDC's "Heads Up: Concussion in Youth Sports" initiative and materials. A total of 340 youth sport coaches completed the survey, for a response rate of 34.0%. RESULTS: All youth sport coaches reported having the "Heads Up" materials for approximately 6 months before completing the survey. Seventy-seven percent of youth sports coaches reported being better able to identify athletes who may have a concussion, with 50% reported having learned something new about concussion after reviewing the materials. Sixty-three percent of youth sport coaches viewed concussions as being more serious, while 72% of coaches reporting that they are now educating others on concussion. CONCLUSION: The "Heads Up" materials demonstrated that youth sports coaches' were able to appropriately prevent, recognize, and respond to sports-related concussions after reviewing the materials. Future studies should concentrate on evaluating the impact of concussion policies, laws and media coverage on coaches' awareness and prevention, recognition, and response to concussions using a rigorous design including a control group. |
Comparison of HIV-1 resistance profiles in plasma RNA versus PBMC DNA in heavily treated patients in Honduras, a resource-limited country.
Diallo K , Murillo WE , de Rivera IL , Albert J , Zhou Z , Nkengasong J , Zhang G , Sabatier JF , Yang C . Int J Mol Epidemiol Genet 2012 3 (1) 56-65 The World Health Organization currently does not recommend the use of dried blood spot specimens for drug resistance testing in patients undergoing antiretroviral therapy (ART). Therefore, HIV-1 resistance testing using peripheral blood mononuclear cells (PBMCs) may be of value in resource-limited settings. We compared genotypic resistance profiles in plasma and PBMCs from patients failing ART in two cities of Honduras (Tegucigalpa and San Pedro Sula), a resource-limited country. One hundred patients failing ART were randomly selected from a longitudinal patient monitoring cohort. Plasma and PBMC samples without patient identifier were used for genotypic resistance testing. Sequence data were analyzed, resistance profiles were determined and compared using Stanford HIV Drug Resistance Database algorithm. Specimens with concordant resistance profiles between the two compartments were 88% (95% CI: 80.3% - 94.5 %). Nine specimens (12%, 95% CI: 6.5% - 21.3%) had discordant resistance profiles of clinical significance. Logistic regression analyses indicated that patients on triple therapy were 17.24 times more likely to have concordant drug resistance profile than those on non-triple therapies (OR=17.24, 95% CI: 3.48, 83.33), while patients with increasing number of regimens and years on ART have a decreased rate of concordance (OR = 0.59, 95% CI: 0.32, 1.09 and OR = 0.62, 95% CI: 0.43, 0.88), respectively, than those with less number of regimens and years on ART. Our results show high level of concordance between plasma and PBMC resistance profiles, indicating the possibility of using PBMCs for drug resistance testing in resources-limited settings. |
Evaluation of a high-throughput diagnostic system for detection of HIV-1 in dried blood spot samples from infants in Mozambique.
Jani IV , Sabatier J , Vubil A , Subbarao S , Bila D , de Sousa A , Mabunda N , Garcia A , Skaggs B , Ellenberger D , Ramos A . J Clin Microbiol 2012 50 (4) 1458-60 We performed a comparative analysis between Roche Amplicor HIV-1 DNA test and CAPTAQ assay for the detection of HIV in 830 dried blood spot (DBS) pediatric samples collected in Mozambique. Our results demonstrated no statistical difference between these assays. The CAPTAQ assay approached nearly 100% repeatability/accuracy. The increased throughput of testing with minimal operator interference in performing the CAPTAQ assay clearly demonstrated that this method is an improvement over the Roche Amplicor HIV-1 DNA test, version 1.5. |
Resveratrol inhibits paraquat-induced oxidative stress and fibrogenic response by activating the Nrf2 pathway
He X , Wang L , Szklarz G , Bi Y , Ma Q . J Pharmacol Exp Ther 2012 342 (1) 81-90 Nrf2 is an antioxidant-activated transcription factor that recently emerged as a critical regulator of cellular defense against oxidative and inflammatory lesions. Resveratrol (Res) is a natural phytoalexin that exhibits multiple therapeutic potentials including antioxidative and antiinflammatory effects in animals. Paraquat (PQ) is the second most widely used herbicide worldwide but selectively accumulates in human lungs to cause oxidative injury and fibrosis with high mortality. Here we analyzed the molecular mechanism of the fibrogenic response to PQ and its inhibition by Res and Nrf2. PQ dose-dependently caused toxicity in normal human bronchial epithelial cells (BEAS-2B) resulting in mitochondrial damage, oxidative stress, and cell death; Res at 10 microM markedly inhibited PQ toxicity. PQ at 10 microM stimulated production of inflammatory and profibrogenic factors (TNFalpha, IL-6, and TGFbeta1) and induced transformation of normal human lung fibroblasts (WI38-VA13) to myofibroblasts; both effects were inhibited by Res. Res strongly activated the Nrf2 signaling pathway and induced antioxidant response element-dependent cytoprotective genes. On the other hand, knockout or knockdown of Nrf2 markedly increased PQ-induced cytotoxicity, cytokine production, and myofibroblast transformation, and abolished protection by Res. The findings demonstrate that Res attenuates PQ-induced ROS production, inflammation, and fibrotic reactions by activating Nrf2 signaling. The study reveals a new pathway for molecular intervention against pulmonary oxidative injury and fibrosis. |
Epidemiologic cutoff values for triazole drugs in Cryptococcus gattii: correlation of molecular type and in vitro susceptibility
Lockhart SR , Iqbal N , Bolden CB , Debess EE , Marsden-Haug N , Worhle R , Thakur R , Harris JR . Diagn Microbiol Infect Dis 2012 73 (2) 144-8 Cryptococcus gattii causes infection in tropical and subtropical regions worldwide but has garnered increased attention since its 1999 emergence in North America. C. gattii can be divided into 4 molecular types that may represent cryptic species. Recent evidence has shown that azole antifungal MIC values differ among these molecular types. We tested a large collection of C. gattii isolates for susceptibility to 4 azole drugs. We found that isolates of molecular type VGII have the highest geometric mean (GM) fluconazole MIC values (8.6 mcg/mL), while isolates of molecular type VGI have the lowest (1.7 mcg/mL). For fluconazole, itraconazole, and voriconazole GM MIC values, VGI < VGIII < VGIV < VGII. The GM MIC values for posaconazole were similarly represented across molecular types, with the exception that VGII < VGIII and VGIV. We used the MIC values to establish preliminary epidemiologic cutoff values for each azole and molecular type of C. gattii. |
Frequency of decreased susceptibility and resistance to echinocandins among fluconazole-resistant bloodstream isolates of Candida glabrata
Pfaller MA , Castanheira M , Lockhart SR , Ahlquist AM , Messer SA , Jones RN . J Clin Microbiol 2012 50 (4) 1199-203 The echinocandin class of antifungal agents is considered to be the first-line treatment of bloodstream infections (BSI) due to Candida glabrata. Recent reports of BSI due to strains of C. glabrata resistant to both fluconazole and the echinocandins are of concern and prompted us to review the experience of two large surveillance programs, the SENTRY Antimicrobial Surveillance Program for the years 2006 through 2010 and the Centers for Disease Control and Prevention population-based surveillance conducted in 2008 to 2010. The in vitro susceptibilities of 1,669 BSI isolates of C. glabrata to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin were determined by CLSI broth microdilution methods. Fluconazole MICs of ≥64 mcg/ml were considered resistant. Strains for which anidulafungin and caspofungin MICs were ≥0.5 mcg/ml and for which micafungin MICs were ≥0.25 mcg/ml were considered resistant. A total of 162 isolates (9.7%) were resistant to fluconazole, of which 98.8% were nonsusceptible to voriconazole (MIC > 0.5 mcg/ml) and 9.3%, 9.3%, and 8.0% were resistant to anidulafungin, caspofungin, and micafungin, respectively. There were 18 fluconazole-resistant isolates that were resistant to one or more of the echinocandins (11.1% of all fluconazole-resistant isolates), all of which contained an acquired mutation in fks1 or fks2. By comparison, there were no echinocandin-resistant strains detected among 110 fluconazole-resistant isolates of C. glabrata tested in 2001 to 2004. These data document the broad emergence of coresistance over time to both azoles and echinocandins in clinical isolates of C. glabrata. |
Human papillomavirus antibody reference reagents for use in postvaccination surveillance serology
Bissett SL , Wilkinson D , Tettmar KI , Jones N , Stanford E , Panicker G , Faust H , Borrow R , Soldan K , Unger ER , Dillner J , Minor P , Beddows S . Clin Vaccine Immunol 2012 19 (3) 449-51 Suitably controlled serosurveillance surveys are essential for evaluating human papillomavirus (HPV) immunization programs. A panel of plasma samples from 18-year-old females was assembled, the majority of the samples being from recipients of the bivalent HPV vaccine. Antibody specificities were evaluated by three independent laboratories, and 3 pools that displayed no antibodies to any HPV type tested or intermediate or high levels of antibody to HPV16, HPV18, HPV31, and HPV45 were created. These pools will be useful as control reagents for HPV serology. |
Secular trends in pediatric BMI
Ogden CL , Freedman DS . Am J Clin Nutr 2012 95 (5) 999-1000 Studies that use cross-sectional data have shown an increase in the prevalence of childhood obesity, as assessed by BMI (weight in kilograms divided by height in meters squared), over the past 30 y in the United States (1). Between the 1960s and 2000 the distribution of BMI among children became more skewed, whereas between 2000 and 2010 there was relatively little change among either boys or girls (1). Further elucidation of the trend in obesity can be understood on the basis of both longitudinal and cross-sectional analyses of longer time periods such as Johnson et al (2) have published in the current issue of the Journal with the use of data from the Fels Longitudinal Growth Study. | The Fels study began enrolling pregnant women who lived in the Yellow Springs, Ohio, region in 1929 (3). Longitudinal data on weights and heights, among other measures, have been collected on participants. The authors explored differences in BMI growth velocity between 3 birth cohorts (1929–1953, 1954–1972, and 1973–1999) in the Fels study, comparing various parameters of growth curves. The differences observed between the birth cohorts show increased BMI growth velocity among children born during 1973–1999 compared with the earlier cohorts. This change is generally consistent with the pattern of increases in obesity prevalence seen in national cross-sectional data from the 1980s and 1990s. |
Selling Sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster-randomized controlled trial
Suchdev PS , Ruth LJ , Woodruff BA , Mbakaya C , Mandava U , Flores-Ayala R , Jefferds ME , Quick R . Am J Clin Nutr 2012 95 (5) 1223-30 BACKGROUND: Although the efficacy of micronutrient powders [MNPs; eg, Sprinkles MNP (Sprinkles Global Health Initiative)] in the reduction of anemia has been established, the effectiveness of these powders in real-world programs has seldom been assessed. OBJECTIVE: In this study, we evaluated the effect of community-based marketing and distribution of Sprinkles MNP on childhood rates of anemia and iron and vitamin A deficiency. DESIGN: In a cluster-randomized trial in children aged 6-35 mo in Western Kenya, 60 villages were randomly assigned to either intervention or control groups. Community vendors marketed and sold sachets of Sprinkles MNP in intervention villages. Biweekly household visits monitored the use of Sprinkles MNP. Hemoglobin, ferritin, retinol binding protein, malaria, and anthropometric measures were assessed at baseline (n = 1063) and 12 mo of follow-up (n = 862). Data were analyzed by using an intention-to-treat analysis and generalized linear mixed models. RESULTS: On average, 33% of households in intervention villages purchased Sprinkles MNP; the average weekly intake per child was 0.9 sachets ( approximately 11.3 mg Fe and approximately 328 mcg vitamin A). Compared with control subjects, intervention children had greater improvements in hemoglobin concentrations (increase of 0.9 compared with 0.6 g/dL, respectively; P = 0.02), iron deficiency (decrease of 19.3% compared with 5.3%, respectively; P = 0.001), and vitamin A deficiency (decrease of 7.5% compared with an increase 2.5% increase, respectively; P = 0.01). Results adjusted for age, sex, socioeconomic status, and maternal education showed a significant association between the hemoglobin, iron, and vitamin A concentrations of children and the number of Sprinkles MNP sachets the children consumed. The prevalence of malaria, wasting, and stunting did not change significantly in either group. CONCLUSION: Even with relatively low and infrequent use, Sprinkles MNP sales through community vendors were associated with decreased rates of anemia and iron and vitamin A deficiency in children in a resource-poor setting. This trial was registered at clinicaltrials.gov as NCT01088958. |
Assessing vitamin status in large population surveys by measuring biomarkers and dietary intake - two case studies: folate and vitamin D
Pfeiffer CM , Schleicher RL , Johnson CL , Coates PM . Food Nutr Res 2012 56 The National Health and Nutrition Examination Survey (NHANES) provides the most comprehensive assessment of the health and nutrition status of the US population. Up-to-date reference intervals on biomarkers and dietary intake inform the scientific and public health policy communities on current status and trends over time.The main purpose of dietary assessment methods such as the food-frequency questionnaire, food record (or diary), and 24-hr dietary recall is to estimate intake of nutrients and, together with supplement usage information, describe total intake of various foods or nutrients. As with all self-reporting methods, these tools are challenging to use and interpret. Yet, they are needed to establish dietary reference intake recommendations and to evaluate what proportion of the population meets these recommendations. While biomarkers are generally expensive and, to some degree, invasive, there is no question as to their ability to assess nutrition status. In some cases biomarkers can also be used to assess intake or function, although rarely can one biomarker fulfill all these purposes. For example, serum folate is a good indicator of folate intake, red blood cell (RBC) folate is a good status indicator, and plasma total homocysteine is a good functional indicator of one-carbon metabolism. Using folate and vitamin D - two vitamins that are currently hotly debated in the public health arena - as two case studies, we discuss the complexities of using biomarkers and total intake information to assess nutrition status. These two examples also show how biomarkers and intake provide different information and how both are needed to evaluate and set public health policy. We also provide guidance on general requirements for using nutrition biomarkers and food and supplement intake information in longitudinal, population-based surveys. |
Socioeconomic status and lifetime risk for workplace eye injury reported by a US population aged 50 years and over
Luo H , Beckles GL , Fang X , Crews JE , Saaddine JB , Zhang X . Ophthalmic Epidemiol 2012 19 (2) 103-10 PURPOSE: To examine whether socioeconomic status, as measured by educational attainment and annual household income, is associated with lifetime risk for workplace eye injury in a large US population. METHODS: In analyses of data from the Behavioral Risk Factor Surveillance System (2005-2007, N = 43,510), we used logistic regression analysis and propensity score matching to assess associations between socioeconomic measures and lifetime risk for workplace eye injury among those aged ≥50 years. RESULTS: The lifetime prevalence of self-reported workplace eye injury was significantly higher among men (13.5%) than women (2.6%) (P < 0.001). After adjusting for age, race/ethnicity, eye care insurance, health status, and risk-taking behaviors, men with less than high school education (adjusted odds ratio [OR] = 2.24, 95% CI: 1.74-2.87) or high school education (adjusted OR = 1.92, 95% CI: 1.57-2.33) were more likely to report having had a lifetime workplace eye injury than those with more than a high school education. Men with an annual household income <$15,000 were also more likely to report having had a lifetime workplace eye injury than those whose income was >$50,000 (adjusted OR = 1.44, 95% CI: 1.07-1.95). After adjusting for other factors, no statistically significant associations between education, income, and lifetime workplace eye injury were found among women. CONCLUSIONS: Socioeconomic status was associated with lifetime risk for workplace eye injury among men but not women. Greater public awareness of individual and societal impacts of workplace eye injuries, especially among socioeconomically disadvantaged men, could help support efforts to develop a coordinated prevention strategy to minimize avoidable workplace eye injuries. |
Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey
Luckhaupt SE , Dahlhamer JM , Ward BW , Sweeney MH , Sestito JP , Calvert GM . Am J Ind Med 2012 56 (6) 615-24 BACKGROUND: Patterns of prevalence and work-relatedness of carpal tunnel syndrome (CTS) among workers offer clues about risk factors and targets for prevention. METHODS: Data from an occupational health supplement to the 2010 National Health Interview Survey were used to estimate the prevalence of self-reported clinician-diagnosed CTS overall and by demographic characteristics. The proportion of these cases self-reported to have been attributed to work by clinicians was also examined overall and by demographic characteristics. In addition, the distribution of industry and occupation (I&O) categories to which work-related cases of CTS were attributed was compared to the distribution of I&O categories of employment among current/recent workers. RESULTS: Data were available for 27,157 adults, including 17,524 current/recent workers. The overall lifetime prevalence of clinician-diagnosed CTS among current/recent workers was 6.7%. The 12-month prevalence was 3.1%, representing approximately 4.8 million workers with current CTS; 67.1% of these cases were attributed to work by clinicians, with overrepresentation of certain I&O categories. CONCLUSIONS: CTS affected almost 5 million U.S. workers in 2010, with prevalence varying by demographic characteristics and I&O. (Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
Gender differences in acute pesticide-related illnesses and injuries among farmworkers in the United States, 1998-2007
Kasner EJ , Keralis JM , Mehler L , Beckman J , Bonnar-Prado J , Lee SJ , Diebolt-Brown B , Mulay P , Lackovic M , Waltz J , Schwartz A , Mitchell Y , Moraga-McHaley S , Roisman R , Gergely R , Calvert GM . Am J Ind Med 2012 55 (7) 571-83 BACKGROUND: Farmworkers have a high risk for acute pesticide-related illness and injury, and the rate among female farmworkers is approximately twice as high as that among males. Surveillance data were used to identify reasons for this gender difference. METHODS: We identified acute pesticide-related illness and injury cases among farmworkers from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides Program and the California Department of Pesticide Regulation. Gender-specific associations with acute pesticide-related illness and injury were assessed using chi-square tests. National Agricultural Workers Survey data were also examined. RESULTS: The over-representation of females among farmworker illness and injury cases was confined to females who did not handle pesticides (non-handlers). Female non-handler farmworkers who were affected were more likely to be working on fruit and nut crops, to be exposed to off-target pesticide drift, and to be exposed to fungicides and fumigants compared to males. CONCLUSIONS: Although there is an increased risk for acute pesticide-related illness and injury among female farmworkers, the absolute number of farmworkers with acute pesticide-related illness and injury is far higher among males than females. Furthermore, farmworkers have little or no control over many of the identified contributing factors that led to illness and injury. Stringent enforcement of existing regulations and enhanced regulatory efforts to protect against off-target drift exposures may have the highest impact in reducing acute pesticide-related illness and injury among farmworkers. (Am. J. Ind. Med. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Comparison of filter and wall deposits from samplers used to collect airborne lead-containing dusts at field sites
Chisholm WP , Lee T , Slaven JE , Nelson J , Harper M . Aerosol Sci Technol 2012 46 (4) 411-418 Pairs of Institute of Occupational Medicine (IOM) and 37 mm closed face cassette samplers (CFC) were deployed where occupational exposures to lead-containing dusts were known to occur. Discrete particle analyses of wall and filter deposits were performed by Scanning Electron Microscopy-Energy Dispersive X-ray Spectrometry (SEM-EDX). From the elemental composition and projected area diameter of each particle a density, volume, and mass were calculated, and a mass-weighted size distribution for each filter and corresponding wall deposit determined. Comparison of pairs of wall and filter mass-weighted size distributions by Mann-Whitney statistical analysis shows that in only 3 of 72 examples from either sampler were the distributions significantly different that suggests that the mechanisms of particle deposition on the sampler walls for particles in this size range (0.5 mcm through 20 mcm) do not differ for the different samplers. Furthermore, in only 4 of 33 sampler pairs did the IOM and CFC results differ. Although these results originate from several distinct processes characterized by different chemical and physical dust generation mechanisms, they suggest that in these environments the measurement of "total dust" by the CFC and inhalable dust by the IOM will be very similar when both samplers are processed the same way with respect to the including or excluding wall deposits with the filter catch. However, these results may not be applicable to environments where larger particles exist. |
News from the CDC: scaling up sustainable intervention delivery - lessons learned from the CDC Arthritis Program
Brady TJ , Sniezek J , Ramsey LA . Transl Behav Med 2012 2 (1) 3-5 Expanding behavior change programs into widespread use with meaningful population impact is a public health challenge. This report described the CDC Arthritis Program's strategic approach to fostering widespread availability and sustainability of community-based self-management education and physical activity interventions, and reviews common errors observed in efforts to disseminate and implement these interventions. The Arthritis Program strategic approach focuses on embedding interventions in delivery systems to facilitate spread and sustainability. Minimizing common implementation errors, such as pay-to-play partnerships, unsustainable delivery models, non-strategic growth strategies, non-selective training, imbalance between delivery and demand, infrequent interventions, and inadequate attention to data collection, can also enhance scaling up and sustaining behavior change interventions. (2011 Society of Behavioral Medicine.) |
Trends in health worker performance after implementing the Integrated Management of Childhood Illness strategy in Benin
Rowe AK , Osterholt DM , Kouame J , Piercefield E , Herman KM , Onikpo F , Lama M , Deming MS . Trop Med Int Health 2012 17 (4) 438-446 OBJECTIVE: Training health workers to use Integrated Management of Childhood Illness (IMCI) guidelines can improve care for ill children in outpatient settings in developing countries. However, even after IMCI training, important performance gaps exist. One potential reason is that the effect of training can rapidly wane. Our aim was to determine if the performance of IMCI-trained health workers deteriorated over 3 years. METHODS: We studied two departments in Benin. First, we performed a record review of 32 IMCI-trained health workers during the first year of IMCI implementation (2001-2002). Second, we analysed data from cross-sectional health facility surveys from 2001 to 2004 that represented the entire study area. Primary outcomes were the proportion of children under 5 years old with potentially life-threatening illnesses who received either recommended or adequate treatment, and among all children, an index of overall guideline adherence. Secondary outcomes reflected the treatment of individual diseases. Outcomes were calculated monthly, and time trends were evaluated with regression modelling. RESULTS: The record review included 9393 consultations, and the surveys included 411 consultations performed by 105 health workers. For both data sources, performance trends were essentially flat for nearly all outcomes. Absolute levels of performance revealed substantial performance gaps. CONCLUSIONS: We found no evidence that performance declined over 3 years after IMCI training. However, important performance gaps found immediately after IMCI training persisted and should be addressed. (2012 Blackwell Publishing Ltd.) |
Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women
Stormo AR , Cooper CP , Hawkins NA , Saraiya M . Prev Med 2012 54 (6) 415-21 OBJECTIVE: To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States. METHODS: A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception. RESULTS: A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5). CONCLUSION: Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed. |
Recency of pap testing and future testing plans among women aged 18-64: analysis of the 2007 Health Information National Trends Survey
Ashok M , Berkowitz Z , Hawkins NA , Tangka F , Saraiya M . J Womens Health (Larchmt) 2012 21 (7) 705-12 BACKGROUND: Cervical cancer incidence has declined as a result of Papanicolaou (Pap) test use. Current guidelines recommend increasing screening intervals for women of average risk. The objective of this study is to examine current screening intervals, factors associated with recency of Pap testing, and future testing plans. METHODS: We analyzed data from 2915 female respondents, aged 18-64, using the 2007 Health Information National Trends Survey (HINTS), a biennial national survey of access and use of cancer information in the United States. We divided time since last Pap test into ≤1 year (n=1960), >1 to ≤3 years (n=512), >3 years/never had Pap test (n=443). We performed univariate analyses and multivariate logistic regression, using proportional odds model with cumulative logit link. RESULTS: Sixty-five percent of women had their most recent Pap test within 1 year. Most expected to be screened again within 1 year (81%). This expectation was highest among women who were tested within the previous year (90.9%). Having had a test within 1 year was positively associated with age groups 31-45 vs. 46-64 years; with being non-Hispanic black vs. non-Hispanic white; with being a college graduate vs. having less education; with being married, divorced, or separated vs. widowed; with having at least one visit to a healthcare provider in the past year; and with being aware of the human papillomavirus (HPV). CONCLUSIONS: Most women currently are tested and anticipate future testing at annual intervals. To implement guidelines, increased communication and systematic or policy changes may be needed to reduce overtesting. |
Use of pooled samples from the National Health and Nutrition Examination Survey
Caudill SP . Stat Med 2012 31 (27) 3269-77 The National Centers for Disease Control and Prevention (CDC) provides an ongoing assessment of the US population's exposure to environmental chemicals by using biomonitoring in conjunction with CDC's National Health and Nutrition Examination Survey (NHANES). Characterizing the distributions of concentrations of environmental compounds or their metabolites in the US population is a primary objective of CDC's biomonitoring program. Historically, this characterization has been based on individual measurements of these compounds in body fluid or tissue from representative samples of the population. Pooling samples before making analytical measurements can reduce the costs of biomonitoring by reducing the number of analyses. For the first time in NHANES 2005-2006, a weighted pooled-sample design was implemented to facilitate pooling samples before making analytical measurements. This paper describes this design and the estimation method being developed in the National Center for Environmental Health, Division of Laboratory Sciences (NCEH/DLS) to characterize concentrations of polychlorinated and polybrominated compounds. We present percentile estimates for 2,2',4,4',5,5' -hexachlorobiphenyl (PCB153) in specific subpopulations of the US based on the NHANES 2005-2006 pooled-sample design. We also compare estimates based on individual samples from NHANES 2003-2004 with estimates based on artificially created pools from NHANES 2003-2004 using a pooled-sample design similar to the one used for NHANES 2005-2006. For NHANES 2005-2006 the number of analyses required to characterize the levels of 61 polychlorinated and 13 polybrominated compounds in the US population was reduced from 2201 to 228. At a cost of $1400 per analytical measurement, this represents a savings of approximately $2.78 million. (Copyright (c) 2012 John Wiley & Sons, Ltd.) |
Subtance use and type and severity of injury among hospitalized trauma cases: Ohio, 2004-2007
Socie E , Duffy RE , Erskine T . J Stud Alcohol Drugs 2012 73 (2) 260-7 OBJECTIVE: The purpose of this study was to determine whether persons who were injured severely enough to require hospitalization suffered more severe injury when substance use was involved. This was accomplished by evaluating four proxy outcome measures with Ohio Trauma Registry data from January 2004 through December 2007. METHOD: Four injury outcomes were identified: injury severity score, admission to an intensive care unit, presence of at least one medical complication, and hospital length of stay. We examined their association with substance (alcohol and/or other drug) use stratified by the likelihood of being tested for substance use, mechanism of injury, sex, age, race, and insurance status. Relative risks and t test scores were calculated. RESULTS: Among 89,129 trauma cases reported to the Ohio Trauma Registry during 2004-2007, more than 21% were substance users. Those younger than 45 years of age were 65% more likely to use substances than those 45 or older, men were 110% more likely than women, Blacks were 86% more likely than non-Blacks, and uninsured persons were 127% more likely than insured persons. Stratified analyses yielded 16 comparisons (4 Injury Outcomes x 4 Age-Insurance Subgroups). For 13 of these 16 comparisons, injury severity was significantly worse (p < .0001) among substance users than nonusers. CONCLUSIONS: The evidence is strong enough to conclude that, among hospitalized trauma patients, use of substances (alcohol and/or drug) was associated with increased injury severity. These findings appear to be true for the young and old, regardless of insurance status. |
The conundrum of smoking cessation and weight gain
Flegal KM . Prev Med 2012 54 193-4 Tobacco use is the leading cause of preventable death in the United States, with smoking estimated to be responsible for over 440,000 deaths per year (King et al., 2011), and smoking is associated with myriad adverse health consequences (Office of the Surgeon General, 2004). Smoking rates continue to be high, with almost 1 out of 5 adults in the US being current smokers. The proportion of smokers declined from 20.9% in 2005 to 19.3% in 2010 (King et al., 2011). Smoking cessation is still an important public health goal. | Travier et al. (in press) provide some estimates of the weight gain associated with smoking and quitting smoking. Their general findings are consistent with a large body of evidence (Audrain-McGovern and Benowitz, 2011, Flegal et al., 1995, Williamson et al., 1991). Smokers tend to have a lower prevalence of obesity than non-smokers. When people quit smoking, they are likely to gain weight. After the initial weight gain upon cessation, the subsequent weight gain of quitters tends to be similar to that of non-smokers. |
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