Proxy reports about household members with increased confusion or memory loss, 2011 Behavioral Risk Factor Surveillance System
Edwards VJ , Anderson LA , Deokar AJ . Prev Chronic Dis 2015 12 E47 To provide information about the effects of increased confusion or memory loss (ICML) in households in the United States, we describe primary respondents' reports (proxy reports) about another person in their household experiencing ICML, using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. We used proxy reports on type of assistance needed, effects on functioning in daily activities, and whether confusion or memory was discussed with a health care professional, stratifying by age of the household member with ICML (18-50 y vs ≥65 y). About 3% (n = 3,075 households) of primary respondents reported living with a household member with ICML; 75% of these household members needed some type of assistance, and nearly 60% had discussed ICML with a health care professional. Collecting proxy data about individuals in households may help paint a clearer picture of the characteristics of those experiencing cognitive decline and the potential needs of individuals and families. |
A comparison of cardiometabolic risk factors in households in rural Uganda with and without a resident with type 2 diabetes, 2012-2013
Nielsen J , Bahendeka SK , Gregg EW , Whyte SR , Bygbjerg IC , Meyrowitsch DW . Prev Chronic Dis 2015 12 E44 INTRODUCTION: Few studies have examined the health consequences of living in a household with a person who has been diagnosed with type 2 diabetes (T2D). We assessed the association of sharing a household with a person with diagnosed T2D and risk factors for cardio-metabolic diseases in Uganda, a low-income country. METHODS: Ninety households with 437 residents in southwestern Uganda were studied from December 2012 through March 2013. Forty-five of the households had a member with diagnosed T2D (hereafter "diabetic household"), and 45 households had no member with diagnosed T2D (hereafter "nondiabetic household"). We compared glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), hypertension, anthropometry, aerobic capacity, physical activity, nutrition, smoking, and diabetes-related knowledge of people without diagnosed T2D living in diabetic and nondiabetic households. RESULTS: People living in diabetic households had a significantly higher level of diabetes-related knowledge, lower levels of FPG (5.6 mmol/L vs 6.0 mmol/L), and fewer smoked (1.3% vs 12.9%) than residents of nondiabetic households. HbA1c was significantly lower in people aged 30 years or younger (5.2% vs 5.4%) and in males (5.2% vs 5.4%) living in diabetic households compared to residents of nondiabetic households. No differences were found between the 2 types of households in overweight and obesity, upper-arm fat area, intake of staple foods or cooking oil, or physical activity. CONCLUSIONS: Sharing a household with a person with T2D may have unexpected benefits on the risk factor profile for cardio-metabolic diseases, probably because of improved health behaviors and a closer connection with the health care system. Thus, future studies should consider the household for interventions targeting primary and secondary prevention of T2D. |
Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011
Breiman RF , Cosmas L , Njenga MK , Williamson J , Mott JA , Katz MA , Erdman DD , Schneider E , Oberste MS , Neatherlin JC , Njuguna H , Ondari DM , Odero K , Okoth GO , Olack B , Wamola N , Montgomery JM , Fields BS , Feikin DR . BMC Infect Dis 2015 15 (95) 95 BACKGROUND: Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. We analyzed data from population-based infectious disease surveillance for severe acute respiratory illness (SARI) among children <5 years of age in Kibera, a densely populated urban slum in Nairobi, Kenya. METHODS: Surveillance was conducted among a monthly mean of 5,874 (range=5,778-6,411) children <5 years old in two contiguous villages in Kibera. Participants had free access to the study clinic and their health events and utilization were noted during biweekly home visits. Patients meeting criteria for SARI (WHO-defined severe or very severe pneumonia, or oxygen saturation <90%) from March 1, 2007-February 28, 2011 had blood cultures processed for bacteria, and naso- and oro-pharyngeal swabs collected for quantitative real-time reverse transcription polymerase chain reaction testing for influenza viruses, parainfluenza viruses (PIV), respiratory syncytial virus (RSV), adenovirus, and human metapneumovirus (hMPV). Swabs collected during January 1, 2009-February 28, 2010 were also tested for rhinoviruses, enterovirus, parechovirus, Mycoplasma pneumoniae, and Legionella species. Swabs were collected for simultaneous testing from a selected group of control-children visiting the clinic without recent respiratory or diarrheal illnesses. RESULTS: SARI overall incidence was 12.4 cases/100 person-years of observation (PYO) and 30.4 cases/100 PYO in infants. When comparing detection frequency in swabs from 815 SARI cases and 115 healthy controls, only RSV and influenza A virus were significantly more frequently detected in cases, although similar trends neared statistical significance for PIV, adenovirus and hMPV. The incidence for RSV was 2.8 cases/100 PYO and for influenza A was 1.0 cases/100 PYO. When considering all PIV, the rate was 1.1 case/100 PYO and the rate per 100 PYO for SARI-associated disease was 1.5 for adenovirus and 0.9 for hMPV. RSV and influenza A and B viruses were estimated to account for 16.2% and 6.7% of SARI cases, respectively; when taken together, PIV, adenovirus, and hMPV may account for >20% additional cases. CONCLUSIONS: Influenza viruses and RSV (and possibly PIV, hMPV and adenoviruses) are important pathogens to consider when developing technologies and formulating strategies to treat and prevent SARI in children. |
Susceptibility to measles among perinatally HIV-infected adolescents and young adults
Morris LE , Posada R , Hickman CJ , Latner DR , Singh TA , Rautenberg A , Jao J , Bellini WJ , Sperling R . J Pediatric Infect Dis Soc 2015 4 (1) 63-66 Among our cohort of adolescents and young adults with perinatally acquired human immunodeficiency virus, few (17.6%) had measles protective antibodies by plaque reduction neutralization (PRN). Agreement was demonstrated between the commercial enzyme immunoassay and the PRN assay (K = 0.59 [95% confidence interval: 0.23-0.95]). Further studies are needed to understand the determinants of immunity in this population. |
Progress toward measles elimination - Philippines, 1998-2014
Takashima Y , Schluter WW , LMariano KM , Diorditsa S , Quiroz Castro M , Ou AC , UDucusin MJ , Garcia LC , Elfa DC , Dabbagh A , Rota P , Goodson JL . MMWR Morb Mortal Wkly Rep 2015 64 (13) 357-362 In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR) established a goal to eliminate measles by 2012.The recommended elimination strategies in WPR include 1) ≥95% 2-dose coverage with measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs)dagger; 2) high-quality case-based measles surveillance; 3) laboratory surveillance with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus genotypes; and 4) measles outbreak preparedness, rapid response, and appropriate case management. In the WPR, the Philippines set a national goal in 1998 to eliminate measles by 2008. This report describes progress toward measles elimination in the Philippines during 1998-2014 and challenges remaining to achieve the goal. WHO-United Nations Children's Fund (UNICEF)-estimated coverage with the routine first dose of MCV (MCV1) increased from 80% in 1998 to 90% in 2013, and coverage with the routine second dose of MCV (MCV2) increased from 10% after nationwide introduction in 2010 to 53% in 2013. After nationwide SIAs in 1998 and 2004, historic lows in the numbers and incidence of reported measles cases occurred in 2006. Despite nationwide SIAs in 2007 and 2011, the number of reported cases and incidence generally increased during 2007-2012, and large measles outbreaks occurred during 2013-2014 that affected infants, young children, older children, and young adults and that were prolonged by delayed and geographically limited outbreak response immunization activities during 2013-2014. For the goal of measles elimination in WPR to be achieved, sustained investments are required in the Philippines to strengthen health systems, implement the recommended elimination strategies, and develop additional strategies to identify and reduce measles susceptibility in specific geographic areas and older age groups. |
Ebola active monitoring system for travelers returning from West Africa - Georgia, 2014-2015
Parham M , Edison L , Soetebier K , Feldpausch A , Kunkes A , Smith W , Guffey T , Fetherolf R , Sanlis K , Gabel J , Cowell A , Drenzek C . MMWR Morb Mortal Wkly Rep 2015 64 (13) 347-350 The Ebola virus disease (Ebola) epidemic in West Africa has so far produced approximately 25,000 cases, more than 40 times the number in any previously documented Ebola outbreak. Because of the risk for imported disease from infected travelers, in October 2014 CDC recommended that all travelers to the United States from Ebola-affected countries receive enhanced entry screening and postarrival active monitoring for Ebola signs or symptoms until 21 days after their departure from an Ebola-affected country. The state of Georgia began its active monitoring program on October 25, 2014. The Georgia Department of Public Health (DPH) modified its existing, web-based electronic notifiable disease reporting system to create an Ebola Active Monitoring System (EAMS). DPH staff members developed EAMS from conceptualization to implementation in 6 days. In accordance with CDC recommendations, "low (but not zero) risk" travelers are required to report their daily health status to DPH, and the EAMS dashboard enables DPH epidemiologists to track symptoms and compliance with active monitoring. Through March 31, 2015, DPH monitored 1,070 travelers, and 699 (65%) used their EAMS traveler login instead of telephone or e-mail to report their health status. Medical evaluations were performed on 30 travelers, of whom three were tested for Ebola. EAMS has enabled two epidemiologists to monitor approximately 100 travelers daily, and to rapidly respond to travelers reporting signs and symptoms of potential Ebola virus infection. Similar electronic tracking systems might be useful for other jurisdictions. |
GBD 2013 and HIV incidence in high income countries
Supervie V , Archibald CP , Costagliola D , Delpech V , Hall HI , Lot F , van Sighem A , Wilson DP . Lancet 2015 385 (9974) 1177 The analyses from the Global Burden of Disease (GBD) Study 2013 reported new estimates of HIV incidence, by country.1 Here, we provide strong evidence that the GBD estimates are not correct and systematically underestimate HIV transmission, particularly in high-income countries. | The methodology used in the GBD study does not rely on the strong epidemiological surveillance data of HIV cases in high-income countries, but rather on modelling related to mortality. There are two main issues with use of mortality data to estimate HIV incidence. First, national mortality statistics underestimate the number of deaths caused by HIV.2 Second, mortality directly related to HIV is now rare in high-income countries because of high access to several classes and lines of highly effective antiretroviral therapies. Thus, trends in HIV mortality do not provide information about the latest trends in HIV incidence, but rather about diagnosis of late-stage HIV infections. A similar issue occurred with the original methodologies for back-calculation of incidence with use of data for AIDS cases and the AIDS incubation period,3 but these approaches have long been superseded because they are not applicable in the modern era of HIV and available therapies.4 In particular, extended back-calculation models relying on data not directly altered by antiretroviral therapy (ie, new HIV diagnoses) were developed.3, 4 |
HIV infection and linkage to HIV-related medical care in large urban areas in the United States, 2009
Laffoon BT , Hall HI , Babu AS , Benbow N , Hsu LC , Hu YW . J Acquir Immune Defic Syndr 2015 69 (4) 487-92 BACKGROUND: Residents of urban areas have accounted for the majority of persons diagnosed with human immunodeficiency virus (HIV) disease in the United States (US). Linking persons recently diagnosed with HIV to primary medical care is an important indicator in the National HIV/AIDS Strategy (NHAS). METHODS: We analyzed data reported to the HIV Surveillance System in 18 urban areas in the US. Standardized executable SAS programs were distributed to determine the number of HIV cases living through 2008, number of HIV cases diagnosed in 2009, and the percentage of those diagnosed in 2009 that had reported CD4 lymphocyte or HIV viral load test results within three months of HIV diagnosis. Data were presented by jurisdiction, age group at diagnosis, race/ethnicity, sex at birth, birth country, disease stage, and transmission category. PRINCIPAL FINDINGS: By jurisdiction, the percentage of persons diagnosed in 2009 with at least one CD4 or HIV viral load test within three months of diagnosis ranged from 48.5% to 92.5% (median: 70.9). The percentage of persons linked to care varied by age group and by racial/ethnic groups. Fourteen of the 18 areas reported that the percentage of persons linked to care was greater than 65%, the baseline measure indicated in the NHAS. CONCLUSIONS: A wide range in percent linked to HIV medical care was observed between residents of 18 urban areas in the US with noted age and racial disparities. Routine testing and linkage efforts and intensified prevention efforts should be considered to increase access to primary HIV-related medical care. |
Determination of a viral load threshold to distinguish symptomatic versus asymptomatic rotavirus infection in a high disease burden African population
Bennett A , Bar-Zeev N , Jere KC , Tate JE , Parashar U , Nakagomi O , Heyderman RS , French N , Iturriza-Gomara M , Cunliffe NA . J Clin Microbiol 2015 53 (6) 1951-4 We evaluated quantitative real-time PCR to establish the diagnosis of rotavirus gastroenteritis in a high disease burden population in Malawi using enzyme immunoassay as the gold standard diagnostic test. In 146 children with acute gastroenteritis and 65 asymptomatic children, we defined a cut-off point in cycle threshold value (26.7) that predicts rotavirus-attributable gastroenteritis in this population. These data will inform the evaluation of direct and indirect rotavirus vaccine effects in Africa. |
Perceived medical risks of drinking, alcohol consumption, and hepatitis C status among heavily drinking HIV primary care patients
Elliott JC , Aharonovich E , O'Leary A , Johnston B , Hasin DS . Alcohol Clin Exp Res 2014 38 (12) 3052-9 BACKGROUND: Heavy drinking poses significant risks to the health and survival of individuals infected with HIV, particularly those coinfected with hepatitis C virus (HCV). However, little is known about patients' perceptions of these risks, and whether these perceptions relate to their alcohol consumption. METHODS: A sample of 254 heavily drinking HIV primary care patients (78% male; 94.5% minority; 31.8% with HCV) reported on their perceptions of the medical risks of drinking and on their alcohol consumption prior to participation in a drinking-reduction intervention trial. RESULTS: In the HIV-infected sample as a whole, 62.9% reported that they had a medical problem made worse by drinking, and 64.3% reported restricting drinking to avoid future medical problems. Although patients coinfected with HIV/HCV reported greater efforts to restrict drinking to avoid future medical problems (adjusted odds ratio = 1.94), their reported drinking quantity and frequency did not differ from that of HIV mono-infected patients. Awareness of medical risk was not associated with drinking level. Effort to restrict drinking to avoid medical risk was associated with lower drinking quantity, frequency, and binge frequency (ps < 0.05), but the association with binge frequency was specific to patients without HCV. CONCLUSIONS: Over one-third of HIV patients are unaware of the medical risks of drinking, and do not restrict use, suggesting the need for intervention in this group. Patients coinfected with HIV/HCV may report more effort to restrict drinking, but their reported drinking quantity and frequency suggest that they are actually drinking just as heavily as HIV mono-infected patients. Awareness of medical risk was unrelated to drinking, which suggests the need for interventions consisting of more than simple education. However, reported effort to restrict drinking did predict less drinking, suggesting the importance of patient commitment and initiative in change. |
Spatial variation in hyperthermia emergency department visits among those with employer-based insurance in the United States - a case-crossover analysis
Saha S , Brock JW , Vaidyanathan A , Easterling DR , Luber G . Environ Health 2015 14 (20) 20 BACKGROUND: Predictions of intense heat waves across the United States will lead to localized health impacts, most of which are preventable. There is a need to better understand the spatial variation in the morbidity impacts associated with extreme heat across the country to prevent such adverse health outcomes. METHODS: Hyperthermia-related emergency department (ED) visits were obtained from the Truven Health MarketScan research dataset for 2000-2010. Three measures of daily ambient heat were constructed using meteorological observations from the National Climatic Data Center (maximum temperature, heat index) and the Spatial Synoptic Classification. Using a time-stratified case crossover approach, odds ratio of hyperthermia-related ED visit were estimated for the three different heat measures. Random effects meta-analysis was used to combine the odds ratios for 94 Metropolitan Statistical Areas (MSA) to examine the spatial variation by eight latitude categories and nine U.S. climate regions. RESULTS: Examination of lags for all three temperature measures showed that the odds ratio of ED visit was statistically significant and highest on the day of the ED visit. For heat waves lasting two or more days, additional statistically significant association was observed when heat index and synoptic classification was used as the temperature measure. These results were insensitive to the inclusion of air pollution measures. On average, the maximum temperature on the day of an ED visit was 93.4 degrees F in 'South' and 81.9 degrees F in the 'Northwest' climatic regions of United States. The meta-analysis showed higher odds ratios of hyperthermia ED visit in the central and the northern parts of the country compared to the south and southwest. CONCLUSION: The results showed spatial variation in average temperature on days of ED visit and odds ratio for hyperthermia ED visits associated with extreme heat across United States. This suggests that heat response plans need to be customized for different regions and the potential role of hyperthermia ED visits in syndromic surveillance for extreme heat. |
Regional variations in home canning practices and the risk of foodborne botulism in the Republic of Georgia, 2003
Tarkhashvili N , Chokheli M , Chubinidze M , Abazashvili N , Chakvetadze N , Imnadze P , Kretsinger K , Varma J , Sobel J . J Food Prot 2015 78 (4) 746-50 Foodborne botulism is a severe, paralytic illness caused by ingestion of preformed neurotoxins produced by Clostridium botulinum. In 2003, we conducted a population-based household survey of home canning practices to explore marked regional variations in botulism incidence in the Republic of Georgia (ROG). We designed a cluster sampling scheme and subdivided each of the 10 regions of the ROG into a variable number of strata. Households were selected from each stratum using a two-step cluster sampling methodology. We administered a questionnaire about home canning practices to household members responsible for food preparation. Using multivariate logistic regression analysis, we modeled high (eastern ROG) against low (western ROG) incidence areas. Overall, we surveyed 2,742 households nationwide. Home canning with a capping device hermetically sealing the lid covering the jar was practiced by 1,909 households (65.9%; 95% confidence interval [CI]: 59.8 to 72.1%). Canning was more prevalent in regions of low botulism incidence (34 versus 32%; P < 0.01). When compared with low-botulism areas, the following practices were associated with an increased risk in high-botulism areas: ≥6 months between canning vegetables and consuming them (adjusted odds ratio [aOR] = 2.1; 95% CI: 1.3 to 3.5) and adding any of the following ingredients to the jar at time of preparation: >1 tablespoon of salt per liter (aOR = 5.1; 95% CI: 1.2 to 22.6); vinegar (aOR = 2.2; 95% CI: 1.3 to 3.7), and greens (aOR = 5.6; 95% CI: 1.7 to 18.2). The following practices were associated with a decreased risk in high-botulism areas: >57 jars canned per household annually (aOR = 0.5; 95% CI: 0.3 to 0.9), covering or immersing vegetables in boiling water before placing them into the jar (aOR = 0.3 95% CI: 0.2 to 0.6), covering or immersing vegetables in boiling water after placing them into the jar (aOR = 0.4; 95% CI: 0.2 to 0.9), or adding garlic (aOR = 0.2; 95% CI: 0.1 to 0.5) or aspirin (aOR = 0.1; 95% CI: 0.1 to 0.2) to the jar at the time of preparation. |
Quantitative data analysis to determine best food cooling practices in U.S. restaurants
Schaffner DW , Brown LG , Ripley D , Reimann D , Koktavy N , Blade H , Nicholas D . J Food Prot 2015 78 (4) 778-83 Data collected by the Centers for Disease Control and Prevention (CDC) show that improper cooling practices contributed to more than 500 foodborne illness outbreaks associated with restaurants or delis in the United States between 1998 and 2008. CDC's Environmental Health Specialists Network (EHS-Net) personnel collected data in approximately 50 randomly selected restaurants in nine EHS-Net sites in 2009 to 2010 and measured the temperatures of cooling food at the beginning and the end of the observation period. Those beginning and ending points were used to estimate cooling rates. The most common cooling method was refrigeration, used in 48% of cooling steps. Other cooling methods included ice baths (19%), room-temperature cooling (17%), ice-wand cooling (7%), and adding ice or frozen food to the cooling food as an ingredient (2%). Sixty-five percent of cooling observations had an estimated cooling rate that was compliant with the 2009 Food and Drug Administration Food Code guideline (cooling to 41 degrees F [5 degrees C] in 6 h). Large cuts of meat and stews had the slowest overall estimated cooling rate, approximately equal to that specified in the Food Code guideline. Pasta and noodles were the fastest cooling foods, with a cooling time of just over 2 h. Foods not being actively monitored by food workers were more than twice as likely to cool more slowly than recommended in the Food Code guideline. Food stored at a depth greater than 7.6 cm (3 in.) was twice as likely to cool more slowly than specified in the Food Code guideline. Unventilated cooling foods were almost twice as likely to cool more slowly than specified in the Food Code guideline. Our data suggest that several best cooling practices can contribute to a proper cooling process. Inspectors unable to assess the full cooling process should consider assessing specific cooling practices as an alternative. Future research could validate our estimation method and study the effect of specific practices on the full cooling process. |
Insights into the environmental reservoir of pathogenic Vibrio parahaemolyticus using comparative genomics.
Hazen TH , Lafon PC , Garrett NM , Lowe TM , Silberger DJ , Rowe LA , Frace M , Parsons MB , Bopp CA , Rasko DA , Sobecky PA . Front Microbiol 2015 6 204 Vibrio parahaemolyticus is an aquatic halophilic bacterium that occupies estuarine and coastal marine environments, and is a leading cause of seafood-borne food poisoning cases. To investigate the environmental reservoir and potential gene flow that occurs among V. parahaemolyticus isolates, the virulence-associated gene content and genome diversity of a collection of 133 V. parahaemolyticus isolates were analyzed. Phylogenetic analysis of housekeeping genes, and pulsed-field gel electrophoresis, demonstrated that there is genetic similarity among V. parahaemolyticus clinical and environmental isolates. Whole-genome sequencing and comparative analysis of six representative V. parahaemolyticus isolates was used to identify genes that are unique to the clinical and environmental isolates examined. Comparative genomics demonstrated an O3:K6 environmental isolate, AF91, which was cultured from sediment collected in Florida in 2006, has significant genomic similarity to the post-1995 O3:K6 isolates. However, AF91 lacks the majority of the virulence-associated genes and genomic islands associated with these highly virulent post-1995 O3:K6 genomes. These findings demonstrate that although they do not contain most of the known virulence-associated regions, some V. parahaemolyticus environmental isolates exhibit significant genetic similarity to clinical isolates. This highlights the dynamic nature of the V. parahaemolyticus genome allowing them to transition between aquatic and host-pathogen states. |
Geographic and temporal trends in the molecular epidemiology and genetic mechanisms of transmitted HIV-1 drug resistance: an individual-patient- and sequence-level meta-analysis.
Rhee SY , Blanco JL , Jordan MR , Taylor J , Lemey P , Varghese V , Hamers RL , Bertagnolio S , de Wit TF , Aghokeng AF , Albert J , Avi R , Avila-Rios S , Bessong PO , Brooks JI , Boucher CA , Brumme ZL , Busch MP , Bussmann H , Chaix ML , Chin BS , D'Aquin TT , De Gascun CF , Derache A , Descamps D , Deshpande AK , Djoko CF , Eshleman SH , Fleury H , Frange P , Fujisaki S , Harrigan PR , Hattori J , Holguin A , Hunt GM , Ichimura H , Kaleebu P , Katzenstein D , Kiertiburanakul S , Kim JH , Kim SS , Li Y , Lutsar I , Morris L , Ndembi N , Ng KP , Paranjape RS , Peeters M , Poljak M , Price MA , Ragonnet-Cronin ML , Reyes-Teran G , Rolland M , Sirivichayakul S , Smith DM , Soares MA , Soriano VV , Ssemwanga D , Stanojevic M , Stefani MA , Sugiura W , Sungkanuparph S , Tanuri A , Tee KK , Truong HH , van de Vijver DA , Vidal N , Yang C , Yang R , Yebra G , Ioannidis JP , Vandamme AM , Shafer RW . PLoS Med 2015 12 (4) e1001810 BACKGROUND: Regional and subtype-specific mutational patterns of HIV-1 transmitted drug resistance (TDR) are essential for informing first-line antiretroviral (ARV) therapy guidelines and designing diagnostic assays for use in regions where standard genotypic resistance testing is not affordable. We sought to understand the molecular epidemiology of TDR and to identify the HIV-1 drug-resistance mutations responsible for TDR in different regions and virus subtypes. METHODS AND FINDINGS: We reviewed all GenBank submissions of HIV-1 reverse transcriptase sequences with or without protease and identified 287 studies published between March 1, 2000, and December 31, 2013, with more than 25 recently or chronically infected ARV-naive individuals. These studies comprised 50,870 individuals from 111 countries. Each set of study sequences was analyzed for phylogenetic clustering and the presence of 93 surveillance drug-resistance mutations (SDRMs). The median overall TDR prevalence in sub-Saharan Africa (SSA), south/southeast Asia (SSEA), upper-income Asian countries, Latin America/Caribbean, Europe, and North America was 2.8%, 2.9%, 5.6%, 7.6%, 9.4%, and 11.5%, respectively. In SSA, there was a yearly 1.09-fold (95% CI: 1.05-1.14) increase in odds of TDR since national ARV scale-up attributable to an increase in non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance. The odds of NNRTI-associated TDR also increased in Latin America/Caribbean (odds ratio [OR] = 1.16; 95% CI: 1.06-1.25), North America (OR = 1.19; 95% CI: 1.12-1.26), Europe (OR = 1.07; 95% CI: 1.01-1.13), and upper-income Asian countries (OR = 1.33; 95% CI: 1.12-1.55). In SSEA, there was no significant change in the odds of TDR since national ARV scale-up (OR = 0.97; 95% CI: 0.92-1.02). An analysis limited to sequences with mixtures at less than 0.5% of their nucleotide positions-a proxy for recent infection-yielded trends comparable to those obtained using the complete dataset. Four NNRTI SDRMs-K101E, K103N, Y181C, and G190A-accounted for >80% of NNRTI-associated TDR in all regions and subtypes. Sixteen nucleoside reverse transcriptase inhibitor (NRTI) SDRMs accounted for >69% of NRTI-associated TDR in all regions and subtypes. In SSA and SSEA, 89% of NNRTI SDRMs were associated with high-level resistance to nevirapine or efavirenz, whereas only 27% of NRTI SDRMs were associated with high-level resistance to zidovudine, lamivudine, tenofovir, or abacavir. Of 763 viruses with TDR in SSA and SSEA, 725 (95%) were genetically dissimilar; 38 (5%) formed 19 sequence pairs. Inherent limitations of this study are that some cohorts may not represent the broader regional population and that studies were heterogeneous with respect to duration of infection prior to sampling. CONCLUSIONS: Most TDR strains in SSA and SSEA arose independently, suggesting that ARV regimens with a high genetic barrier to resistance combined with improved patient adherence may mitigate TDR increases by reducing the generation of new ARV-resistant strains. A small number of NNRTI-resistance mutations were responsible for most cases of high-level resistance, suggesting that inexpensive point-mutation assays to detect these mutations may be useful for pre-therapy screening in regions with high levels of TDR. In the context of a public health approach to ARV therapy, a reliable point-of-care genotypic resistance test could identify which patients should receive standard first-line therapy and which should receive a protease-inhibitor-containing regimen. |
Selection and spread of artemisinin-resistant alleles in Thailand prior to the global artemisinin resistance containment campaign.
Talundzic E , Okoth SA , Congpuong K , Plucinski MM , Morton L , Goldman IF , Kachur PS , Wongsrichanalai C , Satimai W , Barnwell JW , Udhayakumar V . PLoS Pathog 2015 11 (4) e1004789 The recent emergence of artemisinin resistance in the Greater Mekong Subregion poses a major threat to the global effort to control malaria. Tracking the spread and evolution of artemisinin-resistant parasites is critical in aiding efforts to contain the spread of resistance. A total of 417 patient samples from the year 2007, collected during malaria surveillance studies across ten provinces in Thailand, were genotyped for the candidate Plasmodium falciparum molecular marker of artemisinin resistance K13. Parasite genotypes were examined for K13 propeller mutations associated with artemisinin resistance, signatures of positive selection, and for evidence of whether artemisinin-resistant alleles arose independently across Thailand. A total of seven K13 mutant alleles were found (N458Y, R539T, E556D, P574L, R575K, C580Y, S621F). Notably, the R575K and S621F mutations have previously not been reported in Thailand. The most prevalent artemisinin resistance-associated K13 mutation, C580Y, carried two distinct haplotype profiles that were separated based on geography, along the Thai-Cambodia and Thai-Myanmar borders. It appears these two haplotypes may have independent evolutionary origins. In summary, parasites with K13 propeller mutations associated with artemisinin resistance were widely present along the Thai-Cambodia and Thai-Myanmar borders prior to the implementation of the artemisinin resistance containment project in the region. |
Teachback methodology: building global training capacity with a unique training-of-trainers course
Tryon C , Hopkins P , Khan A , Walton W . Public Health Action 2015 5 (1) 79-82 To meet the global demand for training assistance in tuberculosis (TB) and human immunodeficiency virus (HIV) infection, a systematic model was created to conduct training-of-trainers courses. The Teachback Methodology curriculum was created using adult learning principles and implemented by collaborating with partners to create training-of-trainers courses. A total of 42 courses were held in 18 countries, resulting in 901 participants being able to enhance their training skills. During training- of-trainers courses, the participants practice teaching a course. Trainers observe the participants' performance and provide feedback on training skills and accuracy of course content. The methodology can be integrated with TB and HIV courses to enhance training capacity and help build a competent workforce. |
Sustained decrease in laboratory detection of rotavirus after implementation of routine vaccination - United States, 2000-2014
Aliabadi N , Tate JE , Haynes AK , Parashar UD . MMWR Morb Mortal Wkly Rep 2015 64 (13) 337-342 Rotavirus infection is the leading cause of severe gastroenteritis among infants and young children worldwide. Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection caused significant morbidity among U.S. children, with an estimated 55,000-70,000 hospitalizations and 410,000 clinic visits annually. The disease showed a characteristic winter-spring seasonality and geographic pattern, with annual seasonal activity beginning in the West during December-January, extending across the country, and ending in the Northeast during April-May. To characterize changes in rotavirus disease trends and seasonality following introduction of rotavirus vaccines in the United States, CDC compared data from CDC's National Respiratory and Enteric Virus Surveillance System (NREVSS), a passive laboratory reporting system, for prevaccine (2000-2006) and postvaccine (2007-2014) years. National declines in rotavirus detection were noted, ranging from 57.8%-89.9% in each of the 7 postvaccine years compared with all 7 prevaccine years combined. A biennial pattern of rotavirus activity emerged in the postvaccine era, with years of low activity and highly erratic seasonality alternating with years of moderately increased activity and seasonality similar to that seen in the prevaccine era. These results demonstrate the substantial and sustained effect of rotavirus vaccine in reducing the circulation and changing the epidemiology of rotavirus among U.S. children. |
Evaluation of anthrax vaccine safety in 18 to 20 year olds: a first step towards age de-escalation studies in adolescents
King JC Jr , Gao Y , Quinn CP , Dreier TM , Vianney C , Espeland EM . Vaccine 2015 33 (21) 2470-6 BACKGROUND/OBJECTIVES: Anthrax vaccine adsorbed (AVA, BioThrax(R)) is recommended for post-exposure prophylaxis administration for the US population in response to large-scale Bacillus anthracis spore exposure. However, no information exists on AVA use in children and ethical barriers exist to performing pre-event pediatric AVA studies. A Presidential Ethics Commission proposed a potential pathway for such studies utilizing an age de-escalation process comparing safety and immunogenicity data from 18 to 20 year-olds to older adults and if acceptable proceeding to evaluations in younger adolescents. We conducted exploratory summary re-analyses of existing databases from 18 to 20 year-olds (n=74) compared to adults aged 21 to 29 years (n=243) who participated in four previous US government funded AVA studies. METHODS: Data extracted from studies included elicited local injection-site and systemic adverse events (AEs) following AVA doses given subcutaneously at 0, 2, and 4 weeks. Additionally, proportions of subjects with ≥4-fold antibody rises from baseline to post-second and post-third AVA doses (seroresponse) were obtained. RESULTS: Rates of any elicited local AEs were not significantly different between younger and older age groups for local events (79.2% vs. 83.8%, P=0.120) or systemic events (45.4% vs. 50.5%, P=0.188). Robust and similar proportions of seroresponses to vaccination were observed in both age groups. CONCLUSIONS: AVA was safe and immunogenic in 18 to 20 year-olds compared to 21 to 29 year-olds. These results provide initial information to anthrax and pediatric specialists if AVA studies in adolescents are required. |
Influenza vaccination in children with neurologic or neurodevelopmental disorders
Smith M , Peacock G , Uyeki TM , Moore C . Vaccine 2015 33 (20) 2322-7 BACKGROUND: Children with neurologic or neurodevelopmental disorders (NNDDs) are at increased risk of complications from influenza. Although the Advisory Committee on Immunization Practices (ACIP) has recognized NNDDs as high-risk conditions for influenza complications since 2005, little is known about influenza vaccination practices in this population. METHODS: CDC collaborated with Family Voices, a national advocacy group for children with special healthcare needs, to recruit parents of children with chronic medical conditions. Parents were surveyed about their knowledge, attitudes, and practices surrounding influenza vaccination. The primary outcome of interest was parental report of vaccination, or intent to vaccinate, at the time of survey participation. CDC also collaborated with the American Academy of Pediatrics to recruit primary care and specialty physicians who provide care for high-risk children, specifically those with neurologic conditions. The primary outcome was physician recognition of ACIP high-risk influenza conditions. RESULTS: 2138 surveys were completed by parents of children with high-risk conditions, including 1143 with at least one NNDD. Overall, 50% of children with an NNDD were vaccinated, or their parents planned to have them vaccinated against influenza. Among all 2138 children, in multivariable analysis, the presence of a respiratory condition and prior seasonal influenza vaccination was significantly associated with receipt or planned current season influenza vaccination, but the presence of an NNDD was not. 412 pediatricians completed the provider survey. Cerebral palsy was recognized as a high-risk influenza condition by 74% of physician respondents, but epilepsy (51%) and intellectual disability (46%) were less commonly identified. CONCLUSIONS: Our estimates of influenza vaccination in children with NNDDs are comparable to published reports of vaccination in healthy children, which continue to be suboptimal. Education of parents of children with NNDDs and healthcare providers about influenza and the benefit of annual influenza vaccination is needed. |
Rectal application of a highly osmolar personal lubricant in a macaque model induces acute cytotoxicity but does not increase risk of SHIV infection
Vishwanathan SA , Morris MR , Wolitski RJ , Luo W , Rose CE , Blau DM , Tsegaye T , Zaki SR , Garber DA , Jenkins LT , Henning TC , Patton DL , Hendry RM , McNicholl JM , Kersh EN . PLoS One 2015 10 (4) e0120021 BACKGROUND: Personal lubricant use is common during anal intercourse. Some water-based products with high osmolality and low pH can damage genital and rectal tissues, and the polymer polyquaternium 15 (PQ15) can enhance HIV replication in vitro. This has raised concerns that lubricants with such properties may increase STD/HIV infection risk, although in vivo evidence is scarce. We use a macaque model to evaluate rectal cytotoxicity and SHIV infection risk after use of a highly osmolar (>8,000 mOsm/kg) water-based lubricant with pH of 4.4, and containing PQ15. METHODS: Cytotoxicity was documented by measuring inflammatory cytokines and epithelial tissue sloughing during six weeks of repeated, non-traumatic lubricant or control buffer applications to rectum and anus. We measured susceptibility to SHIVSF162P3 infection by comparing virus doses needed for rectal infection in twenty-one macaques treated with lubricant or control buffer 30 minutes prior to virus exposure. RESULTS: Lubricant increased pro-inflammatory cytokines and tissue sloughing while control buffer (phosphate buffered saline; PBS) did not. However, the estimated AID50 (50% animal infectious dose) was not different in lubricant- and control buffer-treated macaques (p = 0.4467; logistic regression models). CONCLUSIONS: Although the test lubricant caused acute cytotoxicity in rectal tissues, it did not increase susceptibility to infection in this macaque model. Thus neither the lubricant-induced type/extent of inflammation nor the presence of PQ15 affected infection risk. This study constitutes a first step in the in vivo evaluation of lubricants with regards to HIV transmission. |
Measuring estrogen exposure and metabolism: workshop recommendations on clinical issues
Demers LM , Hankinson SE , Haymond S , Key T , Rosner W , Santen RJ , Stanczyk FZ , Vesper HW , Ziegler RG . J Clin Endocrinol Metab 2015 100 (6) jc20151040 Not Available. |
Treatment of attention deficit/hyperactivity disorder among children with special health care needs
Visser SN , Bitsko RH , Danielson ML , Ghandour RM , Blumberg SJ , Schieve LA , Holbrook JR , Wolraich ML , Cuffe SP . J Pediatr 2015 166 (6) 1423-30 e1-2 OBJECTIVES: To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. STUDY DESIGN: Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. RESULTS: Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). CONCLUSION: These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group. |
Next steps for birth defects research and prevention: the Birth Defects Study to Evaluate Pregnancy Exposures (BD-STEPS)
Tinker SC , Carmichael SL , Anderka M , Browne ML , Caspers Conway KM , Meyer RE , Nembhard WN , Olney RS , Reefhuis J . Birth Defects Res A Clin Mol Teratol 2015 103 (8) 733-40 BACKGROUND: The Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS) is a population-based, multi-Center case-control study of modifiable risk factors for selected birth defects in the United States. BD-STEPS is the second major research effort of the Centers for Birth Defects Research and Prevention, which extends and expands the initial research effort, the National Birth Defects Prevention Study (NBDPS). METHODS: BD-STEPS focuses on 17 categories of structural birth defects selected based on severity, prevalence, consistent ascertainment, and previous findings that warrant additional research. Cases are identified through existing birth defects surveillance programs; controls are from vital records or birth hospital logs from the same catchment area. BD-STEPS uses a standardized computer-assisted telephone interview to collect information from case and control mothers on topics including demographics, health conditions, and medication use. Following the maternal interview, selected Centers request permission to sample residual newborn screening blood spots from state repositories for genetic analyses. New components planned for BD-STEPS include linkages with external datasets and use of online questionnaires to collect in-depth information on selected exposures. RESULTS: BD-STEPS extends NBDPS by continuing to collect data on many exposures that were assessed in NBDPS, allowing data from both studies to be combined and providing an unprecedented sample size to analyze rare exposures. BD-STEPS expands upon NBDPS by collecting more detailed information on existing exposures as well as new exposures. CONCLUSION: The goal of BD-STEPS is to provide women and healthcare providers with information they need to make decisions to promote the healthiest pregnancy possible. |
Progress in identifying infants with hearing loss - United States, 2006-2012
Williams TR , Alam S , Gaffney M . MMWR Morb Mortal Wkly Rep 2015 64 (13) 351-356 Congenital hearing loss affects one to three of every 1,000 live born infants and negatively impacts children through delayed speech, language, social, and emotional development when undetected. To address this public health issue, jurisdiction-based Early Hearing Detection and Intervention (EHDI) programs are working to ensure all newborns are screened for hearing loss, receive follow-up diagnostic testing (DX) if they do not pass the screening, and are enrolled in early intervention (EI) services if diagnosed with a permanent hearing loss. Although substantial progress has been made in the provision and documentation of services, challenges remain because, unlike screening results, diagnostic test results and enrollment in EI are not consistently reported to the EHDI programs. Therefore, it is difficult for states and territories to know if infants received recommended follow-up services (diagnostic testing and/or EI services), often resulting in infants being classified at either stage as lost to follow-up (LFU)/lost to documentation (LTD). To assess progress toward identifying children with hearing loss and reducing LFU/LTD for DX (LFU/LTD-DX) and EI enrollment (LFU/LTD-EI), CDC analyzed EHDI surveillance data for 2006-2012. Results indicated that the number of jurisdictions reporting data increased from 49 to 57, rates of screening increased from 95.2% to 96.6%, rates of referral from screening decreased from 2.3% to 1.6%, rates of diagnosis among infants not passing their final screening increased from 4.8% to 10.3%, and enrollment in EI among children diagnosed with hearing loss increased from 55.4% to 61.7%, whereas rates for both LFU/LTD-DX and LFU/LTD-EI declined. These findings show sustained progress toward screening, identification, and enrollment in EI as well as highlighting the need for continued improvements in the provision and documentation of EHDI services. |
Reported use and perceived understanding of sodium information on US nutrition labels
Levings JL , Maalouf J , Tong X , Cogswell ME . Prev Chronic Dis 2015 12 E48 INTRODUCTION: Comparing nutrition labels and choosing lower sodium foods are tactics to help reduce excessive sodium intake, a major risk factor for hypertension. Our objective was to assess US adult consumers' reported use and perceived understanding of sodium information on nutrition labels by sociodemographic and health status. METHODS: We analyzed responses to questions from 3,729 adults aged 18 years or older participating in 2 national cross-sectional mail panel surveys in 2010. RESULTS: We found that 19.3% (95% confidence interval [CI], 17.2%-21.6%) of respondents agreed they were confused about how to figure out how much sodium is in the foods they eat; 57.9% (95% CI, 55.4%-60.5%) reported that they or the person who shops for their food buy items labeled low salt or low sodium; and 46.8% (95% CI, 44.3%-49.4%) reported they check nutrition labels for sodium content as a tactic to limit salt. Consumers with a high school education or less were more likely than college graduates to report they were confused about sodium content on labels (adjusted odds ratio [AOR], 1.9; 95% CI, 1.4-2.8) and less likely to check labels for sodium as a tactic to limit salt intake (AOR, 0.7; 95% CI, 0.6-0.98). CONCLUSION: Most survey respondents in our study reported buying low sodium food items. However, a higher proportion of respondents with low education than respondents with high education reported confusion with and less use of sodium content information, suggesting enhanced efforts may be needed to assist this group. Opportunity exists for health care professionals to educate patients about using and understanding nutrition labels and consuming a diet consistent with the Dietary Approaches to Stop Hypertension (DASH) eating plan. |
Sodium content in packaged foods by census division in the United States, 2009
Lee AK , Schieb LJ , Yuan K , Maalouf J , Gillespie C , Cogswell ME . Prev Chronic Dis 2015 12 E43 Excess sodium intake correlates positively with high blood pressure. Blood pressure varies by region, but whether sodium content of foods sold varies across regions is unknown. We combined nutrition and sales data from 2009 to assess the regional variation of sodium in packaged food products sold in 3 of the 9 US census divisions. Although sodium density and concentration differed little by region, fewer than half of selected food products met Food and Drug Administration sodium-per-serving conditions for labeling as "healthy." Regional differences in hypertension were not reflected in differences in the sodium content of packaged foods from grocery stores. |
Variations in head-and-face shape of Chinese civilian workers
Liu Y , Xi P , Joseph M , Zhuang Z , Shu C , Jiang L , Bergman M , Chen W . Ann Occup Hyg 2015 59 (7) 932-44 This study aims to elucidate variations in head-and-face shape among the Chinese civilian workers. Most respirator manufacturers are using outdated, Western anthropometric data to design respirators for the Chinese workers. Therefore, newly acquired anthropometric data specific to the Chinese population are needed to create more effective personal protective equipment. The three-dimensional (3D) head scans of 350 participants, who were selected from the 3000 participants in the 2006 Chinese Anthropometric Survey, were processed using geometric processing techniques. Each scan was then linked with the others, making statistical shape analysis on a dense set of 3D points possible. Furthermore, this provided for the reduction of scan noise as well as for the patching of holes. Following general scan correspondence and fine tuning, principal component analysis was used to analyze the variability in head-and-face shape of the 3D images. More than 90% of the variability among head-and-face shapes was accounted for with 26 principal components. Future study is recommended so the overall usefulness of the point cloud-based approach for the quantification of variations in facial morphology may be determined. |
Work-related asthma - 22 states, 2012
Mazurek JM , White GE . MMWR Morb Mortal Wkly Rep 2015 64 (13) 343-346 Work-related asthma (WRA) is a preventable occupational disease associated with serious adverse health outcomes. Using the 2006-2009 Behavioral Risk Factor Surveillance System (BRFSS) Adult Asthma Call-back Survey (ACBS) data from 38 states and the District of Columbia, CDC estimated that among ever-employed adults with current asthma, the proportion of current asthma that is work-related was 9.0%. In 2011, the BRFSS cellular telephone samples were added to the traditional landline telephone samples and the weighting methodology was changed.dagger In 2012, a revised ACBS question on WRA diagnosis section sign was asked. To provide updated estimates of current asthma prevalence and the proportion of asthma that is work-related, by state, CDC analyzed data from BRFSS and ACBS collected from 22 states using both landline and cellular telephone samples during 2012. This report summarizes the results of that analysis, which indicate that 9.0% of adults had current asthma and that among ever-employed adults with current asthma, the overall proportion of current asthma that is work-related was 15.7%. State-specific proportions of asthma that is work-related ranged from 9.0% to 23.1%. Distribution of the proportion of WRA significantly differed by age and was highest among persons aged 45-64 years (20.7%). These findings provide a new baseline after the implementation of changes in survey methodology and the adoption of a revised WRA question. These results can assist states, other government agencies, health professionals, employers, workers, and worker representatives to better target intervention and prevention efforts to reduce the burden of WRA. |
Carbon nanotube and nanofiber exposure assessments: an analysis of 14 site visits
Dahm MM , Schubauer-Berigan MK , Evans DE , Birch ME , Fernback JE , Deddens JA . Ann Occup Hyg 2015 59 (6) 705-23 Recent evidence has suggested the potential for wide-ranging health effects that could result from exposure to carbon nanotubes (CNT) and carbon nanofibers (CNF). In response, the National Institute for Occupational Safety and Health (NIOSH) set a recommended exposure limit (REL) for CNT and CNF: 1 microg m-3 as an 8-h time weighted average (TWA) of elemental carbon (EC) for the respirable size fraction. The purpose of this study was to conduct an industrywide exposure assessment among US CNT and CNF manufacturers and users. Fourteen total sites were visited to assess exposures to CNT (13 sites) and CNF (1 site). Personal breathing zone (PBZ) and area samples were collected for both the inhalable and respirable mass concentration of EC, using NIOSH Method 5040. Inhalable PBZ samples were collected at nine sites while at the remaining five sites both respirable and inhalable PBZ samples were collected side-by-side. Transmission electron microscopy (TEM) PBZ and area samples were also collected at the inhalable size fraction and analyzed to quantify and size CNT and CNF agglomerate and fibrous exposures. Respirable EC PBZ concentrations ranged from 0.02 to 2.94 microg m-3 with a geometric mean (GM) of 0.34 microg m-3 and an 8-h TWA of 0.16 microg m-3. PBZ samples at the inhalable size fraction for EC ranged from 0.01 to 79.57 microg m-3 with a GM of 1.21 microg m-3. PBZ samples analyzed by TEM showed concentrations ranging from 0.0001 to 1.613 CNT or CNF-structures per cm3 with a GM of 0.008 and an 8-h TWA concentration of 0.003. The most common CNT structure sizes were found to be larger agglomerates in the 2-5 microm range as well as agglomerates >5 microm. A statistically significant correlation was observed between the inhalable samples for the mass of EC and structure counts by TEM (Spearman rho = 0.39, P < 0.0001). Overall, EC PBZ and area TWA samples were below the NIOSH REL (96% were <1 mug m-3 at the respirable size fraction), while 30% of the inhalable PBZ EC samples were found to be >1 mug m-3. Until more information is known about health effects associated with larger agglomerates, it seems prudent to assess worker exposure to airborne CNT and CNF materials by monitoring EC at both the respirable and inhalable size fractions. Concurrent TEM samples should be collected to confirm the presence of CNT and CNF. |
Case cluster of pneumoconiosis at a coal slag processing facility
Fagan KM , Cropsey EB , Armstrong JL . Am J Ind Med 2015 58 (5) 568-76 BACKGROUND: During an inspection by the Occupational Safety and Health Administration (OSHA) of a small coal slag processing plant with 12 current workers, four cases of pneumoconiosis were identified among former workers. METHODS: The OSHA investigation consisted of industrial hygiene sampling, a review of medical records, and case interviews. RESULTS: Some personal sampling measurements exceeded the OSHA Permissible Exposure Limit (PEL) for total dust exposures of 15 mg/m(3) , and the measured respirable silica exposure of 0.043 mg/m(3) , although below OSHA's current PEL for respirable dust containing silica, was above the American Conference of Governmental Industrial Hygienists' Threshold Limit Value (TLV). Chest x-rays for all four workers identified small opacities consistent with pneumoconiosis. CONCLUSION: This is the first known report of lung disease in workers processing coal slag and raises concerns for workers exposed to coal slag dust. |
Evaluation of a multiple sclerosis cluster among nurses in an inpatient oncology ward
Page EH , Couch JR , de Perio MA . J Occup Environ Hyg 2014 12 (5) D54-9 In January 2011 the National Institute for Occupational Safety and Health (NIOSH) received a request from three employees in the inpatient oncology unit of a university hospital in Wisconsin concerning a potential multiple sclerosis (MS) cluster. Three of the 41 nurses in the unit were diagnosed with MS between 2007 and 2010, and employees were concerned about their exposures to chemotherapy drugs and helicopter exhaust. The employees were also concerned that exposure to acrolein, a metabolite from exposure to some chemotherapy drugs that is also present in helicopter engine exhaust, may be associated with MS.(Citation1) | The 39-bed unit housed hematology/oncology, bone marrow transplant, and palliative care patients. At the time of this evaluation, the average occupancy was 68%, and 17% of the patients received chemotherapy daily. The hospital oncology unit administers a wide variety of chemotherapy drugs and daily administration amounts vary depending upon patient load. The decision to concentrate sampling efforts on cyclophosphamide and ifosfamide was made based upon their frequent use at the hospital and that fact that these drugs are metabolized into acrolein in the human body. |
Does perceived neighborhood walkability and safety mediate the association between education and meeting physical activity guidelines?
Pratt M , Yin S , Soler R , Njai R , Siegel PZ , Liao Y . Prev Chronic Dis 2015 12 E46 The role of neighborhood walkability and safety in mediating the association between education and physical activity has not been quantified. We used data from the 2010 and 2012 Communities Putting Prevention to Work Behavioral Risk Factor Surveillance System and structural equation modeling to estimate how much of the effect of education level on physical activity was mediated by perceived neighborhood walkability and safety. Neighborhood walkability accounts for 11.3% and neighborhood safety accounts for 6.8% of the effect. A modest proportion of the important association between education and physical activity is mediated by perceived neighborhood walkability and safety, suggesting that interventions focused on enhancing walkability and safety could reduce the disparity in physical activity associated with education level. |
The role of law in supporting secondary uses of electronic health information
Ramanathan T , Schmit C , Menon A , Fox C . J Law Med Ethics 2015 43 Suppl 1 48-51 Law establishes the foundation for the "secondary use" of electronic health information (EHI) for public health purposes. Federal law, state law, and legal tools, such as contracts and policies, support data exchange between providers, facilities, and public health departments. This article describes the legal landscape surrounding secondary use of EHI. |
Superficial venous disease and combined hormonal contraceptives: a systematic review
Tepper NK , Marchbanks PA , Curtis KM . Contraception 2015 94 (3) 275-9 BACKGROUND: Superficial venous disease, which includes superficial venous thrombosis (SVT) and varicose veins, may be associated with a higher risk of venous thromboembolism (VTE). Use of combined hormonal contraceptives (CHCs) has been associated with an increased risk of VTE compared with non-use. Little is known about whether use of CHCs by women with superficial venous disease may further elevate the risk of VTE. OBJECTIVES: To investigate evidence regarding risk of VTE in women with SVT or varicose veins who use CHCs compared with non-CHC users. METHODS: We searched the PubMed database for all English language articles published from database inception through September 2014. We included primary research studies that examined women with SVT or varicose veins who used CHCs compared to women with these conditions who did not use CHCs. Outcomes of interest included VTE (among women with SVT or varicose veins) and SVT (for those with varicose veins). RESULTS: Two studies were identified that met inclusion criteria. One fair quality case-control study reported an odds ratio (OR) for VTE of 43.0 (95% confidence interval [CI] 15.5-119.3) among women with SVT using oral contraceptives (OCs) compared with non-users without SVT. The OR for VTE was also increased for women with SVT not using OCs (OR 5.1; 95% CI 2.8-9.5) and for women without SVT using OCs (OR 4.0; 95% CI 3.3-4.7), compared with non-users without SVT. One fair quality cohort study demonstrated that women with varicose veins had an increased rate of VTE with use of OCs (1.85 per 1,000 women-years [WY]), compared with users without varicose veins (0.84 per 1,000 WY), non-users with varicose veins (0.31 per 1,000 WY), and non-users without varicose veins (0.19 per 1,000 WY). This study also demonstrated that women with varicose veins had an increased rate of SVT with use of OCs (10.63 per 1,000 WY), compared with non-users with varicose veins (7.59 per 1,000 WY), users without varicose veins (1.89 per 1,000 WY), and non-users without varicose veins (0.77 per 1,000 WY). CONCLUSION: Two studies suggest increased risk of VTE among OC users with superficial venous disease; however, no definitive conclusions can be made due to the limited number of studies and limitations in study quality. Theoretical concerns need to be clarified with further research on whether the risk of significant sequelae from superficial venous disease among CHC users is related to clinical severity of disease and underlying factors. |
Vital Signs: trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive services - United States, 2005-2013
Romero L , Pazol K , Warner L , Gavin L , Moskosky S , Besera G , Loyola Briceno AC , Jatlaoui T , Barfield W . MMWR Morb Mortal Wkly Rep 2015 64 (13) 363-369 The teen birth rate in the United States has continued to decline during the past two decades, from 61.8 births per 1,000 teens aged 15-19 years in 1991 to an all-time low of 26.5 births per 1,000 teens in 2013. Improved contraceptive use has contributed substantially to this decline; however, there were approximately 273,000 births to teens in 2013, and the U.S. teen pregnancy rate remains up to seven times higher than in some developed countries. Teen childbearing has potential negative health, economic, and social consequences for mothers and their children, and each year costs the United States approximately $9.4 billion. |
Adaptation guidance for evidence-based teen pregnancy and STI/HIV prevention curricula: from development to practice
Rolleri LA , Fuller TR , Firpo-Triplett R , Lesesne CA , Moore C , Leeks KD . Am J Sex Educ 2014 9 (2) 135-154 Evidence-based interventions (EBIs) are effective in preventing adolescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field. To address this need, the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health initiated the Adaptation Guidance Project. The project included the development of a comprehensive adaptation guidance framework and adaptation kits for select evidence-based teen pregnancy and HIV prevention programs. In addition, three innovative concepts emerged that have application to other adaptation program and evaluation efforts, including moving research into practice. First, the authors defined the core components of an EBI in three distinct ways: core content, core pedagogy, and core implementation. Second, they piloted a practitioner-friendly adaptation guidance-messaging schema-Green, Yellow, and Red Light Adaptations, and last they included fidelity/adaptation monitoring logs. This article will describe the process used to develop the adaptation guidance kits, including the main features and tools. |
Assessment of compliance with US Public Health Service Clinical Practice Guideline for tobacco by primary care physicians
Kruger J , O'Halloran A , Rosenthal A . Harm Reduct J 2015 12 7 BACKGROUND: The US Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update established an expanded standard of care, calling on physicians to consistently identify their patients who use tobacco and treat them using counseling and medication. FINDINGS: To assess compliance, we examined the extent to which physicians self-report following four of the five components of the 5A model: Ask about tobacco use, Advise patients who use tobacco to quit, Assist the patient in making a quit attempt, and Arrange for follow-up care. We used data from a Web-based panel survey administered to a convenience sample of 1,253 primary care providers (family/general practitioners, internists, and obstetrician/gynecologists). We found that 97.1% of the providers reported that they consistently Asked and documented tobacco use, while 98.6% reported that they consistently Advised their patients to quit using tobacco. Among the family/general practitioners and internists, 98.3% recommended "any" (medication, counseling, counseling and medication, telephone quitline) smoking cessation strategies (Assist). Among all providers, 48.0% reported that they consistently scheduled a follow-up visit (Arrange). CONCLUSIONS: This study revealed that most primary care physicians reported that they Ask their patients about tobacco use, Advise them to quit, and Assist them in making a quit attempt, but only half reported that they Arrange a follow-up visit. Tobacco use screening and intervention are among the most effective clinical preventive services; thus, efforts to educate, encourage, and support primary care physicians to provide evidence-based treatments to their patients should be continued. |
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