Long-term health and economic impact of preventing and reducing overweight and obesity in adolescence
Wang LY , Denniston M , Lee S , Galuska D , Lowry R . J Adolesc Health 2010 46 (5) 467-73 PURPOSE: Using data from the 2000 National Medical Expenditure Panel Survey and estimates from published studies, this study projected the long-term health and economic impacts of preventing and reducing overweight and obesity in today's adolescents. METHODS: We developed a body mass index progression model to project the impact of a 1% point reduction in both overweight and obese adolescents aged 16-17 years at present on the number of nonoverweight, overweight, and obese adults at age 40 years. We then estimated its impact on the lifetime medical costs and quality-adjusted life years (QALYs) after age 40. Medical costs (in 2007 dollars) and QALYs were discounted to age 17 years. RESULTS: A 1% point reduction in both overweight and obese adolescents ages 16-17 years at present could reduce the number of obese adults by 52,821 in the future. As a result, lifetime medical care costs after age 40 years would decrease by $586 million and lifetime QALYs would increase by 47,138. In the worst case scenario, the 1% point reduction would lower medical costs by $463 million and increase QALYs by 34,394; in the best case scenario, it would reduce medical costs by $691 million and increase QALYs by 57,149. CONCLUSIONS: Obesity prevention in adolescents goes beyond its immediate benefits; it can also reduce medical costs and increase QALYs substantially in later life. Therefore, it is important to include long-term health and economic benefits when quantifying the impact of obesity prevention in adolescents. |
A large Q fever outbreak in an urban school in central Israel
Amitai Z , Bromberg M , Bernstein M , Raveh D , Keysary A , David D , Pitlik S , Swerdlow D , Massung R , Rzotkiewicz S , Halutz O , Shohat T . Clin Infect Dis 2010 50 (11) 1433-8 BACKGROUND: On 28 June 2005, numerous cases of febrile illness were reported among 322 students and employees of a boarding high school located in an urban area in central Israel. Subsequent investigation identified a large outbreak of Q fever which started 2 weeks earlier. We describe the investigation of this outbreak and its possible implications. METHODS: We conducted a case-control study to identify risk factors for Q fever disease. Environmental sampling was conducted to identify the source and the mode of transmission of Coxiella burnetii, the infectious agent. RESULTS: Of 303 individuals, 187 (62%) reported being ill between 15 June and 13 July 2005. Serological evidence for C. burnetii infection was evident in 144 (88%) of the 164 tested individuals. Being a student, dining regularly at the school dining room, and boarding at school during a June religious holiday and the preceding weekend were all significant risk factors for contracting Q fever. C. burnetii DNA was detected using polymerase chain reaction on samples from the school dining room's air conditioning system, supporting contribution of the air conditioning system to the aerosol transmission of the infectious agent. CONCLUSIONS: We report a large outbreak of Q fever in an urban school, possibly transmitted through an air conditioning system. A high level of suspicion for C. burnetii infection should be maintained when investigating point source outbreaks of influenza-like disease, especially outside the influenza season. |
Association of chest radiographic abnormalities with tuberculosis disease in asymptomatic HIV-infected adults
Agizew T , Bachhuber MA , Nyirenda S , Makwaruzi VZ , Tedla Z , Tallaksen RJ , Parker JE , Mboya JJ , Samandari T . Int J Tuberc Lung Dis 2010 14 (3) 324-31 SETTING: Francistown and Gaborone, Botswana. OBJECTIVE: Chest radiography is used to screen for tuberculosis (TB) in asymptomatic persons living with the human immunodeficiency virus (PLWH) seeking isoniazid preventive therapy (IPT). We describe radiographic features in PLWH in a TB-endemic setting and identify features associated with TB disease. DESIGN: Asymptomatic PLWH seeking IPT under program conditions for a clinical trial between 2004 and 2006 received chest radiographs (CXRs) that were read using the standardized Chest Radiograph Reading and Recording System (CRRS). Clinical characteristics, including TB disease, were compared with the radiographic findings. RESULTS: From 2732 screening CXRs, 183 had one or more abnormalities and were scored using CRRS, with 42% having infiltrates (36% upper lobes), 35% parenchymal fibrosis and 32% adenopathy. TB disease status was determined in 129 (70%) PLWH, of whom 22 (17%) had TB disease. TB disease was associated with upper lobe infiltrates (relative risk [RR] 3.0, 95%CI 1.5-6.2) and mediastinal adenopathy (RR 3.9, 95%CI 1.8-8.4). The sensitivity and specificity of either upper lobe infiltrates or mediastinal lymphadenopathy for TB disease were respectively 64% and 82%. CONCLUSION: A combination of CXR features was useful for predicting TB disease in asymptomatic PLWH. CRRS should be used more frequently in similar studies. |
National program scale-up and patient outcomes in a pediatric antiretroviral treatment program, Thailand, 2000-2007
McConnell MS , Chasombat S , Siangphoe U , Yuktanont P , Lolekha R , Pattarapayoon N , Kohreanudom S , Mock PA , Fox K , Thanprasertsuk S . J Acquir Immune Defic Syndr 2010 54 (4) 423-9 BACKGROUND: There are limited reports of public sector scale-up of antiretroviral treatment (ART) for HIV-infected children. We describe patient outcomes for HIV-infected children initiating ART in Thailand from 2000 to 2005. METHODS: ART-naive patients <15 years old initiating ART from January 2000 to December 2005 were included; follow-up was through March 2007. Survival probabilities were estimated with Kaplan-Meier and hazard ratios for death and loss to follow-up (LTFU) with Cox proportional hazards models. RESULTS: Analysis included 3409 children. Median follow-up time was 1.7 years (interquartile range = 1.0-2.5). Median age at ART initiation was 7.3 years, weight-for-age z score was -2.0, CD4% was 5.0%. ART was initiated in 1428 (41.9%) children at regional/university hospitals and in 689 (20.2%) at district/community hospitals. At last visit, 346 (10.1%) were LTFU and 305 (9.0%) had died. Age <1 (P = 0.008), weight-for-age z score <-2.0 (P < 0.001), CD4% <5% (P < 0.001), and clinical stage C (P < 0.001) were associated with death; district/community hospital patients had a lower hazard of death (P = 0.011). Clinical stage C (P = 0.052) and regional/university hospital (P < 0.001) were associated with increased LTFU. CONCLUSIONS: Pediatric ART has been successfully scaled-up in Thailand, including to district/community hospitals. Late entry to care is associated with poorer outcomes, and earlier ART initiation should be prioritized. |
A review of events that expose children to elemental mercury in the United States
Lee R , Middleton D , Caldwell K , Dearwent S , Jones S , Lewis B , Monteilh C , Mortensen ME , Nickle R , Orloff K , Reger M , Risher J , Rogers HS , Watters M . Cien Saude Colet 2010 15 (2) 585-98 Concern for children exposed to elemental mercury prompted the Agency for Toxic Substances and Disease Registry and the Centers for Disease Control and Prevention to review the sources of elemental mercury exposures in children, describe the location and proportion of children affected, and make recommendations on how to prevent these exposures. In this review, we excluded mercury exposures from coal-burning facilities, dental amalgams, fish consumption, medical waste incinerators, or thimerosal-containing vaccines. We reviewed federal, state, and regional programs with data on mercury releases along with published reports of children exposed to elemental mercury in the United States. We selected all mercury-related events that were documented to expose (or potentially expose) children. Primary exposure locations were at home, at school, and at others such as industrial property not adequately remediated or medical facilities. Exposure to small spills from broken thermometers was the most common scenario; however, reports of such exposures are declining. The information reviewed suggests that most releases do not lead to demonstrable harm if the exposure period is short and the mercury is properly cleaned up. Primary prevention should include health education and policy initiatives. |
Stochastic analysis of pesticide transport in the shallow groundwater of Oatland Island, Georgia, USA
Anderson BA , Maslia ML , Caparoso JL , Ausdemore D , Aral MM . Water Qual Expo Health 2010 2 (1) 47-64 Analytical models, when used in stochastic analysis mode, may provide an effective tool for making informed management decisions for simplified environmental systems. This approach was used to evaluate migration of an organochlorine pesticide plume in a shallow, unconfined aquifer underlying a barrier island in coastal Georgia, USA. The contaminant plume at the site consists of four isomers of benzene hexachloride (BHC), also known as hexachlorocyclohexane (HCH). The deterministic analysis conducted at the site, which used calibrated, single-value input parameters, indicates that the contaminant plume will not reach wetlands that are downgradient of the source. Given the uncertainties involved in the deterministic analysis, this outcome was not considered to be sufficient to make effective management decisions at the site. Subsequently, probabilistic analysis using a range of input parameter values was conducted to estimate the risk that the pesticide plume would reach the downgradient wetlands. The two-stage Monte Carlo analysis that was conducted indicates the probability that contaminant levels will exceed the detection limit of BHC (0.044 micrograms per liter) at the wetlands increases from 1 percent to a maximum of 13 percent during the period 2005-2065. This represents an 87% or greater confidence level that the pesticide plume will not reach the wetlands. This outcome was used to inform environmental management decisions at the site. The modeling analysis was conducted using the publicly available analytical contaminant transport analysis system (ACTS) software. |
Turbidity and chlorine demand reduction using alum and moringa flocculation before household chlorination in developing countries
Preston K , Lantagne D , Kotlarz N , Jellison K . J Water Health 2010 8 (1) 60-70 Over 1.1 billion people in the world lack access to improved drinking water. Diarrhoeal and other waterborne diseases cause an estimated 1.87 million deaths per year. The Safe Water System (SWS) is a household water treatment intervention that reduces diarrhoeal disease incidence among users in developing countries. Turbid waters pose a particular challenge to implementation of SWS programmes; although research shows that a 3.75 mg l(-1) sodium hypochlorite dose effectively treats turbid waters, users sometimes object to the strong chlorine taste and prefer to drink water that is more aesthetically pleasing. This study investigated the efficacy of two locally available chemical water treatments-alum and Moringa oleifera flocculation-to reduce turbidity and chlorine demand at turbidities of 10, 30, 70, 100 and 300 NTU. Both treatments effectively reduced turbidity (alum flocculation 23.0-91.4%; moringa flocculation 14.2-96.2%). Alum flocculation effectively reduced chlorine demand compared with controls at 30, 70, 100 and 300 NTU (p=0.01-0.06). Moringa flocculation increased chlorine demand to the point where adequate free chlorine residual was not maintained for 24 hours after treatment. Alum pretreatment is recommended in waters>or=30 NTU for optimum water disinfection. Moringa flocculation is not recommended before chlorination. |
Approaching a perfect storm: responding to new challenges without losing critical core capacities
Kochtitzky C . J Environ Health 2010 72 (8) 30-3 Life expectancy in industrialized countries like the United States increased | 30 or more years in the 20th century, | resulting primarily from public health efforts in areas such as sanitation and immunization. Ensuring availability of clean | water and safe food was a primary contributor to approximately 80% of this impressive improvement in life expectancy | (Koplan & Fleming, 2000). Unfortunately, | the U.S. environmental health (EH) system | and the workforce that is its primary engine may become a victim of its own success—the ratio of public health workers to | population served shrank from an estimated | 220/100,000 in 1980 to 158/100,000 in 2000 | (Merrill, Btoush, Gupta, & Gebbie, 2003); | 10% of these workers are in EH. Given projected resource and demographic trends, this | shrinking per capita public health workforce | is unlikely to be reversed; at best it may only | be stabilized. Because of past successes and | current economic realities, the EH system | may be heading into a perfect storm. |
Epidemiological and genetic characteristics of norovirus outbreaks in long-term care facilities, 2003-2006.
Rosenthal NA , Lee LE , Vermeulen BA , Hedberg K , Keene WE , Widdowson MA , Cieslak PR , Vinje J . Epidemiol Infect 2010 139 (2) 1-9 To identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003-2006. Faecal specimens were tested for NoV by real-time reverse transcriptase-polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3.1% and a case-fatality rate of 0.5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0.001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004-2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon. |
Racial/ethnic differences in microalbuminuria among adults with prehypertension and hypertension: National Health and Nutrition Examination Survey (NHANES), 1999-2006
Ogunniyi MO , Croft JB , Greenlund KJ , Giles WH , Mensah GA . Am J Hypertens 2010 23 (8) 859-64 BACKGROUND: Microalbuminuria, a biomarker of endothelial dysfunction, is associated with increased cardiovascular, renal, and cerebrovascular morbidity and mortality, especially among ethnic minorities. METHODS: A total of 16,567 adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2006 were categorized according to JNC 7 blood pressure (BP) definitions. Microalbuminuria was defined as spot urinary albumin/creatinine ratio (ACR) of 30-299 mg/g. Logistic regression estimated the odds of having microalbuminuria among BP categories compared with normal BP after adjusting for age, race/ethnicity, sex, education level, smoking status, body mass index (BMI), systolic BP, and diabetes. RESULTS: Prevalence of microalbuminuria was 4.5% for normal BP, 6.3% for prehypertension, 12.4% for stage 1 hypertension, 25.3% for stage 2 hypertension, and 11.3% among those with treated, controlled hypertension. Compared with participants with normal BP, the adjusted odds ratios and 95% confidence intervals (CIs) for microalbuminuria were 1.3 (1.0-1.7, P = 0.03) for those with prehypertension, 2.3 (1.8-3.0, P < 0.01) with stage 1 hypertension, 4.8 (3.7-6.3 P < 0.01) with stage 2 hypertension, and 1.6 (1.3-2.1, P < 0.01) with treated, controlled hypertension. The treated controlled hypertension group exhibited the strongest race-ethnicity gradient. CONCLUSIONS: Participants with hypertension and prehypertension had a higher likelihood of microalbuminuria than those with normal BP, especially ethnic minorities, suggesting greater target organ damage. Our observations suggest that further research is necessary to determine whether microalbuminuria can be used as a screening tool in adults with prehypertension, to identify adults at highest risk for cardiovascular disease or decline in renal function.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.77. |
Rates of hospital-acquired respiratory illness in Bangladeshi tertiary care hospitals: results from a low-cost pilot surveillance strategy
Gurley ES , Zaman RU , Sultana R , Bell M , Fry AM , Srinivasan A , Rahman M , Rahman MW , Hossain MJ , Luby SP . Clin Infect Dis 2010 50 (8) 1084-90 BACKGROUND: Patients hospitalized in resource-poor health care settings are at increased risk for hospital-acquired respiratory infections due to inadequate infrastructure. METHODS: From 1 April 2007 through 31 March 2008, we used a low-cost surveillance strategy to identify new onset of respiratory symptoms in patients hospitalized for >72 h and in health care workers in medicine and pediatric wards at 3 public tertiary care hospitals in Bangladesh. RESULTS: During 46,273 patient-days of observation, we recorded 136 episodes of hospital-acquired respiratory disease, representing 1.7% of all patient hospital admissions; rates by ward ranged from 0.8 to 15.8 cases per 1000 patient-days at risk. We identified 22 clusters of respiratory disease, 3 of which included both patients and health care workers. Of 226 of heath care workers who worked on our surveillance wards, 61 (27%) experienced a respiratory illness during the study period. The cost of surveillance was US$43 per month per ward plus 30 min per day in data collection. CONCLUSIONS: Patients on these study wards frequently experienced hospital-acquired respiratory infections, including 1 in every 20 patients hospitalized for >72 h on 1 ward. The surveillance method was useful in calculating rates of hospital-acquired respiratory illness and could be used to enhance capacity to quickly detect outbreaks of respiratory disease in health care facilities where systems for outbreak detection are currently limited and to test interventions to reduce transmission of respiratory pathogens in resource-poor settings. |
Hospitalization of paediatric patients for methicillin-resistant Staphylococcus aureus skin and soft-tissue infection, 1998-2006
Sircar KD , Bancroft E , Nguyen DM , Mascola L . Epidemiol Infect 2010 138 (5) 677-82 Hospital discharge reports have provided data for studies of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection (SSTI) studies. This analysis determined the sensitivity and positive predictive value of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations to calculate hospitalization incidence rates, representativeness of a set of three ICD-9-CM codes to define MRSA SSTI, and hospitalization incidence rate trends for paediatric MRSA SSTIs in Los Angeles County (LAC). Using 133 cases from 31 hospitals, we found that the set of three ICD-9-CM codes used to define laboratory-confirmed cases had one of the highest positive predictive values (49%). There was no difference in age and race between those categorized using three codes vs. other code combinations. A dramatic increase in paediatric MRSA SSTI cases occurred in LAC during 1998-2006. We conclude that this combination of codes may be used to determine the rise of MRSA SSTIs in paediatric populations. |
Examining modifiable health behaviors, body weight, and use of preventive health services among caregivers and non-caregivers aged 65 years and older in Hawaii, Kansas, and Washington using 2007 BRFSS
McGuire L , Bouldin EL , Andresen EM , Anderson LA . J Nutr Health Aging 2010 14 (5) 373-9 OBJECTIVE: To examine the associations among health behaviors, healthy body weight, and use of preventive services of adults 65 years and older using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) as a function of caregiving status. METHODS: Participants (N=6,138) residing in the states of Hawaii, Kansas, and Washington completed questions about caregiving. We examined if there were any associations among body weight--having a healthy weight (body mass index 18.5-24.9 kg/m2); modifiable health behaviors--not smoking, consuming ≤ 1 alcoholic beverage per day, consuming at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week; and using preventive services--receiving an annual influenza immunization, and ever receiving a pneumococcal immunization. RESULTS: The two groups did not differ significantly on the modifiable health behaviors of fruit and vegetable consumption, smoking status, or alcohol consumption, or having a healthy weight. Caregivers were significantly more likely to meet physical activity recommendations than non-caregivers (54.1%, 42.0%, respectively, p < 0.001). No significant differences were found between caregivers and non-caregivers on receiving influenza and pneumococcal immunization. CONCLUSIONS: Older adults who are caregivers are more likely than other older adults to meet government recommendations for physical activity; however, they have similar patterns of engaging in other health behaviors, including health eating and use of preventive services. |
Shape-enhanced photocatalytic activity of single-crystalline anatase TiO(2) (101) nanobelts
Wu N , Wang J , Tafen DN , Wang H , Zheng JG , Lewis JP , Liu X , Leonard SS , Manivannan A . J Am Chem Soc 2010 132 (19) 6679-85 Particle size is generally considered to be the primary factor in the design of nanocrystal photocatalysts, because the reduction of particle size increases the number of active sites. However, the benefit from the size reduction can be canceled by a higher electron-hole recombination rate due to the confined space in sphere-shaped nanoparticles. Here we report a mechanistic study on a novel nanobelt structure that overcomes the drawback of sphere-shaped nanoparticles. Single-crystalline anatase TiO(2) nanobelts with two dominant surfaces of (101) facet exhibit enhanced photocatalytic activity over the nanosphere counterparts with an identical crystal phase and similar specific surface area. The ab initio density functional theory (DFT) calculations show that the exposed (101) facet of the nanobelts yields an enhanced reactivity with molecular O(2), facilitating the generation of superoxide radical. Moreover, the nanobelts exhibit a lower electron-hole recombination rate than the nanospheres due to the following three reasons: (i) greater charge mobility in the nanobelts, which is enabled along the longitudinal dimension of the crystals; (ii) fewer localized states near the band edges and in the bandgap due to fewer unpassivated surface states in the nanobelts; and (iii) enhanced charge separation due to trapping of photogenerated electrons by chemisorbed molecular O(2) on the (101) facet. Our results suggest that the photocatalysis efficiency of nanocrystals can be significantly improved by tailoring the shape and the surface structure of nanocrystals, which provides a new concept for rational design and development of high-performance photocatalysts. |
Statistical modeling of occupational chlorinated solvent exposures for case-control studies using a literature-based database
Hein MJ , Waters MA , Ruder AM , Stenzel MR , Blair A , Stewart PA . Ann Occup Hyg 2010 54 (4) 459-72 OBJECTIVES: Occupational exposure assessment for population-based case-control studies is challenging due to the wide variety of industries and occupations encountered by study participants. We developed and evaluated statistical models to estimate the intensity of exposure to three chlorinated solvents-methylene chloride, 1,1,1-trichloroethane, and trichloroethylene-using a database of air measurement data and associated exposure determinants. METHODS: A measurement database was developed after an extensive review of the published industrial hygiene literature. The database of nearly 3000 measurements or summary measurements included sample size, measurement characteristics (year, duration, and type), and several potential exposure determinants associated with the measurements: mechanism of release (e.g. evaporation), process condition, temperature, usage rate, type of ventilation, location, presence of a confined space, and proximity to the source. The natural log-transformed measurement levels in the exposure database were modeled as a function of the measurement characteristics and exposure determinants using maximum likelihood methods. Assuming a single lognormal distribution of the measurements, an arithmetic mean exposure intensity level was estimated for each unique combination of exposure determinants and decade. RESULTS: The proportions of variability in the measurement data explained by the modeled measurement characteristics and exposure determinants were 36, 38, and 54% for methylene chloride, 1,1,1-trichloroethane, and trichloroethylene, respectively. Model parameter estimates for the exposure determinants were in the anticipated direction. Exposure intensity estimates were plausible and exhibited internal consistency, but the ability to evaluate validity was limited. CONCLUSIONS: These prediction models can be used to estimate chlorinated solvent exposure intensity for jobs reported by population-based case-control study participants that have sufficiently detailed information regarding the exposure determinants. |
Tungsten carbide-cobalt particles activate Nrf2 and its downstream target genes in JB6 cells possibly by ROS generation
Zhang XD , Zhao J , Bowman L , Shi X , Castranova V , Ding M . J Environ Pathol Toxicol Oncol 2010 29 (1) 31-40 Hard metal consisting of a mixture of tungsten carbide (WC) and metallic cobalt (Co) was evaluated as a possible carcinogen in humans by IARC in 2003. Studies have suggested that nuclear factor erythroid 2-related factor 2 (Nrf2) constitutes one of the chemical-sensing and transcription systems that play an essential role(s) in chemical toxicity, carcinogenesis, and pathological processes. To elucidate the mechanisms of health hazards of WC-Co, effects of nano-WC-Co particles on Nrf2 signaling pathway were investigated in the present study in a JB6 cell line. After a 5 h treatment with nano-WC-Co particles, Nrf2 was released from Keap1 in the cytoplasm and translocated into the nucleus. Enzymatic activities of Nrf2 target genes, including glutathione S-transferase (GST) and NAD(P)H:quinone oxidoreductase 1 (NQO1), increased at 24 and 48 h after the treatment. Studies using reactive oxygen species (ROS) sensitive dyes indicated that ROS were produced in nano-WC-Co particle-treated cells. Pretreatment of the cells with catalase, but not sodium formate, resulted in a significant inhibitory effect on nano-WC-Co particle-induced Nrf2 target gene activation. These findings suggest that activation of Nrf2 and its downstream genes may be initiated by ROS generation, and ROS may act as a major contributor in nano-WC-Co particle-induced adverse health effects. |
Virulence differences among Francisella tularensis subsp. tularensis clades in mice
Molins CR , Delorey MJ , Yockey BM , Young JW , Sheldon SW , Reese SM , Schriefer ME , Petersen JM . PLoS One 2010 5 (4) e10205 Francisella tularensis subspecies tularensis (type A) and holarctica (type B) are of clinical importance in causing tularemia. Molecular typing methods have further separated type A strains into three genetically distinct clades, A1a, A1b and A2. Epidemiological analyses of human infections in the United States suggest that A1b infections are associated with a significantly higher mortality rate as compared to infections caused by A1a, A2 and type B. To determine if genetic differences as defined by molecular typing directly correlate with differences in virulence, A1a, A1b, A2 and type B strains were compared in C57BL/6 mice. Here we demonstrate significant differences between survival curves for infections caused by A1b versus A1a, A2 and type B, with A1b infected mice dying earlier than mice infected with A1a, A2 or type B; these results were conserved among multiple strains. Differences were also detected among type A clades as well as between type A clades and type B with respect to bacterial burdens, and gross anatomy in infected mice. Our results indicate that clades defined within F. tularensis subsp. tularensis by molecular typing methods correlate with virulence differences, with A1b strains more virulent than A1a, A2 and type B strains. These findings indicate type A strains are not equivalent with respect to virulence and have important implications for public health as well as basic research programs. |
Molecular epidemiology of varicella zoster virus
Bostikova V , Bostik P , Chlibek R , Schmid DS , Salavec M , Smetana J , Splino M . Epidemiol Mikrobiol Imunol 2010 59 (1) 21-24 Varicella zoster virus has highly conserved genome 125,000 base pairs. The different molecular genetic methods of analyzing VZV genome are discussed, as well as their results with regards to the virus phylogenesis, geographic distributions, possible recombination and virulence of different VZV strains. |
Morphological and elemental classification of freshly emitted soot particles and atmospheric ultrafine particles using the TEM/EDS
Tumolva L , Park JY , Kim JS , Miller AL , Chow JC , Watson JG , Park K . Aerosol Sci Technol 2010 44 (3) 202-215 The Transmission Electron Microscopy (TEM) and Energy Dispersive Spectroscopy (EDS) were used to determine morphology and elemental composition of a variety of freshly emitted soot particles ( acetylene flame, candle flame, kerosene flame, diesel exhaust, electric arc, plastic burning, styrofoam burning, wood burning [white oak and pine bark], and rice straw burning), which can be possible candidate soot in the ambient atmosphere, and ultrafine particles sampled in urban, industrial, and coastal sites during ultrafine particle formation events ( combustion and photochemical events). By using mobility-classified non-refractory ((NH4)(2)SO4) and refractory ( Polystyrene latex (PSL) and salt ( NaCl)) particles, limitation of the TEM was tested. Data showed that the TEM method can be used to examine shapes of both volatile particles such as (NH4)(2)SO4 (100 nm) at low, but not high magnification ( refer to low and high beam intensity, respectively), and nonvolatile particles like NaCl ( 100 nm) and PSL ( 84 nm) at either low or high magnification. Distinct differences in morphological properties such as primary particle diameter, fractal dimension, and microstructure were observed among the different types of fresh soot particles. The atmospheric ultrafine particles were classified as agglomerates, sulfate mixtures ( spherical), metallic oxides ( spherical and polygonal), C-rich refractory ( not agglomerated), C-rich non-refractory ( not agglomerated), Si-rich ( spherical), Na-rich ( porous), or P-containing (non-spherical) particles. At the urbanGwangju site, a higher fraction of fresh and aged agglomerates was observed than at other sites. The C-rich non-refractory and sulfate mixtures were often observed in the photochemical event. The C-rich refractory particles were abundant at the Gwangju and Yeosu sites. The coastal Taean site had few agglomerates due to limited anthropogenic combustion source. |
A multicenter collaborative study for the standardization of Candida albicans genotyping using a polymorphic microsatellite marker
Garcia-Hermoso D , Maccallum DM , Lott TJ , Sampaio P , Buitrago Serna MJ , Grenouillet F , Klaassen CH , Bretagne S . J Clin Microbiol 2010 48 (7) 2578-81 Microsatellite-based genotyping for Candida albicans can give discrepant results between laboratories when expressed in fragment sizes since their determination depends on electrophoretic conditions. The inter-laboratory reproducibility was assessed in six laboratories provided with an allelic ladder. Despite variations in size determination, alleles were correctly assigned, making data transportable between laboratories. |
Promiscuous T-cell epitopes of Plasmodium merozoite surface protein 9 (PvMSP9) induces IFN-gamma and IL-4 responses in individuals naturally exposed to malaria in the Brazilian Amazon
Lima-Junior JC , Banic DM , Tran TM , Meyer VS , De-Simone SG , Santos F , Porto LC , Marques MT , Moreno A , Barnwell JW , Galinski MR , Oliveira-Ferreira J . Vaccine 2010 28 (18) 3185-91 Plasmodium vivax merozoite surface protein (PvMSP9) stimulates both cellular and humoral immune responses in individuals who are naturally infected by this parasite species. To identify immunodominant human T-cell epitopes in PvMSP9, we used the MHC class II binding peptide prediction algorithm ProPred. Eleven synthetic peptides representing predicted putative promiscuous T-cell epitopes were tested in IFN-gamma and IL-4 ELISPOT assays using peripheral blood mononuclear cells (PBMC) derived from 142 individuals from Rondonia State, Brazil who had been naturally exposed to P. vivax infections. To determine whether the predicted epitopes are preferentially recognized in the context of multiple alleles, MHC Class II typing of the cohort was also performed. Five synthetic peptides elicited robust cellular responses, and the overall frequencies of IFN-gamma and IL-4 responders to at least one of the promiscuous peptides were 62% and 46%, respectively. The frequencies of IFN-gamma and IL-4 responders to each peptide were not associated with a particular HLA-DRB1 allelic group since most of the peptides induced a response in individuals of 12 out of 13 studied allelic groups. The prediction of promiscuous epitopes using ProPred led to the identification of immunodominant epitopes recognized by PBMC from a significant proportion of a genetically heterogeneous population exposed to malaria infections. The combination of several such T-cell epitopes in a vaccine construct may increase the frequency of responders and the overall efficacy of subunit vaccines in genetically distinct populations. |
An international multi-centre study to assess a panel of reference materials for the quantification of SIV RNA in plasma
Ham C , Srinivasan P , Thorstensson R , Verschoor E , Vagrouche Z , Sernicola L , Ramos A , Titti F , Almond N , Berry N . J Clin Microbiol 2010 48 (7) 2582-5 An International multi-centre study was conducted to assess the performance of a panel of simian immunodeficiency virus (SIV) RNA reference materials for plasma viral load determinations. Reliable quantification was demonstrated across approximately 6 log10 dynamic range. Availability of external reference materials will enable independent calibration of SIV plasma viral load assays. |
Antigenic and genetic diversity of highly pathogenic avian influenza A (H5N1) viruses isolated in Egypt
Balish AL , Davis CT , Saad MD , El-Sayed N , Esmat H , Tjaden JA , Earhart KC , Ahmed LE , El-Halem MA , Ali AHM , Nassif SA , El-Ebiary EA , Taha M , Mona MA , Arafa A , O'Neill E , Xu XY , Cox NJ , Donis RO , Klimov AI . Avian Dis 2010 54 329-334 Highly pathogenic avian influenza A virus (H5N1) has diverged antigenically and genetically since its initial detection in Asia in 1997. Viruses belonging to clade 2.2 in particular have been reported in numerous countries with the majority occurring in Egypt. Previous reports identified antigenic similarities between viruses belonging to clade 2.2. However, poultry and human viruses isolated in northern Egypt during 2007 and 2008 were found to be antigenically distinct from other clade 2.2 viruses from this country. Genetic analysis of the hemagglutinin revealed a high degree of nucleotide and amino acid divergence. The antigenic changes in Egyptian viruses isolated during 2007-08 necessitated that two of these strains be considered as potential H5N1 pre-pandemic vaccine candidates. |
Detection and characterization of clade 7 high pathogenicity avian influenza H5N1 viruses in chickens seized at ports of entry and live poultry markets in Vietnam
Davis CT , Balish AL , O'Neill E , Nguyen CV , Cox NJ , Xu XY , Klimov A , Tung N , Donis RO . Avian Dis 2010 54 307-312 High pathogenicity avian influenza H5N1 has become an endemic poultry disease in several Asian countries, including Vietnam. Recently, clade 7 H5N1 viruses of the Eurasian lineage were isolated from chickens seized at ports of entry in Lang Son Province, Vietnam. Extensive nucleotide and amino acid divergence across the hemagglutinin (HA) protein gene of these isolates in comparison to previously described clade 7 viruses was identified. Clade 7 viruses are antigenically distinct from contemporary strains of H5N1 known to circulate in Vietnamese poultry (clade 1 and clade 2.3.4). Subsequent surveillance of sick poultry in live poultry markets in Hai Duong Province identified additional clade 7 isolates with HA genes very similar to the group B virus cluster detected previously at the Lang Son Province border. Antigenic analysis of the isolates from the live bird markets revealed significant cross-reactivity only between those clade 7 viruses belonging to the same subgroups. To meet pandemic response preparedness objectives, we have developed a reassortant virus from A/chicken/Vietnam/NCVD-016/2008, which could be used as a new prepandemic vaccine candidate for veterinary or human vaccination, should the need arise. Findings from these studies indicate that viruses with clade 7 HA have continued to evolve in Southeast Asian poultry, leading to significant antigenic drift relative to other H5N1 viruses currently circulating in Vietnam. |
Route of delivery and neonatal birth trauma
Moczygemba CK , Paramsothy P , Meikle S , Kourtis AP , Barfield WD , Kuklina E , Posner SF , Whiteman MK , Jamieson DJ . Am J Obstet Gynecol 2010 202 (4) 361 e1-6 OBJECTIVE: We sought to examine rates of birth trauma in 2 groupings (all International Classification of Diseases, Ninth Revision codes for birth trauma, and as defined by the Agency for Healthcare Research and Quality Patient Safety Indicator [PSI]) among infants born by vaginal and cesarean delivery. STUDY DESIGN: Data on singleton infants were obtained from the 2004-2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. RESULTS: The rates of Agency for Healthcare Research and Quality PSI and all birth trauma were 2.45 and 25.85 per 1000 births, respectively. Compared with vaginal, cesarean delivery was associated with increased odds of PSI birth trauma (odds ratio [OR], 1.71), primarily due to an increased risk for "other specified birth trauma" (OR, 2.61). Conversely, cesarean delivery was associated with decreased odds of all birth trauma (OR, 0.55), due to decreased odds of clavicle fractures (OR, 0.07), brachial plexus (OR, 0.10), and scalp injuries (OR, 0.55). CONCLUSION: Infants delivered by cesarean are at risk for different types of birth trauma from infants delivered vaginally. |
Prepregnancy obesity and birth defects: what's next?
Rasmussen SA , Galuska DA . Am J Clin Nutr 2010 91 (6) 1539-40 Recent data from the National Health and Nutrition Examination Survey for the years 2007–2008 showed that over a third of women ages 20–39 y in the United States are obese [defined as a body mass index [in kg/m2] ≥30] (1). The frequency of obesity among women of childbearing age makes it critical to understand the effects of prepregnancy obesity on maternal and infant outcomes. Prepregnancy obesity has been associated with a wide range of adverse outcomes in the mother and in the fetus and infant. Overall, women who are obese are more likely to experience chronic diseases such as cardiovascular disease, type 2 diabetes, osteoarthritis, and some cancers (2). Additional risks faced by reproductive-aged women who are obese comprise an increased risk of infertility as well as complications during pregnancy, including gestational diabetes, hypertensive disorders, thromboembolic disease, and cesarean delivery. Prepregnancy obesity also has adverse effects on the fetus and infant, with associations observed between maternal obesity and spontaneous abortion, fetal death, macrosomia, shoulder dystocia, and childhood obesity (3, 4). |
Influenza immunization in pregnancy -- antibody responses in mothers and infants
Steinhoff MC , Omer SB , Roy E , Arifeen SE , Raqib R , Altaye M , Breiman RF . N Engl J Med 2010 362 (17) 1644-6 Though the use of seasonal trivalent inactivated influenza vaccines is recommended in pregnancy, there are few data on the immunogenicity of current vaccine formulations in pregnant women or on the duration of passive protection in their infants.1 We present antibody data for mothers and infants from a prospective, randomized, controlled trial of influenza vaccine in pregnant women,2 the Mother'sGift project. | In brief, 340 Bangladeshi women in the third trimester of pregnancy were randomly assigned to receive either a current commercial trivalent inactivated influenza vaccine (with these mothers and their infants called vaccinees) or a control (23-valent pneumococcal polysaccharide) vaccine (with these mothers and their infants called controls). Serum samples were obtained from 311 mothers before immunization and at delivery and from 292 infants at birth (cord-serum samples) and at 10 and 20 to 26 weeks later. The samples were tested with the use of hemagglutination-inhibition assays for the three virus subtypes present in the influenza vaccine: A/New Caledonia (H1N1), A/Fujian (H3N2), and B/Hong Kong (see the Supplementary Appendix, available with the full text of this letter at NEJM.org). |
Cytomegalovirus seroprevalence in the United States: the National Health and Nutrition Examination Surveys, 1988-2004
Bate SL , Dollard SC , Cannon MJ . Clin Infect Dis 2010 50 (11) 1439-47 BACKGROUND: Congenital cytomegalovirus (CMV) infection causes permanent disabilities in more than 5500 children each year in the United States. The likelihood of congenital infection and disability is highest for infants whose mothers were CMV seronegative before conception and who acquire infection during pregnancy. METHODS: To provide a current, nationally representative estimate of the seroprevalence of CMV in the United States and to investigate trends in CMV infection, serum samples from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were tested for CMV-specific immunoglobulin G antibody, and results were compared with those from NHANES III (1988-1994). Individuals aged 6-49 years (21,639 for NHANES III and 15,310 for NHANES 1999-2004) were included. RESULTS: For NHANES 1999-2004, the overall age-adjusted CMV seroprevalence was 50.4%. CMV seroprevalence was higher among non-Hispanic black and Mexican American children compared with non-Hispanic white children and increased more quickly in subsequent age groups. CMV seropositivity was independently associated with older age, female sex, foreign birthplace, low household income, high household crowding, and low household education. Compared with NHANES 1988-1994, the overall age-adjusted CMV seroprevalence for NHANES 1999-2004 was not significantly different. CONCLUSIONS: Many women of reproductive age in the United States are still at risk of primary CMV infection during pregnancy. There is an urgent need for vaccine development and other interventions to prevent and treat congenital CMV. The substantial disparities in CMV risk among seronegative women suggest that prevention strategies should include an emphasis on reaching racial or ethnic minorities and women of low socioeconomic status. |
Reducing control selection errors associated with underground bolting equipment
Burgess-Limerick R , Krupenia V , Zupanc C , Wallis G , Steiner L . Appl Ergon 2010 41 (4) 549-55 Selecting the incorrect control during the operation of underground bolting and drilling equipment causes serious injuries. Shape coding and the layout of dual control banks are two aspects of control design which require further examination. The aims of this research were: (i) to determine whether arbitrary shape coding was effective in reducing selection error rates in a virtual analogy of roof-bolting; and (ii) to determine whether any advantages exist for mirror or place layouts for dual control situations in this situation. Two experiments were conducted to address these questions. No benefits of arbitrary shape coding were evident while control location remained constant. When control location was altered, shape coding did provide a significant reduction in selection error rate. No differences between mirror or place arrangements were detected and this question remains open. |
Shape analysis of 3D head scan data for U.S. respirator users
Zhuang Z , Slice DE , Benson S , Lynch S , Viscusi DJ . EURASIP J Adv Signal Process 2010 2010 (1) 248954 In 2003, the National Institute for Occupational Safety and Health (NIOSH) conducted a head-and-face anthropometric survey of diverse, civilian respirator users. Of the 3,997 subjects measured using traditional anthropometric techniques, surface scans and 26 three-dimensional (3D) landmark locations were collected for 947 subjects. The objective of this study was to report the size and shape variation of the survey participants using the 3D data. Generalized Procrustes Analysis (GPA) was conducted to standardize configurations of landmarks associated with individuals into a common coordinate system. The superimposed coordinates for each individual were used as commensurate variables that describe individual shape and were analyzed using Principal Component Analysis (PCA) to identify population variation. The first four principal components (PC) account for 49% of the total sample variation. The first PC indicates that overall size is an important component of facial variability. The second PC accounts for long and narrow or short and wide faces. Longer narrow orbits versus shorter wider orbits can be described by PC3, and PC4 represents variation in the degree of ortho/prognathism. GeometricMorphometrics provides a detailed and interpretable assessment ofmorphological variation that may be useful in assessing respirators and devising new test and certification standards. |
N-Acetyl L-Cysteine does not protect mouse ears from the effects of noise
Davis R , Custer D , Krieg E , Alagramam K . J Occup Med Toxicol 2010 5 11 BACKGROUND:Noise-induced hearing loss (NIHL) is one of the most common occupational injuries in the United States. It would be extremely valuable if a safe, inexpensive compound could be identified which protects worker hearing from noise. In a series of experiments, Kopke has shown that the compound N-acetyl-L-cysteine (L-NAC) can protect the hearing of chinchillas from the effects of a single exposure to noise. L-NAC is used in clinical medicine and is very safe. Although L-NAC was reported to be promising, it has not been successful in other studies (Kramer et al., 2006; Hamernik et al., 2008). The present study was undertaken to determine if L-NAC could protect C57BL/6J (B6) mice from the permanent effects of noise. METHOD:Two groups of five B6 mice were injected with either 300 or 600 mg/kg L-NAC approximately 1 hr prior to a 104 dB broadband noise exposure and again immediately after the exposure. A control group (N=7) was exposed to the same noise level but injected with vehicle (sterile saline). Auditory brainstem response measurements were made at 4, 8, 16 and 32 kHz one week prior to and 12 days after exposure.CONCLUSIONS:There were no statistically significant differences in ABR threshold shifts between the mice receiving L-NAC and the control mice. This indicates that L-NAC was not effective in preventing permanent threshold shift in this mouse model of NIHL. |
Physiological impact of the n95 filtering facepiece respirator on healthcare workers
Roberge RJ , Coca A , Williams WJ , Powell JB , Palmiero AJ . Respir Care 2010 55 (5) 569-77 OBJECTIVE: To assess the physiological impact of the N95 filtering facepiece respirator (FFR) on healthcare workers. METHODS: Ten healthcare workers each conducted multiple 1-hour treadmill walking sessions, at 1.7 miles/h, and at 2.5 miles/h, while wearing FFR with exhalation valve, FFR without exhalation valve, and without FFR (control session). We monitored heart rate, respiratory rate, tidal volume, minute volume, blood oxygen saturation, and transcutaneously measured P(CO(2)). We also measured user comfort and exertion, FFR moisture retention, and the carbon dioxide and oxygen concentrations in the FFR's dead space. RESULTS: There were no significant differences between FFR and control in the physiological variables, exertion scores, or comfort scores. There was no significant difference in moisture retention between FFR with and without exhalation valve. Two subjects had peak P(CO(2)) ≥ 50 mm Hg. The FFR with exhalation valve offered no benefit in physiological burden over the FFR without valve. The FFR dead-space oxygen and carbon dioxide levels did not meet the Occupational Safety and Health Administration's ambient workplace standards. CONCLUSIONS: In healthy healthcare workers, FFR did not impose any important physiological burden during 1 hour of use, at realistic clinical work rates, but the FFR dead-space carbon dioxide and oxygen levels were significantly above and below, respectively, the ambient workplace standards, and elevated P(CO(2)) is a possibility. Exhalation valve did not significantly ameliorate the FFR's P(CO(2)) impact. |
Innovative safety interventions
Ruff TM . IEEE Ind Appl Mag 2010 16 (3) 45-49 Researchers at the National Institute for Occupational Safety and Health (NIOSH) studied methods to prevent workers from being entangled in machinery used at mining operations. An analysis of mining accidents in the United States, which resulted in a fatality or permanent disability from 2000 through 2005, showed 438 severe incidents that involved contact with machinery or equipment, an average of 73 per year. The researchers determined that the most common machinery involved in these severe accidents was conveyors. In addition, a significant portion of the accidents occurred during machine maintenance and repair. Researchers focused on improved methods to prevent unintentional machine start-up during maintenance activity and methods to detect workers near moving machine components. One new technology that showed promise for this application was intelligent video. Popular in the surveillance and security industries, these systems use cameras and computerized video analysis techniques to automatically detect the presence of people in preset zones within the camera's field of view. A preliminary study was initiated to determine if this technology could reliably detect the presence of workers in hazardous locations near machinery. The possible advantages of using this technology include improved detection zone demarcation and improved ability to distinguish between hazardous and nonhazardous proximity, compared with conventional proximity sensor techniques. Initial tests to detect a person near a conveyor system in daylight conditions showed promising results. A description of the technology, test procedures and results, implementation challenges, and future research needs are discussed in this article. |
Adverse respiratory outcomes associated with occupational exposures at a soy processing plant
Cummings KJ , Gaughan DM , Kullman GJ , Beezhold DH , Green BJ , Blachere FM , Bledsoe T , Kreiss K , Cox-Ganser J . Eur Respir J 2010 36 (5) 1007-15 This study aimed to characterize the relationship between adverse health outcomes and occupational risk factors among workers at a soy processing plant.A questionnaire, spirometry, methacholine challenge, immune testing, and air sampling for dust and soy were offered. Prevalence ratios (PRs) of respiratory problems from comparisons with the US adult population were calculated. Soy-specific IgG and IgE among participants and healthcare worker controls were compared. Associations between health outcomes and potential explanatory variables were examined using logistic regression.One hundred forty-seven (52%) of 281 employees, including 66 (70%) of 94 production workers, participated. PRs were significantly elevated for wheeze, sinusitis, ever-asthma, and current asthma. Participants had significantly higher mean concentrations of soy-specific IgG (97.9 mg.L(-1) vs. 1.5 mg.L(-1)) and prevalence of soy-specific IgE (21% vs. 4%) than controls. Participants with soy-specific IgE had 3-fold greater odds of current asthma or asthma-like symptoms, and 6-fold greater odds of work-related asthma-like symptoms; the latter additionally was associated with production work and higher peak dust exposures. Airways obstruction was associated with higher peak dust. Work-related sinusitis, nasal allergies, and rash were associated with reported workplace mold exposure.Asthma and symptoms of asthma, but not other respiratory problems, were associated with immune reactivity to soy. |
Effect of longwall face advance on spontaneous heating in longwall gob area
Yuan L , Smith AC . Min Eng 2010 62 (3) 34-38 To reduce fire hazards from spontaneous combustion of coal in longwall gob areas, a series of computational fluid dynamics (CFD) simulations were conducted by the National Institute for Occupational Safety and Health (NIOSH) to model the spontaneous heating of coal in longwall gob areas. The previous modeling results demonstrate that spontaneous heating of coal usually occurred behind the longwall shields and along the face with a bleeder ventilation system. Assuming a stationary longwall face, the spontaneous heating could turn to a spontaneous fire in several days for the most reactive coal under favorable conditions. When the longwall face advances, the spontaneous heating process will be significantly affected. In this study, the effect of longwall face advance on the spontaneous heating in the gob area is investigated using the CFD model developed in previous studies. One longwall panel with a bleeder ventilation system is simulated. The width of the panel is 300 m (984 ft), while the length of the panel is changed between 1,000 to 2,000 m (3,280 to 6,560 ft). The same permeability and porosity profiles are used for gobs with different lengths. The spontaneous heating first develops in the gob when the longwall face is stationary. Then, the face advances at a certain rate. The face advance is simulated as a series of discrete movements, and the effect of the face advance on the maximum temperature developed during the face stoppage is examined. |
Evaluation of an international training course to build programmatic capacity for tuberculosis control
Ohkado A , Pevzner E , Sugiyama T , Murakami K , Yamada N , Cavanaugh S , Ishikawa N , Harries AD . Int J Tuberc Lung Dis 2010 14 (3) 371-3 We evaluated the international training course of the Research Institute of Tuberculosis, Kiyose, Japan, by e-mailing structured questionnaires to participants who attended the course from 2001 to 2007. Of 62 responding participants, 34 developed action plan projects (APPs) and 28 developed operations research projects (ORPs). Among respondents drafting APPs, 27 (79%) started implementing projects, and 24 (88%) completed over half of their planned activities. Among respondents drafting ORPs, 11 (39%) started projects but no scientific papers were published. The main reasons for the failure to implement ORPs were due to lack of time, funds, and disapproval by supervisors. A sequential training model may better address barriers to teaching and assisting ORPs. |
Feasibility and effectiveness of basic lymphedema management in Leogane, Haiti, an area endemic for bancroftian filariasis
Addiss DG , Louis-Charles J , Roberts J , Leconte F , Wendt JM , Milord MD , Lammie PJ , Dreyer G . PLoS Negl Trop Dis 2010 4 (4) e668 BACKGROUND: Approximately 14 million persons living in areas endemic for lymphatic filariasis have lymphedema of the leg. Clinical studies indicate that repeated episodes of bacterial acute dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that basic lymphedema management, which emphasizes hygiene, skin care, exercise, and leg elevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema management or assessed the role of compressive bandaging for lymphedema in resource-poor settings. METHODOLOGY/PRINCIPAL FINDINGS: Between 1995 and 1998, we prospectively monitored ADLA incidence and leg volume in 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereria bancrofti. During the first phase of the study, when a major focus of the program was to reduce leg volume using compression bandages, ADLA incidence was 1.56 episodes per person-year. After March 1997, when hygiene and skin care were systematically emphasized and bandaging discouraged, ADLA incidence decreased to 0.48 episodes per person-year (P<0.0001). ADLA incidence was significantly associated with leg volume, stage of lymphedema, illiteracy, and use of compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statistically significant only for legs with stage 2 lymphedema (P = 0.01). CONCLUSIONS/SIGNIFICANCE: Basic lymphedema management, which emphasized hygiene and self-care, was associated with a 69% reduction in ADLA incidence. Use of compression bandages in this setting was associated with an increased risk of ADLA. Basic lymphedema management is feasible and effective in resource-limited areas that are endemic for lymphatic filariasis. |
Implications of the one health paradigm for clinical microbiology
Miller JM . Clin Microbiol Newsl 2010 32 (7) 51-56 Clinical microbiologists have a new and unique opportunity to increase our value to health care by broadening how we think about disease processes and asking ourselves what we can do to help resolve a disease, assist in tracking a cause, or even predict an outbreak before it occurs. Human health, animal health (both wildlife and domestic animals), and environmental health are forever bound together. The convergence of people, animals, and the environment defines the parameters of One Health and directs attention to the impact this overlap has on public health, disease detection, and control. One Health (sometimes referred to as One Medicine) is a concept that promotes, improves, and defends the health and well-being of all species through the integration of the sciences of human medicine, veterinary medicine, and environmental studies. As microbiologists, we need to be aware of this One Health concept and how it can positively impact our profession by allowing us to be more productive members of the health care team. There are several things we can do to get started. We can review organism pathogenicity and evaluate and question test results that may signal an unusual event or process that led to a disease. We can be alert to the epidemiologic potential of organism isolates from patients as they may apply to infection control or community epidemiology. We can become familiar with the zoonotic diseases and recognize the etiologic agents associated with wild and domestic animals and apply that knowledge to our diagnostic skills. As we further understand the " big picture" of One Health, we can ask strategic questions that can lead us to provide further technical assistance to facilitate earlier interventions that lead to positive patient outcomes and ultimately healthier populations. In human medicine, we generally work with one species of animal. Veterinarians work with all the rest. It is time to communicate with and learn from our veterinary clinical microbiology colleagues and begin to understand the critical nature of the human, animal, and environment interface. This is our opportunity to be at the front of this line and not stand on the sidelines watching. copyright 2010 Elsevier Inc. |
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