Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010
Cheng YJ , Imperatore G , Geiss LS , Wang J , Saydah SH , Cowie CC , Gregg EW . Diabetes Care 2013 36 (9) 2690-6 OBJECTIVE: To examine the age-specific changes of prevalence of diabetes among U.S. adults during the past 2 decades. RESEARCH DESIGN AND METHODS: This study included 22,586 adults sampled in three periods of the National Health and Nutrition Examination Survey (1988-1994, 1999-2004, and 2005-2010). Diabetes was defined as having self-reported diagnosed diabetes or having a fasting plasma glucose level ≥126 mg/dL or HbA1c ≥6.5% (48 mmol/mol). RESULTS: The number of adults with diabetes increased by 75% from 1988-1994 to 2005-2010. After adjusting for sex, race/ethnicity, and education level, the prevalence of diabetes increased over the two decades across all age-groups. Younger adults (20-34 years of age) had the lowest absolute increase in diabetes prevalence of 1.0%, followed by middle-aged adults (35-64) at 2.7% and older adults (≥65) at 10.0% (all P < 0.001). Comparing 2005-2010 with 1988-1994, the adjusted prevalence ratios (PRs) by age-group were 2.3, 1.3, and 1.5 for younger, middle-aged, and older adults, respectively (all P < 0.05). After additional adjustment for body mass index (BMI), waist-to-height ratio (WHtR), or waist circumference (WC), the adjusted PR remained statistically significant only for adults ≥65 years of age. CONCLUSION: During the past two decades, the prevalence of diabetes increased across all age-groups, but adults ≥65 years of age experienced the largest increase in absolute change. Obesity, as measured by BMI, WHtR, or WC, was strongly associated with the increase in diabetes prevalence, especially in adults <65. |
Multiple chronic conditions among US adults who visited physician offices: data from the National Ambulatory Medical Care Survey, 2009
Ashman JJ , Beresovsky V . Prev Chronic Dis 2013 10 E64 Most research on adults with chronic conditions focuses on a single disease or condition, such as hypertension or diabetes, rather than on multiple chronic conditions (MCC). Our study's objective was to compare physician office visits by adults with MCC with visits by adults without MCC, by selected patient demographic characteristics. We also identified the most prevalent dyads and triads of chronic conditions among these patients. We used the National Ambulatory Medical Care Survey, a nationally representative survey of office visits to nonfederal physicians and used 13 of the 20 conditions defined by the National Strategic Framework on Multiple Chronic Conditions. Descriptive estimates were generated and significant differences were tested. In 2009, an estimated 326 million physician office visits, were made by adults aged 18 years or older with MCC representing 37.6% of all medical office visits by adults. Hypertension was the most prevalent chronic condition that appeared in the top 5 MCC dyads and triads, by sex and age groups. The number of visits by patients with MCC increased with age and was greater for men than for women and for adults with public rather than private insurance. Physicians were more likely to prescribe medications at office visits made by patients with MCC. Physician office visits by adults with MCC were not evenly distributed by demographic characteristics. |
Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010
Ward BW , Schiller JS . Prev Chronic Dis 2013 10 E65 Preventing and ameliorating chronic conditions has long been a priority in the United States; however, the increasing recognition that people often have multiple chronic conditions (MCC) has added a layer of complexity with which to contend. The objective of this study was to present the prevalence of MCC and the most common MCC dyads/triads by selected demographic characteristics. We used respondent-reported data from the 2010 National Health Interview Survey (NHIS) to study the US adult civilian noninstitutionalized population aged 18 years or older (n=27,157). We categorized adults as having 0 to 1, 2 to 3, or 4 or more of the following chronic conditions: hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, chronic obstructive pulmonary disease, or current asthma. We then generated descriptive estimates and tested for significant differences. Twenty-six percent of adults have MCC; the prevalence of MCC has increased from 21.8% in 2001 to 26.0% in 2010. The prevalence of MCC significantly increased with age, was significantly higher among women than men and among non-Hispanic white and non-Hispanic black adults than Hispanic adults. The most common dyad identified was arthritis and hypertension, and the combination of arthritis, hypertension, and diabetes was the most common triad. The findings of this study contribute information to the field of MCC research. The NHIS can be used to identify population subgroups most likely to have MCC and potentially lead to clinical guidelines for people with more common MCC combinations. |
Hospitalizations among people with Down syndrome: a nationwide population-based study in Denmark
Zhu JL , Hasle H , Correa A , Schendel D , Friedman JM , Olsen J , Rasmussen SA . Am J Med Genet A 2013 161 (4) 650-7 Most persons with Down syndrome (DS) now survive to adulthood, but their health care needs beyond childhood are not well described. We followed a national cohort of 3,212 persons with DS and a reference cohort of persons without DS through the Danish National Hospital Register from January 1, 1977, to May 31, 2008. Poisson regression was used to calculate rate ratios for numbers of overnight hospital admissions and hospital days. During the study period, persons with DS had more than twice the rate of hospital admissions and nearly three times as many bed-days as the population as a whole. Malformations, diseases of the respiratory system, and diseases of the nervous system or sensory organs were the principal indications for hospital admissions. The higher rate ratios for hospital admissions were seen especially among persons less than 20 years of age. Hospitalizations for neoplasms or for diseases of the musculoskeletal system or connective tissue were much less frequent among adults with DS. As survival among persons with DS continues to improve, these findings are likely to be useful for health care planning, although the potential utility may be different for different health care systems. |
AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women
Byrd TL , Wilson KM , Smith JL , Coronado G , Vernon SW , Fernandez-Esquer ME , Thompson B , Ortiz M , Lairson D , Fernandez ME . Cancer 2013 119 (7) 1365-72 BACKGROUND: Considerable efforts have been undertaken in the United States to reduce cervical cancer incidence and mortality by increasing screening; however, disparities in screening rates continue to exist among certain racial and ethnic minority groups. The objective of the current study was to determine the effectiveness of a lay health worker-delivered intervention-AMIGAS (Ayudando a las Mujeres con Informacion, Guia, y Amor para su Salud [helping women with information, guidance, and love for their health])-to increase Papanicolaou (Pap) test screening among 3 populations of women of Mexican origin. METHODS: Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n=151), the AMIGAS program without the video (n=154), the AMIGAS program without the flip chart (n=155), and a usual care control group (n=153). Six months after enrollment, women were surveyed and reported whether or not they had been screened. RESULTS: Women in any of the intervention arms were statistically significantly more likely to report being screened than those in the usual care group in both an intent-to-treat analysis and a per-protocol analysis. In the intent-to-treat analysis, 25% of women in the control group and 52% in the full AMIGAS program group reported having had Pap tests (P<.001); in the per-protocol analysis, the percentages were 29% and 62%, respectively (P<.001). CONCLUSIONS: AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention. |
Amyotrophic lateral sclerosis/motor neuron disease deaths in the United States, 1999-2009
Mehal JM , Holman RC , Schonberger LB , Sejvar JJ . Amyotroph Lateral Scler Frontotemporal Degener 2013 14 346-52 Our objective was to examine trends and epidemiology of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND) associated deaths in the United States. ALS/MND associated death rates and trends in the United States for 1999-2009 were examined using the multiple cause-of-death mortality data. Age-specific and age-adjusted death rates were calculated. For 1999-2009, the average annual age-adjusted death rate was 2.17/100,000 persons. The age-specific rate increased with age until 75-79 years. Males experienced a higher death rate than females. There was no definitive trend in the annual ALS/MND associated death rate, although analyses suggested a possible decrease (p = 0.05); however, the rate increased for persons 20-49 years of age and declined for persons ≥ 65 years of age. The annual rate for males decreased whereas the rate for females showed no change. In conclusion, the suggested decreasing annual ALS/MND associated death rate for 1999-2009 contrasts with earlier reports indicating that the incidence and death rate of ALS were increasing. While the ALS/MND associated death rate slightly increased among adults 20-49 years of age, rates declined among two subpopulations at higher risk for ALS/MND - males and persons ≥ 65 years of age. Continued monitoring of ALS/MND mortality data and additional epidemiological studies will be important to further elucidate these epidemiological trends. |
Co-occurrence of leading lifestyle-related chronic conditions among adults in the United States, 2002-2009
Ford ES , Croft JB , Posner SF , Goodman RA , Giles WH . Prev Chronic Dis 2013 10 E60 INTRODUCTION: Public health and clinical strategies for meeting the emerging challenges of multiple chronic conditions must address the high prevalence of lifestyle-related causes. Our objective was to assess prevalence and trends in the chronic conditions that are leading causes of disease and death among adults in the United States that are amenable to preventive lifestyle interventions. METHODS: We used self-reported data from 196,240 adults aged 25 years or older who participated in the National Health Interview Surveys from 2002 to 2009. We included data on cardiovascular disease (coronary heart disease, angina pectoris, heart attack, and stroke), cancer, chronic obstructive pulmonary disease (emphysema and chronic bronchitis), diabetes, and arthritis. RESULTS: In 2002, an unadjusted 63.6% of participants did not have any of the 5 chronic conditions we assessed; 23.9% had 1, 9.0% had 2, 2.9% had 3, and 0.7% had 4 or 5. By 2009, the distribution of co-occurrence of the 5 chronic conditions had shifted subtly but significantly. From 2002 to 2009, the age-adjusted percentage with 2 or more chronic conditions increased from 12.7% to 14.7% (P < .001), and the number of adults with 2 or more conditions increased from approximately 23.4 million to 30.9 million. CONCLUSION: The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice. |
Defining and measuring chronic conditions: imperatives for research, policy, program, and practice
Goodman RA , Posner SF , Huang ES , Parekh AK , Koh HK . Prev Chronic Dis 2013 10 E66 Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model's operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems. |
Risk factors for inadequate TB case finding in rural western Kenya: a comparison of actively and passively identified TB patients
Van't Hoog AH , Marston BJ , Ayisi JG , Agaya JA , Muhenje O , Odeny LO , Hongo J , Laserson KF , Borgdorff MW . PLoS One 2013 8 (4) e61162 BACKGROUND: The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate. OBJECTIVE AND METHODS: We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses. FINDINGS: HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI) 2.0-5.9), but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR) HIV 1.8, 95% CI 0.85-3.7). Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60-0.97 per 10 years increase), and women (aOR 0.27, 95%CI 0.10-0.73). Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23-0.79). Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively. CONCLUSION: HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women and the elderly are needed to improve TB case detection in Kenya. |
Prevalence of cryptococcal antigenemia and cost-effectiveness of a cryptococcal antigen screening program - Vietnam
Smith RM , Nguyen TA , Ha HT , Thang PH , Thuy C , Xuan Lien T , Bui HT , Le TH , Struminger B , McConnell MS , Fanfair RN , Park BJ , Harris JR . PLoS One 2013 8 (4) e62213 BACKGROUND: An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam. METHODS: Serum samples were collected and stored during 2009-2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naive patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines. RESULTS: Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0-99) cells/mm(3). Nine (4%; 95% CI 2-7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3-11%) than in North Vietnam (2%; 95% CI 0-6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively. CONCLUSION: CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care. |
Primary amebic meningoencephalitis in Florida: a case report and epidemiological review of Florida cases
Budge PJ , Lazensky B , Van Zile KW , Elliott KE , Dooyema CA , Visvesvara GS , Beach MJ , Yoder JS . J Environ Health 2013 75 (8) 26-31 Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal infection of the central nervous system caused by the thermophilic, free-living ameba Naegleria fowleri. Since its first description in 1965 through 2010, 118 cases have been reported in the U.S.; all cases are related to environmental exposure to warm freshwater; most have occurred in children and adolescents and are associated with recreational water activities, such as swimming, diving, or playing in freshwater lakes, ponds, or rivers. Over one-fourth of all national PAM cases have occurred in Florida. The authors describe here a fatal case of PAM in a resident of northeast Florida and the ensuing environmental and public health investigation; they also provide a review of all cases of PAM in Florida from 1962 to 2010 and discuss public health responses to PAM in Florida, highlighting opportunities for positive collaboration between state and local environmental health specialists, epidemiologists, and the Centers for Disease Control and Prevention. |
Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence
Mohd Hanafiah K , Groeger J , Flaxman AD , Wiersma ST . Hepatology 2013 57 (4) 1333-42 In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%); South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%); whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). CONCLUSION: The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. (HEPATOLOGY 2013). |
Immunopathogenesis of hepatitis E virus infection
Wedemeyer H , Rybczynska J , Pischke S , Krawczynski K . Semin Liver Dis 2013 33 (1) 71-8 The course of hepatitis E virus infection (HEV) can vary substantially between different individuals. Although most infections take a clinically silent asymptomatic course, a few patients may develop severe hepatitis that can progress to fulminant hepatic failure. In addition, cases of chronic hepatitis E have been described in immunosuppressed patients. The detailed mechanisms leading to different clinical outcomes of HEV infection are only partially understood. Both viral factors including the HEV genotype and the dose of the infectious inoculum, as well as host factors such as stage of liver disease, pregnancy or distinct genetic polymorphisms determine the course of HEV infection. Recent studies were able to associate T-cell responses, activation of the interferon system and viral evolution with severity or chronicity of hepatitis E. We here summarize the emerging data on the immunopathogenesis of HEV infection. |
Acceptance of treatment for latent tuberculosis infection: prospective cohort study in the United States and Canada
Colson PW , Hirsch-Moverman Y , Bethel J , Vempaty P , Salcedo K , Wall K , Miranda W , Collins S , Horsburgh CR . Int J Tuberc Lung Dis 2013 17 (4) 473-9 SETTING: An estimated 300,000 individuals are treated for latent tuberculosis infection (LTBI) in the United States and Canada annually. Little is known about the proportion or characteristics of those who decline treatment. OBJECTIVE: To define the proportion of individuals in various groups who accept LTBI treatment and to identify factors associated with non-acceptance of treatment. DESIGN: Persons offered LTBI treatment at 30 clinics in 12 Tuberculosis Epidemiologic Studies Consortium sites were prospectively enrolled. Multivariate regression models were constructed based on manual stepwise assessment of potential predictors. RESULTS: Of 1692 participants enrolled from March 2007 to September 2008, 1515 (89.5%) accepted treatment and 177 (10.5%) declined. Predictors of acceptance included believing one could personally spread TB germs, having greater TB knowledge, finding clinic schedules convenient and having low acculturation. Predictors of non-acceptance included being a health care worker, being previously recommended for treatment and believing that taking medicines would be problematic. CONCLUSION: This is the first prospective multisite study to examine predictors of LTBI treatment acceptance in general clinic populations. Greater efforts should be made to increase acceptance among health care workers, those previously recommended for treatment and those who expect problems with LTBI medicines. Ensuring convenient clinic schedules and TB education to increase knowledge could be important for ensuring acceptance. |
Cutaneous presentation of progressive disseminated histoplasmosis nine years after renal transplantation
Rosado-Odom VM , Daoud J , Johnson R , Allen SD , Lockhart SR , Iqbal N , Shieh WJ , Zaki S , Sharfuddin AA . Transpl Infect Dis 2013 15 (2) E64-9 Initial presentation of invasive fungal infections such as histoplasmosis can include non-specific clinical manifestations, especially in immunocompromised patients. A high index of suspicion is required to identify atypical manifestations of these diseases, which carry a high risk of mortality, if the diagnosis is delayed or missed. We describe a case of a kidney transplant recipient with cutaneous lesions as initial manifestation of progressive disseminated histoplasmosis where a skin biopsy was crucial to an early diagnosis. |
Monitoring and controlling West Nile virus: are your prevention practices in place?
Nasci RS . J Environ Health 2013 75 (8) 42-4 In a remarkable demonstration of the potential for invasive organisms to spread | and establish in new, permissive habitats. West Nile virus (WNV) expanded from | a small area in New York City in 1999 and | is now found across much of the western | hemisphere from central Canada to southern Argentina. Enzootic WNV transmission | and human WNV disease have been reported | from all 48 of the continental United States. | The disease burden imposed by this new addition to the U.S. public health scene has | been equally remarkable. During 1999-2012, | more than 36,000 cases of human disease | were reported to the Centers for Disease | Control and Prevention (CDC), including | approximately 16,000 cases of neuroinvasive disease and 1,500 deaths (Petersen & | Fischer, 2012). Some models estimate that | between two million and four milUon people | have been infected with WNV since 1999, | and 400,000 to 1 million people may have | experienced some degree of illness due to the | infection (Petersen et al., 2012). |
Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse
Logan J , Liu Y , Paulozzi L , Zhang K , Jones C . Med Care 2013 51 (8) 646-53 OBJECTIVE: Emergency departments (EDs) routinely provide care for patients seeking treatment for painful conditions; however, they are also targeted by people seeking opioid analgesics for nonmedical use. This study determined the prevalence of indicators of potential ED opioid misuse and inappropriate prescription practices by ED providers in a large, commercially insured, adult population. RESEARCH DESIGN AND INDICATORS: We analyzed the 2009 Truven Health MarketScan Research Databases to examine the ED visits of enrollees aged 18-64 years. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by one week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (≥100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain, and overlapping LA/ER opioids. Analyses were stratified by sex. RESULTS: We identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3% of enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were for acute pain, and 14.6% were overlapping. Females were more likely to have at least one indicator. CONCLUSIONS: In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing the risk of their misuse. Guidelines for the cautious use of opioid analgesics in EDs and timely data from prescription drug monitoring programs could help EDs treat patients with pain while reducing the risk of nonmedical use. |
Prenatal and postnatal bisphenol A exposure and body mass index in childhood in the CHAMACOS cohort
Harley KG , Schall RA , Chevrier J , Tyler K , Aguirre H , Bradman A , Holland NT , Lustig RH , Calafat AM , Eskenazi B . Environ Health Perspect 2013 121 (4) 514-20 BACKGROUND: Bisphenol A (BPA), a widely used endocrine-disrupting chemical, has been associated with increased body weight and fat deposition in rodents. OBJECTIVES: We examined whether prenatal and postnatal urinary BPA concentrations were associated with body mass index (BMI), waist circumference, percent body fat, and obesity in 9-year-old children (n = 311) in the CHAMACOS longitudinal cohort study. METHODS: BPA was measured in spot urine samples collected from mothers twice during pregnancy and from children at 5 and 9 years of age. RESULTS: Prenatal urinary BPA concentrations were associated with decreased BMI at 9 years of age in girls but not boys. Among girls, being in the highest tertile of prenatal BPA concentrations was associated with decreased BMI z-score (beta = -0.47, 95% CI: -0.87, -0.07) and percent body fat (beta = -4.36, 95% CI: -8.37, -0.34) and decreased odds of overweight/obesity [odds ratio (OR) = 0.37, 95% CI: 0.16, 0.91] compared with girls in the lowest tertile. These findings were strongest in prepubertal girls. Urinary BPA concentrations at 5 years of age were not associated with any anthropometric parameters at 5 or 9 years, but BPA concentrations at 9 years were positively associated with BMI, waist circumference, fat mass, and overweight/obesity at 9 years in boys and girls. CONCLUSIONS: Consistent with other cross-sectional studies, higher urinary BPA concentrations at 9 years of age were associated with increased adiposity at 9 years. However, increasing BPA concentrations in mothers during pregnancy were associated with decreased BMI, body fat, and overweight/obesity among their daughters at 9 years of age. |
Screening for pulmonary tuberculosis in HIV-infected individuals: AIDS Clinical Trials Group Protocol A5253
Swindells S , Komarow L , Tripathy S , Cain KP , MacGregor RR , Achkar JM , Gupta A , Veloso VG , Asmelash A , Omoz-Oarhe AE , Gengiah S , Lalloo U , Allen R , Shiboski C , Andersen J , Qasba SS , Katzenstein DK . Int J Tuberc Lung Dis 2013 17 (4) 532-9 BACKGROUND: Improved tuberculosis (TB) screening is urgently needed for human immunodeficiency virus (HIV) infected patients. METHODS: An observational, multi-country, cross-sectional study of HIV-infected patients to compare a standardized diagnostic evaluation (SDE) for TB with standard of care (SOC). SOC evaluations included TB symptom review (current cough, fever, night sweats and/or weight loss), sputum Ziehl-Neelsen staining and chest radiography. SDE screening added extended clinical signs and symptoms and fluorescent microscopy (FM). All participants underwent all evaluations. Mycobacterium tuberculosis on sputum culture was the primary outcome. RESULTS: A total of 801 participants were enrolled from Botswana, Malawi, South Africa, Zimbabwe, India, Peru and Brazil. The median age was 33 years; 37% were male, and median CD4 count was 275 cells/mm(3). Thirty-one participants (4%) had a positive culture on Lowenstein-Jensen media and 54 (8%) on MGIT. All but one positive culture came from sub-Saharan Africa, where the prevalence of TB was 54/445 (12%). SOC screening had 54% sensitivity (95%CI 40-67) and 76% specificity (95%CI 72-80). Positive and negative predictive values were respectively 24% and 92%. No elements of the SDE improved the predictive values of SOC. CONCLUSIONS: Symptom-based screening with smear microscopy was insufficiently sensitive. More sensitive diagnostic testing is required for HIV-infected patients. |
Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources
Tong VT , Dietz PM , Farr SL , D'Angelo DV , England LJ . Public Health Rep 2013 128 (3) 179-88 OBJECTIVES: We compared three measures of maternal smoking status--prepregnancy, during pregnancy, and smoking cessation during pregnancy-between the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the 2003 revised birth certificate (BC). METHODS: We analyzed data from 10,485 women with live births in eight states from the 2008 PRAMS survey, a confidential, anonymous survey administered in the postpartum period that is linked to select BC variables. We calculated self-reported prepregnancy and prenatal smoking (last trimester only) prevalence based on the BC, the PRAMS survey, and the two data sources combined, and the percentage of smoking cessation during pregnancy based on the BC and PRAMS survey. We used two-sided t-tests to compare BC and PRAMS estimates. RESULTS: Prepregnancy smoking prevalence estimates were 17.3% from the BC, 24.4% from PRAMS, and 25.4% on one or both data sources. Prenatal smoking prevalence estimates were 11.3% from the BC, 14.0% from PRAMS, and 15.2% on one or both data sources. The percentages of prepregnancy smokers who indicated that they quit smoking by the last trimester were 35.1% from the BC and 42.6% from PRAMS. The PRAMS estimates of prepregnancy and prenatal smoking, and smoking cessation during pregnancy were statistically higher than the corresponding BC estimates (t-tests, p<0.05). CONCLUSIONS: PRAMS captured more women who smoked before and during the last trimester than the revised BC. States implementing PRAMS and the revised BC should consider information from both sources when developing population-based estimates of smoking before pregnancy and during the last trimester of pregnancy. |
Cholesterol screening for women: who is "at-risk"?
Robbins CL , Dietz PM , Cox S , Kuklina EV . J Womens Health (Larchmt) 2013 22 (5) 404-11 BACKGROUND: High cholesterol often precedes cardiovascular disease (CVD) and guidelines recommend cholesterol screening among at-risk women. Definitions of CVD risk vary and prevalence of dyslipidemia (abnormal total cholesterol, high-density lipoprotein (HDL-C), or non-HDL-C) among at-risk women may vary by age and definition of CVD risk. METHODS: This study used 2007-2008 National Health and Nutrition Examination Survey data (n=1,781), a representative sample of the U.S. civilian, non-institutionalized population, to estimate the proportion of women without previous dyslipidemia diagnosis who are U.S. Preventive Services Task Force (USPSTF) at-risk and American Heart Association (AHA) at-risk. We also report dyslipidemia prevalence stratified by age. RESULTS: Over half (55.0%) of younger women (20-44 years) and 74.2% of older women (≥45 years) were USPSTF at-risk, while nearly all younger and older women had at least one AHA risk factor (99.5% and 99.6%, respectively). Dyslipidemia prevalence among younger women was 47.3% (95% confidence interval [CI]: 42.2-52.5) for USPSTF-at-risk and 39.5% (95% CI: 35.7-43.4) for AHA at-risk. Among older women, it was 65.5% (95% CI: 60.8-69.9) for USPSTF at-risk and 63.3% (95% CI: 59.0-67.4) for AHA at-risk. CONCLUSIONS: The AHA risk definition identified 45% more young women and 25% more older women than the USPSTF risk definition; however, both definitions of at-risk identified similar prevalence estimates of dyslipidemia among women. Given a high prevalence of dyslipidemia among younger women, future research is needed to assess whether identification and treatment of young women with dyslipidemia will decrease CVD mortality among them later in life. |
"Straight Talk" for African-American heterosexual men: results of a single-arm behavioral intervention trial
Frye V , Henny K , Bonner S , Williams K , Bond KT , Hoover DR , Lucy D , Greene E , Koblin BA . AIDS Care 2013 25 (5) 627-31 In the United States, heterosexual transmission is the second leading cause of HIV/AIDS, and two-thirds of all heterosexually acquired cases diagnosed between 2005 and 2008 occurred among African-Americans. Few HIV prevention interventions have been designed specifically for African-American heterosexual men not seeking clinical treatment. Here we report results of a single-arm intervention trial of a theory-based HIV prevention intervention designed to increase condom use, reduce concurrent partnering and increase HIV testing among heterosexually active African-American men living in high HIV prevalence areas of New York City. We tested our hypothesis using McNemar discordant pairs exact test for binary variables and paired t-tests for continuous variables. We observed statistically significant declines in mean number of total and new female partners, unprotected sex partners, and partner concurrency in both primary and nonprimary sex partnerships between baseline and 3 months postintervention. |
Correlates of unprotected vaginal or anal intercourse with women among substance-using men who have sex with men
Greene E , Frye V , Mansergh G , Colfax GN , Hudson SM , Flores SA , Hoover DR , Bonner S , Koblin BA . AIDS Behav 2013 17 (3) 889-99 The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10% (n=194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66% (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR=2.28; 95% CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR=3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR=1.73; 95% CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR=0.71; 95% CI 0.56, 0.91) and Viagra use (OR=0.31; 95% CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW. |
Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies
Rao AK , Luckman E , Wise ME , MacCannell T , Blythe D , Lin Y , Xia G , Drobeniuc J , Noble-Wang J , Arduino MJ , Thompson ND , Patel PR , Wilson LE . Nephrol Nurs J 2013 40 (2) 101-164 In the United States, the prevalence of hepatitis C virus infection among patients treated in hemodialysis facilities is five times higher than among the general population. This study investigated eight new hepatitis C virus infections among patients treated at an outpatient hemodialysis facility. Epidemiologic investigation and viral sequencingdemonstrated that transmission likely occurred between patients typically treated during the same or consecutive shifts at the same or a nearby station. Several infection control breaches were observed, including lapses involving the preparation, handling, and administration of parenteral medications. Improved infection control education and training for all hemodialysis facility staff is an important component of assuring adherence to appropriate procedures and preventing future outbreaks. |
The role of the GAVI Alliance in improving childhood hepatitis B vaccination in China: successes, lessons learned, and future global challenges
Averhoff F , Kolwaite A , Ward JW . Vaccine 2013 31 Suppl 9 J5-7 China has the world's largest burden of hepatitis B virus (HBV) infection. With an overall prevalence of chronic HBV infection of 7% [1], HBV is a major contributor to morbidity and mortality in China, primarily from cirrhosis and liver cancer [2], [3], [4]. Because transmission during birth and early childhood was contributing substantially to HBV acquisition, China embarked on an aggressive program to implement hepatitis B control through improving rates of vaccination coverage and improving birth dose coverage by leveraging a program to encourage facility-based deliveries. This issue of Vaccine chronicles China's remarkable success in implementing infant and adolescent vaccination programs, promoting safe injection practices, and vaccinating hard to reach populations. This commentary highlights the successful partnership between China's public health authorities and the GAVI Alliance, the GAVI Alliance's contribution to control of hepatitis B globally, and the continued need for GAVI Alliance support to meet the WHO goal of vaccinating all newborns within the first 24 h of life with hepatitis B vaccine. | HBV infection is a major cause of acute and chronic liver disease (e.g., cirrhosis and primary liver cancer) globally and is the sixth leading cause of death from infectious disease worldwide with an estimated 785,000 deaths annually [5]. The World Health Organization (WHO) estimates that a third of the world's population (more than two billion people) have been infected with HBV and that 240 million people are living with chronic HBV infection [6], [7], placing them at risk for serious illness and death from cirrhosis and hepatocellular carcinoma (HCC). Worldwide, 30% of cirrhosis and 53% of all HCC deaths are attributable to HBV infection [3]. In China, HBV prevalence reaches 10% in certain birth cohorts [1]. HBV has taken a heavy toll in China. An estimated 100 million persons are living with chronic HBV infection in China, 350,000 of whom die from HBV-related cirrhosis and liver cancer each year [2], [3], [4]. |
Effectiveness of monovalent 2009 pandemic influenza A virus subtype H1N1 and 2010-2011 trivalent inactivated influenza vaccines in Wisconsin during the 2010-2011 influenza season
Bateman AC , Kieke BA , Irving SA , Meece JK , Shay DK , Belongia EA . J Infect Dis 2013 207 (8) 1262-9 BACKGROUND: The 2009 influenza A virus subtype H1N1 (A[H1N1]pdm09) did not exhibit antigenic drift during the 2010-2011 influenza season, providing an opportunity to investigate the duration of protection after vaccination. We estimated the independent effects of 2010-2011 seasonal trivalent inactivated influenza vaccine (TIV) and A(H1N1)pdm09 vaccine for preventing medically attended influenza A virus infection during the 2010-2011 season. METHODS: Individuals were tested for influenza A virus by real-time reverse transcription polymerase chain reaction (rRT-PCR) after a clinical encounter for acute respiratory illness. Case-control analyses compared participants with rRT-PCR-confirmed influenza A virus infection and test-negative controls. Vaccine effectiveness was estimated separately for monovalent pandemic vaccine and TIV and was calculated as 100 x [1 - adjusted odds ratio], where the odds ratio was adjusted for potential confounders. RESULTS: The effectiveness of TIV against influenza A virus infection was 63% (95% confidence interval [CI], 37%-78%). The effectiveness of TIV against A(H1N1)pdm09 infection was 77% (95% CI, 44%-90%). Monovalent vaccine administered between October 2009 and April 2010 was not protective during the 2010-2011 season, with an effectiveness of -1% (95% CI, -146% to 59%) against A(H1N1)pdm09 infection. CONCLUSIONS: Monovalent vaccine provided no sustained protection against A(H1N1)pdm09 infection during the 2010-2011 season. This waning effectiveness supports the need for annual revaccination, even in the absence of antigenic drift in A(H1N1)pdm09. |
The case test-negative design for studies of the effectiveness of seasonal influenza vaccine
Foppa IM , Haber M , Ferdinands JM , Shay DK . Vaccine 2013 31 (30) 3104-9 BACKGROUND: A modification to the case-control study design has become popular to assess vaccine effectiveness (VE) against viral infections. Subjects with symptomatic illness seeking medical care are tested by a highly specific polymerase chain reaction (PCR) assay for the detection of the infection of interest. Cases are subjects testing positive for the virus; those testing negative represent the comparison group. Influenza and rotavirus VE studies using this design are often termed "test-negative case-control" studies, but this design has not been formally described or evaluated. We explicitly state several assumptions of the design and examine the conditions under which VE estimates derived with it are valid and unbiased. METHODS: We derived mathematical expressions for VE estimators obtained using this design and examined their statistical properties. We used simulation methods to test the validity of the estimators and illustrate their performance using an influenza VE study as an example. RESULTS: Because the marginal ratio of cases to non-cases is unknown during enrollment, this design is not a traditional case-control study; we suggest the name "case test-negative" design. Under sets of increasingly general assumptions, we found that the case test-negative design can provide unbiased VE estimates. However, if there were differences in health care-seeking behavior among cases and non-cases by vaccine status, with strong viral interference or when the vaccine modifies the probability of symptomatic illness VE estimates may be biased. CONCLUSIONS: Vaccine effectiveness estimates derived from case test-negative studies are valid and unbiased under a wide range of assumptions. However, if vaccinated cases are less severely ill and seek care less frequently than unvaccinated cases, then an appropriate adjustment for illness severity is required to avoid bias in effectiveness estimates. Viral interference will lead to a non-trivial bias in the vaccine effectiveness estimate from case test-negative studies only when incidence of influenza is extremely high and when duration of transient non-specific immunity is long. |
The impact of decreasing U.S. hip fracture rates on future hip fracture estimates
Stevens JA , Rudd RA . Osteoporos Int 2013 24 (10) 2725-8 We examined age- and sex-specific hip fracture hospitalization rates among people aged 65 and older using 1990-2010 National Hospital Discharge Survey data. Trends calculated using Joinpoint regression analysis suggest that future increases in hip fractures due to the aging population will be largely offset by decreasing hip fracture rates among women. However, this trend will be counterbalanced by rising numbers of hip fractures among men. INTRODUCTION: From 1990 to 2006, age-adjusted U.S. hip fracture rates among people aged 65 years and older declined significantly. We wanted to determine whether decreasing age group-specific hip fracture rates might offset increases in hip fractures among the aging population over the next two decades. METHODS: This study used data from the National Hospital Discharge Survey, a national probability survey of inpatient discharges from nonfederal U.S. hospitals, to analyze hip fracture hospitalizations, defined as cases with first diagnosis coded ICD-9 CM 820. We analyzed trends in rates by sex and 10-year age groups using Joinpoint analysis software and used the results and projected population estimates to obtain the expected number of hip fractures in 2020 and 2050. RESULTS: Based on current age- and sex-specific trends in hip fracture hospitalization rates, the number of hip fractures is projected to rise 11.9 %-from 258,000 in 2010 to 289,000 (Projection Interval [PI] = 193,000-419,000) in 2030. The number of hip fractures among men is expected to increase 51.8 % (PI = 15.9-119.4 %) while the number among women is expected to decrease 3.5 % (PI = -44.3-37.3 %). These trends will affect the future distribution of hip fractures among the older population. CONCLUSIONS: Although the number of older people in the U.S.A. will increase appreciably over the next 20 years, the expected increase in the total number of hip fractures will be largely offset by decreasing hip fracture rates among women. However, this trend will be counterbalanced by rising numbers of hip fractures among men. |
Titanium dioxide nanoparticles: a review of current toxicological data
Shi H , Magaye R , Castranova V , Zhao J . Part Fibre Toxicol 2013 10 15 Titanium dioxide (TiO2) nanoparticles (NPs) are manufactured worldwide in large quantities for use in a wide range of applications. TiO2 NPs possess different physicochemical properties compared to their fine particle (FP) analogs, which might alter their bioactivity. Most of the literature cited here has focused on the respiratory system, showing the importance of inhalation as the primary route for TiO2 NP exposure in the workplace. TiO2 NPs may translocate to systemic organs from the lung and gastrointestinal tract (GIT) although the rate of translocation appears low. There have also been studies focusing on other potential routes of human exposure. Oral exposure mainly occurs through food products containing TiO2 NP-additives. Most dermal exposure studies, whether in vivo or in vitro, report that TiO2 NPs do not penetrate the stratum corneum (SC). In the field of nanomedicine, intravenous injection can deliver TiO2 nanoparticulate carriers directly into the human body. Upon intravenous exposure, TiO2 NPs can induce pathological lesions of the liver, spleen, kidneys, and brain. We have also shown here that most of these effects may be due to the use of very high doses of TiO2 NPs. There is also an enormous lack of epidemiological data regarding TiO2 NPs in spite of its increased production and use. However, long-term inhalation studies in rats have reported lung tumors. This review summarizes the current knowledge on the toxicology of TiO2 NPs and points out areas where further information is needed. |
The Trypanosoma rangeli trypomastigote surfaceome reveals novel proteins and targets for specific diagnosis
Wagner G , Eiko Yamanaka L , Moura H , Denardin Luckemeyer D , Schlindwein AD , Hermes Stoco P , Bunselmeyer Ferreira H , Barr JR , Steindel M , Grisard EC . J Proteomics 2013 82C 52-63 Sympatric distribution and sharing of hosts and antigens by Trypanosoma rangeli and Trypanosoma cruzi, the etiological agent of Chagas' disease, often incur in misdiagnosis and improper epidemiological inferences. Many secreted and surface proteins (SP) have been described as important antigens shared by these species. This work describes the T. rangeli surfaceome obtained by gel-free (LC-ESI-MS/MS) and gel-based (GeLC-ESI-MS/MS) proteomic approaches, and immunoblotting analyses and the comparison of these SP with T. cruzi. A total of 138 T. rangeli proteins and 343 T. cruzi proteins were obtained, among which, 42 and 157 proteins were exclusively identified in T. rangeli or T. cruzi trypomastigotes, respectively. Immunoblotting assays using sera from experimentally infected mice revealed a distinct band pattern for each species. MS/MS analysis of T. rangeli exclusive bands revealed two unique GP63-related proteins and flagellar calcium-binding protein. Also, a ~32kDa band composed of 12 distinct proteins was exclusively recognized by anti-T. cruzi serum. This highly sensitive proteomic assessment of surface proteins characterized the T. rangeli surfaceome, revealing several differences and similarities between these two parasites. The study reports new T. rangeli-specific proteins with promising use in differential diagnosis from T. cruzi. BIOLOGICAL SIGNIFICANCE: In this manuscript, we report the first proteomic analysis of the T. rangeli surface (surfaceome), a non-pathogenic parasite occurring in sympatry with T. cruzi, the etiological agent of Chagas disease. This comparative proteomic analysis was performed using high-throughput in-gel and gel-free proteomic approaches combined with immunoblotting, allowing us to identify new T. rangeli-specific proteins with promising use in differential serodiagnosis, among several other protein not previously reported for this taxon. Additionally, cross-recognition assays showed that T. cruzi surface proteins were recognized by heterologous serum (anti-T. rangeli) that strengthens the possibility of misdiagnosis of Chagas disease in humans and other mammals. Thus, this work provides new insights to understand the serological cross-reactivity between T. cruzi and T. rangeli, as well as, the identification of targets for specific T. rangeli diagnosis as revealed by the comparative surfaceome analysis. We strongly believe that this research is of importance to the readers of Journal of Proteomics since it provides new potential markers for diagnosis of both T. cruzi and T. rangeli parasites increasing the spectrum of specific targets for unambiguous diagnosis of T. rangeli and T. cruzi infections, besides describing new approaches to assess the trypanosomatids proteome. |
LUMINEX(R): a new technology for the simultaneous identification of five Entamoeba spp. commonly found in human stools
Santos HL , Bandyopadhyay K , Bandea R , Peralta RH , Peralta JM , Da Silva AJ . Parasit Vectors 2013 6 69 BACKGROUND: Six species of the genus Entamoeba, i.e., E. histolytica, E. dispar, E. moshkovskii, E. polecki, E. coli, and E. hartmanii can be found in human stools. Among these, only E. histolytica is considered to be pathogenic, causing intestinal and extra-intestinal disease, but it is morphologically identical to E. dispar and E. moshkovskii. In general, E. polecki, E. coli, and E. hartmanii can be differentiated morphologically from E. histolytica, but some of their diagnostic morphologic features may overlap creating issues for the differential diagnosis. Moreover, the previous inability to differentiate among Entamoeba species has limited epidemiologic information on E histolytica. The objective of this study was to develop a rapid, high-throughput screening method using Luminex technique for the simultaneous detection and differentiation of Entamoeba species. METHODS: PCR amplification was performed with biotinylated Entamoeba sp 18S rRNA gene primers, designed to amplify a fragment ranging from 382 to 429 bp of the Entamoeba spp studied. Regions of this fragment that could differentiate among E. histolytica, E. moshkovskii, E. dispar, E. hartmanii and E. coli were selected to design hybridization probes to link to Luminex beads. The assay was standardized with cloned DNA samples of each species and evaluated with 24 DNA extracts from samples obtained from individuals diagnosed with these amebas in their stools. RESULTS: Using this approach we were able to correctly identify E. histoltyica, E. dispar, E hartmanni, E. coli and E. moshkovskii in all specimens studied. From twenty four samples tested by microscopy, PCR/DNA Sequencing and real-time PCR, 100% agreed with PCR-Luminex assay for identification of E. dispar, E. moshkovskii, E. hartmanni, E. histolytica, and E. coli. CONCLUSION: These results show that this method could be used in the diagnostic detection of Entamoeba spp in fecal samples. This diagnostic test was useful to clearly distinguish E histolytica from other species and also to strengthen epidemiologic data on Entamoeba spp. |
Neoplastic-like transformation effect of single-walled and multi-walled-carbon nanotubes compared to asbestos on human lung small airway epithelial cells
Wang L , Stueckle T , Mishra A , Derk R , Meighan T , Castranova V , Rojanasakul Y . Nanotoxicology 2013 8 (5) 485-507 Accumulating evidence indicates that carbon nanotubes (CNTs) are biopersistent and can cause lung damage. With similar fibrous morphology and mode of exposure to asbestos, a known human carcinogen, growing concern has arisen for elevated risk of CNT-induced lung carcinogenesis; however, relatively little is known about the long-term carcinogenic effect of CNT. Neoplastic transformation is a key early event leading to carcinogenesis. We studied the ability of single- and multi-walled CNTs to induce neoplastic transformation of human lung epithelial cells compared to asbestos. Long-term (6 month) exposure of the cells to occupationally relevant concentrations of CNT in culture caused a neoplastic-like transformation phenotype as demonstrated by increased cell proliferation, anchorage-independent growth, invasion and angiogenesis. Whole genome expression signature and protein expression analyses showed that single- and multi-walled CNTs shared similar signaling signatures which were distinct from asbestos. These results provide novel toxicogenomic information and suggest distinct particle-associated mechanisms of neoplasia promotion induced by CNTs and asbestos. |
Prophage induction is enhanced and required for renal disease and lethality in an EHEC mouse model
Tyler JS , Beeri K , Reynolds JL , Alteri CJ , Skinner KG , Friedman JH , Eaton KA , Friedman DI . PLoS Pathog 2013 9 (3) e1003236 Enterohemorrhagic Escherichia coli (EHEC), particularly serotype O157:H7, causes hemorrhagic colitis, hemolytic uremic syndrome, and even death. In vitro studies showed that Shiga toxin 2 (Stx2), the primary virulence factor expressed by EDL933 (an O157:H7 strain), is encoded by the 933W prophage. And the bacterial subpopulation in which the 933W prophage is induced is the producer of Stx2. Using the germ-free mouse, we show the essential role 933W induction plays in the virulence of EDL933 infection. An EDL933 derivative with a single mutation in its 933W prophage, resulting specifically in that phage being uninducible, colonizes the intestines, but fails to cause any of the pathological changes seen with the parent strain. Hence, induction of the 933W prophage is the primary event leading to disease from EDL933 infection. We constructed a derivative of EDL933, SIVET, with a biosensor that specifically measures induction of the 933W prophage. Using this biosensor to measure 933W induction in germ-free mice, we found an increase three logs greater than was expected from in vitro results. Since the induced population produces and releases Stx2, this result indicates that an activity in the intestine increases Stx2 production. |
Prophylactic effficacy of oral emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) combination against a tenofovir-resistant shiv containing the K65R mutation in macaques
Cong ME , Mitchell J , Sweeney E , Bachman S , Hanson DL , Heneine W , Garcia-Lerma JG . J Infect Dis 2013 208 (3) 463-7 Daily pre-exposure prophylaxis with FTC/TDF is a novel HIV prevention strategy. We investigated in macaques if FTC/TDF prevents transmission of a tenofovir-resistant SHIV containing the K65R mutation. Six macaques received weekly a dose of FTC/TDF 3 days before rectal SHIV exposures and a second dose 2h after. Six untreated animals were controls. Animals were exposed rectally to escalating virus doses weekly for up to 28 weeks. PrEP significantly delayed infection with SHIV(K65R) (p=0.028) although 4/6 FTC/TDF-treated macaques were infected at the end of the challenges. These findings highlight the need to closely monitor PrEP efficacy in areas with prevalent K65R. |
Influenza A virus nucleoprotein induces apoptosis in human airway epithelial cells: implications of a novel interaction between nucleoprotein and host protein Clusterin
Tripathi S , Batra J , Cao W , Sharma K , Patel JR , Ranjan P , Kumar A , Katz JM , Cox NJ , Lal RB , Sambhara S , Lal SK . Cell Death Dis 2013 4 (3) e562 Apoptosis induction is an antiviral host response, however, influenza A virus (IAV) infection promotes host cell death. The nucleoprotein (NP) of IAV is known to contribute to viral pathogenesis, but its role in virus-induced host cell death was hitherto unknown. We observed that NP contributes to IAV infection induced cell death and heterologous expression of NP alone can induce apoptosis in human airway epithelial cells. The apoptotic effect of IAV NP was significant when compared with other known proapoptotic proteins of IAV. The cell death induced by IAV NP was executed through the intrinsic apoptosis pathway. We screened host cellular factors for those that may be targeted by NP for inducing apoptosis and identified human antiapoptotic protein Clusterin (CLU) as a novel interacting partner. The interaction between IAV NP and CLU was highly conserved and mediated through beta-chain of the CLU protein. Also CLU was found to interact specifically with IAV NP and not with any other known apoptosis modulatory protein of IAV. CLU prevents induction of the intrinsic apoptosis pathway by binding to Bax and inhibiting its movement into the mitochondria. We found that the expression of IAV NP reduced the association between CLU and Bax in mammalian cells. Further, we observed that CLU overexpression attenuated NP-induced cell death and had a negative effect on IAV replication. Collectively, these findings indicate a new function for IAV NP in inducing host cell death and suggest a role for the host antiapoptotic protein CLU in this process. |
Application of Markov chain Monte Carlo analysis to biomathematical modeling of respirable dust in US and UK coal miners
Sweeney LM , Parker A , Haber LT , Tran CL , Kuempel ED . Regul Toxicol Pharmacol 2013 66 (1) 47-58 A biomathematical model was previously developed to describe the long-term clearance and retention of particles in the lungs of coal miners. The model structure was evaluated and parameters were estimated in two data sets, one from the United States and one from the United Kingdom. The three-compartment model structure consists of deposition of inhaled particles in the alveolar region, competing processes of either clearance from the alveolar region or translocation to the lung interstitial region, and very slow, irreversible sequestration of interstitialized material in the lung-associated lymph nodes. Point estimates of model parameter values were estimated separately for the two data sets. In the current effort, Bayesian population analysis using Markov chain Monte Carlo simulation was used to recalibrate the model while improving assessments of parameter variability and uncertainty. When model parameters were calibrated simultaneously to the two data sets, agreement between the derived parameters for the two groups was very good, and the central tendency values were similar to those derived from the deterministic approach. These findings are relevant to the proposed update of the ICRP human respiratory tract model with revisions to the alveolar-interstitial region based on this long-term particle clearance and retention model. |
Comparison of field portable measurements of ultrafine TiO: X-ray fluorescence, laser-induced breakdown spectroscopy, and Fourier-transform infrared spectroscopy
Lebouf RF , Miller AL , Stipe C , Brown J , Murphy N , Stefaniak AB . Environ Sci Process Impacts 2013 15 (6) 1191-8 Laboratory measurements of ultrafine titanium dioxide (TiO2) particulate matter loaded on filters were made using three field portable methods (X-ray fluorescence (XRF), laser-induced breakdown spectroscopy (LIBS), and Fourier-transform infrared (FTIR) spectroscopy) to assess their potential for determining end-of-shift exposure. Ultrafine TiO2 particles were aerosolized and collected onto 37 mm polycarbonate track-etched (PCTE) filters in the range of 3 to 578 mcg titanium (Ti). Limit of detection (LOD), limit of quantification (LOQ), and calibration fit were determined for each measurement method. The LOD's were 11.8, 0.032, and 108 mug Ti per filter, for XRF, LIBS, and FTIR, respectively and the LOQ's were 39.2, 0.11, and 361 mcg Ti per filter, respectively. The XRF calibration curve was linear over the widest dynamic range, up to the maximum loading tested (578 mcg Ti per filter). LIBS was more sensitive but, due to the sample preparation method, the highest loaded filter measurable was 252 mcg Ti per filter. XRF and LIBS had good predictability measured by regressing the predicted mass to the gravimetric mass on the filter. XRF and LIBS produced overestimations of 4% and 2%, respectively, with coefficients of determination (R2) of 0.995 and 0.998. FTIR measurements were less dependable due to interference from the PCTE filter media and overestimated mass by 2% with an R2 of 0.831. |
Maternal medication and herbal use and risk for hypospadias: data from the National Birth Defects Prevention Study, 1997-2007
Lind JN , Tinker SC , Broussard CS , Reefhuis J , Carmichael SL , Honein MA , Olney RS , Parker SE , Werler MM . Pharmacoepidemiol Drug Saf 2013 22 (7) 783-93 PURPOSE: To investigate associations between maternal use of common medications and herbals during early pregnancy and risk for hypospadias in male infants. METHODS: We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1537 infants with second-degree or third-degree isolated hypospadias and 4314 live-born male control infants without major birth defects, with estimated dates of delivery from 1997 to 2007. Exposure was reported use of prescription or over-the-counter medications or herbal products, from 1 month before to 4 months after conception. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, previous live births, maternal subfertility, study site, and year. RESULTS: We assessed 64 medication and 24 herbal components. Maternal uses of most components were not associated with an increased risk of hypospadias. Two new associations were observed for venlafaxine (aOR 2.4; 95%CI 1.0, 6.0) and progestin-only oral contraceptives (aOR 1.9; 95%CI 1.1, 3.2). The previously reported association for clomiphene citrate was confirmed (aOR 1.9; 95%CI 1.2, 3.0). Numbers were relatively small for exposure to other specific patterns of fertility agents, but elevated aORs were observed for the most common of them. CONCLUSIONS: Overall, findings were reassuring that hypospadias is not associated with most medication components examined in this analysis. New associations will need to be confirmed in other studies. Increased risks for hypospadias associated with various fertility agents raise the possibility of confounding by underlying subfertility. (Copyright (c) 2013 John Wiley & Sons, Ltd.) |
Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease
Fairlie T , Zell ER , Schrag S . Obstet Gynecol 2013 121 (3) 570-7 OBJECTIVE: To estimate the effectiveness against early-onset group B streptococcal (GBS) disease of intrapartum antibiotic prophylaxis among term and preterm deliveries, deliveries with fewer than 4 hours of antibiotics, and deliveries receiving clindamycin regimens. METHODS: We performed a secondary analysis of the Birthnet cohort, a survey of 7,691 births to residents of the Active Bacterial Core surveillance system from 2003 to 2004. We used propensity score matching on covariates associated with prophylaxis and early-onset GBS disease to evaluate the effectiveness (1-risk ratio) of specific intrapartum antibiotic prophylaxis regimens against the disease end point. RESULTS: The effectiveness of 4 or more hours of prophylaxis with penicillin or ampicillin was high among term (91%, 95% confidence interval [CI] +63% to +98%) and preterm (86%, 95% CI +38% to +97%) neonates. Effectiveness was significantly lower for clindamycin (22%, 95% CI -53% to +60%). The effectiveness of 2 or fewer to fewer than 4 hours of prophylaxis with penicillin or ampicillin before delivery (47%, 95% CI -16% to +76%) and the effectiveness of prophylaxis with penicillin or ampicillin fewer than 2 hours before delivery (38%, 95% CI -17% to +67%) were both lower than the effectiveness of prophylaxis durations at 4 or more hours. CONCLUSION: Beta-lactam prophylaxis given 4 or more hours before delivery is highly effective for prevention of early-onset GBS disease. Prophylaxis of shorter durations or with clindamycin is less effective, reinforcing the need for health care providers to adhere to prevention recommendations, particularly for preterm deliveries, penicillin-allergic women, and neonates exposed to fewer than 4 hours of prophylaxis. LEVEL OF EVIDENCE: II. |
Health care seeking for childhood diarrhea in developing countries: evidence from seven sites in Africa and Asia
Nasrin D , Wu Y , Blackwelder WC , Farag TH , Saha D , Sow SO , Alonso PL , Breiman RF , Sur D , Faruque AS , Zaidi AK , Biswas K , Van Eijk AM , Levine MM , Kotloff KL . Am J Trop Med Hyg 2013 89 3-12 We performed serial healthcare use surveys among caretakers of children ages 0-59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0-11 months of age), from 0.4% to 4.7% for toddlers (12-23 months of age), and from 0.3% to 2.4% for preschoolers (24-59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15-56%, 17-64%, and 7-33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking behavior outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial healthcare use surveys as an invaluable tool for optimizing operational and methodological issues related to the performance of a large case control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings. |
Health-seeking behavior during childhood diarrheal illness: results of healthcare use and attitude surveys of caretakers in western Kenya, 2007-2010
Omore R , O'Reilly CE , Williamson J , Moke F , Were V , Farag TH , van Eijk AM , Kotloff KL , Levine MM , Obor D , Odhiambo F , Vulule J , Laserson KF , Mintz ED , Breiman RF . Am J Trop Med Hyg 2013 89 29-40 We interviewed caretakers of 1,043 children < 5 years old in a baseline cross-sectional survey (April to May 2007) and > 20,000 children on five separate subsequent occasions (May of 2009 to December 31, 2010) to assess healthcare seeking patterns for diarrhea. Diarrhea prevalence during the preceding 2 weeks ranged from 26% at baseline to 4-11% during 2009-2010. Caretakers were less likely to seek healthcare outside the home for infants (versus older children) with diarrhea (adjusted odds ratio [aOR] = 0.33, confidence interval [CI] = 0.12-0.87). Caretakers of children with reduced food intake (aOR = 3.42, CI = 1.37-8.53) and sunken eyes during their diarrheal episode were more likely to seek care outside home (aOR = 4.76, CI = 1.13-8.89). Caretakers with formal education were more likely to provide oral rehydration solution (aOR = 3.01, CI = 1.41-6.42) and visit a healthcare facility (aOR = 3.32, CI = 1.56-7.07). Studies calculating diarrheal incidence and healthcare seeking should account for seasonal trends. Improving caretakers' knowledge of home management could prevent severe diarrhea. |
Diarrheal disease constitutes one of the top two causes of mortality among young children in developing countries. Preface
Levine MM , Kotloff KL , Breiman RF , Zaidi AK . Am J Trop Med Hyg 2013 89 1-2 Diarrheal disease constitutes one of the top two causes of mortality among young children in developing countries, accounting for more than 1 in 10 deaths among children 1–59 months of age.1 Despite many studies that have attempted to address the overall burden, etiology, and consequences of diarrheal disease in infants and young children, at the turn of the millennium, many knowledge gaps remained, making it difficult to set priorities for implementing existing interventions and investing in new ones.2 To address these gaps, the Bill and Melinda Gates Foundation sponsored the Global Enteric Multicenter Study (GEMS), a project designed to quantify the population-based incidence, mortality, and sequelae of moderate-to-severe diarrheal illness (MSD) attributable to different etiologies in children < 60 months of age in sub-Saharan Africa and South Asia.2 The GEMS research agenda was pursued in seven representative field sites (four sites in sub-Saharan Africa and three sites in South Asia), with each site linked to a defined population (of ∼200,000 subjects) under continuous demographic surveillance, where all births, deaths, and migrations were recorded during three to four annual visits to each household.3 | The keystone component of GEMS is completion of a meticulously designed case control study undertaken to investigate the etiology of MSD; it is linked to a demographically monitored and defined population at each site, with surveillance activities and case enrollment proceeding at selected healthcare facilities (i.e., sentinel health centers). Of note, GEMS also happens to be one of the largest case control studies ever undertaken of an infectious disease syndrome. Over 3 years, GEMS accumulated ∼467,000 child-years of observation of children in three age strata (0–11, 12–23, and 24–59 months of age) and enrolled ∼9,500 cases of MSD and > 13,100 age- and sex-matched controls. Biostatistical methods used by GEMS biostatisticians and investigators allowed adjusted attributable fractions for the various pathogens associated with MSD to be calculated.4 |
Hymenoptera of Afghanistan and the Central Command area of operations: assessing the threat to deployed U.S. service members with insect venom hypersensitivity
Turbyville JC , Dunford JC , Nelson MR . Allergy Asthma Proc 2013 34 (2) 179-84 Insect venom hypersensitivity can pose a threat to personnel deployed to a combat zone but the exposure risk in Afghanistan is currently unknown. This study was designed to assess the threat of Hymenoptera stings and associated allergic reactions in Afghanistan. Hymenoptera species were collected during a deployment to southern Afghanistan from June 2010 through January 2011. The literature was also reviewed to determine species of medically important Hymenoptera recorded in the region. The U.S. Army theater electronic medical data system was mined for ICD-9 codes associated with insect stings to determine the number of theater medical clinic encounters addressing insect sting reactions. Three species of flying hymenoptera were commonly encountered during the study period: Vespa orientalis L., Polistes wattii Cameron, and Vespula germanica (F.). A literature review also confirms the presence of honeybees (Apidae), numerous velvet ant (Mutillidae) species, and various ant (Formicidae) species all capable of stinging. No evidence was identified to suggest that fire ants (Solenopsis ssp.) are a threat in the region. Based on electronic medical records from the U.S. Central Command area of operations over a 2-year period, roughly 1 in 500 clinic visits involved a patient with a diagnosis of insect bite or sting. Cross-reactive members of all five flying Hymenoptera species commonly assessed for in Hymenoptera allergy evaluations are present in Afghanistan. The review of in-theater medical records confirms that insect stings pose an environmental threat to deployed service members. |
The World Trade Center disaster: a tragic source of medical advancement
Antao VC . Eur Respir J 2013 41 (5) 999-1001 The history of medicine is full of examples of the determination of scientists when faced with public health disasters. As a result of this strength, many tragedies that occurred in the 20th century were followed by important scientific developments. If World War I marked the advent of chemical weapons, it also provided respiratory specialists with knowledge about the effects of poisonous gases on the lungs and led to the development of the first practical gas mask for mass production. The increased use of aircraft in warfare during World War II prompted Forrest M. Bird to develop oxygen masks to enable pilots to fly at higher altitudes than ever before. Further improvements of this technology led to the invention of the first modern ventilators, such as the Bird Universal Medical Respirator. The legacy of the Vietnam War to the medical field was the identification of acute respiratory distress syndrome (called Da Nang Lung at that time), by Colorado researchers in 1967 [1]. Other tragedies, such as the 1986 catastrophic nuclear accident of Chernobyl, led to a better understanding of the physiology of radiation poisoning, which had been evolving since the Hiroshima bombing, and helped improve treatment for victims of other disasters. There were advances in the creation of sterile hospital rooms, infection prevention, intravenous transfusion, life support systems, plasmapheresis, platelet transfusion, and bone marrow transplants. | The dawn of the 21st century saw another tragedy that will remain in the memory of many generations to come: the terrorist attacks on September 11, 2001 in New York City, NY, USA that led to the destruction of the World Trade Center (WTC) Twin Towers and other buildings, and claimed thousands of lives. In the past 10 years, hundreds of manuscripts have been published on the effects of the 9/11 disaster. These papers reported on the findings of several medical monitoring programmes [2–4] as well as the largest post-disaster public health registry in US history [5]; they described new syndromes [6] and striking cases of lung injury [7]; demonstrated the association between lung and mental health problems among rescue/recovery workers [8]; and expanded the understanding of the importance of respiratory protection in disaster situations [9]. In this issue of the European Respiratory Journal, a manuscript by Weiden et al. [10] goes beyond traditional WTC research. It looks at the association between serum levels of cardiovascular biomarkers and subsequent development of pulmonary disease, providing new insights into the pathophysiological mechanisms of particle-induced lung injury in humans. |
Obliterative bronchiolitis in fibreglass workers: a new occupational disease?
Cullinan P , McGavin CR , Kreiss K , Nicholson AG , Maher TM , Howell T , Banks J , Newman Taylor AJ , Chen CH , Tsai PJ , Shih TS , Burge PS . Occup Environ Med 2013 70 (5) 357-9 RATIONALE AND OBJECTIVES: Obliterative bronchiolitis (OB) is a rare disease with a small number of established occupational aetiologies. We describe a case series of severe OB in workers making glass-reinforced plastics. METHODS: Workplace exposures were the likely cause after the independent diagnosis of OB in two workers laying up the fibreglass hulls of yachts; the second worker took over the job of the first after he left following a lung transplant. Presentation of these two cases at international meetings led to others identifying similar workers. MAIN RESULTS: We identified six workers with good evidence of OB. All were involved in preparing fibreglass with styrene resins, five as boat builders laying up fibreglass hulls and one during cooling-tower fabrication. The disease came on rapidly without unusual acute exposures. Two patients had lung transplants, while another died while waiting for one. Histology confirmed OB in the four with biopsies/post-mortem examinations or explanted lungs. CONCLUSIONS: A rare, potentially fatal disease occurring in six workers laying up fibreglass with styrene resins from five different worksites suggests that work exposures were the cause of their OB. The precise agent responsible awaits identification. |
The face of occupational safety and health: 2020 and beyond
Kitt M , Howard J . Public Health Rep 2013 128 (3) 138-9 Every year on April 28, Workers Memorial Day, we honor those who have suffered injury, illness, and death on the job. Great strides have been made in workplace safety and health since Dr. Alice Hamilton and her colleagues began their historic investigation of occupationally related illnesses, as chronicled in her book, Exploring the Dangerous Trades.1 However, as long as the cost of any job is an injury, illness, or death that results in physical, financial, or emotional hardship for a worker or a worker's family, we fall short as a nation. | There is no doubt that workplace hazards such as asbestos, coal-mine dust, and industrial chemicals still exist as in the days of Dr. Hamilton, despite great advancements in controlling exposures and reducing the toll of job-related impairment, disability, and death. However, the National Institute for Occupational Safety and Health (NIOSH) and its partners must not only deal with these legacy hazards, but also recognize new challenges resulting from the evolving nature of work as we move toward 2020 and beyond. | The pace of technological change and the rapid diffusion of information require a vigilant eye to recognize emerging hazards often before their risks are fully understood or characterized. For example, novel materials such as nanoparticles have potential implications for worker health risk that have not been fully defined. There are also likely exposures to toxic materials in relatively new “downstream” processes (e.g., electronic-waste recycling) where the hazards may not be well recognized. |
Biomechanical loading of the shoulder complex and lumbosacral joints during dynamic cart pushing task
Nimbarte AD , Sun Y , Jaridi M , Hsiao H . Appl Ergon 2013 44 (5) 841-9 The primary objective of this study was to quantify the effect of dynamic cart pushing exertions on the biomechanical loading of shoulder and low back. Ten participants performed cart pushing tasks on flat (0 degrees ), 5 degrees , and 10 degrees ramped walkways at 20 kg, 30 kg, and 40 kg weight conditions. An optoelectronic motion capturing system configured with two force plates was used for the kinematic and ground reaction force data collection. The experimental data was modeled using AnyBody modeling system to compute three-dimensional peak reaction forces at the shoulder complex (sternoclavicular, acromioclavicular, and glenohumeral) and low back (lumbosacral) joints. The main effect of walkway gradient and cart weight, and gradient by weight interaction on the biomechanical loading of shoulder complex and low back joints was statistically significant (all p < 0.001). At the lumbosacral joint, negligible loading in the mediolateral direction was observed compared to the anterioposterior and compression directions. Among the shoulder complex joints, the peak reaction forces at the acromioclavicular and glenohumeral joints were comparable and much higher than the sternoclavicular joint. Increased shear loading of the lumbosacral joint, distraction loading of glenohumeral joint and inferosuperior loading of the acromioclavicular joint may contribute to the risk of work-related low back and shoulder musculoskeletal disorder with prolonged and repetitive use of carts. |
COPD causation and workplace exposures: an assessment of agreement among expert clinical raters
Fishwick D , Darby A , Hnizdo E , Barber C , Sumner J , Barraclough R , Bolton C , Burge S , Calverley P , Hopkinson N , Hoyle J , Lawson R , Niven R , Pickering T , Prowse K , Reid P , Warburton C , Blanc PD . COPD 2013 10 (2) 172-9 BACKGROUND: Although occupational exposure is a known risk factor for Chronic Obstructive Pulmonary Disease (COPD), it is difficult to identify specific occupational contributors to COPD at the individual level to guide COPD prevention or for compensation. The aim of this study was to gain an understanding of how different expert clinicians attribute likely causation in COPD. METHODS: Ten COPD experts and nine occupational lung disease experts assigned occupational contribution ratings to fifteen hypothetical cases of COPD with varying combinations of occupational and smoking exposures. Participants rated the cause of COPD as the percentage contribution to the overall attribution of disease for smoking, occupational exposures and other causes. RESULTS: Increasing pack-years of tobacco smoking was associated with significantly decreased proportional occupational causation ratings. Increasing weighted occupational exposure was associated with increased occupational causation ratings by 0.28% per unit change. Expert background also contributed significantly to the proportion of occupational causation rated, with COPD experts rating on average a 9.4% greater proportion of occupational causation per case. CONCLUSION: Our findings support the notion that respiratory physicians are able to assign attribution to different sources of causation in COPD, taking into account both smoking and occupational histories. The recommendations on whether to continue to work in the same job also differ, the COPD experts being more likely to recommend change of work rather than change of work practice. |
It is time to rethink tactics in the fight against malaria
Slutsker L , Kachur SP . Malar J 2013 12 140 April 25 marks World Malaria Day, an opportunity for those who work to defeat the illness, to review progress and renew commitments. After a decade of steady success, this year's commemoration of the date is also an opportunity to reconsider current approaches and assess the state of the science needed to keep pace in the global effort to combat malaria. |
Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010
Schirmer PL , Lucero-Obusan CA , Benoit SR , Santiago LM , Stanek D , Dey A , Martinez M , Oda G , Holodniy M . PLoS Negl Trop Dis 2013 7 (3) e2040 BACKGROUND: Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. METHODOLOGY: Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. FINDINGS: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. CONCLUSIONS: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans. |
What evidence and support do state-level public health practitioners need to address obesity prevention
Leeman J , Teal R , Jernigan J , Reed JH , Farris R , Ammerman A . Am J Health Promot 2013 28 (3) 189-96 PURPOSE: Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. SETTING: State-level public health obesity prevention programs. PARTICIPANTS: Public health practitioners and CDC project officers. METHOD: We conducted 10 in-depth interviews with public health practitioners (n=7) and project officers (n=3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. RESULTS: Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. CONCLUSION: We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems. |
Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers
Roland KB , Benard VB , Greek A , Hawkins NA , Manninen D , Saraiya M . Prev Med 2013 57 (5) 419-25 OBJECTIVE: Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. METHOD: Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. RESULTS: 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screenings (77%), patient concerns about missing cancer (62%), and liability (52%). CONCLUSION: Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals. |
The Radon transform inversion using moments
Mnatsakanov RM , Li SQ . Stat Probab Lett 2013 83 (3) 936-942 The problem of recovering the multivariate probability density function f from the moments of its Radon transform Rf is studied. The approximation of the Radon transform Rf itself is obtained from the moments off. Under the mild conditions on f the uniform rates of convergence for the proposed constructions are established. (C) 2012 Elsevier B.V. All rights reserved. |
A note on recovering the distributions from exponential moments
Mnatsakanov RM , Sarkisian K . Appl Math Comput 2013 219 (16) 8730-8737 The problem of recovering a cumulative distribution function of a positive random variable via the scaled Laplace transform inversion is studied. The uniform upper bound of proposed approximation is derived. The approximation of a compound Poisson distribution as well as the estimation of a distribution function of the summands given the sample from a compound Poisson distribution are investigated. Applying the simulation study, the question of selecting the optimal scaling parameter of the proposed Laplace transform inversion is considered. The behavior of the approximants are demonstrated via plots and table. |
Asymptomatic and chronic carriage of Leptospira interrogans serovar Pomona in California sea lions (Zalophus californianus)
Prager KC , Greig DJ , Alt DP , Galloway RL , Hornsby RL , Palmer LJ , Soper J , Wu Q , Zuerner RL , Gulland FM , Lloyd-Smith JO . Vet Microbiol 2013 164 177-83 Since 1970, periodic outbreaks of leptospirosis, caused by pathogenic spirochetes in the genus Leptospira, have caused morbidity and mortality of California sea lions (Zalophus californianus) along the Pacific coast of North America. Yearly seasonal epizootics of varying magnitude occur between the months of July and December, with major epizootics occurring every 3-5 years. Genetic and serological data suggest that Leptospira interrogans serovar Pomona is the infecting serovar and is enzootic in the California sea lion population, although the mechanism of persistence is unknown. We report asymptomatic carriage of Leptospira in 39% (33/85) of wild, free-ranging sea lions sampled during the epizootic season, and asymptomatic seroconversion with chronic asymptomatic carriage in a rehabilitated sea lion. This is the first report of asymptomatic carriage in wild, free-ranging California sea lions and the first example of seroconversion and asymptomatic chronic carriage in a sea lion. Detection of asymptomatic chronic carriage of Leptospira in California sea lions, a species known to suffer significant disease and mortality from the same Leptospira strain, goes against widely-held notions regarding leptospirosis in accidental versus maintenance host species. Further, chronic carriage could provide a mechanism for persistent circulation of Leptospira in the California sea lion population, particularly if these animals shed infectious leptospires for months to years. |
Oldest old long-term care recipients: findings from the National Center for Health Statistics’ long-term care surveys
Park-Lee E , Sengupta M , Bercovitz A , Caffrey C . Res Aging 2013 35 (3) 296-321 The purpose of this study was to examine socio-demographic and health characteristics of the oldest old receiving services from three types of long term care (LTC) providers. About 45% of nursing home residents in 2004 and 22% of home health care patients and 38% of discharged hospice care patients in 2007 were 85 years and older. The oldest old across the three LTC settings were predominantly White and women. More than two thirds of oldest old nursing home residents, home health care patients, and discharged hospice care patients needed assistance in performing three or more activities of daily living (ADLs) and were bladder incontinent. Hypertension and heart disease were the two most common chronic health conditions that the oldest old LTC recipients had across the care settings. Results provide a baseline that can be used to make comparisons with other new and emerging LTC providers like residential care and home care. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
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- Epidemiology and Surveillance
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