About one-half of adults with active epilepsy and seizures have annual family incomes under $25,000: The 2010 and 2013 US National Health Interview Surveys
US Centers For Disease Control and Prevention Epilepsy Program , Kobau R , Cui W , Zack MM . Epilepsy Behav 2016 58 33-34 People with active epilepsy are those who reported being told that they have epilepsy or a seizure disorder and either take antiseizure medication or have had a seizure during the past 12months. We used combined 2010 and 2013 National Health Interview Survey (NHIS) data on US adults with active epilepsy to examine whether taking medications and seizure frequency differed by sex, age, race/ethnicity, and reported or imputed annual family income. Of adults with active epilepsy, 45.5% reported taking medication and having at least one seizure, 41.3% reported taking medication and having no seizures, and 13.2% reported not taking any medication and having at least one seizure. About one-half of adults with active epilepsy and seizures have annual family incomes of less than $25,000. Promoting self-management supports and improved access to specialty care may reduce the burden of uncontrolled seizures in adults with epilepsy. |
Change in provider beliefs regarding cervical cancer screening intervals after an educational intervention
Benard VB , Greek A , Roland KB , Hawkins NA , Lin L , Saraiya M . J Womens Health (Larchmt) 2016 25 (5) 422-7 BACKGROUND: Current cervical cancer screening guidelines include the option of lengthening the screening interval to 5 years for average-risk women aged 30-65 years when screened with Pap and human papillomavirus (HPV) test (co-test). Because many providers are reluctant to extend screening intervals, we launched an educational intervention to promote recommended screening practices. The study objective was to assess changes in provider attitudes and beliefs to extending screening intervals among low-income women. METHODS: The study was conducted in 15 clinics in Federally Qualified Health Centers in Illinois. Providers in the intervention arm received a multicomponent educational intervention. Fifty-six providers (n = 29 intervention and n = 27 control) completed baseline and 12-month follow-up surveys assessing beliefs and intentions about extending screening intervals. RESULTS: The 12-month assessment showed providers in the intervention arm were significantly more likely than those in the control arm to recommend a 3-year screening interval (guideline recommendation at time of study) with a normal co-test result. Providers who received the intervention were significantly more likely to agree that routine co-testing is the best way to screen for cervical cancer, that extending the screening interval would be good, easy, and beneficial, and to disagree that the increased screening interval would cause patients to lose contact with the medical system. CONCLUSION: Educating providers on the natural history of HPV infection and cervical cancer and the benefits of extended intervals increased their willingness to follow guidelines. This study provides evidence that an educational intervention delivered with HPV testing materials may be effective in encouraging appropriate cervical screening intervals. |
Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective.
Kim L , McGee L , Tomczyk S , Beall B . Clin Microbiol Rev 2016 29 (3) 525-52 Streptococcus pneumoniae inflicts a huge disease burden as the leading cause of community-acquired pneumonia and meningitis. Soon after mainstream antibiotic usage, multiresistant pneumococcal clones emerged and disseminated worldwide. Resistant clones are generated through adaptation to antibiotic pressures imposed while naturally residing within the human upper respiratory tract. Here, a huge array of related commensal streptococcal strains transfers core genomic and accessory resistance determinants to the highly transformable pneumococcus. beta-Lactam resistance is the hallmark of pneumococcal adaptability, requiring multiple independent recombination events that are traceable to nonpneumococcal origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal strains with elevated MICs of beta-lactams are most often resistant to additional antibiotics. Basic underlying mechanisms of most pneumococcal resistances have been identified, although new insights that increase our understanding are continually provided. Although all pneumococcal infections can be successfully treated with antibiotics, the available choices are limited for some strains. Invasive pneumococcal disease data compiled during 1998 to 2013 through the population-based Active Bacterial Core surveillance program (U.S. population base of 30,600,000) demonstrate that targeting prevalent capsular serotypes with conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010, respectively) is extremely effective in reducing resistant infections. Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand. |
Etiological role and repeated infections of sapovirus among children aged less than two years in a cohort study in a peri-urban community of Peru.
Liu X , Jahuira H , Gilman RH , Alva A , Cabrera L , Okamoto M , Xu H , Windle HJ , Kelleher D , Varela M , Verastegui M , Calderon M , Sanchez G , Sarabia V , Ballard SB , Bern C , Mayta H , Crabtree JE , Cama V , Saito M , Oshitani H . J Clin Microbiol 2016 54 (6) 1598-1604 Human sapovirus has been shown to be one of the most important etiologies in pediatric patients with acute diarrhea. However, very limited data are available about the causative roles and epidemiology of sapovirus in community settings. A nested matched case-control study within a birth cohort study of acute diarrhea in a peri-urban community in Peru from 2007 to 2010 was conducted to investigate the attributable fraction (AF) and genetic diversity of sapovirus. By quantitative reverse transcription real-time polymerase chain reaction (RT-qPCR), sapovirus was detected in 12.4% (37/299) of diarrheal and 5.7% (17/300) of non-diarrheal stools (p=0.004). Sapovirus AF (7.1%) was higher in the second (13.2%) than the first year (1.4%) of life of children. Ten known genotypes and one novel cluster (n=5) within four genogroups (GI, GII, GIV and GV) were identified by phylogenetic analysis of partial VP1 gene. Further sequence analysis of full VP1 gene revealed a possible novel genotype, tentatively named as GII.8. Notably, symptomatic reinfections with different genotypes within the same (n=3) or different genogroups (n=5) were observed in eight children. Sapovirus exhibited high attributable burden for acute gastroenteritis especially in the second year of life of children in a Peruvian community. Further large-scale studies are needed to understand better the global burden, genetic diversity, and repeated infections of sapovirus. |
HIV virological failure and drug resistance in a cohort of Tanzanian HIV-infected adults.
Hawkins C , Ulenga N , Liu E , Aboud S , Mugusi F , Chalamilla G , Sando D , Aris E , Carpenter D , Fawzi W . J Antimicrob Chemother 2016 71 (7) 1966-74 OBJECTIVES: There are few data on ART failure rates and drug resistance from Tanzania, where there is a wide diversity of non-B HIV subtypes. We assessed rates and predictors of virological failure in HIV-infected Tanzanians and describe drug resistance patterns in a subgroup of these patients. METHODS: ART-naive, HIV-1-infected adults enrolled in a randomized controlled trial between November 2006 and 2008 and on ≥24 weeks of first-line NNRTI-containing ART were included. Population-based genotyping of HIV-1 protease and reverse transcriptase was performed on stored plasma from patients with virological failure (viral load >1000 copies/mL at ≥24 weeks of ART) and at baseline, where available. RESULTS: A total of 2403 patients [median (IQR) age 37 (32-43) years; 70% female] were studied. The median (IQR) baseline CD4+ T cell count was 128 (62-190) cells/muL. Predominant HIV subtypes were A, C and D (92.2%). The overall rate of virological failure was 14.9% (95% CI 13.2%-16.1%). In adjusted analyses, significant predictors of virological failure were lower CD4+ T cell count (P = 0.01) and non-adherence to ART (P < 0.01). Drug resistance mutations were present in 87/115 samples (75.7%); the most common were M184V/I (52.2%) and K103N (35%). Thymidine analogue mutations were uncommon (5.2%). The prevalence of mutations in 45 samples pre-ART was 22%. CONCLUSIONS: High levels of early ART failure and drug resistance were observed among Tanzanian HIV-1-infected adults enrolled in a well-monitored study. Initiating treatment early and ensuring optimal adherence are vital for the success and durability of first-line ART in these settings. |
A randomized controlled trial of POWER: An internet-based HIV prevention intervention for black bisexual men
Fernandez MI , Hosek SG , Hotton AL , Gaylord SE , Hernandez N , Alfonso SV , Joseph H . AIDS Behav 2016 20 (9) 1951-60 POWER is a theory-based, on-line HIV prevention intervention developed specifically for Black men who have sex with men and women (BMSMW), an understudied group significantly impacted by HIV. To test its efficacy, we recruited 224 BMSMW using chain referral methods and randomly assigned 108 to POWER and 103 to a health information comparison condition. Three months after the intervention, participants assigned to POWER had lower odds of reporting any condomless vaginal or condomless anal intercourse (CVAI) compared to those in the comparison group (aOR = 0.49; 95 % CI 0.25-0.98; p = 0.044). The intervention was associated with significantly lower odds of condomless anal intercourse with male partners (aOR = 0.55; 95 % CI 0.34-0.91; p = 0.020) but not with female partners and serodiscordant sex with male partners but not with female partners. Future studies are needed to replicate these findings in larger and more diverse samples of BMSMW and to understand the underlying mechanisms through which intervention efficacy was achieved. |
Recent transmission of tuberculosis - United States, 2011-2014
Yuen CM , Kammerer JS , Marks K , Navin TR , France AM . PLoS One 2016 11 (4) e0153728 Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011-September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9-4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3-4.5), and black (aPR = 3.0, 95% CI 2.6-3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0-2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2-0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations. |
The World Health Organization measles programmatic risk assessment tool-pilot testing in India, 2014
Goel K , Naithani S , Bhatt D , Khera A , Sharapov UM , Kriss JL , Goodson JL , Laserson KF , Goel P , Kumar RM , Chauhan LS . Risk Anal 2016 37 (6) 1063-1071 Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs. |
Parental presence at the bedside of a child with suspected ebola: an expert discussion
Hinton CF , Davies HD , Hocevar SN , Krug SE , Milstone AM , Ortmann L , Cassell CH , Peacock G , Griese SE . Clin Pediatr Emerg Med 2016 17 (1) 81-86 The Ebola virus disease (Ebola) outbreak in West Africa (2014-2015) prompted domestic planning to address the scenario in which a traveler imports Ebola into the United States. Parental presence at the bedside of a child with suspected or confirmed Ebola emerged as a challenging issue for pediatric health care providers and public health practitioners. At the heart of the issue was the balance of family-centered care and appropriate infection control, which are not easily aligned in the setting of Ebola. In the following dialogue, pediatricians, who participated in discussions about parental presence during the evaluation of pediatric persons under investigation, and a public health ethicist discuss the interplay between family-centered care and appropriate infection control. Reaching a balance between the 2 ideals is difficult and may require the facility and providers to engage in a deliberate conversation to determine how they will handle parental presence for such high-risk scenarios, including Ebola and other high-consequence pathogens, in their institution. © 2016 Elsevier Inc. |
Incomplete sputum smear microscopy monitoring among smear-positive tuberculosis patients in Uganda
Nakaggwa P , Odeke R , Kirenga BJ , Bloss E . Int J Tuberc Lung Dis 2016 20 (5) 594-9 SETTING: All 11 tuberculosis (TB) diagnostic and treatment units in Kyankwanzi and Kiboga Districts in Uganda. OBJECTIVES: To determine the frequency of, factors associated with and barriers related to incomplete anti-tuberculosis treatment sputum monitoring. DESIGN: Data were abstracted from anti-tuberculosis treatment and laboratory registers of sputum smear-positive patients who started treatment between January 2009 and December 2011 in the study districts. Patients missing documentation for any smear results at 2 or 3, 5, and 6 or 8 months were classified as having incomplete monitoring. Health providers and patients were interviewed about barriers to sputum monitoring. RESULTS: Overall, 272 (55%) of 492 patients had incomplete monitoring: 16% (78/492) at 2 or 3 months, 39% (181/465) at 5 months and 28% (119/428) at 6 or 8 months of treatment. More sputum results were recorded in laboratory than in TB treatment registers. Incomplete monitoring was significantly associated with being male, living in Kyankwanzi District and not receiving directly observed treatment. Patients' inability to produce sputum, long laboratory waiting times, and insufficient patient and provider education were primary reasons for incomplete monitoring. CONCLUSION: Over half of patients missed at least one smear result during treatment, which has implications for treatment monitoring and treatment outcomes in Uganda. |
Influenza activity in Kenya, 2007-2013: timing, association with climatic factors, and implications for vaccination campaigns
Emukule GO , Mott JA , Spreeuwenberg P , Viboud C , Commanday A , Muthoka P , Munywoki PK , Nokes DJ , van der Velden K , Paget JW . Influenza Other Respir Viruses 2016 10 (5) 375-85 BACKGROUND: Information on the timing of influenza circulation remains scarce in Tropical regions of Africa. OBJECTIVES: We assessed the relationship between influenza activity and several meteorological factors (temperature, specific humidity, precipitation), and characterized the timing of influenza circulation, and its implications to vaccination strategies in Kenya. METHODS: We analyzed virologically-confirmed influenza data for outpatient influenza-like illness (ILI), hospitalized for severe acute respiratory infections (SARI), and cases of severe pneumonia over the period 2007-2013. Using logistic and negative binomial regression methods, we assessed the independent association between climatic variables (lagged up to 4 weeks) and influenza activity. RESULTS: There were multiple influenza epidemics occurring each year and lasting a median duration of 2-4 months. On average, there were two epidemics occurring each year in most of the regions in Kenya, with the first epidemic occurring between the months of February and March and the second one between July and November. Specific humidity was independently and negatively associated with influenza activity. Combinations of low temperature (<18 degrees C) and low specific humidity (<11g/Kg) were significantly associated with increased influenza activity. CONCLUSIONS: Our study broadens understanding of the relationships between seasonal influenza activity and meteorological factors in the Kenyan context. While rainfall is frequently thought to be associated with influenza circulation in the tropics, the present findings suggest low humidity is more important in Kenya. If annual vaccination were a component of a vaccination strategy in Kenya, the months of April to June are proposed as optimal for associated campaigns. |
Insights in public health: Eliminating tuberculosis in Hawai'i: Yesterday, today, and tomorrow
Brostrom R , Wasserman G . Hawaii J Med Public Health 2016 75 (4) 117-20 The Hawai‘i Department of Health has actively engaged in tuberculosis (TB) control for more than 100 years. During that time, Hawai‘i has witnessed a remarkable decline in TB morbidity and mortality. New diagnostic tests and changing TB epidemiology warrant a change in our current approach to TB control. Currently, TB is a reportable condition under Hawai‘i Administrative Rules (HAR), Title 11, Chapter 156. Updated HAR for TB screening are nearly complete and reflect best practices and priorities for TB control. These changes include use of a TB Risk Assessment Screening Questionnaire, a new State TB Clearance Form, and inclusion of interferon gamma release assay (IGRA) blood tests to identify individuals with TB infection.1 These improvements will affect the medical community and others who partner with the State of Hawai‘i Department of Health to provide quality TB screening. |
Assessing patient exposure to a video-based intervention in STD clinic waiting rooms: Findings From the Safe in the City Trial
Besera GT , Cox S , Malotte CK , Rietmeijer CA , Klausner JD , O'Donnell L , Margolis AD , Warner L . Health Promot Pract 2016 17 (5) 731-8 Safe in the City, a video intervention for clinic waiting rooms, was previously shown to reduce sexually transmitted disease (STD) incidence. However, little is known about patients' recall of exposure to the intervention. Using data from a nested study of patients attending clinics during the trial, we assessed whether participants recalledSafe in the City, and, if so, how the intervention affected subsequent attitudes and behaviors. Analyses were restricted to responses to a 3-month follow-up questionnaire among participants who were exposed to the video (n= 708). Impact was measured as participants' reports of the video's effect on behaviors and attitudes. Associations were evaluated using multivariable logistic regression. Of participants who were exposed, 685 (97%) recalled viewing the video, and 68% recalled all three vignettes. After watching the video, participants felt more positive about condoms (69%) and comfortable acquiring condoms (56%), were reminded of important information about STDs and condoms (90%), and tried to apply what they learned to their lives (59%). Compared with those who recalled viewing one or two vignettes, participants who recalled viewing all three vignettes reported more positive attitudes toward condoms and peer/provider communication. These findings demonstrate that a low-resource video intervention for waiting rooms can provide sufficient exposure to positively influence STD-related attitudes/behaviors. |
Changing patterns in enteric fever incidence and increasing antibiotic resistance of enteric fever isolates in the United States, 2008-2012
Date KA , Newton AE , Medalla F , Blackstock A , Richardson L , McCullough A , Mintz ED , Mahon BE . Clin Infect Dis 2016 63 (3) 322-9 BACKGROUND: Enteric fever in the United States has been primarily associated with travel and with worrisome changes in global patterns of antimicrobial resistance. We present the first comprehensive report of National Typhoid and Paratyphoid Fever Surveillance System (NTPFS) data for a 5-year period (2008-2012). METHODS: We reviewed data on laboratory-confirmed cases reported to NTPFS, and related antimicrobial susceptibility results of SalmonellaTyphi and Paratyphi A isolates sent for testing by participating public health laboratories to CDC's National Antimicrobial Resistance Monitoring System laboratory. RESULTS: During 2008-2012, 2341 enteric fever cases were reported, 80% typhoid and 20% paratyphoid A. The proportion caused by paratyphoid A increased from 16% (2008) to 22% (2012). Foreign travel within 30 days preceding illness onset was reported by 1961 (86%) patients (86% typhoid and 92% paratyphoid A). Travel to southern Asia was common (82% for typhoid, 97% for paratyphoid A). Among 1091 (58%) typhoid and 262 (56%) paratyphoid A isolates tested for antimicrobial susceptibility, the proportion resistant to nalidixic acid (NAL-R) increased from 2008 to 2012 (Typhi 60% to 68%; Paratyphi-A 91% to 94%). Almost all NAL-R isolates were resistant or showed decreased susceptibility to ciprofloxacin. Resistance to at least ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole (multidrug resistant [MDR]) was limited to Typhi isolates, primarily acquired in southern Asia (13%). Most MDR isolates were also NAL-R. CONCLUSIONS: Enteric fever in the US is primarily associated with travel to southern Asia and increasing resistance is adding to treatment challenges. A bivalent typhoid and paratyphoid vaccine is needed. |
Barriers and facilitators to sustaining school health teams in coordinated school health programs
Cheung K , Lesesne CA , Rasberry CN , Kroupa E , Fisher D , Robin L , Pitt Barnes S . Health Promot Pract 2016 18 (3) 418-427 Coordinated school health (CSH) programs address multiple factors related to students' overall health, thereby increasing their physical and mental readiness to learn. A formative evaluation of three school districts in 2010-2011 examined strategies for sustaining the school health teams (SHTs) that lead CSH efforts. Qualitative data from 39 interviews and 13 focus groups revealed facilitators and barriers for sustaining SHTs. Quantitative data from 68 questionnaires completed by SHT members and school principals examined factors associated with having more active SHTs and district and school characteristics SHT members believed to be important to their schools' efforts to implement CSH. Facilitators of sustaining SHTs included administrative support, staff engagement in the SHT, and shared goals and responsibility. Barriers to sustaining SHTs included limited time and competing priorities, budget and funding constraints, and staff turnover. Findings provide valuable insight into challenges and potential solutions for improving the sustainability of SHTs to enable them to better support CSH efforts. |
The Next Generation of Risk Assessment Multiyear Study- Highlights of Findings, Applications to Risk Assessment and Future Directions.
Cote I , Andersen ME , Ankley GT , Barone S , Birnbaum LS , Boekelheide K , Bois FY , Burgoon LD , Chiu WA , Crawford-Brown D , Crofton KM , DeVito M , Devlin RB , Edwards SW , Guyton KZ , Hattis D , Judson RS , Knight D , Krewski D , Lambert J , Maull EA , Mendrick D , Paoli GM , Patel CJ , Perkins EJ , Poje G , Portier CJ , Rusyn I , Schulte PA , Simeonov A , Smith MT , Thayer KA , Thomas RS , Thomas R , Tice RR , Vandenberg JJ , Villeneuve DL , Wesselkamper S , Whelan M , Whittaker C , White R , Xia M , Yauk C , Zeise L , Zhao J , DeWoskin RS . Environ Health Perspect 2016 124 (11) 1671-1682 BACKGROUND: The Next Generation (NexGen) of Risk Assessment effort is a multiyear collaboration among several organizations evaluating new, potentially more efficient molecular, computational and systems biology approaches to risk assessment. This paper summarizes our findings, suggests applications to risk assessment, and identifies strategic research directions. OBJECTIVE: Our specific objectives were to test whether advanced biological data and methods could better inform our understanding of public health risks posed by environmental exposures. METHODS: New data and methods were applied and evaluated for use in hazard identification and dose-response assessment. Biomarkers of exposure and effect, and risk characterization were also examined. Consideration was given to various decision contexts with increasing regulatory and public health impacts. Data types included transcriptomics, genomics, and proteomics; methods included molecular epidemiology and clinical studies, bioinformatic knowledge mining, pathway and network analyses, short-duration in vivo and in vitro bioassays, and quantitative structure activity relationship modeling. DISCUSSION: NexGen has advanced our ability to apply new science by more rapidly identifying chemicals and exposures of potential concern, helping characterize mechanisms of action that influence conclusions about causality, exposure-response relationships, susceptibility and cumulative risk, and by elucidating new biomarkers of exposure and effects. Additionally, NexGen has fostered extensive discussion among risk scientists and managers and improved confidence in interpreting and applying new data streams. CONCLUSIONS: While considerable uncertainties remain, thoughtful application of new knowledge to risk assessment appears reasonable for augmenting major scope assessments, forming the basis for or augmenting limited scope assessments, and for prioritization and screening of very data limited chemicals. |
Prenatal phthalate exposures and childhood fat mass in a New York City cohort
Buckley JP , Engel SM , Mendez MA , Richardson DB , Daniels JL , Calafat AM , Wolff MS , Herring AH . Environ Health Perspect 2016 124 (4) 507-13 BACKGROUND: Experimental animal studies and limited epidemiologic evidence suggest that prenatal exposure to phthalates may be obesogenic, with potential sex-specific effects of phthalates having anti-androgenic activity. OBJECTIVES: We aimed to assess associations between prenatal phthalate exposures and childhood fat mass in a prospective cohort study. METHODS: We measured phthalate metabolite concentrations in third-trimester maternal urine in a cohort of women enrolled in New York City between 1998 and 2002 (n = 404). Among 180 children (82 girls and 98 boys), we evaluated body composition using a Tanita scale at multiple follow-up visits between ages 4 and 9 years (363 total visits). We estimated associations of standard deviation differences or tertiles of natural log phthalate metabolite concentrations with percent fat mass using linear mixed-effects regression models with random intercepts for repeated outcome measurements. We assessed associations in multiple metabolite models and adjusted for covariates including prepregnancy body mass index, gestational weight gain, maternal smoking during pregnancy, and breastfeeding. RESULTS: We did not observe associations between maternal urinary phthalate concentrations and percent body fat in models examining continuous exposures. Fat mass was 3.06% (95% CI: -5.99, -0.09%) lower among children in the highest tertile of maternal urinary concentrations of summed di(2-ethylhexyl) phthalate (SigmaDEHP) metabolites than in children in the lowest tertile. Though estimates were imprecise, there was little evidence that associations between maternal urinary phthalate concentrations and percent fat mass were modified by child's sex. CONCLUSIONS: Prenatal phthalate exposures were not associated with increased body fat among children 4-9 years of age, though high prenatal DEHP exposure may be associated with lower fat mass in childhood. |
Implementation of Nationwide Real-time Whole-genome Sequencing to Enhance Listeriosis Outbreak Detection and Investigation.
Jackson BR , Tarr C , Strain E , Jackson KA , Conrad A , Carleton H , Katz LS , Stroika S , Gould LH , Mody RK , Silk BJ , Beal J , Chen Y , Timme R , Doyle M , Fields A , Wise M , Tillman G , Defibaugh-Chavez S , Kucerova Z , Sabol A , Roache K , Trees E , Simmons M , Wasilenko J , Kubota K , Pouseele H , Klimke W , Besser J , Brown E , Allard M , Gerner-Smidt P . Clin Infect Dis 2016 63 (3) 380-6 Listeria monocytogenes(Lm) causes severe foodborne illness (listeriosis). Previous molecular subtyping methods, such as pulsed-field gel electrophoresis (PFGE), were critical in detecting outbreaks that led to food safety improvements and declining incidence, but PFGE provides limited genetic resolution. A multiagency collaboration began performing real-time, whole-genome sequencing (WGS) on all U.S.Lmisolates from patients, food, and the environment in September 2013, posting sequencing data into a public repository. Compared with the year before the project began, WGS, combined with epidemiologic and product trace-back data, detected more listeriosis clusters and solved more outbreaks (2 outbreaks in pre-WGS year, 5 in WGS year 1, and 9 in year 2). Whole-genome multilocus sequence typing and single nucleotide polymorphism analyses provided equivalent phylogenetic relationships relevant to investigations; results were most useful when interpreted in context of epidemiological data. WGS has transformed listeriosis outbreak surveillance and is being implemented for other foodborne pathogens. |
Invasive fungal infections acquired from contaminated food or nutritional supplements: A review of the literature
Benedict K , Chiller TM , Mody RK . Foodborne Pathog Dis 2016 13 (7) 343-9 Fungi are an integral part of the natural environment and, therefore, play many roles in relation to food: some fungi are used in food production, some are food sources themselves, and some are agents of food spoilage. Some fungi that contaminate food can also be harmful to human health. The harmful but noninfectious health consequences of mycotoxins have been well-characterized, but the extent to which fungi in food pose a risk for invasive infections is unknown. We conducted a literature review to identify cases of invasive fungal infections (IFIs) believed to have resulted from ingestion or inhalation of food, beverages, or dietary supplements (excluding Saccharomyces infections). We identified 11 publications describing cases or small outbreaks of IFIs related to foods or beverages and three describing IFIs related to dietary supplements. These food-associated IFIs were predominantly mold infections, and the few yeast infections were associated with dairy products. Suspected foodborne IFIs appear to be rare, but are increasingly described in the electronically searchable literature. They are associated with a variety of foods, are due to a variety of fungal pathogens, and primarily occur in persons with immunosuppressive conditions or other predisposing factors. Various guidelines for high-risk patients recommend avoidance of certain food products that may contain high levels of fungi, but further work is needed to evaluate the effectiveness of these restrictive diets in preventing fungal infections. The relationships between food spoilage, food insecurity, and IFI risk are another area that may warrant further exploration. |
Genetic variation of mini- and microsatellites and a clonal structure in Enterocytozoon bieneusi population in foxes and raccoon dogs and population differentiation of the parasite between fur animals and humans.
Li W , Wan Q , Yu Q , Yang Y , Tao W , Jiang Y , Xiao L . Parasitol Res 2016 115 (7) 2899-904 Enterocytozoon bieneusi is an obligate intracellular protozoan parasite that infects a wide range of mammal hosts and birds. Previous genotypic surveys were limited to measure the polymorphisms at the ribosomal internal transcribed spacer (ITS) that evolved slowly. Data on population structure are available only on E. bieneusi isolates from primates. This study explored the genotypic and phylogenetic characteristics of four mini- and microsatellites and performed a population genetic analysis in 39 E. bieneusi isolates of potentially zoonotic ITS genotype D from farmed foxes and raccoon dogs in China. Sequence polymorphisms facilitated determination of six, two, four, and five genotypes at markers MS1, MS3, MS4, and MS7, respectively. Patterns of phylogeny revealed different levels of diversity within and among the genetic markers. Clear genotypic and phylogenetic divergences between E. bieneusi isolates of ITS genotype D from fur animals and humans were observed at individual markers. Complete linkage disequilibrium and very limited recombination in subsequent population genetic analysis supported a clonal structure for E. bieneusi population from fur animals (FID). Phylogenetic analysis, genetic network, and measures of F ST and gene flow demonstrated population differentiation of FID from two known human E. bieneusi populations HID (with a clonal structure) and HIA (with an epidemic structure). The data indicated an ideal resolving power of MLST compared to the previously widely used ITS genotyping and confirmed the clonal nature and population differentiation of E. bieneusi in various hosts. |
Borrelia bissettiae sp. nov. and Borrelia californiensis sp. nov. Prevail in Diverse Enzootic Transmission Cycles.
Margos G , Lane RS , Fedorova N , Koloczek J , Piesman J , Hojgaard A , Sing A , Fingerle V . Int J Syst Evol Microbiol 2016 66 (3) 1447-1452 Two Borrelia species, Borrelia bissettiae sp. nov. and Borrelia californiensis sp. nov., were first described by Postic and co-workers (Postic et al., 2007; Postic et al., 1998) based on genetic analyses of several loci. Multilocus sequence analysis (MLSA) of eight housekeeping loci confirmed that these two Borrelia genospecies are distinct members of the B. burgdorferi s. l. complex (Margos et al., 2010). B. bissettiae sp. nov. initially was described in transmission cycles involving Neotoma fuscipes wood rats and Ixodes pacificus ticks in California, and Neotoma mexicana and Ixodes spinipalpis in Colorado. The preferred host of B. californiensis sp. nov. appears to be the California kangaroo rat, Dipodomys californicus; Ixodes jellisoni, I. spinipalipis and I. pacificus ticks are naturally infected with it. Thus, the ecological associations of the two genospecies and their genetic distance from all other known Borrelia genospecies species justify their validation as separate genospecies: B. bissettiae sp. nov. DN127T (= DSM 17990 T; = CIP 109136 T) and B. californiensis CA446T (= DSM 17989T; =ATCC BAA-2689TM). |
Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America
Barlam TF , Cosgrove SE , Abbo LM , MacDougall C , Schuetz AN , Septimus EJ , Srinivasan A , Dellit TH , Falck-Ytter YT , Fishman NO , Hamilton CW , Jenkins TC , Lipsett PA , Malani PN , May LS , Moran GJ , Neuhauser MM , Newland JG , Ohl CA , Samore MH , Seo SK , Trivedi KK . Clin Infect Dis 2016 62 (10) e51-77 Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics. |
Post-licensure safety surveillance of 23-valent pneumococcal polysaccharide vaccine in the Vaccine Adverse Event Reporting System (VAERS), 1990-2013.
Miller ER , Moro PL , Cano M , Lewis P , Bryant-Genevier M , Shimabukuro T . Vaccine 2016 34 (25) 2841-6 BACKGROUND: 23-Valent pneumococcal polysaccharide vaccine, trade name Pneumovax(R)23 (PPSV23), has been used for decades in the Unites States and has an extensive clinical record. However, limited post-licensure safety assessment has been conducted. OBJECTIVE: To analyze reports submitted to the Vaccine Adverse Event Reporting System (VAERS) following PPSV23 from 1990 to 2013 in order to characterize its safety profile. METHODS: We searched the VAERS database for US reports following PPSV23 for persons vaccinated from 1990 to 2013. We assessed safety through: automated analysis of VAERS data, crude adverse event (AE) reporting rates based on PPSV23 doses distributed in the US market, clinical review of death reports and reports involving vaccine administered to pregnant women, and empirical Bayesian data mining to assess for disproportional reporting. RESULTS: During the study period, VAERS received 25,168 PPSV23 reports; 92% were non-serious, 67% were in females and 86% were in adults aged ≥19 years. When PPSV23 was administered alone, fever (43%), injection site erythema (28%) and injection site pain (25%) were the most commonly reported non-serious AEs in children. Injection site erythema (32%), injection site pain (27%) and injection site swelling (23%) were the most commonly reported non-serious AEs in adults. Of serious reports (2129, 8% of total), fever was most commonly reported in both children (69%) and adults (39%). There were 66 reports of death, four in children and 62 in adults. Clinical review of death reports did not reveal any concerning patterns that would suggest a causal association with PPSV23. No disproportional reporting of unexpected AEs was observed in empirical Bayesian data mining. CONCLUSIONS: We did not identify any new or unexpected safety concerns for PPSV23. The VAERS data are consistent with safety data from pre-licensure clinical trials and other post-licensure studies. |
Which influenza vaccine formulation should be used in Kenya? A comparison of influenza isolates from Kenya to vaccine strains, 2007-2013
Waiboci LW , Mott JA , Kikwai G , Arunga G , Xu X , Mayieka L , Emukule GO , Muthoka P , Njenga MK , Fields BS , Katz MA . Vaccine 2016 34 (23) 2593-601 INTRODUCTION: Every year the World Health Organization (WHO) recommends which influenza virus strains should be included in a northern hemisphere (NH) and a southern hemisphere (SH) influenza vaccine. To determine the best vaccine formulation for Kenya, we compared influenza viruses collected in Kenya from April 2007 to May 2013 to WHO vaccine strains. METHODS: We collected nasopharyngeal and oropharyngeal (NP/OP) specimens from patients with respiratory illness, tested them for influenza, isolated influenza viruses from a proportion of positive specimens, tested the isolates for antigenic relatedness to vaccine strains, and determined the percentage match between circulating viruses and SH or NH influenza vaccine composition and schedule. RESULTS: During the six years, 7.336 of the 60,072 (12.2%) NP/OP specimens we collected were positive for influenza: 30,167 specimens were collected during the SH seasons and 3717 (12.3%) were positive for influenza; 2903 (78.1%) influenza A, 902 (24.2%) influenza B, and 88 (2.4%) influenza A and B positive specimens. We collected 30,131 specimens during the NH seasons and 3978 (13.2%) were positive for influenza; 3181 (80.0%) influenza A, 851 (21.4%) influenza B, and 54 (1.4%) influenza A and B positive specimens. Overall, 362/460 (78.7%) isolates from the SH seasons and 316/338 (93.5%) isolates from the NH seasons were matched to the SH and the NH vaccine strains, respectively (p<0.001). Overall, 53.6% and 46.4% SH and NH vaccines, respectively, matched circulating strains in terms of vaccine strains and timing. CONCLUSION: In six years of surveillance in Kenya, influenza circulated at nearly equal levels during the SH and the NH influenza seasons. Circulating viruses were matched to vaccine strains. The vaccine match decreased when both vaccine strains and timing were taken into consideration. Either vaccine formulation could be suitable for use in Kenya but the optimal timing for influenza vaccination needs to be determined. |
Modest waning of influenza vaccine efficacy and antibody titers during the 2007-2008 influenza season
Petrie JG , Ohmit SE , Truscon R , Johnson E , Braun TM , Levine MZ , Eichelberger MC , Monto AS . J Infect Dis 2016 214 (8) 1142-9 BACKGROUND: Antibody titers decrease with time following influenza vaccination, raising concerns that vaccine efficacy might wane. However, the relationship between time since vaccination and protection is unclear. METHODS: Time-varying vaccine efficacy (VE[t]) was examined in healthy adult participants (age range, 18-49 years) in a placebo-controlled trial of inactivated influenza vaccine (IIV) and live-attenuated influenza vaccine (LAIV) performed during the 2007-2008 influenza season. Symptomatic respiratory illnesses were laboratory-confirmed as influenza. VE(t)was estimated by fitting a smooth function based on residuals from Cox proportional hazards models. Subjects had blood samples collected immediately prior to vaccination, 30 days after vaccination, and at the end of the influenza season for testing by hemagglutination inhibition and neuraminidase inhibition assays. RESULTS: Overall efficacy was 70% (95% confidence interval [CI], 50%-82%) for IIV and 38% (95% CI, 5%-59%) for LAIV. Statistically significant waning was detected for IIV (P= .03) but not LAIV (P= .37); however, IIV remained significantly efficacious until data became sparse at the end of the season. Similarly, antibody titers against influenza virus hemagglutinin and neuraminidase significantly decreased over the season among IIV recipients. CONCLUSIONS: Both vaccines were efficacious but LAIV less so. IIV efficacy decreased slowly over time, but the vaccine remained significantly efficacious for the majority of the season. |
The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal
Cardemil CV , Estivariz C , Shrestha L , Sherchand JB , Sharma A , Gary HE Jr , Oberste MS , Weldon WC 3rd , Bowen MD , Vinje J , Schluter WW , Anand A , Mach O , Chu SY . Vaccine 2016 34 (22) 2519-26 BACKGROUND: A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1+3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown. METHODS: Infants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis. RESULTS: Infants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR]=0.44, 95% CI 0.29-0.68), as did infants with >5 loose stools per day (OR=0.36, 95% CI 0.21-0.62). CONCLUSIONS: Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease. CLINICAL TRIAL REGISTRY: This study is registered at clinicaltrials.gov as NCT01559636. |
Decline in emergency department visits for acute gastroenteritis among children in 10 US states following implementation of rotavirus vaccination, 2003-2013
Shah MP , Tate JE , Steiner CA , Parashar UD . Pediatr Infect Dis J 2016 35 (7) 782-6 BACKGROUND: Rotavirus vaccination of all infants began in the United States in 2006. While the effect of vaccination on childhood hospitalizations for rotavirus have been well described, the effects of rotavirus vaccine on ED visits are less well documented. METHODS: Using the State Emergency Department Databases (SEDD) for 10 US states, we compared rates of gastroenteritis- and rotavirus-coded ED visits among children < 5 years of age in pre-vaccine (2003-2006) with post-vaccine (2008-2013) years; 2007 was excluded as a transition year. We analyzed ED visit rates by age group, sex, race, and rotavirus season. RESULTS: The pre-vaccine annual gastroenteritis-coded ED visit rate among children < 5 years of age of 426 per 10,000 (annual range, 396-477 per 10,000) declined to 382 per 10,000 in post-vaccine years, a 10.3% (+/-0.3%, p<.0001) rate reduction overall. Compared with pre-vaccine years, annual ED visit rates for gastroenteritis decreased by 6.5% (+/-0.6%) in 2008, 12.3% (+/-0.6%) in 2010, 14.8% (+/-0.5%) in 2011, 20.4% (+/-0.5%) in 2012 and 10.1% (+/-0.6%) in 2013; a small increase of 1.8% (+/-0.6%) was seen in 2009 (p<.0001 for all individual comparisons). Declines were similar by sex and race and were greater in children <2 years of age (range 14.1-20.6%, p<.0001) than in older children (increase of 3.3% +/- 0.6%, p<.0001). A decline of 21.2% (+/-0.4%, p<.0001) in ED visits was seen during the rotavirus season months from January through June versus an increase of 9.5% (+/-0.6%, p<.0001) during July to December. ED visits specifically coded for rotavirus showed more prominent declines than for all gastroenteritis. CONCLUSIONS: ED visits for gastroenteritis in US children have declined since introduction of rotavirus vaccine. |
Developmental outcomes of using physical violence against dates and peers
Foshee VA , Gottfredson NC , Reyes HL , Chen MS , David-Ferdon C , Latzman NE , Tharp AT , Ennett ST . J Adolesc Health 2016 58 (6) 665-71 PURPOSE: The negative impact on adolescents of being a victim of violence is well documented, but the impact of being a perpetrator of violence is less well known. Knowing the negative outcomes of being a perpetrator could inform clinical interactions with adolescents, development of violence prevention strategies, and estimates of the societal burden of violence. This longitudinal study examined the effects of physical dating violence (DV) and peer violence (PV) perpetration on internalizing symptoms, relationships with friends and family, academic aspirations and grades, and substance use. METHODS: The four-wave longitudinal study (N = 3,979), conducted in two North Carolina counties over 2(1/2) years, spanned grades 8-12. Generalized linear mixed models were used to examine prospective lagged effects of each type of violence perpetration on each outcome and sex and grade as moderators of effects. RESULTS: Perpetrating DV significantly predicted lower college aspirations and greater likelihood of marijuana use. The effect of DV perpetration on increased family conflict was moderated by school grade; the effect decreased in significance across grades. Perpetrating PV significantly predicted greater likelihood of cigarette and marijuana use. The effects of PV perpetration on increased internalizing symptoms and alcohol intensity and decreased college aspirations were moderated by school grade; effects decreased in significance across grades. Neither type of perpetration predicted changes in number of reciprocated friendships, social status, or academic grades, and no effects varied by sex. CONCLUSIONS: These detrimental outcomes for the perpetrator need to be considered in clinical interactions with adolescents and violence prevention programming. |
Thyroid antagonists (perchlorate, thiocyanate, and nitrate) and childhood growth in a longitudinal study of U.S. girls
Mervish NA , Pajak A , Teitelbaum SL , Pinney SM , Windham GC , Kushi LH , Biro FM , Valentin-Blasini L , Blount BC , Wolff MS . Environ Health Perspect 2016 124 (4) 542-9 BACKGROUND: Perchlorate, thiocyanate, and nitrate are sodium/iodide symporter (NIS) inhibitors that block iodide uptake into the thyroid, thus affecting thyroid function. Thyroid dysfunction can adversely affect somatic growth and development in children. To our knowledge, no studies have examined effects of NIS inhibitors on body size measures. OBJECTIVE: We investigated associations between NIS inhibitors and childhood growth in 940 girls from the Puberty Study of the Breast Cancer and Environment Research Program. METHODS: Urine samples collected from girls 6-8 years of age at enrollment (2004-2007) from New York City, greater Cincinnati, Ohio, and the Bay Area in California were analyzed for NIS inhibitors and creatinine (C). The longitudinal association between NIS inhibitors and anthropometric measures [height, waist circumference, and body mass index (BMI)] during at least three visits was examined using mixed effects linear models, adjusted for race and site. RESULTS: Compared with girls in the low-exposure group (3.6, 626, and 500 mg/gC, median perchlorate, thiocyanate, and nitrate, respectively) girls with the highest NIS inhibitor exposure (9.6, 2,343, and 955 mg/gC, median perchlorate, thiocyanate, and nitrate, respectively) had slower growth in waist circumference and BMI but not height. Significant differences in the predicted mean waist circumference and BMI between the low- and high-exposure groups were observed beginning at 11 years of age. CONCLUSIONS: Higher NIS inhibitor exposure biomarkers were associated with reductions in waist circumference and BMI. These findings underscore the need to assess exposure to NIS inhibitors with respect to their influence on childhood growth. . |
Medium matters: modeling the impact of solid medium performance on tuberculosis trial sample size requirements
Johnson MG , Stout JE , Benator DA , Whitworth WC , Holland DP . Int J Tuberc Lung Dis 2016 20 (5) 600-4 SETTING: Two-month solid medium culture conversion is a commonly used, if suboptimal, endpoint for phase 2 anti-tuberculosis treatment trials. OBJECTIVE AND DESIGN: To model the effect of the performance characteristics (sensitivity and contamination rate) of solid medium on required sample size for a two-arm clinical trial with 85% true (gold standard) culture conversion in the control and 95% in the experimental arm. RESULTS: Increasing sensitivity and decreasing contamination reduced the sample size from 239 subjects/arm (60% sensitivity, 30% contamination) to 138 subjects/arm (95% sensitivity, 1% contamination). CONCLUSION: Optimizing solid medium has significant potential to reduce sample size and increase the efficiency of tuberculosis clinical trials. |
Multiwalled carbon nanotube-induced pulmonary inflammatory and fibrotic responses and genomic changes following aspiration exposure in mice: A 1-year postexposure study
Snyder-Talkington BN , Dong C , Porter DW , Ducatman B , Wolfarth MG , Andrew M , Battelli L , Raese R , Castranova V , Guo NL , Qian Y . J Toxicol Environ Health A 2016 79 (8) 1-15 Pulmonary exposure to multiwalled carbon nanotubes (MWCNT) induces an inflammatory and rapid fibrotic response, although the long-term signaling mechanisms are unknown. The aim of this study was to examine the effects of 1, 10, 40, or 80 mug MWCNT administered by pharyngeal aspiration on bronchoalveolar lavage (BAL) fluid for polymorphonuclear cell (PMN) infiltration, lactate dehydrogenase (LDH) activity, and lung histopathology for inflammatory and fibrotic responses in mouse lungs 1 mo, 6 mo, and 1 yr postexposure. Further, a 120-mug crocidolite asbestos group was incorporated as a positive control for comparative purposes. Results showed that MWCNT increased BAL fluid LDH activity and PMN infiltration in a dose-dependent manner at all three postexposure times. Asbestos exposure elevated LDH activity at all 3 postexposure times and PMN infiltration at 1 mo and 6 mo postexposure. Pathological changes in the lung, the presence of MWCNT or asbestos, and fibrosis were noted at 40 and 80 mug MWCNT and in asbestos-exposed mice at 1 yr postexposure. To determine potential signaling pathways involved with MWCNT-associated pathological changes in comparison to asbestos, up- and down-regulated gene expression was determined in lung tissue at 1 yr postexposure. Exposure to MWCNT tended to favor those pathways involved in immune responses, specifically T-cell responses, whereas exposure to asbestos tended to favor pathways involved in oxygen species production, electron transport, and cancer. Data indicate that MWCNT are biopersistent in the lung and induce inflammatory and fibrotic pathological alterations similar to those of crocidolite asbestos, but may reach these endpoints by different mechanisms. |
Performance of N95 FFRs against combustion and NaCl aerosols in dry and moderately humid air: manikin-based study
Gao S , Kim J , Yermakov M , Elmashae Y , He X , Reponen T , Zhuang Z , Rengasamy S , Grinshpun SA . Ann Occup Hyg 2016 60 (6) 748-60 OBJECTIVES: The first objective of this study was to evaluate the penetration of particles generated from combustion of plastic through National Institute for Occupational Safety and Health (NIOSH)-certified N95 filtering facepiece respirators (FFRs) using a manikin-based protocol and compare the data to the penetration of NaCl particles. The second objective was to investigate the effect of relative humidity (RH) on the filtration performance of N95 FFRs. METHODS: Two NIOSH-certified N95 FFRs (A and B) were fully sealed on a manikin headform and challenged with particles generated by combustion of plastic and NaCl particles. The tests were performed using two cyclic flows [with mean inspiratory flow (MIF) rates = 30 and 85 l min-1, representing human breathing under low and moderate workload conditions] and two RH levels ( approximately 20 and approximately 80%, representing dry and moderately humid air). The total and size-specific particle concentrations inside (Cin) and outside (Cout) of the respirators were measured with a condensation particle counter and an aerosol size spectrometer. The penetration values (Cin/Cout) were calculated after each test. RESULTS: The challenge aerosol, RH, MIF rate, and respirator type had significant (P < 0.05) effects on the performance of the manikin-sealed FFR. Its efficiency significantly decreased when the FFR was tested with plastic combustion particles compared to NaCl aerosols. For example, at RH approximately 80% and MIF = 85 l min-1, as much as 7.03 and 8.61% of combustion particles penetrated N95 respirators A and B, respectively. The plastic combustion particles and gaseous compounds generated by combustion likely degraded the electric charges on fibers, which increased the particle penetration. Increasing breathing flow rate or humidity increased the penetration (reduced the respirator efficiency) for all tested aerosols. The effect of particle size on the penetration varied depending on the challenge aerosol and respirator type. It was observed that the peak of the size distribution of combustion particles almost coincided with their most penetrating particle size, which was not the case for NaCl particles. This finding was utilized for the data interpretation. CONCLUSIONS: N95 FFRs have lower filter efficiency when challenged with contaminant particles generated by combustion, particularly when used under high humidity conditions compared to NaCl particles. |
Polybrominated diphenyl ether exposure and reproductive hormones in North American men
Makey CM , McClean MD , Braverman LE , Pearce EN , Sjodin A , Weinberg J , Webster TF . Reprod Toxicol 2016 62 46-52 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are flame retardant chemicals that are persistent organic pollutants. Animal experiments and some human studies indicate that PBDEs may adversely affect male reproductive function. OBJECTIVES: To assess the association between PBDE exposure and reproductive hormones (RHs) in a North American male adult cohort. METHODS: From 2010-11, we collected three serum samples from 27 healthy adult men. We assessed associations between PBDEs and RHs using mixed effect regression models. RESULTS: PBDEs were inversely associated with inhibin-B. In older men, increased concentrations of BDE-47 and BDE-100 were significantly associated with a decrease in inhibin-B, and an increase in follicular stimulating hormone (FSH). CONCLUSIONS: These findings suggest PBDE exposure may affect RHs in older men. We did not measure other parameters of male reproductive function and therefore these results are preliminary. |
Polybrominated diphenyl ether exposure and thyroid function tests in North American adults
Makey CM , McClean MD , Braverman LE , Pearce EN , He XM , Sjodin A , Weinberg JM , Webster TF . Environ Health Perspect 2016 124 (4) 420-5 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are flame-retardant chemicals that are added to many consumer products. Multiple animal studies have shown PBDEs to be thyroid hormone (TH) disruptors. Epidemiologic evidence of PBDE exposure associated with TH disruption has been inconclusive. OBJECTIVES: We used repeated measures to estimate associations between serum PBDE concentrations and THs in a North American adult cohort. METHODS: From 2010 to 2011, we collected ≤ 3 serum samples at approximately 6-month intervals from 52 healthy adult office workers from Boston, Massachusetts, for analysis of PBDE congeners and THs. RESULTS: The geometric mean sum concentrations of the most prevalent PBDE congeners (BDE-28, BDE-47, BDE-99, BDE-100, and BDE-153) were 22 ng/g lipid in winter 2010, 23 ng/g lipid in summer 2010, and 19 ng/g lipid in winter 2011. BDE-47 was the predominant congener. Based on a multivariable mixed regression model, we estimated that on average, a 1-ng/g serum increase in BDE-47 was associated with a 2.6-mug/dL decrease in total thyroxine (T4) (95% CI: -4.7, -0.35). Total T4 was inversely associated with each PBDE congener. Serum concentrations of PBDEs were not strongly associated with total triiodothyronine (T3), free T4, or thyroid-stimulating hormone (TSH). CONCLUSION: These results are consistent with those from animal studies showing that exposure to PBDEs is associated with a decrease in serum T4. Because the other TH concentrations did not appear to be associated with BDE exposures, our findings do not indicate effects on the pituitary-thyroid axis. Taken together, our findings suggest that PBDE exposure might decrease the binding of T4 to serum T4 binding proteins. |
Population impact of preterm birth and low birth weight on developmental disabilities in US children
Schieve LA , Tian LH , Rankin K , Kogan MD , Yeargin-Allsopp M , Visser S , Rosenberg D . Ann Epidemiol 2016 26 (4) 267-74 PURPOSE: Although previous studies demonstrate associations between adverse perinatal outcomes and developmental disabilities (DDs), study of population impacts is limited. METHODS: We computed relative risks adjusted (aRRs) for sociodemographic factors and component and summary population attributable fractions (PAFs) for associations between very low birth weight (VLBW, all preterm births), moderately low birth weight (MLBW) + Preterm, MLBW at term, and normal birth weight (NBW) + Preterm and seven DDs (cerebral palsy [CP], autism spectrum disorder [ASD], intellectual disability [ID], behavioral-conduct disorders, attention-deficit-hyperactivity disorder [ADHD], learning disability [LD], and other developmental delay) among children aged 3-17 years in the 2011-2012 National Survey of Children's Health. RESULTS: VLBW-Preterm, MLBW-Preterm and NBW-Preterm were strongly to moderately associated with CP (aRRs: 43.5, 10.1, and 2.2, respectively; all significant) and also associated with ID, ASD, LD, and other developmental delay (aRR ranges: VLBW-Preterm 2.8-5.3; MLBW-Preterm 1.9-2.8; and NBW-Preterm 1.6-2.3). Summary PAFs for preterm birth and/or LBW were 55% for CP, 10%-20% for ASD, ID, LD, and other developmental delay, and less than 5% for ADHD and behavioral-conduct disorders. Findings were similar whether we assessed DDs as independent outcomes or within mutually exclusive categories accounting for DD co-occurrence. CONCLUSIONS: Preterm birth has a sizable impact on child neurodevelopment. However, relative associations and population impacts vary widely by DD type. |
Prenatal Exposure to Phthalates and Childhood Body Size in an Urban Cohort
Maresca MM , Hoepner LA , Hassoun A , Oberfield SE , Mooney SJ , Calafat AM , Ramirez J , Freyer G , Perera FP , Whyatt RM , Rundle AG . Environ Health Perspect 2016 124 (4) 514-20 BACKGROUND: Phthalate exposures are hypothesized to increase obesity; however, prior research has been largely cross-sectional. OBJECTIVE: We evaluated associations between prenatal phthalate exposures and body mass index (BMI) at child ages 5 and 7 years. METHODS: Nine metabolites of six phthalates-di(2-ethylhexyl) phthalate (DEHP), di-n-octyl-, di-iso-butyl-, di-n-butyl-, butylbenzyl-, and diethyl phthalates-were measured in spot urine samples collected from pregnant African-American and Dominican women during their third trimester, and from their children at ages 3 and 5 years. To reduce multiple comparison issues, we initially used principal component analysis (PCA) to identify major patterns of natural log (ln)-transformed metabolite concentrations. Height and weight were assessed at ages 5 and 7 years, and fat mass and waist circumference at age 7. Linearized generalized estimating equation analyses related maternal component scores to child anthropometric outcomes at ages 5 (n = 326) and 7 (n = 330) years. RESULTS: PCA identified a DEHP component and a non-DEHP component. In boys, higher maternal non-DEHP, but not DEHP, component scores were associated with lower BMI z-score (beta = -0.30; 95% CI: -0.50, -0.10, n = 156), lower fat percentage (beta = -1.62; 95% CI: -2.91, -0.34, n = 142), and smaller waist circumference (beta = -2.02; 95% CI: -3.71, -0.32, n = 124). No significant associations with anthropometric outcomes were seen in girls (for BMI z-score, beta = 0.07; 95% CI: -0.18, 0.31, n = 181). Interactions between sex and non-DEHP component association with outcomes were statistically significant (p < 0.01). CONCLUSIONS: Contrary to hypotheses, prenatal non-DEHP phthalate exposures were associated with lower BMI z-score, waist circumference, and fat mass in boys during early childhood. |
Estimates of social contact in a middle school based on self-report and wireless sensor data
Leecaster M , Toth DJ , Pettey WB , Rainey JJ , Gao H , Uzicanin A , Samore M . PLoS One 2016 11 (4) e0153690 Estimates of contact among children, used for infectious disease transmission models and understanding social patterns, historically rely on self-report logs. Recently, wireless sensor technology has enabled objective measurement of proximal contact and comparison of data from the two methods. These are mostly small-scale studies, and knowledge gaps remain in understanding contact and mixing patterns and also in the advantages and disadvantages of data collection methods. We collected contact data from a middle school, with 7th and 8th grades, for one day using self-report contact logs and wireless sensors. The data were linked for students with unique initials, gender, and grade within the school. This paper presents the results of a comparison of two approaches to characterize school contact networks, wireless proximity sensors and self-report logs. Accounting for incomplete capture and lack of participation, we estimate that "sensor-detectable", proximal contacts longer than 20 seconds during lunch and class-time occurred at 2 fold higher frequency than "self-reportable" talk/touch contacts. Overall, 55% of estimated talk-touch contacts were also sensor-detectable whereas only 15% of estimated sensor-detectable contacts were also talk-touch. Contacts detected by sensors and also in self-report logs had longer mean duration than contacts detected only by sensors (6.3 vs 2.4 minutes). During both lunch and class-time, sensor-detectable contacts demonstrated substantially less gender and grade assortativity than talk-touch contacts. Hallway contacts, which were ascertainable only by proximity sensors, were characterized by extremely high degree and short duration. We conclude that the use of wireless sensors and self-report logs provide complementary insight on in-school mixing patterns and contact frequency. |
Harsh parenting, physical health, and the protective role of positive parent-adolescent relationships
Schofield TJ , Conger RD , Gonzales JE , Merrick MT . Soc Sci Med 2016 157 18-26 RATIONALE: Harsh, abusive and rejecting behavior by parents toward their adolescents is associated with increased risk of many developmental problems for youth. OBJECTIVE: In the present study we address behaviors of co-parents that might help disrupt the hypothesized health risk of harsh parenting. METHOD: Data come from a community study of 451 early adolescents followed into adulthood. During early adolescence, observers rated both parents separately on harshness towards the adolescent. Adolescents reported on their physical health at multiple assessments from age 12 through age 20, and on parental warmth. RESULTS: Harsh parenting predicted declines in adolescent self-reported physical health and increases in adolescent body mass index (BMI). Although the health risk associated with harshness from one parent was buffered by warmth from the other parent, warmth from the second parent augmented the association between harshness from the first parent and change over time in adolescent BMI. CONCLUSION: As appropriate, preventive interventions should include a focus on spousal or partner behaviors in their educational or treatment programs. Additional research is needed on the association between self-reported physical health and BMI in adolescence. |
Community engagement to inform the development of a sickle cell counselor training and certification program in Ghana
Anie KA , Treadwell MJ , Grant AM , Dennis-Antwi JA , Asafo MK , Lamptey ME , Ojodu J , Yusuf C , Otaigbe A , Ohene-Frempong K . J Community Genet 2016 7 (3) 195-202 Sickle cell disease (SCD) and sickle cell trait (SCT) are highly prevalent in Africa. Despite public health implications, there is limited understanding of community issues for implementing newborn screening and appropriate family counseling. We conducted a 3-day workshop in Kumasi, Ghana, with community leaders as lay program development advisors to assist the development and implementation of a Sickle Cell Counselor Training and Certification Program. We employed qualitative methods to understand cultural, religious, and psychosocial dimensions of SCD and SCT, including the advisors' attitudes and beliefs in relation to developing a culturally sensitive approach to family education and counseling that is maximally suited to diverse communities in Ghana. We collated advisors' discussions and observations in order to understand community issues and potential challenges and guide strategies for advocacy in SCD family education and counseling. Results from the workshop revealed that community leaders representing diverse communities in Ghana were engaged constructively in discussions about developing a culturally sensitive counselor training program. Key findings included the importance of improved knowledge about SCD among the public and youth in particular, the value of stakeholders such as elders and religious and traditional leaders, and government expectations of reduced SCD births. We submitted a report to the Ministry of Health in Ghana with recommendations for the next steps in developing a national sickle cell counselor training program. We named the program "Genetic Education and Counseling for Sickle Cell Conditions in Ghana" (GENECIS-Ghana). The first GENECIS-Ghana Training and Certification Program Workshop was conducted from June 8 to 12, 2015. |
Dietary iodine sufficiency and moderate insufficiency in the lactating mother and nursing infant: A computational perspective
Fisher W , Wang J , George NI , Gearhart JM , McLanahan ED . PLoS One 2016 11 (3) e0149300 The Institute of Medicine recommends that lactating women ingest 290 mug iodide/d and a nursing infant, less than two years of age, 110 mug/d. The World Health Organization, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders recommend population maternal and infant urinary iodide concentrations ≥ 100 mug/L to ensure iodide sufficiency. For breast milk, researchers have proposed an iodide concentration range of 150-180 mug/L indicates iodide sufficiency for the mother and infant, however no national or international guidelines exist for breast milk iodine concentration. For the first time, a lactating woman and nursing infant biologically based model, from delivery to 90 days postpartum, was constructed to predict maternal and infant urinary iodide concentration, breast milk iodide concentration, the amount of iodide transferred in breast milk to the nursing infant each day and maternal and infant serum thyroid hormone kinetics. The maternal and infant models each consisted of three sub-models, iodide, thyroxine (T4), and triiodothyronine (T3). Using our model to simulate a maternal intake of 290 mug iodide/d, the average daily amount of iodide ingested by the nursing infant, after 4 days of life, gradually increased from 50 to 101 mug/day over 90 days postpartum. The predicted average lactating mother and infant urinary iodide concentrations were both in excess of 100 mug/L and the predicted average breast milk iodide concentration, 157 mug/L. The predicted serum thyroid hormones (T4, free T4 (fT4), and T3) in both the nursing infant and lactating mother were indicative of euthyroidism. The model was calibrated using serum thyroid hormone concentrations for lactating women from the United States and was successful in predicting serum T4 and fT4 levels (within a factor of two) for lactating women in other countries. T3 levels were adequately predicted. Infant serum thyroid hormone levels were adequately predicted for most data. For moderate iodide deficient conditions, where dietary iodide intake may range from 50 to 150 mug/d for the lactating mother, the model satisfactorily described the iodide measurements, although with some variation, in urine and breast milk. Predictions of serum thyroid hormones in moderately iodide deficient lactating women (50 mug/d) and nursing infants did not closely agree with mean reported serum thyroid hormone levels, however, predictions were usually within a factor of two. Excellent agreement between prediction and observation was obtained for a recent moderate iodide deficiency study in lactating women. Measurements included iodide levels in urine of infant and mother, iodide in breast milk, and serum thyroid hormone levels in infant and mother. A maternal iodide intake of 50 mug/d resulted in a predicted 29-32% reduction in serum T4 and fT4 in nursing infants, however the reduced serum levels of T4 and fT4 were within most of the published reference intervals for infant. This biologically based model is an important first step at integrating the rapid changes that occur in the thyroid system of the nursing newborn in order to predict adverse outcomes from exposure to thyroid acting chemicals, drugs, radioactive materials or iodine deficiency. |
US consumer attitudes toward sodium in baby and toddler foods
John KA , Cogswell ME , Zhao L , Maalouf J , Gunn JP , Merritt RK . Appetite 2016 103 171-175 Dietary data from a nationally representative survey indicate about 80% of US toddlers aged 1-3 years consume too much dietary sodium, which can influence their preference for salty foods in later life. Information on consumer attitudes can inform strategies to reduce sodium in baby and toddler foods. Data were obtained from a 2012 online survey sent to a sample of 11636 US adults aged ≥18 years enrolled in a national probability-based consumer panel; 6378 completed the survey and had non-missing responses to the question of interest, "It is important for baby and toddler foods to be low in sodium." Prevalence of agreement was estimated. Logistic regression was used to describe associations of respondent characteristics with agreement. The majority of respondents were non-Hispanic white and had a household income ≥$60,000. About 7 in 10 (68%, 95% CI: 66%-70%) respondents agreed it is important for baby or toddler foods to be low in sodium. More than 6 of 10 respondents in most subgroups agreed. Among parents with a child currently aged <2 years (N = 390), 82% agreed (95% CI: 77%-87%); the highest agreement included parents who thought sodium was very harmful to their own health (92%, 95% CI: 85%-99%) or who were watching/reducing their own sodium intake (95%, 95% CI: 90%-100%). After adjusting for sex, age, race-ethnicity, agreement was most strongly associated with being a parent of a child <2 years, thinking sodium was harmful, and watching/reducing sodium intake (adjusted odds ratios ≥ 2.5, 95% CI's not equal1.0). The majority of respondents including most parents agreed it is important for baby and toddler foods to be low in sodium, suggesting wide consumer support for strategies to lower sodium in these foods. |
Child and caregiver attitudes about sports drinks and weekly sports drink intake among U.S. youth
Zytnick D , Park S , Onufrak SJ . Am J Health Promot 2016 30 (3) e110-9 Purpose To examine caregiver and youth attitudes about sports drinks (SDs) and the association of those attitudes with youth SD intake. Design Study design was cross-sectional. The online YouthStyles survey was sent to youth (ages 12-17 years) whose caregivers completed the online Summer ConsumerStyles survey for adults. Setting The 2011 Styles survey data comprised the setting. Subjects The sample was composed of 815 U.S. caregiver-youth dyads. Measures The outcome variable is youth SD consumption, and exposure variables are youth and caregivers' attitudes that SDs are healthy for children, and caregivers' attitude that children need SDs for hydration. Covariates are youth demographic and physical activity variables. Analysis Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for youth SD consumption one or more times per week after controlling for covariates. Results About one in five youth consumed SDs one or more times per week. Caregiver attitudes about the healthfulness of SDs and children's need of SDs for hydration both significantly differed by race and caregiver education level. The odds of youth SD consumption one or more times per week were significantly higher among youth of caregivers who agreed that SDs are good, healthy drinks for children (OR, 2.72 vs. disagreed) and among youth of caregivers who agreed that children need SDs for hydration (OR, 3.15 vs. disagreed). Youth attitude about SD healthfulness was not associated with intake. Conclusion Caregivers, particularly minority and less educated caregivers, may need more education about SD use. |
Toward a more complete picture of outpatient, office-based health care in the U.S
Lau DT , McCaig LF , Hing E . Am J Prev Med 2016 51 (3) 403-9 The healthcare system in the U.S., particularly outpatient, office-based care, has been shifting toward service delivery by advanced practice providers, particularly nurse practitioners (NPs) and physician assistants (PAs). The National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, is the leading source of nationally representative data on care delivered by office-based physicians. This paper first describes NAMCS, then discusses key NAMCS expansion efforts, and finally presents major findings from two exploratory studies that assess the feasibility of collecting data from NPs and PAs as sampled providers in NAMCS. The first NAMCS expansion effort began in 2006 when the NAMCS sample was expanded to include community health centers and started collecting and disseminating data on physicians, NPs, PAs, and nurse midwives in these settings. Then, in 2013, NCHS included workforce questions in NAMCS on the composition and clinical tasks of all healthcare staff in physician offices. Finally, in 2013-2014, NCHS conducted two exploratory studies and found that collecting data from NPs and PAs as sampled providers in NAMCS is feasible. However, modifications to the current NAMCS procedures may be necessary, for example, changing recruitment strategies, visit sampling procedures, and physician-centric survey items. Collectively, these NCHS initiatives are important for healthcare research, practice, and policy communities in their efforts toward providing a more complete picture of the changing outpatient, office-based workforce, team-based care approach, and service utilization in the U.S. |
A meta-analysis of studies investigating the effects of occupational lead exposure on thyroid hormones
Krieg EF Jr . Am J Ind Med 2016 59 (7) 583-90 INTRODUCTION: Investigations of the effects of occupational exposure to lead on the concentrations of thyroid hormones in the blood have not produced consistent results. A meta-analysis was performed to assess the effect of occupational exposure to lead on thyroid hormone concentrations using the results from published studies. METHODS: Group means from studies of the thyroid function of persons occupationally exposed to lead were used in a meta-analysis. Differences between the control and exposed groups, and the slopes between thyroid hormone concentrations and log10 blood lead concentrations or duration of exposure to lead were estimated using mixed models. The hormones analyzed were thyroid stimulating hormone, total and free thyroxine, and total and free triiodothyronine. RESULTS: No differences in mean thyroid hormone concentrations were found between the exposed and control groups. No relationships were found between blood lead or the duration of exposure to lead and thyroid hormone concentrations. CONCLUSION: The results of the analysis do not provide evidence for an effect of occupational lead exposure on thyroid function in men. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya
Dellicour S , Hill J , Bruce J , Ouma P , Marwanga D , Otieno P , Desai M , Hamel MJ , Kariuki S , Webster J . Malar J 2016 15 (1) 221 BACKGROUND: Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC). METHODS: A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated. RESULTS: Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively. CONCLUSION: This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level. |
Trends and outcomes of gestational surrogacy in the United States
Perkins KM , Boulet SL , Jamieson DJ , Kissin DM . Fertil Steril 2016 106 (2) 435-442 e2 OBJECTIVE: To evaluate trends and reproductive outcomes of gestational surrogacy in the United States. DESIGN: Retrospective cohort study. SETTING: Infertility clinics. PATIENT(S): IVF cycles transferring at least one embryo. INTERVENTION(S): Use of a gestational carrier. MAIN OUTCOME MEASURE(S): Trends in gestational carrier cycles during 1999-2013, overall and for non-U.S. residents; reproductive outcomes for gestational carrier and nongestational carrier cycles during 2009 to 2013, stratified by the use of donor or nondonor oocytes. RESULT(S): Of 2,071,984 assisted reproductive technology (ART) cycles performed during 1999-2013, 30,927 (1.9%) used a gestational carrier. The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013. Among gestational carrier cycles, the proportion with non-U.S. residents declined during 1999-2005 (9.5% to 3.0%) but increased during 2006-2013 (6.3% to 18.5%). Gestational carrier cycles using nondonor oocytes had higher rates of implantation (adjusted risk ratio [aRR], 1.22; 95% confidence interval [CI], 1.17-1.26), clinical pregnancy (aRR, 1.14; 95% CI, 1.10-1.19), live birth (aRR, 1.17; 95% CI, 1.12-1.21), and preterm delivery (aRR, 1.14; 95% CI, 1.05-1.23) compared with nongestational carrier cycles. When using donor oocytes, multiple birth rates were higher among gestational carrier compared with nongestational carrier cycles (aRR, 1.13; 95% CI, 1.08-1.19). CONCLUSION(S): Use of gestational carriers increased during 1999-2013. Gestational carrier cycles had higher rates of ART success than nongestational carrier cycles, but multiple birth and preterm delivery rates were also higher. These risks may be mitigated by transferring fewer embryos given the higher success rates among gestational carrier cycles. |
Weekly miscarriage rates in a community-based prospective cohort study in rural western Kenya
Dellicour S , Aol G , Ouma P , Yan N , Bigogo G , Hamel MJ , Burton DC , Oneko M , Breiman RF , Slutsker L , Feikin D , Kariuki S , Odhiambo F , Calip G , Stergachis A , Laserson KF , Ter Kuile FO , Desai M . BMJ Open 2016 6 (4) e011088 OBJECTIVE: Information on adverse pregnancy outcomes is important to monitor the impact of public health interventions. Miscarriage is a challenging end point to ascertain and there is scarce information on its rate in low-income countries. The objective was to estimate the background rate and cumulative probability of miscarriage in rural western Kenya. DESIGN: This was a population-based prospective cohort. PARTICIPANTS AND SETTING: Women of childbearing age were followed prospectively to identify pregnancies and ascertain their outcomes in Siaya County, western Kenya. The cohort study was carried out in 33 adjacent villages under health and demographic surveillance. OUTCOME MEASURE: Miscarriage. RESULTS: Between 2011 and 2013, among 5536 women of childbearing age, 1453 pregnancies were detected and 1134 were included in the analysis. The cumulative probability was 18.9%. The weekly miscarriage rate declined steadily with increasing gestation until approximately 20 weeks. Known risk factors for miscarriage such as maternal age, gravidity, occupation, household wealth and HIV infection were confirmed. CONCLUSIONS: This is the first report of weekly miscarriage rates in a rural African setting in the context of high HIV and malaria prevalence. Future studies should consider the involvement of community health workers to identify the pregnancy cohort of early gestation for better data on the actual number of pregnancies and the assessment of miscarriage. |
Emergency department visits and inpatient admissions associated with priapism among males with sickle cell disease in the United States, 2006-2010
Dupervil B , Grosse S , Burnett A , Parker C . PLoS One 2016 11 (4) e0153257 People with sickle cell disease (SCD) suffer from numerous acute complications that can result in multiple hospitalizations and emergency department (ED) and outpatient care visits. Priapism, a prolonged unwanted erection of the penis not due to sexual stimulation, is a serious complication among males with SCD. Variations in estimates of prevalence make it difficult to accurately assess the burden of this complication of SCD. We analyzed data from the Nationwide Emergency Department Sample (NEDS), a product of the Healthcare Cost and Utilization Project, for the years 2006 through 2010 to measure the numbers of ED visits and to examine patterns of subsequent hospitalizations associated with priapism among male patients with SCD. We find that among ED visits associated with males with SCD, those prompted by priapism are more likely to result in hospitalization than are those associated with pain. |
Application of implementation science methodology to immediate postpartum long-acting reversible contraception policy roll-out across states
Rankin KM , Kroelinger CD , DeSisto CL , Pliska E , Akbarali S , Mackie CN , Goodman DA . Matern Child Health J 2016 20 173-179 Purpose Providing long-acting reversible contraception (LARC) in the immediate postpartum period is an evidence-based strategy for expanding women's access to highly effective contraception and for reducing unintended and rapid repeat pregnancy. The purpose of this article is to demonstrate the application of implementation science methodology to study the complexities of rolling-out policies that promote immediate postpartum LARC use across states. Description The Immediate Postpartum LARC Learning Community, sponsored by the Association of State and Territorial Health Officials (ASTHO), is made up of multi-disciplinary, multi-agency teams from 13 early-adopting states with Medicaid reimbursement policies promoting immediate postpartum LARC. Partners include federal agencies and maternal and child health organizations. The Learning Community discussed barriers, opportunities, strategies, and promising practices at an in-person meeting. Implementation science theory and methods, including the Consolidated Framework for Implementation Research (CFIR), and a recent compilation of implementation strategies, provide useful tools for studying the complexities of implementing immediate postpartum LARC policies in birthing facilities across early adopting states. Assessment To demonstrate the utility of this framework for guiding the expansion of immediate postpartum LARC policies, illustrative examples of barriers and strategies discussed during the in-person ASTHO Learning Community meeting are organized by the five CFIR domains-intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and process. Conclusion States considering adopting policies can learn from ASTHO's Immediate Postpartum LARC Learning Community. Applying implementation science principles may lead to more effective statewide scale-up of immediate postpartum LARC and other evidence-based strategies to improve women and children's health. |
Passive suicidal ideation and community mental health resources in South Africa
Collins PY , Kondos L , Pillai A , Joestl SS , Frohlich J . Community Ment Health J 2016 52 (5) 541-50 South African communities continue to experience elevated incidence and prevalence of HIV infection. Passive suicidal ideation (PSI) may be one expression of distress in high prevalence communities. We report the prevalence of PSI and examine the relationship between PSI and participation in community organizations in a semi-rural sample of South African adults (N = 594). The prevalence of PSI in the 2 weeks prior to the interview was 9.1 %. Members of burial societies (Chi 2 = 7.34; p = 0.01) and stokvels (Chi 2 = 4.1; p = 0.04) (community-based savings groups) reported significantly less PSI compared to other respondents. Using a multivariate model adjusted for demographic characteristics, psychological distress, and socioeconomic status, we found lower odds of reporting PSI for members of burial societies (OR 0.48, CI 0.25 -0.91). Participation in community organizations that provide contextually salient resources in settings with high levels of distress may be a resource for mental health. |
New product marketing blurs the line between nicotine replacement therapy and smokeless tobacco products
Kostygina G , England L , Ling P . Am J Public Health 2016 106 (7) e1-e4 Tobacco companies have begun to acquire pharmaceutical subsidiaries and recently started to market nicotine replacement therapies, such as Zonnic nicotine gum, in convenience stores. Conversely, tobacco companies are producing tobacco products such as tobacco chewing gum and lozenges that resemble pharmaceutical nicotine replacement products, including a nicotine pouch product that resembles snus pouches. This convergence of nicotine and tobacco product marketing has implications for regulation and tobacco cessation. (Am J Public Health. Published online ahead of print April 14, 2016: e1-e4. doi:10.2105/AJPH.2016.303057). |
Preventing tobacco epidemic in LMICs with low tobacco use - using Nigeria GATS to review WHO MPOWER tobacco indicators and prevention strategies
Mbulo L , Ogbonna N , Olarewaju I , Musa E , Salandy S , Ramanandraibe N , Palipudi K . Prev Med 2016 91S S9-S15 INTRODUCTION: Tobacco is a major preventable cause of disease and death globally and increasingly shifting its burden to low and middle-income countries (LMICs) including African countries. We use Nigeria Global Adult Tobacco Survey data to examine indications of a potential tobacco epidemic in a LMIC setting and provide potential interventions to prevent the epidemic. METHODOLOGY: Global Adult Tobacco Survey data from Nigeria (2012; sample=9765) were analyzed to examine key tobacco indicators. Estimates and confidence intervals for each indicator were computed using SPSS software version 21 for complex samples. RESULTS: 5.5% of adult Nigerians use any tobacco and exposure to secondhand smoke was mainly high in bars (80.0%) and restaurants (29.3%). Two-thirds of smokers (66.3%) are interested in quitting. Among those who attempted to quit, 15.0% used counseling/advice and 5.2% pharmacotherapy. Awareness was high that tobacco use causes serious illnesses (82.4%), heart attack (76.8%) and lung cancer (73.0%) but only 51.4% for stroke. Awareness that secondhand smoke can cause serious illness was also high (74.5%). Overall 88.5% support tobacco products tax increase. CONCLUSION: Although tobacco use is relatively low in Nigeria as in other African countries, high smoking rate among men compared to women might indicate potential increase in prevalence. Challenges to preventing increasing smoking rate include limited use of evidence-based cessation methods among quit attempters, social acceptability of smoking particularly in bars and restaurants, and gap in knowledge on tobacco-related diseases. However, ratification of WHO FCTC and signing into law of the Tobacco Control law provide the impetus to implement evidence-based interventions. |
Association between media dose, ad tagging, and changes in web traffic for a national tobacco education campaign: A market-level longitudinal study
Shafer PR , Davis KC , Patel D , Rodes R , Beistle D . J Med Internet Res 2016 18 (2) e39 BACKGROUND: In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website. OBJECTIVE: The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media. METHODS: Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW. RESULTS: In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude. CONCLUSIONS: Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers' use of campaign-specific websites. |
Does digital ad exposure influence information-seeking behavior online? Evidence From the 2012 Tips From Former Smokers national tobacco prevention campaign
Kim A , Hansen H , Duke J , Davis K , Alexander R , Rowland A , Mitchko J . J Med Internet Res 2016 18 (3) e64 BACKGROUND: Measuring the impact of online health campaigns is challenging. Ad click-through rates are traditionally used to measure campaign reach, but few Internet users ever click on ads. Alternatively, self-reported exposure to digital ads would be prone to recall bias. Furthermore, there may be latency effects whereby people do not click on ads when exposed but visit the promoted website or conduct campaign-related searches later. Online panels that unobtrusively collect panelists' Web behavior data and link ad exposure to website visits and searches can more reliably assess the impact of digital ad exposure. From March to June 2012, the Centers for Disease Control and Prevention aired the national Tips From Former Smokers (Tips 2012) media campaign designed to encourage current smokers to quit. Advertisements ran across media channels, and the digital ads directed users to the Tips 2012 campaign website. OBJECTIVE: Our aim was to examine whether exposure to Tips 2012 digital ads influenced information-seeking behaviors online. METHODS: ComScore mined its panelists' Web behavior data for unique codes that would indicate exposure to Tips 2012 ads, regardless of whether panelists clicked the ad or not. A total of 15,319 US adults were identified as having been exposed to a Tips 2012 campaign ad. An equal number of unexposed adults (N=15,319) were identified and matched on demographics and Internet use behavior to the exposed group. Panelists' Web behavior data were mined for up to 4 weeks after initial Tips 2012 ad exposure to determine whether they visited the Tips 2012 campaign website or other cessation-related websites (eg, nicotine replacement therapy site) or conducted searches for campaign-related topics (eg, quit smoking). RESULTS: The proportion of exposed adults visiting the Tips 2012 sites increased from 0.4% in Week 1 to 0.9% 4 weeks after ad exposure, and these rates were significantly higher than in the unexposed group (0.1% in Week 1 to 0.4% in Week 4, P<.001) across all weeks examined. The proportion of exposed panelists visiting other cessation websites increased from 0.2% in Week 1 to 0.3% 4 weeks after initial ad exposure, and these rates were significantly higher than in the unexposed group (0.0% in Week 1 to 0.2% in Week 4, P=.001 to P=.019) across all weeks examined. There were no significant differences in searches for campaign-related topics between the exposed and unexposed group during most of the weeks examined. CONCLUSIONS: These results suggest that online ad exposure is associated with confirmed visits to the Tips 2012 campaign sites and visits to other cessation websites and that these information-seeking behaviors occur up to several weeks after ad exposure. Web behavior data from online panels are useful for examining exposure and behavioral responses to digital campaign ads. |
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