The relation of BMI and skinfold thicknesses to risk factors among young and middle-aged adults: the Bogalusa Heart Study
Freedman DS , Katzmarzyk PT , Dietz WH , Srinivasan SR , Berenson GS . Ann Hum Biol 2010 37 (6) 726-37 OBJECTIVE: Although adverse levels of cardiovascular disease risk factors are related to skinfold thicknesses and BMI among adults, the relative strengths of these associations are unknown. We examine whether the triceps and subscapular skinfold thicknesses are more strongly related to adult levels of lipids, fasting insulin and blood pressure than BMI. DESIGN AND SUBJECTS: Cross-sectional (n = 3318) and longitudinal (n = 1593) analyses of 18- to 44-year-olds examined in the Bogalusa Heart Study from 1983 to 2002. Principal components analysis was used to derive a summary index of the six examined risk factors (triglycerides, low- and high-density lipoprotein cholesterol, insulin, and systolic and diastolic blood pressures). RESULTS: The magnitudes of the differences were generally small, but all comparisons indicated that BMI was at least as strongly related to adverse risk factor levels as was the sum of subscapular and triceps skinfold thicknesses (SF sum). For example, adjusted cross-sectional associations with the risk factor summary were r = 0.55 (BMI) and r = 0.49 (SF sum), p < 0.001 for difference between correlations. Similar differences were seen in longitudinal analyses, with changes in the risk factor summary being more strongly associated with changes in BMI (r = 0.50) than with changes in the SF sum (r = 0.38). CONCLUSION: BMI appears to be at least as accurate as skinfold thicknesses in identifying metabolic risk among adults. The advantages of BMI should be considered in the design and interpretation of clinical and epidemiologic studies. |
Guidance for isolation precautions for mumps in the United States: a review of the scientific basis for policy change
Kutty PK , Kyaw MH , Dayan GH , Brady MT , Bocchini JA , Reef SE , Bellini WJ , Seward JF . Clin Infect Dis 2010 50 (12) 1619-28 The 2006 mumps resurgence in the United States raised questions about the appropriate isolation period for people with mumps. To determine the scientific basis for isolation recommendations, we conducted a literature review and considered isolation of virus and virus load in saliva and respiratory secretions as factors that were related to mumps transmission risk. Although mumps virus has been isolated from 7 days before through 8 days after parotitis onset, the highest percentage of positive isolations and the highest virus loads occur closest to parotitis onset and decrease rapidly thereafter. Most transmission likely occurs before and within 5 days of parotitis onset. Transmission can occur during the prodromal phase and with subclinical infections. Updated guidance, released in 2007-2008, changed the mumps isolation period from 9 to 5 days. It is now recommended that mumps patients be isolated and standard and droplet precautions be followed for 5 days after parotitis onset. |
Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya
van Eijk AM , Brooks JT , Adcock PM , Garrett V , Eberhard M , Rosen DH , Ayisi JG , Ochieng JB , Kumar L , Gentsch JR , Nahlen BL , Mintz ED , Slutsker L . Int J Infect Dis 2010 14 (3) e220-5 OBJECTIVE: To compare the frequency and etiology of diarrhea in children aged less than 2 years with known HIV status. METHODS: This was a nested cohort study, whereby children were followed during monthly routine and unscheduled visits. The HIV status of children was determined with PCR. A stool culture was obtained from children with diarrhea. A subset of stool samples was examined for parasites and tested for rotavirus. RESULTS: Between 1997 and 2001, 682 children (51.0% male) contributed observation periods with a mean of 47 weeks. Overall there were 198 episodes of diarrhea per 100 child-years of observation (CYO); diarrhea was more common among HIV-positive children than among HIV-negative children (321 vs. 183 episodes/100 CYO, respectively, p<0.01) and was not statistically different for HIV-negative children born to HIV-positive compared with HIV-negative mothers (182 vs. 187 episodes/100 CYO, respectively, p=0.36). For 66.5% of the acute episodes a stool culture was obtained; 27.8% of stool cultures yielded a bacterial pathogen. A positive stool culture was less likely among HIV-positive children compared to children of HIV-negative mothers (20.5% vs. 34.3%, p=0.01). Susceptibility of Salmonella and Shigella to commonly used antibiotics was low. Rotavirus was detected in 13.9% of 202 examined stool samples, and a stool parasite in 3.8% of 394 samples. Diarrhea was associated with 37.8% of child deaths. CONCLUSIONS: Diarrhea was more common among HIV-infected children, but was not associated with specific bacterial pathogens. Measures that reduce diarrhea will benefit all children, but may benefit HIV-infected children in particular. |
Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization, and cost-effectiveness
Grabbe KL , Menzies N , Taegtmeyer M , Emukule G , Angala P , Mwega I , Musango G , Marum E . J Acquir Immune Defic Syndr 2010 54 (3) 317-23 INTRODUCTION: This study compares client volume, demographics, testing results, and costs of 3 "mobile" HIV counseling and testing (HCT) approaches with existing "stand-alone" HCT in Kenya. A retrospective cohort of 62,173 individuals receiving HCT between May 2005 and April 2006 was analyzed. Mobile HCT approaches assessed were community-site mobile HCT, semimobile container HCT, and fully mobile truck HCT. Data were obtained from project monitoring data, project accounts, and personnel interviews. RESULTS: Mobile HCT reported a higher proportion of clients with no prior HIV test than stand-alone (88% vs. 58%). Stand-alone HCT reported a higher proportion of couples than mobile HCT (18% vs. 2%) and a higher proportion of discordant couples (12% vs. 4%). The incremental cost-effectiveness of adding mobile HCT to stand-alone services was $14.91 per client tested (vs. $26.75 for stand-alone HCT); $16.58 per previously untested client (vs. $43.69 for stand-alone HCT); and $157.21 per HIV-positive individual identified (vs. $189.14 for stand-alone HCT). CONCLUSIONS: Adding mobile HCT to existing stand-alone HCT seems to be a cost-effective approach for expanding HCT coverage for reaching different target populations, including women and young people, and for identifying persons with newly diagnosed HIV infection for referral to treatment and care. |
Perchlorate exposure from infant formula and comparisons with the perchlorate reference dose
Schier JG , Wolkin AF , Valentin-Blasini L , Belson MG , Kieszak SM , Rubin CS , Blount BC . J Expo Sci Environ Epidemiol 2010 20 (3) 281-7 Perchlorate exposure may be higher in infants compared with older persons, due to diet (infant formula) and body weight versus intake considerations. Our primary objective was to quantitatively assess perchlorate concentrations in commercially available powdered infant formulas (PIFs). Secondary objectives were: (1) to estimate exposure in infants under different dosing scenarios and compare them with the perchlorate reference dose (RfD); (2) estimate the perchlorate concentration in water used for preparing PIFs that would result in a dose exceeding the RfD; and (3) estimate iodine intakes from PIFs. We quantified perchlorate levels in three samples (different lot numbers) of reconstituted PIF (using perchlorate-free water) from commercial brands of PIF in each of the following categories: bovine milk-based with lactose, soy-based, bovine milk-based but lactose-free, and elemental (typically consisting of synthetic amino acids). Exposure modeling was conducted to determine whether the RfD might be exceeded in 48 dosing scenarios that were dependent on age, centile energy intake per unit of body weight, body weight percentile, and PIF perchlorate concentration. We obtained three different samples in each of the five brands of bovine- and soy-based PIF, three different samples in each of the three brands of lactose-free PIF, and three different samples in two brands of elemental PIF. The results were as follows: bovine milk-based with lactose (1.72 microg/l, range: 0.68-5.05); soy-based (0.21 microg/l, range: 0.10-0.44); lactose-free (0.27 microg/l, range: 0.03-0.93); and elemental (0.18 microg/l, range: 0.08-0.4). Bovine milk-based PIFs with lactose had a significantly higher concentration of perchlorate (P<0.05) compared with all. Perchlorate was a contaminant of all commercially available PIFs tested. Bovine milk-based PIFs with lactose had a significantly higher perchlorate concentration perchlorate than soy, lactose-free, and elemental PIFs. The perchlorate RfD may be exceeded when certain bovine milk-based PIFs are ingested and/or when PIFs are reconstituted with perchlorate-contaminated water. |
Polycyclic aromatic hydrocarbon metabolite levels and pediatric allergy and asthma in an inner-city cohort
Miller RL , Garfinkel R , Lendor C , Hoepner L , Li Z , Romanoff L , Sjodin A , Needham L , Perera FP , Whyatt RM . Pediatr Allergy Immunol 2010 21 260-7 Exposure to polycyclic aromatic hydrocarbons (PAH) has been associated with allergic sensitization and asthma. We hypothesized that increased urinary PAH metabolites are associated with allergy or asthma among children age 5 yrs in an inner-city birth cohort. As part of an ongoing prospective birth cohort under the auspices of the Columbia Center for Children's Environmental Health (CCCEH), urine was collected from 5-yr-old children (n = 222) of Dominican American and African American mothers in Northern Manhattan and South Bronx of New York City. Twenty-four PAH metabolites were measured in these specimens, and their levels (unadjusted and specific gravity corrected) were evaluated with IgE levels and asthma outcomes. Ten metabolites were detected in urine from all children. Concentrations ranged higher than those in representative samples of US children ages 6-11 in the National Health and Nutrition Examination Survey (NHANES). Among CCCEH children, compared with African Americans, the Dominican children had higher 2-hydroxynaphthalene but lower 9-hydroxyfluorene and 4-hydroxyphenanthrene concentrations. Increased 3-hydroxyfluorene and 3-hydroxyphenanthrene levels were associated with higher anti-mouse IgE levels (p < 0.05). These plus 2-hydroxynaphthalene, 2-hydroxyflourene and 1-hydroxyphenanthrene concentrations were associated with higher anti-mouse IgE levels on multivariate analyzes. Increased 2-hydroxyphenanthrene, 3-hydroxyphenanthrene and 4-hydroxyphenanthrene levels were associated with higher anti-cat IgE levels (p < 0.05) in univariate, but not multivariate, analyzes. Levels of PAH metabolites were not associated with respiratory symptoms. Measures of PAH metabolites suggest considerable exposure in an urban pediatric population, and possible associations with allergic sensitization to mouse. |
Interpreting NHANES biomonitoring data, cadmium
Ruiz P , Mumtaz M , Osterloh J , Fisher J , Fowler BA . Toxicol Lett 2010 198 (1) 44-8 Cadmium (Cd) occurs naturally in the environment and the general population's exposure to it is predominantly through diet. Smoking is another source of Cd exposure. Chronic Cd exposure is a public health concern because Cd is a known carcinogen; it accumulates in the body and causes kidney damage. The National Health and Nutritional Examination Survey (NHANES) has measured urinary Cd; the 2003-2004 NHANES survey cycle reported estimates for 2,257 persons aged six years and older in the Fourth National Report on Human Exposure to Environmental Chemicals. We developed a computational toxicology model to predict the urinary excretion of cadmium; the model compares well with the NHANES-measured data. Preliminary studies using this model showed that Cd uptake/exposure has increased among 6-11-year-olds, followed by a continuous monotonic rise into the seventh decade of life. Urinary excretion of Cd was approximately twofold higher among females than males in all age groups. The model describes Cd's cumulative nature in humans and accommodates the observed variation in exposure/uptake over the course of a lifetime. Such models may be useful for interpreting biomonitoring data and risk assessment. |
Aerosol and biological sampling of a ventilation fan-bank modified with ultraviolet germicidal irradiation and improved filter holders
Moyer ES , Miller WE , Commodore MA , Coffey CC , Hayes JL , Fotta SA , Sims G . Indoor Built Environ 2010 19 (2) 230-238 Two independent modifications were made to one of two identical side-by-side filter banks for a large air-handler: ( 1) new filter holders, intended to provide a better seal and ( 2) ultraviolet germicidal irradiation (UVGI) lamps, intended to control microbiological growth. Total system efficiency testing with optical particle counters was performed to determine the effectiveness of the new filter holders. The efficacy of the UVGI lamps was determined through biological surface and air sampling. Results indicated that the side with the new filter holders was about 3.4% more efficient per year during the 22-month sampling period, whereas the coil chamber with the UVGI lamps had less biological contamination than the corresponding control chamber for over 75% of the sampling days. |
Working with local, state and federal partners to address health education needs of Hurricane Katrina evacuees in Houston: a CDC case study
Hoover DM , Dopson S , Drehobl P . Am J Health Educ 2010 41 (2) 124-126 For health educators to successfully meet the challenges of responding to public health emergencies, it is important to establish and understand the role of collaborations with local, state and federal partners in identifying potential public health issues and to develop theory-based models or strategies to address these issues before, during and after an event. This paper presents a case study examining the health education and communication response to Hurricane Katrina in Houston, Texas. CDC's Health Education and Communication Teams and the Harris County Public Health and Environmental Services Division of Health Education worked with identified populations, environmental specialists, epidemiologists and other key partners to identify health education needs and develop appropriate messages and then developed and implemented a broad comprehensive health education and promotion plan. The paper discusses lessons learned and how health educators can use the model developed for this response to plan for future disasters and public health emergencies, including pandemic influenza. |
The importance of sex-worker interventions: the case of Avahan in India
Laga M , Galavotti C , Sundaramon S , Moodie R . Sex Transm Infect 2010 86 Suppl 1 i6-7 Since the very beginning of the HIV epidemic, sex workers have been at increased risk for HIV, because of multiple partners, and highly vulnerable because of environmental and structural barriers that prevent them from accessing services or having control over their activities.1 Experience with feasible and effective prevention programmes has been accumulating for more than 20 years. In Democratic Republic of Congo,2 Côte d'Ivoire3 and Bolivia,4 HIV and or STI rates among sex workers declined as a result of individual interventions including condom promotion, STI care and risk-reduction messages. Experience from the Dominican Republic5 and India6 7 illustrated the effectiveness of contextual interventions to reduce the vulnerability of sex workers and create an enabling environment. | So far, large-scale implementation of sex-worker interventions to reduce either risks or vulnerability has lagged behind. Most countries today still do not have a national plan to address the needs for this population, and worldwide less than 50% of sex workers have access to a minimum of prevention services.1 8 India is clearly an exception! |
African American women's retrospective perceptions of the intergenerational transfer of gynecological health care information received from mothers: implications for families and providers
Warren-Jeanpiere L , Miller KS , Warren AM . J Fam Commun 2010 10 (2) 81-98 Seeking preventive care and communicating openly with providers during clinical encounters could reduce adolescent African American (AA) women's risk of acquiring STIs or HIV. This study examines how the intergenerational transfer of gynecological health care information between mothers and daughters may influence the health care-seeking behavior of AA adolescent women and their ability to speak openly with providers about sexual health concerns, including sexually transmitted infection (STI) and HIV prevention during clinical encounters. In-depth interviews were conducted with 17 AA women (ages 20-55) to elicit retrospective narrative accounts including reason for the first visit, decision to seek care, and mother-daughter communication regarding gynecological health care. Data were analyzed using Critical Incident Analysis (CIA). Most participants (70%) sought gynecological health care as adolescents based upon their mothers' recommendations. Many (59%) reported that the visit was not preventive. Participants (29%) reported that a lack of communication from mothers regarding gynecological health was critical to their ability to speak openly with providers. Knowledge gained from this study could increase mothers' as well as providers' ability to facilitate family gynecological health communication, which could decrease young women's risk of experiencing negative health outcomes including HIV. |
Factors associated with mortality in transplant patients with invasive aspergillosis
Baddley JW , Andes DR , Marr KA , Kontoyiannis DP , Alexander BD , Kauffman CA , Oster RA , Anaissie EJ , Walsh TJ , Schuster MG , Wingard JR , Patterson TF , Ito JI , Williams OD , Chiller T , Pappas PG . Clin Infect Dis 2010 50 (12) 1559-67 BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA. METHODS: Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression. RESULTS: Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; [Formula: see text]). Independent poor prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death. CONCLUSIONS: There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials. |
Treatment with cationic liposome-DNA complexes (CLDC) protects mice from lethal Western equine encephalitis virus (WEEV) challenge
Logue CH , Phillips AT , Mossel EC , Ledermann JP , Welte T , Dow SW , Olson KE , Powers AM . Antiviral Res 2010 87 (2) 195-203 Having recently characterized a CD-1 outbred mouse model of pathogenesis for Western equine encephalitis virus, we examined the possible protective effects of cationic lipid DNA complexes (CLDC) against encephalitic arboviral infection. In this investigation, mice were pre-treated, co-treated, or post-treated with CLDC then challenged with a subcutaneous or aerosol dose of the highly virulent WEEV McMillan strain, lethal in mice 4-5 days after inoculation. Pre-treatment with CLDC provided a significant protective effect in mice, which was reflected in significantly increased survival rates. Further, in some instances a therapeutic effect of CLDC administration up to 12hours after WEEV challenge was observed. Mice treated with CLDC had significantly increased serum IFN-gamma, TNF-alpha, and IL-12, suggesting a strong Th1-biased antiviral activation of the innate immune system. In virus-infected animals, large increases in production of IFN-gamma, TNF-alpha, MCP-1, IL-12, and IL-10 in the brain were observed by 72hours after infection, consistent with neuroinvasion and viral replication in the CNS. These results indicate that strong non-specific activation of innate immunity with an immune therapeutic such as CLDC is capable of eliciting significant protective immunity against a rapidly lethal strain of WEEV and suggest a possible prophylactic option for exposed individuals. |
Utility of a Luminex-based assay for multiplexed, rapid species identification of Candida isolates from an ongoing candidemia surveillance
Deak E , Etienne KA , Lockhart SR , Gade L , Chiller T , Balajee SA . Can J Microbiol 2010 56 (4) 348-51 A Candida-specific Luminex-based assay with 11 probes was employed for multiplexed, rapid identification of 1182 Candida sp. isolates that were received as part of an ongoing population-based surveillance. All the Candida isolates were previously identified by a combination of methods, including phenotype and sequence analysis. Results showed that the Luminex assay was an attractive alternative to reference methods, as it is rapid, yields correct species identification, and is user friendly. |
PB2 residue 271 plays a key role in enhanced polymerase activity of influenza A viruses in mammalian host cells
Bussey KA , Bousse TL , Desmet EA , Kim B , Takimoto T . J Virol 2010 84 (9) 4395-406 The direct infection of humans with highly pathogenic avian H5N1 influenza viruses has suggested viral mutation as one mechanism for the emergence of novel human influenza A viruses. Although the polymerase complex is known to be a key component in host adaptation, mutations that enhance the polymerase activity of avian viruses in mammalian hosts are not fully characterized. The genomic comparison of influenza A virus isolates has identified highly conserved residues in influenza proteins that are specific to either human or avian viruses, including 10 residues in PB2. We characterized the activity of avian polymerase complexes containing avian-to-human mutations at these conserved PB2 residues and found that, in addition to the E627K mutation, the PB2 mutation T271A enhances polymerase activity in human cells. We confirmed the effects of the T271A mutation using recombinant WSN viruses containing avian NP and polymerase genes with wild-type (WT) or mutant PB2. The 271A virus showed enhanced growth compared to that of the WT in mammalian cells in vitro. The 271A mutant did not increase viral pathogenicity significantly in mice compared to that of the 627K mutant, but it did enhance the lung virus titer. Also, cell infiltration was more evident in lungs of 271A-infected mice than in those of the WT. Interestingly, the avian-derived PB2 of the 2009 pandemic H1N1 influenza virus has 271A. The characterization of the polymerase activity of A/California/04/2009 (H1N1) and corresponding PB2 mutants indicates that the high polymerase activity of the pandemic strain in mammalian cells is, in part, dependent on 271A. Our results clearly indicate the contribution of PB2 amino acid 271 to enhanced polymerase activity and viral growth in mammalian hosts. |
Phylogenetic analysis of rubella viruses involved in congenital rubella infections in France between 1995 and 2009
Vauloup-Fellous C , Hubschen JM , Abernathy ES , Icenogle J , Gaidot N , Dubreuil P , Parent-du-Chatelet I , Grangeot-Keros L , Muller CP . J Clin Microbiol 2010 48 (7) 2530-5 BACKGROUND: Rubella is an acute infectious disease with normally a mild clinical course. However, infections during pregnancy, especially before week 12 of gestation (WG), can cause severe birth defects known as congenital rubella syndrome (CRS). OBJECTIVES: The aim of this study was to perform genotyping and a molecular characterization of rubella viruses involved in congenital infections in France during the past fifteen years (1995 - 2009). STUDY DESIGN: Amniotic fluid (AF) (N= 80) of pregnant women with a congenital rubella infection (CRI) before week 20 of gestation and a few other samples available from children/newborns with congenital rubella syndrome (CRS) (N = 26), were analysed. The rubella virus E1 gene coding region was amplified by reverse transcriptase polymerase chain reaction directly from clinical specimens, and the resulting DNA fragments were sequenced. Sequences were assigned to genotypes by phylogenetic analysis with rubella virus reference sequences. RESULTS: A sufficient E1 gene sequence was obtained from 56 cases. Phylogenetic analysis of the sequences showed that at least five different genotypes (1E, 1G, 1B, 2B, and 1h) were present in France and involved in congenital infections, with a strong predominance of genotype 1E (87%). CONCLUSION: This is one of the very few comprehensive studies of rubella viruses involved in CRI. The results indicated that during the past 15 years multiple introductions of the dominant genotype E caused most of the CRI cases in France. A few sporadic cases were due to other genotypes (1B, 1G, 1h, 2B). |
Pseudomonas aeruginosa cytotoxin ExoU is injected into phagocytic cells during acute pneumonia
Diaz MH , Hauser AR . Infect Immun 2010 78 (4) 1447-56 ExoU, a cytotoxin translocated into host cells via the type III secretion system of Pseudomonas aeruginosa, is associated with increased mortality and disease severity. We previously showed that impairment of recruited phagocytic cells allowed survival of ExoU-secreting P. aeruginosa in the lung. Here we analyzed types of cells injected with ExoU in vivo using translational fusions of ExoU with a beta-lactamase reporter (ExoU-Bla). Cells injected with ExoU-Bla were detectable in vitro but not in vivo, presumably due to the rapid cytotoxicity induced by the toxin. Therefore, we used a noncytotoxic ExoU variant, designated ExoU(S142A)-Bla, to analyze injection in vivo. We determined that phagocytic cells in the lung were frequently injected with ExoU(S142A). Early during infection, resident macrophages constituted the majority of cells into which ExoU was injected, but neutrophils and monocytes became the predominant types of cells into which ExoU was injected upon recruitment into the lung. We observed a modest preference for injection into neutrophils over injection into other cell types, but in general the repertoire of injected immune cells reflected the relative abundance of these cells in the lung. Our results indicate that phagocytic cells in the lung are injected with ExoU and support the hypothesis that ExoU-mediated impairment of phagocytes has a role in the pathogenesis of pneumonia caused by P. aeruginosa. |
Quantification of monofluoroacetate and monochloroacetate in human urine by isotope dilution liquid chromatography tandem mass spectrometry
Hamelin EI , Mawhinney DB , Parry R , Kobelski RJ . J Chromatogr B Analyt Technol Biomed Life Sci 2010 878 1045-50 The rodenticide monofluoroacetate (MFA) and monochloroacetate (MCA), a chemical intermediate from several chemical syntheses, have been identified as potential agents of chemical terrorism due to their high toxicity. In preparation for response to poisonings and mass exposures, we have developed a quantification method using isotopic dilution to determine MFA and MCA in urine from 50 to 5000 ng/mL. Both analytes were extracted from urine using solid-phase extraction; extraction recoveries were 62% (MFA) and 76% (MCA). The extracts were then separated with isocratic high-performance liquid chromatography and identified using electrospray ionization tandem mass spectrometry, with detection limits of 0.9 and 7.0 ng/mL for MFA and MCA, respectively. Selectivity was established for both analytes with unique chromatographic retention times which were correlated with isotopically labeled internal standards and the use of two mass spectral transitions for each compound. The intra-day variability was less than 5% for both analytes and the inter-day variability was 7% for MFA and 6% for MCA. |
Field performance of the CATHIA-T sampler and two cyclones against the standard cowled sampler for thoracic fiber concentrations
Lee EG , Nelson J , Hintz PJ , Joy G , Andrew ME , Harper M . Ann Occup Hyg 2010 54 (5) 545-56 The performance of two thoracic samplers, the GK2.69 cyclone and the CATHIA-T sampler, and the GK3.51 cyclone was investigated in the field against the standard cowled sampler (current NIOSH 7400 method) to determine the effect of thoracic sampling. The CATHIA-T sampler and the GK2.69 cyclone were operated at 7 and 1.6 l min(-1), respectively. The GK3.51 sampler is related to the GK2.69 cyclone, but designed to give a thoracic cut at a flow rate of 3.2 l min(-1). A total of 136 area samples were obtained from a tremolitic talc processing mill and 148 area samples were obtained within a quarry in which metamorphosed volcanic rocks were being crushed for construction stone. Sample slides were prepared using the dimethyl formamide/Euparal technique and relocatable cover slips. NIOSH 7400 'A' counting rules were used to examine fibers. Additionally, counters were asked to record the number of fibers where a fiber meets the 'A' rules and is wider than 3-mum physical diameter in order to estimate the proportion of extra-thoracic fibers. A few slides from each sampler type were randomly selected and fiber widths for those fibers satisfying the counting rules were measured to determine median width ratios of each thoracic sampler to the cowled sampler. Overall, the combined results of this study and the previous study by the same authors (Lee et al., 2008) showed lower fiber concentrations for the CATHIA-T sampler and higher concentrations for the GK2.69 cyclone and the GK3.51 cyclone compared to the standard cowled sampler. The proportion of extra-thoracic fibers (>3-mum physical diameter) on the filters collected with each type of thoracic samplers was comparable to the proportion of such fibers collected with the cowled sampler. The most consistent result over this study and our previous study is that both cyclones gave higher fiber concentrations than the CATHIA-T sampler. However, the estimated width ratios of each cyclone type to the cowled sampler were similar to or equal to 1 indicating no separation of fiber bundles due to cyclone effects. An inverse relationship between the fiber concentration ratios of each thoracic sampler type to the cowled sampler and the relative sample loading rate compared to the cowled sampler was observed. The difference in fiber concentration ratios might be a function of sample loading rather than an effect of thoracic size selection. Therefore, it is not recommended that any of these samplers be used to replace the cowled sampler in measurements intended for comparison with limit values arising from risk assessments developed from cowled sampler measurements without considering this possible effect. |
Brucella inopinata sp. nov., isolated from a breast implant infection
Scholz HC , Nockler K , Gollner C , Bahn P , Vergnaud G , Tomaso H , Al Dahouk S , Kampfer P , Cloeckaert A , Maquart M , Zygmunt MS , Whatmore AM , Pfeffer M , Huber B , Busse HJ , De BK . Int J Syst Evol Microbiol 2010 60 801-8 A Gram-negative, non-motile, non-spore-forming coccoid bacterium (strain BO1(T)) was isolated recently from a breast implant infection of a 71-year-old female patient with clinical signs of brucellosis. Affiliation of strain BO1(T) to the genus Brucella was confirmed by means of polyamine pattern, polar lipid profile, fatty acid profile, quinone system, DNA-DNA hybridization studies and by insertion sequence 711 (IS711)-specific PCR. Strain BO1(T) harboured four to five copies of the Brucella-specific insertion element IS 711, displaying a unique banding pattern, and exhibited a unique 16S rRNA gene sequence and also grouped separately in multilocus sequence typing analysis. Strain BO1(T) reacted with Brucella M-monospecific antiserum. Incomplete lysis was detected with bacteriophages Tb (Tbilisi), F1 and F25. Biochemical profiling revealed a high degree of enzymic activity and metabolic capabilities. In multilocus VNTR (variable-number tandem-repeat) analysis, strain BO1(T) showed a very distinctive profile and clustered with the other 'exotic' Brucella strains, including strains isolated from marine mammals, and Brucella microti, Brucella suis biovar 5 and Brucella neotomae. Comparative omp2a and omp2b gene sequence analysis revealed the most divergent omp2 sequences identified to date for a Brucella strain. The recA gene sequence of strain BO1(T) differed in seven nucleotides from the Brucella recA consensus sequence. Using the Brucella species-specific multiplex PCR assay, strain BO1(T) displayed a unique banding pattern not observed in other Brucella species. From the phenotypic and molecular analysis it became evident that strain BO1( T) was clearly different from all other Brucella species, and therefore represents a novel species within the genus Brucella. Because of its unexpected isolation, the name Brucella inopinata with the type strain BO1(T) (=BCCN 09-01(T)=CPAM 6436(T)) is proposed. |
Delivery is not the end of the story: follow-up of women with gestational diabetes mellitus
Callaghan WM . Contemp Ob Gyn 2010 55 (4) 40 This article will help you to identify at-risk patients and guide your interventions in controlling the disease and preventing its complications. |
Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants?
Li R , Fein SB , Grummer-Strawn LM . Pediatrics 2010 125 (6) e1386-93 OBJECTIVE: How breastfeeding reduces the risk of childhood obesity is unclear, and 1 hypothesis pertains to the ability of breastfed infants to self-regulate. We studied whether infants' self-regulation of milk intake is affected by feeding mode (bottle versus breast) and the type of milk in the bottle (formula versus expressed breast milk). PATIENTS AND METHODS: Participants in the 2005-2007 Infant Feeding Practices Study II received monthly questionnaires during their infant's first year, and compete data were available for 1250 infants. We tested the impact of feeding mode and type of milk during early infancy on self-regulation during late infancy. RESULTS: Although only 27% of infants fed exclusively at the breast in early infancy emptied the bottle or cup in late infancy, 54% of infants who were fed both at the breast and by bottle did so, and 68% of those who were fed only by bottle did so. Multivariate regression analysis indicated that infants who were bottle-fed more intensively early in life were approximately 71% or 2 times more likely to empty the bottle or cup later in life than those who were bottle-fed less intensively ((1/3)-(2/3) or (2/3) of milk feeds given by bottle versus < (1/3) of milk feeds). When feeding formula and expressed milk were considered separately, similar dose-response relationships were observed. CONCLUSIONS: Infants who are bottle-fed in early infancy are more likely to empty the bottle or cup in late infancy than those who are fed directly at the breast. Bottle-feeding, regardless of the type of milk, is distinct from feeding at the breast in its effect on infants' self-regulation of milk intake. |
The informationist: building evidence for an emerging health profession
Grefsheim SF , Whitmore SC , Rapp BA , Rankin JA , Robison RR , Canto CC . J Med Libr Assoc 2010 98 (2) 147-56 BACKGROUND: To encourage evidence-based practice, an Annals of Internal Medicine editorial called for a new professional on clinical teams: an informationist trained in science or medicine as well as information science. OBJECTIVES: The study explored the effects of informationists on information behaviors of clinical research teams, specifically, frequency of seeking information for clinical or research decisions, range of resources consulted, perceptions about access to information, confidence in adequacy of literature searches, and effects on decision making and practice. It also explored perceptions about training and experience needed for successful informationists. METHODS: Exploratory focus groups and key interviews were followed by baseline and follow-up surveys conducted with researchers and clinicians receiving the service. Survey data were analyzed with Pearson's chi-square or Fisher's exact test. RESULTS: Comparing 2006 to 2004 survey responses, the researchers found that study participants reported: seeking answers to questions more frequently, spending more time seeking or using information, believing time was less of an obstacle to finding or using information, using more information resources, and feeling greater satisfaction with their ability to find answers. Participants' opinions on informationists' qualifications evolved to include both subject knowledge and information searching expertise. CONCLUSION: Over time, clinical research teams with informationists demonstrated changes in their information behaviors, and they valued an informationist's subject matter expertise more. |
Predictors of 2,4-dichlorophenoxyacetic acid exposure among herbicide applicators
Bhatti P , Blair A , Bell EM , Rothman N , Lan Q , Barr DB , Needham LL , Portengen L , Figgs LW , Vermeulen R . J Expo Sci Environ Epidemiol 2010 20 (2) 160-8 To determine the major factors affecting the urinary levels of 2,4-dichlorophenoxyacetic acid (2,4-D) among county noxious weed applicators in Kansas, we used a regression technique that accounted for multiple days of exposure. We collected 136 12-h urine samples from 31 applicators during the course of two spraying seasons (April to August of 1994 and 1995). Using mixed-effects models, we constructed exposure models that related urinary 2,4-D measurements to weighted self-reported work activities from daily diaries collected over 5 to 7 days before the collection of the urine sample. Our primary weights were based on an earlier pharmacokinetic analysis of turf applicators; however, we examined a series of alternative weighting schemes to assess the impact of the specific weights and the number of days before urine sample collection that were considered. The derived models accounting for multiple days of exposure related to a single urine measurement seemed robust with regard to the exact weights, but less to the number of days considered; albeit the determinants from the primary model could be fitted with marginal losses of fit to the data from the other weighting schemes that considered a different numbers of days. In the primary model, the total time of all activities (spraying, mixing, other activities), spraying method, month of observation, application concentration, and wet gloves were significant determinants of urinary 2,4-D concentration and explained 16% of the between-worker variance and 23% of the within-worker variance of urinary 2,4-D levels. As a large proportion of the variance remained unexplained, further studies should be conducted to try to systematically assess other exposure determinants. |
Field-portable methods for monitoring occupational exposures to metals
Ashley K . J Chem Health Saf 2010 17 (3) 22-28 Millions of workers are employed in manufacturing, mining, construction, and other industries where significant amounts of airborne metals and metal compounds are generated. Depending on the work practices, processes, techniques, and locations, exposures to airborne and surface sources of a variety of metals can cause occupational illness. These exposures can lead to a plethora of adverse health effects such as lung disease, anemia, cancer, asthma, dermal sensitization, dermatitis and neurological damage. The ability to monitor worker exposures to metals on-site in the field has been a goal of the National Institute for Occupational Safety and Health (NIOSH) since the early 1990s. In the last 15 years or so, several fieldportable procedures for metals have been developed, evaluated and published as NIOSH methods. These methods, published in the NIOSH Manual of Analytical Methods, describe field screening tests and on-site analysis for lead, hexavalent chromium and beryllium. Some of these methods have also been published in the form of ASTM International voluntary consensus standards. This paper gives an overview of NIOSH research and development efforts on field screening and portable analytical methods for metals in the workplace. The goal of such efforts has been to provide screening and analytical tools that can be used onsite in the field to aid in the prevention of excessive exposures to toxic metals in the workplace. |
A handheld electrostatic precipitator for sampling airborne particles and nanoparticles
Miller A , Frey G , King G , Sunderman C . Aerosol Sci Technol 2010 44 (6) 417-427 Researchers at NIOSH are developing methods for characterizing ultrafine aerosols in workplaces. One method includes the detailed analysis of collected particles using electron microscopy (EM). In order to collect samples for EM at remote workplaces including mining and manufacturing facilities, researchers have developed a handheld electrostatic precipitator (ESP) particle sampler capable of collecting airborne particles including nanoscale materials, for subsequent EM analysis. The handheld ESP has been tested in the laboratory and is currently undergoing beta testing in the field. Gross collection efficiencies were measured with a CPC and net efficiencies by EM analysis of collected samples. Using laboratory-generated NaCl aerosols in the 30-400 nm size range at a flow rate of 55 cc/min and ESP operating voltages between 5.6- 6.8 kV, both gross and net efficiencies were measured and showed a similar correlation with voltage, with maximum efficiency of approximately 86% at 6.4 kV. EM images from samples were also used to estimate particle size distributions of the original aerosols and the size-dependent deposition was evaluated for upstream versus downstream locations on the sample media. Results suggest that the number concentration and particle size distribution of sampled aerosols may potentially be estimated from a single ESP sample, but that the accuracy and repeatability of such quantification need to be investigated and refined. NIOSH is planning to license the ESP sampler for commercial manufacturing. |
Aerosol monitoring during carbon nanofiber production: mobile direct-reading sampling
Evans DE , Ku BK , Birch ME , Dunn KH . Ann Occup Hyg 2010 54 (5) 514-31 Detailed investigations were conducted at a facility that manufactures and processes carbon nanofibers (CNFs). Presented research summarizes the direct-reading monitoring aspects of the study. A mobile aerosol sampling platform, equipped with an aerosol instrument array, was used to characterize emissions at different locations within the facility. Particle number, respirable mass, active surface area, and photoelectric response were monitored with a condensation particle counter (CPC), a photometer, a diffusion charger, and a photoelectric aerosol sensor, respectively. CO and CO(2) were additionally monitored. Combined simultaneous monitoring of these metrics can be utilized to determine source and relative contribution of airborne particles (CNFs and others) within a workplace. Elevated particle number concentrations, up to 1.15 x 10(6) cm(-3), were found within the facility but were not due to CNFs. Ultrafine particle emissions, released during thermal treatment of CNFs, were primarily responsible. In contrast, transient increases in respirable particle mass concentration, with a maximum of 1.1 mg m(-3), were due to CNF release through uncontrolled transfer and bagging. Of the applied metrics, our findings suggest that particle mass was probably the most useful and practical metric for monitoring CNF emissions in this facility. Through chemical means, CNFs may be selectively distinguished from other workplace contaminants (Birch et al., in preparation), and for direct-reading monitoring applications, the photometer was found to provide a reasonable estimate of respirable CNF mass concentration. Particle size distribution measurements were conducted with an electrical low-pressure impactor and a fast particle size spectrometer. Results suggest that the dominant CNF mode by particle number lies between 200 and 250 nm for both aerodynamic and mobility equivalent diameters. Significant emissions of CO were also evident in this facility. Exposure control recommendations were described for processes as required. |
The state public health laboratory system
Inhorn SL , Astles JR , Gradus S , Malmberg V , Snippes PM , Wilcke Jr BW , White VA . Public Health Rep 2010 125 4-17 This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided. |
Laboratory services in support of public health: a status report
Wilcke Jr BW , Inhorn SL , Astles JR , Su B , Wright A , White VA . Public Health Rep 2010 125 40-46 OBJECTIVES: To assess Healthy People 2010 Objective 23-13 and its related sub-objectives measuring comprehensive laboratory services in support of essential public health programs, the Association of Public Health Laboratories (APHL) collaborated with the Centers for Disease Control and Prevention (CDC) to create and administer a survey of state public health laboratories (PHLs). METHODS: A committee of APHL, with representation from CDC, constructed the survey based on the 11 Core Functions of State Public Health Laboratories (hereafter, Core Functions)-the premise being that the extent to which they fulfilled these Core Functions would represent their level of providing or assuring comprehensive laboratory services in support of public health. The survey was distributed biennially to all state health agencies from 2004 to 2008, and respondents were given two months to complete it. RESULTS: The response rate for all surveys was > or =90.2%. State PHLs were more likely to meet the sub-objectives relating to traditional functions (e.g., disease surveillance and reference testing) than other areas (e.g., food safety and environmental testing). Emergency preparedness fell in between. Overall, but most notably in the areas of food safety and training and education, there was improvement from 2006 to 2008, with the percentage of respondents who met more than half of the sub-objectives increasing from 58.7% in 2006 to 61.2% in 2008. CONCLUSIONS: The comprehensive laboratory services survey has been a valuable tool in measuring the laboratory infrastructure that underpins public health in the U.S. It will be necessary to continue monitoring laboratory infrastructure in this way to determine where the gaps in services exist and how they can best be addressed. |
Origins and development of the national laboratory system for public health testing
Astles JR , White VA , Williams LO . Public Health Rep 2010 125 18-30 Although not recognized as such, a National Laboratory System (NLS) has existed since the inception of public health laboratory (PHL) testing more than a century ago. The NLS has always relied upon the participation of clinical laboratories, both to report test results that represent public health threats and to submit specimens and isolates to PHLs for additional or confirmatory testing. Historically, a number of factors have hindered the strengthening of the relationships between clinical laboratories and PHLs, but the reality of bioterrorism and subsequent focus on strengthening public-private relationships has stimulated the development of a more robust NLS. Since 2002, there has been substantial strengthening of the NLS through the sharing of lessons learned from several demonstration projects. There is a growing emphasis on defining critical elements of the NLS, including the State Public Health Laboratory System (SPH Laboratory System) and the functions of the Laboratory Program Advisor, a position that every state should have at the center of its laboratory system's capacity-building. Additional strengthening of the NLS is occurring through (1) national biennial measurement of state PHLs' abilities to meet the Core Functions and Capabilities of State PHLs, (2) the new Laboratory System Improvement Program (L-SIP) for the SPH Laboratory System, and (3) sharing ideas to integrate and improve the SPH Laboratory System (e.g., using the L-SIP Online Resource Center). Public health emergencies, such as the recent H1N1 epidemic, illustrate and reinforce the need for a strong NLS within which federal, public health, and clinical (i.e., hospital and private reference) laboratories function in close collaboration. |
Knowledge gaps remain in the use of family health history in public health.
Valdez R , Coates RJ , St Pierre J , Grossniklaus D , Khoury MJ . Public Health Genomics 2010 14 (2) 94-5 The National Institutes of Health convened a State-ofthe-Science Conference to examine the evidence for the | role of family history when assessing and managing risk | for common chronic diseases in primary health care [1] . | A panel of health professionals was assembled for this | conference. They evaluated the strength of the science for | the following questions: | (1) What are the key elements of a family history in a | primary care setting for the purposes of risk assessment | for common diseases? | (2) What is the accuracy of the family history, and under what conditions does the accuracy vary? | (3) What is the direct evidence that getting a family | history will improve health outcomes for the patient or | family? | (4) What is the direct evidence that getting a family | history will result in adverse outcomes for the patient or | family? | (5) What are the factors that encourage or discourage | obtaining and using a family history? | (6) What are future research directions for assessing | the value of family history for common diseases in the | primary care setting? |
Estimation of multi-state life table functions and their variability from complex survey data using the SPACE Program
Cai L , Hayward MD , Saito Y , Lubitz J , Hagedorn A , Crimmins E . Demogr Res 2010 22 (6) 129-158 The multistate life table (MSLT) model is an important demographic method to document life cycle processes. In this paper, we present the SPACE (Stochastic Population Analysis for Complex Events) program to estimate MSLT functions and their sampling variability. It has several advantages over other programs, including the use of micro-simulation and the bootstrap method to estimate the variance of MSLT functions. Simulation enables researchers to analyze a broader array of statistics than the deterministic approach, and may be especially advantageous in investigating distributions of MSLT functions. The bootstrap method takes sample design into account to correct the potential bias in variance estimates. |
Comparison of statistical approaches to evaluate factors associated with metabolic syndrome
Fekedulegn D , Andrew M , Violanti J , Hartley T , Charles L , Burchfiel C . J Clin Hypertens (Greenwich) 2010 12 (5) 365-373 In statistical analyses, metabolic syndrome as a dependent variable is often utilized in a binary form (presence/absence) where the logistic regression model is used to estimate the odds ratio as the measure of association between health-related factors and metabolic syndrome. Since metabolic syndrome is a common outcome the interpretation of odds ratio as an approximation to prevalence or risk ratio is questionable as it may overestimate its intended target. In addition, dichotomizing a variable that could potentially be treated as discrete may lead to reduced statistical power. In this paper, the authors treat metabolic syndrome as a discrete outcome by defining it as the count of syndrome components. The goal of this study is to evaluate the usefulness of alternative generalized linear models for analysis of metabolic syndrome as a count outcome and compare the results with models that utilize the binary form. Empirical data were used to examine the association between depression and metabolic syndrome. Measures of association were calculated using two approaches; models that treat metabolic syndrome as a binary outcome (the logistic, log-binomial, Poisson, and the modified Poisson regression) and models that utilize metabolic syndrome as discrete/count data (the Poisson and the negative binomial regression). The method that treats metabolic syndrome as a count outcome (Poisson/negative binomial regression model) appears more sensitive in that it is better able to detect associations and hence can serve as an alternative to analyze metabolic syndrome as count dependent variable and provide an interpretable measure of association. |
The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance
Sofair AN , Barry V , Manos MM , Thomas A , Zaman A , Terrault NA , Murphy RC , Stabach N , Huie S , Van Ness G , Bell BP , Bialek S . J Clin Gastroenterol 2010 44 (4) 301-7 GOALS: We describe the epidemiology of outpatients newly diagnosed with chronic alcoholic liver disease and describe predictors of cirrhosis and referral for specialty care. BACKGROUND: Alcohol is a major cause of liver disease in the United States. Most previous work has described hospitalized patients. STUDY: Participants were identified through prospective population-based surveillance in gastroenterology practices Multnomah County, Oregon and New Haven County, Connecticut; and primary care and gastroenterology practices from Kaiser Permanente Northern California in Alameda County during 1999 to 2001. Patients were interviewed, a blood specimen obtained, and their medical record reviewed. RESULTS: We identified 82 patients from gastroenterology practices with newly diagnosed alcoholic liver disease. Their median age was 50.0 years. 72.0% were male and 79.3% were White. The median age at initiation of alcohol use was 17.0 years. 43.9% of patients had evidence of cirrhosis at the time of diagnosis. Only 40.2% reported alcohol as the cause of their liver disease. Patients with cirrhosis were more likely to be older, have a higher median number of years of heavy alcohol consumption, and to have been hospitalized for a liver-related complication than noncirrhotic patients. An additional 83 primary care patients were more likely to be older, to be drinking alcohol at study interview, and to not have cirrhosis than patients referred for gastroenterology care. CONCLUSIONS: Patients with alcoholic liver disease may present at a late stage and may not identify alcohol as a cause for their liver disease. Improved patient screening and education may limit morbidity and mortality. |
Content Index (Achived Edition)
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- Healthcare Associated Infections
- Laboratory Sciences
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- Statistics as Topic
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