The Environmental Determinants of Diabetes in the Young (TEDDY): genetic criteria and international diabetes risk screening of 421 000 infants.
Hagopian WA , Erlich H , Lernmark A , Rewers M , Ziegler AG , Simell O , Akolkar B , Vogt R Jr , Blair A , Ilonen J , Krischer J , She J . Pediatr Diabetes 2011 12 (8) 733-43 AIMS: The Environmental Determinants of Diabetes in the Young (TEDDY) study seeks to identify environmental factors influencing the development of type 1 diabetes (T1D) using intensive follow-up of children at elevated genetic risk. This study requires a cost-effective yet accurate screening strategy to identify the high-risk cohort. METHODS: The TEDDY cohort was identified through newborn screening using human leukocyte antigen (HLA) class II genes based on criteria established with pre-TEDDY data. HLA typing was completed at six international centers using different genotyping methods that can achieve >98% accuracy. RESULTS: TEDDY developed separate inclusion criteria for the general population (GP) and first-degree relatives (FDRs) of T1D patients. The FDR eligibility includes nine haplogenotypes (DR3/4, DR4/4, DR4/8, DR3/3, DR4/4b, DR4/1, DR4/13, DR4/9, and DR3/9) for broad HLA diversity, whereas the GP eligibility includes only the first four haplogenotypes with DRB1*0403 as an exclusion allele. TEDDY has screened 414 714 GP infants, of which 19 906 (4.8%) were eligible, whereas 1415 of the 6333 screened FDR infants (22.2%) were eligible. High-resolution confirmation testing of the eligible subjects indicated that the low-cost and low-resolution genotyping techniques employed at the screening centers yielded an accuracy of 99%. There were considerable variations in eligibility rates among the centers for GP (3.5-7.4%) and FDR (19-32%) subjects. The eligibility rates among US ethnic groups were 0.9, 1.3, 5.0, and 6.9% for Asians, Black, Caucasians, and Hispanics, respectively. CONCLUSIONS: Different low-cost and low-resolution genotyping methods are useful for the efficient and accurate identification of a high-risk cohort for follow-up based on the TEDDY HLA inclusion criteria (ClinicalTrials.gov NCT00279318). |
Renal-related biomarkers and long-term mortality in the US subjects with different coronary risks
Wu CK , Chang MH , Lin JW , Caffrey JL , Lin YS . Atherosclerosis 2011 216 (1) 226-36 OBJECTIVE: The objective was to evaluate the association of a panel of renal biomarkers with long-term mortalities. METHODS: Participants in the Third National Health and Nutrition Examination Survey (NHANES III) aged 35 years and above were included and Framingham risk scores were calculated. Renal-related biomarkers, including creatinine-based estimated glomerular filtration rate (eGFR), cystatin C, uric acid, C-reactive protein (CRP), fibrinogen, urinary cadmium, albuminuria, homocysteine, and vitamin D were tested by Cox-regression model for their association with all-cause, cardiovascular (CV), and non-CV mortality obtained from the 2006 NHANES III-linked follow-up data, stratified by sex and Framingham risk. RESULTS: In the 4873 men and 5372 women, 36.3%, 28.1%, and 35.6% of men and 67.2%, 25.8%, and 7.0% of women were classified into low-, intermediate-, and high coronary risk groups. With an average follow-up of 13.2 years, a total of 3632 deaths and 1657 CV deaths were recorded. Albuminuria was associated with all-cause mortality in both sexes across coronary risk groups. Creatinine-based eGFR provided additional differential capacity only in the women with intermediate-to-high coronary risk. Cystatin C was associated with all-cause mortality in the men with intermediate-to-high coronary risk and with CV mortality in the women with low coronary risk. Urinary cadmium was positively related to non-CV mortality. High vitamin D was protective against cardiovascular mortality in a limited category of men and women. CONCLUSIONS: Albuminuria is associated with long-term all-cause mortalities independent of Framingham risks. Adding the panel of renal biomarkers provides limited advantages for predicting risk when compared to FRS alone. |
Diverse origin of P[19] rotaviruses in children with acute diarrhea in Taiwan: Detection of novel lineages of the G3, G5, and G9 VP7 genes.
Wu FT , Banyai K , Huang JC , Wu HS , Chang FY , Yang JY , Hsiung CA , Huang YC , Lin JS , Hwang KP , Jiang B , Gentsch JR . J Med Virol 2011 83 (7) 1279-87 We previously reported the detection of genotype P[19] rotavirus strains from children hospitalized with acute dehydrating diarrhea during a 5-year surveillance period in Taiwan. The characterization of five P[19] strains (0.4% of all typed), including three G3P[19], a novel G5P[19], and a unique G9P[19] genotype is described in this study. Phylogenetic analysis of the VP4, VP7, VP6, and NSP4 genes was performed, which demonstrated novel lineages for respective genotypes of the VP4 and the VP7 genes. The sequence similarities of the P[19] VP4 gene among Taiwanese human strains was higher (nt, 91.5-96.2%; aa, 93.7-97.6%) than to other P[19] strains (nt, 83.5-86.6%; aa, 89.4-94.1%) from different regions of the world. The VP7 gene of the three G3P[19] Taiwanese strains shared up to 93.4% nt and 97.5% aa identity to each other but had lower similarity to reference strain sequences available in GenBank (nt, <90.1%; aa, <95.6%). Similarly, the VP7 gene of the novel G5P[19] strain was only moderately related to the VP7 gene of reference G5 strains (nt, 82.2-87.3%; aa, 87.0-93.1%), while the VP7 gene of the single G9P[19] strain was genetically distinct from other known human and animal G9 rotavirus strains (nt, ≤92.0%; aa, ≤95.7%). Together, these findings suggest that the Taiwanese P[19] strains originated by independent interspecies transmission events. Synchronized surveillance of human and animal rotaviruses in Taiwan should identify possible hosts of these uncommon human rotavirus strains. J. Med. Virol. 83:1279-1287, 2011. (c) 2011 Wiley-Liss, Inc. |
Knowledge and practice of prechewing/prewarming food by HIV-infected women
Gaur AH , Freimanis-Hance L , Dominguez K , Mitchell C , Menezes J , Mussi-Pinhata MM , Peixoto MF , Alarcon J , Coelho DF , Read JS . Pediatrics 2011 127 (5) e1206-11 OBJECTIVE: HIV transmission has been associated with offering a child food prechewed by an HIV-infected caregiver. We assessed awareness of prechewing and oral prewarming of food by an adult before offering it to a child among HIV-infected pregnant women and clinical investigators in 3 Latin American countries. METHODS: HIV-infected pregnant women at 12 sites (Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal Longitudinal Study in Latin American Countries, a prospective cohort trial) in Argentina, Brazil, and Peru were administered a screening survey about prechewing/prewarming of infant foods and cautioned against these feeding practices. Survey responses were analyzed, overall, and stratified according to country. RESULTS: Of the 401 HIV-infected pregnant women interviewed, 34% had heard about prechewing (50% from Argentina, 32% from Brazil, and 36% from Peru), 23% knew someone who prechewed food for infants, and 4% had prechewed food in the past. Seventeen percent had heard about oral prewarming of food, 13% knew someone who prewarmed food for infants, and 3% had prewarmed food for an infant in the past. Women who reported knowing someone who prechewed were more likely to also know someone who prewarmed food (P < .0001). Few site investigators anticipated that their patients would be aware of these practices. CONCLUSIONS: Prechewing food, a potential risk factor for HIV transmission, and orally prewarming food, which has not been associated with HIV transmission but might expose a child to blood from an HIV-infected adult, are not uncommon practices in Latin America. Both practices should be further investigated. Site investigator responses underscore that health care providers could be missing information about cultural practices that patients may not report unless specifically asked. |
School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students
Ethier KA , Dittus PJ , Derosa CJ , Chung EQ , Martinez E , Kerndt PR . J Adolesc Health 2011 48 (6) 562-5 PURPOSE: The current analyses compared receipt of reproductive health care, contraceptive use, and screening for sexually transmitted diseases (STD) among adolescents who are sexually experienced, with or without access to a school clinic. METHODS: A total of 12 urban California high schools, selected from areas with high teen pregnancy and STD rates, half with school-based health centers (SBHCs), participated in an intervention study designed to improve sexual health among adolescents. Of the participating students, 44% indicated that they had ever had intercourse and were included in these analyses. RESULTS: Access to an SBHC did not influence receipt of reproductive health care for either males or females and did not influence contraceptive use, either hormonal or condoms, for males. For females, however, those with access to an SBHC had increased odds of having received pregnancy or disease prevention care (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = 1.16-1.80), having used hormonal contraceptives at last sex (AOR = 1.68, 95% CI = 1.24-2.28), and were more likely to have ever been screened for an STD (AOR = 1.85, 95% CI = 1.43-2.40). Also among female students, those with access to an SBHC were more likely to have used emergency contraception at last sex (AOR = 2.1, 95% CI = 1.08-4.22). CONCLUSION: Although access to an on-site clinic does not seem to lead to increases in all types of reproductive care in the population as a whole, sexually active females are more likely to have received more specific care and to have used hormonal contraceptives if their school has an SBHC. |
Home health care and discharged hospice care patients: United States, 2000 and 2007
Caffrey C , Sengupta M , Moss A , Harris-Kojetin L , Valverde R . Natl Health Stat Report 2011 (38) 1-27 OBJECTIVES: This report presents national estimates on home health care patients and discharged hospice care patients. Information on characteristics, length of service, medical diagnoses, functional limitations, service use, advance care planning, and emergent and hospital care use are presented for home health care patients and hospice care discharges. A comparison of selected characteristics for 2000 and 2007 is also provided to highlight changes. METHODS: Estimates are based on data collected on agencies from the 2000 and 2007 National Home and Hospice Care Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are derived from data collected during interviews with administrators and staff designated by the administrators. RESULTS: Each day in 2007, there were an estimated 1,459,900 home health care patients. They were predominantly aged 65 years or over, female, and white. Their mean length of service was 315 days, and their most common primary diagnosis at admission was diabetes mellitus. About one-fourth of them had advance care planning and one-fifth had at least one overnight hospital stay since admission to the home health care agency. In 2007, there were 1,045,100 discharged hospice care patients. The majority of discharged patients were aged 65 or over, female, and white, and most were discharged deceased. Their mean length of service was 65 days, and the most common primary diagnosis at admission was malignant neoplasm. Most of them had advance care planning, and about one-fourth had three or more types of advance care planning instruments. |
Claims about the misuse of insecticide-treated mosquito nets: are these evidence-based?
Eisele TP , Thwing J , Keating J . PLoS Med 2011 8 (4) e1001019 Thomas Eisele and colleagues dispute reports in the media and elsewhere that insecticide-treated nets are not widely used, or are misused, and say that such misconceptions are not evidence-based and are damaging to malaria control efforts. |
Emergency department visits for overdoses of acetaminophen-containing products
Budnitz DS , Lovegrove MC , Crosby AE . Am J Prev Med 2011 40 (6) 585-92 BACKGROUND: Limited national data on the circumstances of acetaminophen overdoses have hindered identification and implementation of prevention strategies. PURPOSE: To estimate the frequency of and characterize risks for emergency department visits for acetaminophen overdoses that were not related to abuse in the U.S. METHODS: Data were collected from two components of the National Electronic Injury Surveillance System from January 1, 2006, through December 31, 2007, and analyzed from 2009 to 2010 to estimate the annual number of emergency department visits for non-abuse-related acetaminophen overdose by patient demographics, treatments, and type and amount of acetaminophen-containing product ingested. RESULTS: There were an estimated 78,414 emergency department visits (95% CI=63655, 93172) annually for non-abuse-related overdoses of acetaminophen-containing products. Most emergency department visits for acetaminophen overdose were for self-directed violence (69.8%, 95% CI=66.4%, 73.2%), with the highest rate among patients aged 15-24 years (46.4 per 100,000 individuals per year). Unsupervised ingestions by children aged <6 years accounted for 13.4% (95% CI=11.0%, 15.9%) of visits for acetaminophen overdoses (42.5 per 100,000 individuals per year). Therapeutic misadventures accounted for 16.7% (95% CI=14.0%, 19.5%) of visits and most involved overuse for medicinal effects (56.1%, 95% CI=50.6%, 61.6%) rather than use of multiple acetaminophen-containing products or dose confusion. CONCLUSIONS: Non-abuse-related overdoses of acetaminophen products lead to many emergency department visits each year, particularly emergency department visits for self-directed violence. Acetaminophen overdose prevention efforts will likely need to be multidimensional. |
Making child care centers SAFER: a non-regulatory approach to improving child care center siting
Somers TS , Harvey ML , Rusnak SM . Public Health Rep 2011 126 Suppl 1 34-40 Licensed child care centers are generally considered to be safe because they are required to meet state licensing regulations. As part of their licensing requirements, many states inspect child care centers and include an assessment of the health and safety of the facility to look for hazardous conditions or practices that may harm children. However, most states do not require an environmental assessment of the child care center building or land to prevent a center from being placed on, next to, or inside contaminated buildings. Having worked on several sites where child care centers were affected by environmental contaminants, the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry (ATSDR) endeavor to raise awareness of this issue. One of ATSDR's partner states, Connecticut, took a proactive, non-regulatory approach to the issue with the development its Child Day Care Screening Assessment for Environmental Risk Program. |
Potential strategies to eliminate built environment disparities for disadvantaged and vulnerable communities
Hutch DJ , Bouye KE , Skillen E , Lee C , Whitehead L , Rashid JR . Am J Public Health 2011 101 (4) 587-595 In 2006, the Federal Collaboration on Health Disparities Research (FCHDR) identified the built environment as a priority for eliminating health disparities, and charged the Built Environment Workgroup with identifying ways to eliminate health disparities and improve health outcomes. Despite extensive research and the development of a new conceptual health factors framework, gaps in knowledge exist in areas such as disproportionate environmental and community hazards, individual and cumulative risks, and other factors. The FCHDR provides the structure and opportunity to mobilize and partner with built environment stakeholders, federal partners, and interest groups to develop tools, practices, and policies for translating and disseminating the best available science to reduce health disparities. |
The 2009 National Environmental Public Health Conference: one model for planning green and healthy conferences
Ruckart PZ , Moore C , Burgin D , Byrne MK . Public Health Rep 2011 126 Suppl 1 58-63 The Centers for Disease Control and Prevention's National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry committed to making their 2009 National Environmental Public Health Conference a model for green and healthy conferences. The conference included increased opportunities for physical activity, both as part of conference events and for transportation to the conference. In addition, conference meals were healthy and sustainably sourced. The conference also implemented intuitive, accessible recycling; online scheduling and evaluation to minimize hard-copy materials; and the purchase of carbon offsets to reduce the unwanted environmental impact of the conference. Public health professionals have an opportunity and obligation to support healthy behaviors at their events and to serve as leaders in this area. Facilitating healthy and sustainable choices is in alignment with goals for both public health and broader social issues-such as environmental quality-that have a direct bearing on public health. |
Carbon monoxide poisoning after an ice storm in Kentucky, 2009
Lutterloh EC , Iqbal S , Clower JH , Spiller HA , Riggs MA , Sugg TJ , Humbaugh KE , Cadwell BL , Thoroughman DA . Public Health Rep 2011 126 Suppl 1 108-15 OBJECTIVES: Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during natural disasters. On January 26-27, 2009, a severe ice storm occurred in Kentucky, causing widespread, extended power outages and disrupting transportation and communications. After the storm, CO poisonings were reported throughout the state. The objectives of this investigation were to determine the extent of the problem, identify sources of CO poisoning, characterize cases, make recommendations to reduce morbidity and mortality, and develop prevention strategies. METHODS: We obtained data from the Kentucky Regional Poison Center (KRPC), hyperbaric oxygen treatment (HBOT) facilities, and coroners. Additionally, the Kentucky Department for Public Health provided statewide emergency department (ED) and hospitalization data. RESULTS: During the two weeks after the storm, KRPC identified 144 cases of CO poisoning; exposure sources included kerosene heaters, generators, and propane heaters. Hospitals reported 202 ED visits and 26 admissions. Twenty-eight people received HBOT. Ten deaths were attributed to CO poisoning, eight of which were related to inappropriate generator location. Higher rates of CO poisoning were reported in areas with the most ice accumulation. CONCLUSIONS: Although CO poisonings are preventable, they continue to occur in postdisaster situations. Recommendations include encouraging use of CO alarms, exploring use of engineering controls on generators to decrease CO exposure, providing specific information regarding safe use and placement of CO-producing devices, and using multiple communication methods to reach people without electricity. |
Comprehensive environmental public health
Portier CJ . Public Health Rep 2011 126 Suppl 1 3-6 Typically, people thinking about environmental health focus on how the environment can affect the four key physiological factors: air, water, food, and shelter. However, the environment can have a much broader impact on human health through changes to security, and personal and endogenous factors, such as genes, age, and past medical history. Every change in an external environmental factor can affect a broad array of diseases and alter morbidity and mortality in a population, sometimes in unpredictable ways. Our nation's disease burden is due to numerous causes, and we must address the complexity of the environment in which we live in a comprehensive way if we are to make significant strides in reducing morbidity and mortality. Addressing single issues undoubtedly will help to reduce health risks, but not nearly as well as addressing a much broader range of exposures that can harm an individual. | The human body consists of a series of interconnected systems. At the highest level is the entire human, where our major concerns are overall morbidity and mortality and general health. As defined by the World Health Organization, health is not merely the absence of disease or infirmity; rather, a healthy human being is one in a state of complete physical, mental, and social well-being.1 To achieve this state, our organ systems must function properly, doing their jobs to provide oxygen and nutrients to the body and to mount a comprehensive defense against environmental agents and pathogens that would otherwise overwhelm us. Paracrine, autocrine, and other signaling processes must function according to plan. Each cell contributes to this interplay, and for each cell to function properly, the intricate intercellular biochemistry that drives that function must be maintained and balanced. This happens through a complex array of organelles and intracellular components that form their own system, with each cell type in each different organ of the body maintaining its own special biochemistry. This cellular machinery comes about as a function of genetic and epigenetic controls during development and then functions throughout the life of that cell. Molecular control mechanisms under genetic control are subject to changes in nutrition and other environmental factors. Hence, from the molecular level to the functioning of the whole, humans are very complex biochemical reactors that have to be maintained throughout a lifetime. |
Rotavirus-coded deaths in children, United States, 1999-2007
Desai R , Esposito DH , Lees C , Goodin K , Harris M , Blostein J , Parashar UD . Pediatr Infect Dis J 2011 30 (11) 986-8 The introduction of specific International Classification of Diseases-10th revision code for rotavirus in 1999 prompted us to examine the US mortality data for 1999-2007 to validate rotavirus-coded deaths. Of 38 rotavirus-coded deaths identified in the national multiple cause-of-death database, results of laboratory testing could be obtained for 21 deaths, all of which had confirmation of rotavirus by either microbiologic or histopathologic testing. |
Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers
Schwartz DN , Scott Evans R , Camins BC , Khan YM , Lloyd JF , Shehab N , Stevenson K . Infect Control Hosp Epidemiol 2011 32 (5) 472-80 OBJECTIVE: To outline methods for deriving and validating intensive care unit (ICU) antimicrobial utilization (AU) measures from computerized data and to describe programming problems that emerged. DESIGN: Retrospective evaluation of computerized pharmacy and administrative data. SETTING: ICUs from 4 academic medical centers over 36 months. Interventions. Investigators separately developed and validated programming code to report AU measures in selected ICUs. Use of antibacterial and antifungal drugs for systemic administration was categorized and expressed as antimicrobial-days (each day that each antimicrobial drug was given to each patient) and patient-days receiving antimicrobials (each day that any antimicrobial drug was given to each patient). Monthly rates were compiled and analyzed centrally, with ICU patient-days as the denominator. Results were validated against data collected from manual review of medical records. Frequent discussion among investigators aided identification and correction of programming problems. RESULTS: AU data were successfully programmed though a reiterative process of computer code revision. After identifying and resolving major programming errors, comparison of computerized patient-level data with data collected by manual review of medical records revealed discrepancies in antimicrobial-days and patient-days receiving antimicrobials that ranged from less than 1% to 17.7%. The hospital from which numerator data were derived from electronic records of medication administration had the least discrepant results. CONCLUSIONS: Computerized AU measures can be derived feasibly, but threats to validity must be sought out and corrected. The magnitude of discrepancies between computerized AU data and a gold standard based on manual review of medical records varies, with electronic records of medication administration providing maximal accuracy. |
Evaluation of an HIV prevention intervention for African Americans and Hispanics: findings from the VOICES/VOCES Community-based Organization Behavioral Outcomes Project
Fisher HH , Patel-Larson A , Green K , Shapatava E , Uhl G , Kalayil EJ , Moore A , Williams W , Chen B . AIDS Behav 2011 15 (8) 1691-706 There is limited knowledge about whether the delivery of evidence-based, HIV prevention interventions in 'real world' settings will produce outcomes similar to efficacy trial outcomes. In this study, we describe longitudinal changes in sexual risk outcomes among African American and Hispanic participants in the Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) program at four CDC-funded agencies. VOICES/VOCES was delivered to 922 high-risk individuals in a variety of community settings such as substance abuse treatment centers, housing complex centers, private residences, shelters, clinics, and colleges. Significant risk reductions were consistently observed at 30- and 120-days post-intervention for all outcome measures (e.g., unprotected sex, self-reported STD infection). Risk reductions were strongest for African American participants, although Hispanic participants also reported reducing their risky behaviors. These results suggest that, over a decade after the first diffusion of VOICES/VOCES across the U.S. by CDC, this intervention remains an effective tool for reducing HIV risk behaviors among high-risk African American and Hispanic individuals. |
Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention: a mediation analysis
Painter JE , Sales JM , Pazol K , Wingood GM , Windle M , Orenstein WA , Diclemente RJ . J Sch Health 2011 81 (6) 304-312 BACKGROUND: School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake. METHODS: Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between study condition and influenza vaccine uptake. RESULTS: Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow-up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. CONCLUSION: Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine. |
Attitudes about carbon monoxide safety in the United States: results from the 2005 and 2006 HealthStyles Survey
King ME , Damon SA . Public Health Rep 2011 126 Suppl 1 100-7 OBJECTIVES: We sought to identify attitudes and behaviors related to carbon monoxide (CO) safety that can be targeted with public health prevention strategies in the U.S. METHODS: The Centers for Disease Control and Prevention added questions about (1) proper placement of gas-powered generators, (2) maintenance of fuel-burning appliances, and (3) use of CO detectors to the 2005 and 2006 HealthStyles national health marketing surveys. RESULTS: In 2005, 63.3% of HealthStyles respondents agreed with or were uncertain about the incorrect statement, "It is safe to run a generator in a garage as long as the door is open," while 43.1% agreed with or were uncertain about the incorrect statement, "It is safe to run a generator in the basement." Most of the 2006 respondents (63.5%) agreed that it is important to have their furnace inspected annually. However, fewer than half of the 2006 respondents (42.0%)-most of whom were homeowners-reported owning a CO detector. CONCLUSIONS: A large proportion of adults in the U.S. reported attitudes and behaviors that may place them at increased risk for unintentional, non-fire-related CO poisoning, suggesting that current safety messages may not be reaching much of the public. Prevention messages should continue to promote proper generator placement, maintenance of fuel-burning appliances, and use of CO detectors. Development of a comprehensive national strategy for CO surveillance and communication may help identify populations at increased risk and prevent future poisonings. |
A social marketing approach to building a behavioral intervention for congenital cytomegalovirus
Bate SL , Cannon MJ . Health Promot Pract 2011 12 (3) 349-60 Congenital cytomegalovirus (CMV) is the most common congenital infection in the United States, causing permanent disabilities in more than 5,500 children born each year. In the absence of a vaccine, a promising means of prevention is through a behavioral intervention that educates women about CMV and promotes adherence to hygiene guidelines during pregnancy. Although effective behavioral interventions have been identified for other infectious diseases with similar transmission modes, current research has not yet identified an effective intervention for CMV. One way to gather evidence and identify key elements of a successful CMV intervention is through a social marketing approach. This article describes a five-step process for applying social marketing principles to the research and development, implementation, and evaluation of a CMV behavioral intervention. |
Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients
Shimokura G , Chai F , Weber DJ , Samsa GP , Xia GL , Nainan OV , Tobler LH , Busch MP , Alter MJ . Infect Control Hosp Epidemiol 2011 32 (5) 415-24 OBJECTIVE: To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients. DESIGN: Survey. SETTING: Chronic hemodialysis facilities in the United States. PARTICIPANTS: Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30-150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate. METHODS: Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation. RESULTS: The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%-11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4-3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3-3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0-2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8-5.2]), patient-to-staff ratio of at least 7ratio1 (OR, 2.4 [95% CI, 1.4-4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3-4.4]). CONCLUSIONS: This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas. |
A community outbreak of rotavirus diarrhea associated with exposures in a hospital outpatient department in South China
Li Y , Guo H , Xu W , Wu T , Ma H , Fontaine RE . Pediatr Infect Dis J 2011 30 (9) 745-8 INTRODUCTION: Between October 1 and December 10, 2006, Bao'an, China had a 5-fold increase in acute rotavirus gastroenteritis (ARGE) cases compared with the same time in 2005. To identify the risk factors for ARGE during this outbreak, we conducted a case-control study among children ≤24 months old from the most heavily affected area. METHODS: We defined an ARGE case as diarrhea, with group A rotavirus antigen detected from fecal samples by the enzyme-linked immunosorbent assay test. In the case-control study, 86 confirmed ARGE cases were identified. We enrolled 98 healthy control children matched by age. We administered questionnaires about exposures through telephone interviews. RESULTS: Of 8 general exposure types, we identified the following as being associated with ARGE: visiting outpatient services of hospital X, odds ratio (OR) = 7.1 (95% confidence interval [CI], 2.2-26); contact with other children with diarrhea, OR = 2.1 (95% CI, 1.1-3.7); and hand-washing before eating, OR = 0.48 (95% CI, 0.27-0.82). After improvements in the outpatient department of hospital X, ARGE incidence in the community during the ARGE transmission season (October through December) decreased from 4.3/10000 in 2006 to 1.4/10000 in 2009. CONCLUSIONS: Outpatient services in hospital X may have contributed to the transmission of ARGE and improvements in infection control practices in this setting were associated a marked decrease incidence of ARGE in this community. |
Prevalence and genetic diversity of candidate vaccine antigens among invasive Neisseria meningitidis isolates in the United States.
Wang X , Cohn A , Comanducci M , Andrew L , Zhao X , Macneil JR , Schmink S , Muzzi A , Bambini S , Rappuoli R , Pizza M , Murphy E , Hoiseth SK , Jansen KU , Anderson AS , Harrison LH , Clark TA , Messonnier NE , Mayer LW . Vaccine 2011 29 4739-44 Neisseria meningitidis (Nm) serogroups B, C and Y are the major causes of meningococcal diseases in the United States. NmB accounts for approximately 1/3 of the disease but no licensed vaccine is yet available. Two candidate vaccines are being developed specifically to target NmB, but may also provide protection against other serogroups. To assess the potential impact of these vaccines on NmB and other serogroups causing disease in the US, we determined the prevalence, genetic diversity and epidemiological characteristics of three candidate antigen genes in Nm isolates collected through Active Bacterial Core surveillance (ABCs), a population-based active surveillance program. fHbp was detected in all NmB, NmY and NmW135 isolates. Eleven NmC isolates contain fHbp with a single base-pair deletion creating a frame shift in the C-terminal region. Among NmB, 59% were fHbp subfamily/variant B/v1 and 41% A/v2-3. Among NmC and NmY, 39% and 3% were B/v1, respectively. nadA was detected in 39% of NmB, 61% of NmC and 4% of NmY. Among isolates tested, nhbA was present in all NmB and 96% of non-B. For the subset of strains sequenced for NadA and NhbA, pairwise identity was greater than 93% and 78%, respectively. The proportion of FHbp subfamily/variant was different between ABCs site and year, but no linear temporal trend was observed. Although assessment of the vaccine coverage also requires understanding of the antigen expression and the ability to induce bactericidal activity, our finding that all isolates contain one or more antigen genes suggests these vaccines may protect against multiple Nm serogroups. |
Rates and correlates of influenza vaccination among HIV-infected adults in the HIV Outpatient Study (HOPS), USA, 1999-2008
Durham MD , Buchacz K , Armon C , Patel P , Wood K , Brooks JT . Prev Med 2011 53 89-94 BACKGROUND: We sought to describe rates of vaccination among HIV-infected adults in care and identify factors associated with vaccination. METHODS: Using data abstracted from medical records of participants in the HIV Outpatient Study (HOPS) during 8 influenza seasons (1999-2008) and negative binomial models with generalized estimating equation methods, we examined factors associated with increased prevalence of annual influenza vaccination. RESULTS: Among active patients, 25.8% to 43.3% were vaccinated for influenza each year (annual mean=35%, test for trend p=0.71). Vaccination rates peaked in October and November of each season and decreased sharply thereafter. Patients who were male (67.2%), non-Hispanic white (70%) or Hispanic (66%), had lower HIV viral loads (73.5%), were prescribed antiretroviral treatment (72.7%), or had attended a greater number of clinical encounters per year (86.7%) were more likely to receive influenza vaccination in multivariable analysis. DISCUSSION: The decreased likelihood of vaccination among women and non-Hispanic black patients suggests the need for focused efforts to reduce disparities. Increasing patient and clinician education on the importance of universal vaccination, and ensuring that vaccination activities continue in HIV clinics during the later months of the influenza season may improve influenza vaccine coverage. |
The need for experimental methodology in intimate partner violence: finding programs that effectively prevent IPV
Feder L , Niolon PH , Campbell J , Wallinder J , Nelson R , Larrouy H . Violence Against Women 2011 17 (3) 340-358 The lack of rigorous evaluations of intimate partner violence (IPV) programs has severely limited our knowledge about what works. However, IPV programs can be rigorously evaluated through randomized controlled trials (RCTs) conducted ethically and safely. This article provides an example of how a RCT to test an IPV preventive intervention—the Enhanced Nurse Family Partnership Study (ENFPS)—was successfully implemented by a partnership of researchers and practitioners. The article concludes with some recommendations, arrived at by the researchers and practitioners on the ENFPS team, for achieving a successful collaboration thought to be essential in executing a field experiment. |
The public health approach to older adult fall prevention: comments from the U.S. Centers for Disease Control and Prevention
Noonan RK , Stevens JA , Baldwin G . Open Longev Sci 2011 5 26-31 Unintentional falls among persons aged 65 years and older are an important public health issue, associated with significant mortality and morbidity. About one third of older adults fall annually and, although many fall outcomes are minor, between 10% and 20% cause serious injuries such as traumatic brain injury, contusions, and fractures. Therefore the U.S. Centers for Disease Control and Prevention (CDC) is working to prevent injuries and fatalities due to older adult falls. The public health approach to older adult falls focuses on prevention and is based on scientific rigor. Its steps include defining the problem, identifying causes, developing and testing interventions, and then implementing effective approaches on a large scale. We highlight current CDC activities that map onto each step of the public health model and close by providing future directions for older adult fall prevention, including improved surveillance, support for program implementation, and enhanced partnership building. Noonan et al. |
Home fires in America: progress and opportunities
Diekman S , Ballesteros MF , Ahrens M . Am J Lifestyle Med 2011 6 (2) 141-151 Fires are the third leading cause of unintentional home injury deaths. Young children and older adults are especially at risk for home fire deaths. Other high-risk groups include males, people with physical disabilities, people impaired by alcohol or other drugs, and people living in rural communities or in poverty. Lifestyle decisions (eg, choosing products) and behaviors (eg, maintaining working smoke alarms or smoking) can influence the risk of being in and surviving a home fire. Fortunately, medical practitioners can foster safer home environments for their patients by promoting effective fire prevention and protection strategies to reduce home fire risks. This review highlights the association between lifestyle and home fires with a focus on achievable lifestyle changes that can prevent fires and fire-related injuries and deaths. |
Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007
Iqbal S , Law HZ , Clower JH , Yip FY , Elixhauser A . Am J Emerg Med 2011 30 (5) 657-64 BACKGROUND: Unintentional, non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States, but the overall hospital burden is unknown. This study presents patient characteristics and the most recent comprehensive national estimates of UNFR CO-related emergency department (ED) visits and hospitalizations. METHODS: Data from the 2007 Nationwide Inpatient and Emergency Department Sample of the Hospitalization Cost and Utilization Project were analyzed. The Council of State and Territorial Epidemiologists' CO poisoning case definition was used to classify confirmed, probable, and suspected cases. RESULTS: In 2007, more than 230 000 ED visits (772 visits/million) and more than 22 000 hospitalizations (75 stays/million) were related to UNFR CO poisoning. Of these, 21 304 ED visits (71 visits/million) and 2302 hospitalizations (8 stays/million) were confirmed cases of UNFR CO poisoning. Among the confirmed cases, the highest ED visit rates were among persons aged 0 to 17 years (76 visits/million) and 18 to 44 years (87 visits/million); the highest hospitalization rate was among persons aged 85 years or older (18 stays/million). Women visited EDs more frequently than men, but men were more likely to be hospitalized. Patients residing in a nonmetropolitan area and in the northeast and midwest regions of the country had higher ED visit and hospitalization rates. Carbon monoxide exposures occurred mostly (>60%) at home. The hospitalization cost for confirmed CO poisonings was more than $26 million. CONCLUSION: Unintentional, non-fire-related CO poisonings pose significant economic and health burden; continuous monitoring and surveillance of CO poisoning are needed to guide prevention efforts. Public health programs should emphasize CO alarm use at home as the main prevention strategy. |
Announcing a decade of action for global road safety
Baldwin G , Sleet DA . Am J Lifestyle Med 2011 5 (3) 291-292 In March 2010, a “Decade of Action for Global Road Safety, 2011-2020” was declared by the United Nations. According to Michael R. Bloomberg, Mayor of New York City, “Unless we take some vigorous steps now, traf-fi c fatalities are expected to overtake HIV/AIDS, tuberculosis, and lung can-cer to become the fi fth leading cause of death globally by 2030.” The road safety tag (above) is the global symbol of the movement to improve safety on the road (www.decadeofaction.org).Each year, 1.3 million people are killed on the world’s roads, at least 90% in developing countries. Deaths and injuries from road crashes rival those of malaria and tuberculosis, killing 3500 people every day around the world, with 90% of the casualties occurring in the develop-ing world. This annual toll is forecast by the World Health Organization to increase to around 1.9 million deaths by 2020. The cost of road injuries to developing coun-tries is $100 billion a year, roughly equiv-alent to all overseas aid. Even though effective interventions to prevent global road trauma to drivers, vehicle occupants, pedestrians, and cyclists already exist, they are not widely adopted |
The decade of action for global road safety
Sleet DA , Baldwin G , Dellinger A , Dinh-Zarr B . J Safety Res 2011 42 (2) 147-8 Road traffic injuries are the ninth leading cause of death in the world, resulting in 1.3 million deaths and between 20 and 50 million nonfatal injuries each year, and are the leading cause of death among young people aged 15–29 years. They are expected to become the fifth leading cause of death globally by 2030, and at least 90% of these deaths and injuries occur in low- and middle-income countries. Deaths and injuries from road crashes rival those of malaria and TB, killing over 3,000 persons every day around the world (World Health Organization [WHO], 2009, Peden et al., 2004). Projections indicate that, without new and sustained commitment to preventing such injuries, the situation will worsen with a projected increase in deaths of about 65% over the next 20 years (Kopits and Cropper, 2003, Murray and Lopez, 1996). |
sodC-based real-time PCR for detection of Neisseria meningitidis.
Dolan Thomas J , Hatcher CP , Satterfield DA , Theodore MJ , Bach MC , Linscott KB , Zhao X , Wang X , Mair R , Schmink S , Arnold KE , Stephens DS , Harrison LH , Hollick RA , Andrade AL , Lamaro-Cardoso J , de Lemos AP , Gritzfeld J , Gordon S , Soysal A , Bakir M , Sharma D , Jain S , Satola SW , Messonnier NE , Mayer LW . PLoS One 2011 6 (5) e19361 Real-time PCR (rt-PCR) is a widely used molecular method for detection of Neisseria meningitidis (Nm). Several rt-PCR assays for Nm target the capsule transport gene, ctrA. However, over 16% of meningococcal carriage isolates lack ctrA, rendering this target gene ineffective at identification of this sub-population of meningococcal isolates. The Cu-Zn superoxide dismutase gene, sodC, is found in Nm but not in other Neisseria species. To better identify Nm, regardless of capsule genotype or expression status, a sodC-based TaqMan rt-PCR assay was developed and validated. Standard curves revealed an average lower limit of detection of 73 genomes per reaction at cycle threshold (C(t)) value of 35, with 100% average reaction efficiency and an average R(2) of 0.9925. 99.7% (624/626) of Nm isolates tested were sodC-positive, with a range of average C(t) values from 13.0 to 29.5. The mean sodC C(t) value of these Nm isolates was 17.6+/-2.2 (+/-SD). Of the 626 Nm tested, 178 were nongroupable (NG) ctrA-negative Nm isolates, and 98.9% (176/178) of these were detected by sodC rt-PCR. The assay was 100% specific, with all 244 non-Nm isolates testing negative. Of 157 clinical specimens tested, sodC detected 25/157 Nm or 4 additional specimens compared to ctrA and 24 more than culture. Among 582 carriage specimens, sodC detected Nm in 1 more than ctrA and in 4 more than culture. This sodC rt-PCR assay is a highly sensitive and specific method for detection of Nm, especially in carriage studies where many meningococcal isolates lack capsule genes. |
Design and performance of the CDC real-time reverse transcriptase PCR swine flu panel for detection of 2009 A (H1N1) pandemic influenza virus.
Shu B , Wu KH , Emery S , Villanueva J , Johnson R , Guthrie E , Berman L , Warnes C , Barnes N , Klimov A , Lindstrom S . J Clin Microbiol 2011 49 (7) 2614-9 Swine influenza viruses (SIV), have been shown to sporadically infect humans, and are infrequently identified by Influenza Division of the Centers for Disease Control and Prevention (CDC) after being received as unsubtypable influenza A virus samples. Real-time RT-PCR (rRT-PCR) procedures for detection and characterization of North American lineage (N.Am) SIV were developed and implemented at CDC for rapid identification of specimens from cases of suspected infections with SIV. These procedures were utilized in April 2009 for detection of human cases of 2009 A (H1N1) pandemic (pdm) influenza virus infection. Based on genetic sequence data of the first two viruses, the previously developed rRT-PCR procedures were optimized to create the CDC rRT-PCR Swine Flu Panel for detection of the 2009 A (H1N1) pdm influenza virus. Analytical sensitivity of the CDC rRT-PCR Swine Flu Panel was shown to be 5 copies of RNA per-reaction and 10(-1.3 approximately -0.7) ID(50) per-reaction for cultured viruses. Cross reactivity was not observed when testing human clinical specimens or cultured viruses that were positive for human seasonal A (H1N1, H3N2) and B influenza viruses. The CDC rRT-PCR Swine Flu Panel was distributed to public health laboratories in the United States and internationally from April 2009 until June 2010. The CDC rRT-PCR Swine Flu Panel served as effective tool for timely and specific detection of 2009 A (H1N1) pdm influenza viruses and facilitated subsequent public health response implementation. |
No association of xenotropic murine leukemia virus-related viruses with prostate cancer.
Switzer WM , Jia H , Zheng H , Tang S , Heneine W . PLoS One 2011 6 (5) e19065 BACKGROUND: The association of the xenotropic murine leukemia virus-related virus (XMRV) with prostate cancer continues to receive heightened attention as studies report discrepant XMRV prevalences ranging from zero up to 23%. It is unclear if differences in the diagnostic testing, disease severity, geography, or other factors account for the discordant results. We report here the prevalence of XMRV in a population with well-defined prostate cancers and RNase L polymorphism. We used broadly reactive PCR and Western blot (WB) assays to detect infection with XMRV and related murine leukemia viruses (MLV). METHODOLOGY/PRINCIPAL FINDINGS: We studied specimens from 162 US patients diagnosed with prostate cancer with a intermediate to advanced stage (Gleason Scores of 5-10; moderate (46%) poorly differentiated tumors (54%)). Prostate tissue DNA was tested by PCR assays that detect XMRV and MLV variants. To exclude contamination with mouse DNA, we also designed and used a mouse-specific DNA PCR test. Detailed phylogenetic analysis was used to infer evolutionary relationships. RNase L typing showed that 9.3% were homozygous (QQ) for the R462Q RNase L mutation, while 45.6% and 45.1% were homozygous or heterozygous, respectively. Serologic testing was performed by a WB test. Three of 162 (1.9%) prostate tissue DNA were PCR-positive for XMRV and had undetectable mouse DNA. None was homozygous for the QQ mutation. Plasma from all three persons was negative for viral RNA by RT-PCR. All 162 patients were WB negative. Phylogenetic analysis inferred a distinct XMRV. CONCLUSIONS AND THEIR SIGNIFICANCE: We found a very low prevalence of XMRV in prostate cancer patients. Infection was confirmed by phylogenetic analysis and absence of contaminating mouse DNA. The finding of undetectable antibodies and viremia in all three patients may reflect latent infection. Our results do not support an association of XMRV or MLV variants with prostate cancer. |
Detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. in clinical specimens using a single-tube multiplex real-time PCR assay.
Thurman KA , Warner AK , Cowart KC , Benitez AJ , Winchell JM . Diagn Microbiol Infect Dis 2011 70 (1) 1-9 A multiplex real-time PCR assay for the detection of Mycoplasma pneumoniae (MP181), Chlamydia (Chlamydophila) pneumoniae (CP-Arg), Legionella spp. (Pan-Leg), and the human RNase P (RNase P) gene was developed for rapid testing of atypical bacterial respiratory pathogens in clinical specimens. This method uses 4 distinct hydrolysis probes to detect 3 leading causes of community-acquired pneumonia. The assay was evaluated for specificity and sensitivity by testing against 35 related organisms, a dilution series of each specific target and 197 clinical specimens. Specificity testing demonstrated no cross-reactivity. A comparison to previously validated singleplex real-time PCR assays for each agent was also performed. The analytical sensitivity for specific pathogen targets in both the singleplex and multiplex was identical (50 fg), while efficiencies ranged from 82% to 97% for the singleplex assays and from 90% to 100% for the multiplex assay. The clinical sensitivity of the multiplex assay was improved for the Pan-Leg and CP-Arg targets when compared to the singleplex. The MP181 assay displayed equivalent performance. This multiplex assay provides an overall improvement in the diagnostic capability for these agents by demonstrating a sensitive, high-throughput and rapid method. This procedure may allow for a practical and efficient means to test respiratory clinical specimens for atypical pneumonia agents in health care settings and facilitate an appropriate public health response to outbreaks. |
The virulence of 1997 H5N1 influenza viruses in the mouse model is increased by correcting a defect in their NS1 proteins
Spesock A , Malur M , Hossain MJ , Chen LM , Njaa B , Davis CT , Lipatov AS , York I , Krug RM , Donis RO . J Virol 2011 85 (14) 7048-58 The NS1 protein of human influenza A viruses binds the 30-kDa subunit of the cleavage and polyadenylation specificity factor (CPSF30), a protein required for 3' end processing of cellular pre-mRNAs, thereby inhibiting production of interferon-beta (IFN-beta) mRNA. The NS1 proteins of pathogenic 1997 H5N1 viruses contain the CPSF30-binding site, but lack the consensus amino acids at positions 103 and 106, F and M, respectively, that are required for the stabilization of CPSF30 binding, resulting in non-optimal CPSF30 binding in infected cells. Here we demonstrate that strengthening CPSF30 binding, by changing positions 103 and 106 in the 1997 H5N1 NS1 protein to the consensus amino acids, results in a remarkable 300-fold increase in the lethality of the virus in mice. Unexpectedly this increase in virulence is not associated with increased lung pathology, but rather is characterized by faster systemic spread of the virus, particularly to the brain, where increased replication and severe pathology occur. This increased spread is associated with increased cytokine and chemokine levels in extrapulmonary tissues. We conclude that strengthening CPSF30 binding by the NS1 protein of 1997 H5N1 viruses enhances virulence in mice by increasing the systemic spread of the virus from the lungs, particularly to the brain. |
Method for evaluating the relative efficiency of selected N95 respirators and surgical masks to prevent the inhalation of airborne vegetative cells by healthcare personnel
Davidson C , Green CF , Panlilio AL , Jensen PA , Stover BH , Roselle G , Gibbs SG , Scarpino PV . Indoor Built Environ 2011 20 (2) 265-277 Aerosol droplet-and airborne-transmitted diseases are an important healthcare concern. The anthrax attacks of 2001, severe acute respiratory syndrome outbreaks in 2003 which resulted in transmission to numerous healthcare personnel (HCP) and concerns about smallpox as a bioterrorist agent have contributed to heightened concern about airborne infectious agents. Respirators and surgical masks can provide respiratory protection against such airborne diseases but their efficacy needs to be assessed. This study describes a method for quantitatively assessing the relative efficiency of respiratory protective equipment (RPE) when challenged with a bioaerosol. Five surgical masks, three N95 respirators and three surgical N95 respirators were evaluated. All are commercially available and used in US healthcare settings. Bacterial aerosols of vegetative Bacillus anthracis strain Sterne 34F2 (a surrogate for pathogenic B. anthracis) were generated with a six-jet Collison nebuliser. To mimic human respiratory breathing, an automated breathing simulator (ABS) calibrated to normal tidal volume and active breathing rate (500 mL/breath and 20 breath/min, respectively) was used. Respirators were placed on manikin head-forms designed for use in cardiopulmonary resuscitation training and used in our investigation as surrogates for HCP. The method showed that a Collison nebuliser could generate monodisperse bacterial aerosol to effectively test RPE total inward leakage. Also, the AGI-30 air samplers, combined with the ABS, provided an accurate method of quantifying RPE relative efficiency. For the 11 RPE this ranged from 34% to 69% with statistically significant differences between several RPE models. We conclude that neither RPE type nor brand name was an indicator of RPE relative efficiency. |
Polymerase chain reaction confirmed by immunohistochemistry: a two-pronged diagnostic approach in endophthalmitis
Horton JC , Yoon MK , Carvalho MD , McLeod SD . Acta Ophthalmol 2011 89 (3) 301-2 A 53-year-old man with adult-onset diabetes mellitus developed confusion, fever, pneumonia and loss of vision in his right eye. He was treated intravenously with cefotaxime, levofloxacin and fluconazole. His medical condition stabilized after 2 weeks and he was transferred to our institution. On examination, the right eye had minimal light perception with proptosis, conjunctival oedema and a hypopyon (Fig. 1A). Cultures of the conjunctiva, cornea, aqueous and vitreous resulted in no growth of organisms, presumably because the eye had been sterilized by prior treatment with antibiotics. Vancomycin and ceftazidime were injected intravitreally. After light perception was lost, the painful blind eye was enucleated. |
Factors to consider in using [U-13C]palmitate for analysis of sphingolipid biosynthesis by tandem mass spectrometry
Haynes CA , Allegood JC , Wang EW , Kelly SL , Sullards MC , Merrill AH Jr . J Lipid Res 2011 52 (8) 1583-94 This study describes the use of a stable-isotope labeled precursor ([U-13C]palmitate) to analyze de novo sphingolipid biosynthesis by tandem mass spectrometry, and factors to consider in interpreting the data, which include the isotope's location (13C appears in three isotopomers and isotopologues: [M + 16 for the sphingoid base or N-acyl fatty acid, and [M + 32] for both), the isotopic enrichment of palmitoyl-CoA, and its elongation, desaturation, and incorporation into N-acyl-sphingolipids. For HEK293 cells incubated with 0.1 mM [U-13C]-palmitic acid, ~60% of the total palmitoyl-CoA was 13C-labeled by 3 h (which was near isotopic equilibrium); with this correction, the rates of de novo biosynthesis of C16:0-ceramide, -monohexosylceramide and -sphingomyelin were 62 + 3, 13 + 2, and 60 + 11 pmol/h per mg protein, respectively, which are consistent with an estimated rate of appearance of C16:0-ceramide using exponential growth modeling (119 + 11 pmol/h per mg protein). Including estimates for the very-long-chain fatty acyl-CoAs, the overall rate of sphingolipid biosynthesis can be estimated to be at least ~1.6-fold higher. Thus, consideration of these factors gives a more accurate picture of de novo sphingolipid biosynthesis than has heretofore been possible, while acknowledging that there are inherent limitations to such approximations. |
Control of glucosylceramide production and morphogenesis by the Bar1 ceramide synthase in Fusarium graminearum
Rittenour WR , Chen M , Cahoon EB , Harris SD . PLoS One 2011 6 (4) e19385 The contribution of plasma membrane proteins to the virulence of plant pathogenic fungi is poorly understood. Accordingly, the objective of this study was to characterize the acyl-CoA dependent ceramide synthase Bar1 (previously implicated in plasma membrane organization) in the wheat pathogen Fusarium graminearum. The role of Bar1 in mediating cell membrane organization was confirmed as DeltaBAR1 mutants failed to display a distinct sterol-rich domain at the hyphal tip. The DeltaBAR1 mutants were non-pathogenic when inoculated onto wheat heads, and their in vitro growth also was severely perturbed. DeltaBAR1 mutants were incapable of producing perithecia (sexual fruiting structures) and only produced macroconidia (asexual spores) in the presence of NaCl. Sphingolipid analyses indicated that Bar1 is specifically necessary for the production of glucosylceramides in both F. graminearum and Aspergillus nidulans. Interestingly, glucosylceramides appear to mediate sensitivity to heat stable antifungal factor (HSAF), as, in addition to DeltaBAR1 mutants, a glucosylceramide synthase deficient mutant of Yarrowia lipolytica is also resistant to HSAF. |
Development and characterization of a bead-based, multiplex assay for estimation of recent HIV-1 infection
Curtis K , Kennedy S , Charurat ME , Nasidi A , Delaney K , Spira T , Owen M . AIDS Res Hum Retroviruses 2011 28 (2) 188-97 Estimation of HIV-1 incidence is an important public health tool for understanding the status of the epidemic, identifying high-risk populations, and assessing various intervention strategies. Several laboratory-based methods have been developed for distinguishing recent from long-term HIV-1 infection; however, each exhibits some degree of misclassification, particularly among AIDS patients and those taking antiretroviral therapy (ART). To improve upon the limitations associated with measuring responses to a single analyte, we have developed a bead-based, multiplex assay for determination of HIV recent infection based on total antibody binding and antibody avidity to multiple analytes. An HIV-specific, multiplex panel was created by coupling the recombinant HIV-1 proteins p66, gp120, gp160, and gp41 to Bio-Plex COOH microspheres. Longitudinal plasma specimens from recent seroconverters were tested for reactivity to the coupled microspheres using the Bio-Plex 200 System. For each analyte, HIV-specific antibody binding and avidity increased for 1-2 years post-seroconversion, leading to a significant difference in reactivity between recent and long-term specimens. While the potential for misclassification of individuals diagnosed with AIDS or receiving antiretroviral therapy appears to be minimal with avidity measures, the impact on total antibody binding was variable, depending on the individual analyte. This bead-based, HIV-specific multiplex assay measures several distinct immune responses in a single assay plate, allowing for sampling of multiple analytes in the determination of recent infection, which could aid in the development of improved statistical methods or algorithms that will more accurately estimate HIV incidence. |
Development and evaluation of an M2-293FT cell-based flow cytometric assay for quantification of antibody response to native form of matrix protein 2 of influenza A viruses
Zhong W , He J , Tang X , Liu F , Lu X , Zeng H , Vafai A , Fu TM , Katz JM , Hancock K . J Immunol Methods 2011 369 115-24 Matrix protein 2 (M2) of influenza A viruses is an attractive target for the development of broadly cross-protective influenza vaccines and therapeutic antibodies. The available evidence suggests that antibodies reactive to the natural tetrameric form of M2 proteins, rather than those to synthetic peptides of M2 ectodomain (M2e), best correlate with M2-mediated immune protection. However, the current ability to quantify strain-specific and/or subtype-cross-reactive M2 antibodies against the natural form of M2 antigens from influenza A viruses of different host origin is limited. In the present study, we generated a panel of 293FT transfected cell lines stably expressing full-length tetrameric forms of M2 molecules from human, avian and the swine-origin 2009 pandemic H1N1 influenza A virus, respectively, and developed an M2-293FT cell line-based flow cytometric assay (M2-FCA). Side-by-side comparison of M2-FCA with a synthetic M2e peptide-based indirect ELISA (M2e-ELISA) reveals that M2-FCA is highly efficient in quantifying both M2e sequence-specific and cross-reactive antibodies to the native form of M2 antigens. In contrast, promiscuity was evident when specificity and cross-reactivity of anti-M2 antibodies were assessed by M2e-ELISA. These results demonstrate that M2-FCA represents a rapid, simple and sensitive method to quantitatively assess specificity and cross-reactivity of anti-M2 antibodies after infection or vaccination. |
Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues
Stoll BJ , Hansen NI , Sanchez PJ , Faix RG , Poindexter BB , Van Meurs KP , Bizzarro MJ , Goldberg RN , Frantz ID 3rd , Hale EC , Shankaran S , Kennedy K , Carlo WA , Watterberg KL , Bell EF , Walsh MC , Schibler K , Laptook AR , Shane AL , Schrag SJ , Das A , Higgins RD . Pediatrics 2011 127 (5) 817-826 BACKGROUND: Guidelines for prevention of group B streptococcal (GBS) infection have successfully reduced early onset (EO) GBS disease. Study results suggest that Escherichia coli is an important EO pathogen. OBJECTIVE: To determine EO infection rates, pathogens, morbidity, and mortality in a national network of neonatal centers. METHODS: Infants with EO infection were identified by prospective surveillance at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Network centers. Infection was defined by positive culture results for blood and cerebrospinal fluid obtained from infants aged ≤72 hours plus treatment with antibiotic therapy for ≥5 days. Mother and infant characteristics, treatments, and outcomes were studied. Numbers of cases and total live births (LBs) were used to calculate incidence. RESULTS: Among 396 586 LBs (2006-2009), 389 infants developed EO infection (0.98 cases per 1000 LBs). Infection rates increased with decreasing birth weight. GBS (43%, 0.41 per 1000 LBs) and E coli (29%, 0.28 per 1000 LBs) were most frequently isolated. Most infants with GBS were term (73%); 81% with E coli were preterm. Mothers of 67% of infected term and 58% of infected preterm infants were screened for GBS, and results were positive for 25% of those mothers. Only 76% of mothers with GBS colonization received intrapartum chemoprophylaxis. Although 77% of infected infants required intensive care, 20% of term infants were treated in the normal newborn nursery. Sixteen percent of infected infants died, most commonly with E coli infection (33%). CONCLUSION: In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease. GBS remains the most frequent pathogen in term infants, and E coli the most significant pathogen in preterm infants. Missed opportunities for GBS prevention continue. Prevention of E coli sepsis, especially among preterm infants, remains a challenge. |
Association of recent HIV infection and in utero HIV-1 transmission: findings from the PEPI-Malawi trial
Taha TE , James MM , Hoover DR , Sun J , Laeyendecker O , Mullis CE , Kumwenda JJ , Lingappa JR , Auvert B , Morrison CS , Mofensen LM , Taylor A , Fowler MG , Kumenda NI , Eshleman SH . AIDS 2011 25 (11) 1357-64 INTRODUCTION: We previously developed a multi-assay algorithm (MAA) to identify recent HIV infection that includes the BED-Capture Enzyme Immunoassay, an avidity assay based on the Genetic Systems HIV-1/HIV-2+O Enzyme Immunoassay, CD4 cell count, and HIV viral load. We used this MAA to evaluate the association between recent maternal HIV infection and in utero transmission of HIV. METHODS: Plasma samples were collected at delivery from 2,561 HIV-infected women in the PEPI-Malawi trial. The MAA described above was used to identify women with recent HIV infection. Logistic regression models assessed association between recent HIV infection and in utero HIV transmission (defined as a positive infant HIV DNA test at birth). RESULTS: Seventy-three women were identified as recently infected using the MAA. Those women were younger and had lower parity than women who were identified as not recently infected using the MAA (P < 0.0001 for age and parity). The frequency of in utero HIV transmission was 17.8% among women identified as recently infected, compared to 6.7% among women identified as not recently infected (13/73 vs. 166/2488, P = 0.001). In a multivariate model, three factors were independently associated with in utero HIV transmission: recent infection (adjusted odds ratio [AOR]: 2.49, 95% CI: 1.30-4.78, P = 0.006), log10 HIV viral load at delivery (AOR: 2.01, 95% CI: 1.60-2.51, P < 0.0001), and younger age (per 10 year increase, AOR: 0.66, 95% CI: 0.43-0.93, P = 0.02). CONCLUSIONS: Results obtained using a MAA suggest that recent maternal HIV acquisition is strongly associated with in utero HIV transmission, independent of HIV viral load at delivery. |
Comparison of changes in growth percentiles of US children on CDC 2000 growth charts with corresponding changes on WHO 2006 growth charts
Mei Z , Grummer-Strawn LM . Clin Pediatr (Phila) 2011 50 (5) 402-7 Longitudinal data with 37,964 length and weight measurements from 10,844 children who participated in the California Child Health and Development Study was used to compare the proportion of children aged ≤24 months who crossed major percentile lines on the Centers for Disease Control and Prevention (CDC) 2000 growth charts with the percentage who crossed corresponding lines on the World Health Organization (WHO) 2006 growth charts. Percentage of children aged ≤24 months who crossed at least 2 major percentile lines for length-for-age, weight-for-age, and weight-for-length according to CDC 2000 charts were compared with the percentage who did so according to WHO 2006 charts. The results from this analysis suggest that pediatricians who monitor children's growth on the basis of WHO 2006 growth charts may be more likely to refer children aged <6 months and less likely to refer those aged 6 to 12 months for further evaluation for failure to thrive. |
Overview of a roundtable on NHANES monitoring of biomarkers of folate and vitamin B-12 status: measurement procedure issues
Yetley EA , Coates PM , Johnson CL . Am J Clin Nutr 2011 94 (1) 297S-302S A roundtable dialogue to discuss "NHANES Monitoring of Biomarkers of Folate and Vitamin B-12 Status" took place in July 2010. This article provides an overview of the meeting and this supplement issue. Although the focus of the roundtable dialogue was on the measurement of folate and vitamin B-12 status biomarkers in the NHANES, this article also describes the relevance and importance of these issues for clinical and research laboratories. The roundtable identified the microbiological assay (MA) as the gold standard for measurement of serum and red blood cell folate concentrations. The roundtable noted that differences in results between the Bio-Rad Quantaphase II procedure (Bio-Rad Laboratories, Hercules, CA) that NHANES 1991-1994 and 1999-2006 used and the MA that NHANES 2007-2010 used will require adjustment equations to evaluate time trends. The roundtable found that the close agreement between the serum results for the MA and liquid chromatography-tandem mass spectrometry (LC-MS/MS) procedures supported the conversion to LC-MS/MS for serum folate in future NHANES. The roundtable recognized the uncertainty about whether subclinical vitamin B-12 deficiency is a public health concern but encouraged reinstatement of at least one circulating vitamin B-12 measure and one functional vitamin B-12 status measure in future NHANES. The use of serum vitamin B-12 and plasma methylmalonic acid would provide continuity with past NHANES. The roundtable supported the continued use of the National Institute of Standards and Technology (NIST) reference materials in NHANES biomarker analyses and the further development of additional reference materials by the NIST. |
Biomarkers of folate status in NHANES: a roundtable summary
Yetley EA , Pfeiffer CM , Phinney KW , Fazili Z , Lacher DA , Bailey RL , Blackmore S , Bock JL , Brody LC , Carmel R , Curtin LR , Durazo-Arvizu RA , Eckfeldt JH , Green R , Gregory JF 3rd , Hoofnagle AN , Jacobsen DW , Jacques PF , Molloy AM , Massaro J , Mills JL , Nexo E , Rader JI , Selhub J , Sempos C , Shane B , Stabler S , Stover P , Tamura T , Tedstone A , Thorpe SJ , Coates PM , Johnson CL , Picciano MF . Am J Clin Nutr 2011 94 (1) 303S-312S A roundtable to discuss the measurement of folate status biomarkers in NHANES took place in July 2010. NHANES has measured serum folate since 1974 and red blood cell (RBC) folate since 1978 with the use of several different measurement procedures. Data on serum 5-methyltetrahydrofolate (5MTHF) and folic acid (FA) concentrations in persons aged ≥60 y are available in NHANES 1999-2002. The roundtable reviewed data that showed that folate concentrations from the Bio-Rad Quantaphase II procedure (Bio-Rad Laboratories, Hercules, CA; used in NHANES 1991-1994 and NHANES 1999-2006) were, on average, 29% lower for serum and 45% lower for RBC than were those from the microbiological assay (MA), which was used in NHANES 2007-2010. Roundtable experts agreed that these differences required a data adjustment for time-trend analyses. The roundtable reviewed the possible use of an isotope-dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) measurement procedure for future NHANES and agreed that the close agreement between the MA and LC-MS/MS results for serum folate supported conversion to the LC-MS/MS procedure. However, for RBC folate, the MA gave 25% higher concentrations than did the LC-MS/MS procedure. The roundtable agreed that the use of the LC-MS/MS procedure to measure RBC folate is premature at this time. The roundtable reviewed the reference materials available or under development at the National Institute of Standards and Technology and recognized the challenges related to, and the scientific need for, these materials. They noted the need for a commutability study for the available reference materials for serum 5MTHF and FA. |
Dietary supplement use among U.S. adults has increased since NHANES III (1988-1994)
Gahche J , Bailey R , Burt V , Hughes J , Yetley E , Dwyer J , Picciano MF , McDowell M , Sempos C . NCHS Data Brief 2011 (61) 1-8 KEY FINDINGS: Use of dietary supplements is common among the U.S. adult population. Over 40% used supplements in 1988-1994, and over one-half in 2003-2006. Multivitamins/multiminerals are the most commonly used dietary supplements, with approximately 40% of men and women reporting use during 2003-2006. Use of supplemental calcium increased from 28% during 1988-1994 to 61% during 2003-2006 among women aged 60 and over. Use of supplements containing folic acid among women aged 20-39 did not increase since 1988-1994. In 2003-2006, 34% of women aged 20-39 used a dietary supplement containing folic acid. Use of dietary supplements containing vitamin D increased from 1988-1994 through 1999-2002 for men and women in most age groups. |
Infrared imaging for leak detection of N95 filtering facepiece respirators: a pilot study
Roberge RJ , Monaghan WD , Palmiero AJ , Shaffer R , Bergman MS . Am J Ind Med 2011 54 (8) 628-36 BACKGROUND: This study was undertaken to determine the utility of an infrared camera (IRC) for assessing leaks around filtering facepiece respirators (FFR) during quantitative respirator fit testing. METHODS: Eight subjects underwent quantitative fit testing on six N95 FFR models (48 total fit tests) while simultaneously being recorded with an IRC. RESULTS: The IRC detected 49 exhalation leaks during 39 tests and no leaks in nine tests. Exhalation leaks were identified in all failed fit tests (13) and a majority (26 of 35) of passed tests. Anatomically, the nasal region and malar (cheekbone) regions accounted for 71% of identified leak sites. Fit factors for fit tests without identified exhalation leaks were significantly higher than fit tests with leaks detected by IRC (P = 0.01). CONCLUSIONS: Thermal imaging using IRC can detect leaks in respiratory protective equipment and has the potential as a screening tool for assessment of the adequacy of post-donning FFR fit. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Coal mine methane: a review of capture and utilization practices with benefits to mining safety and to greenhouse gas reduction
Karacan CO , Ruiz FA , Cote M , Phipps S . Int J Coal Geol 2011 86 121-156 Coal mine methane (CMM) is a term given to the methane gas produced or emitted in association with coal mining activities either from the coal seam itself or from other gassy formations underground. The amount of CMM generated at a specific operation depends on the productivity of the coal mine, the gassiness of the coal seam and any underlying and overlying formations, operational variables, and geological conditions. CMM can be captured by engineered boreholes that augment the mine's ventilation system or it can be emitted into the mine environment and exhausted from the mine shafts along with ventilation air. The large amounts of methane released during mining present concerns about adequate mine ventilation to ensure worker safety, but they also can create opportunities to generate energy if this gas is captured and utilized properly. This article reviews the technical aspects of CMM capture in and from coal mines, the main factors affecting CMM accumulations in underground coal mines, methods for capturing methane using boreholes, specific borehole designs for effective methane capture, aspects of removing methane from abandoned mines and from sealed/active gobs of operating mines, benefits of capturing and controlling CMM for mine safety, and benefits for energy production and greenhouse gas (GHG) reduction. Published by Elsevier B.V. |
Success of Senegal's first nationwide distribution of long-lasting insecticide-treated nets to children under five - contribution toward universal coverage
Thwing JI , Perry RT , Townes DA , Diouf MB , Ndiaye S , Thior M . Malar J 2011 10 86 BACKGROUND: In 2009, the first national long-lasting insecticide-treated net (LLIN) distribution campaign in Senegal resulted in the distribution of 2.2 million LLINs in two phases to children aged 6-59 months. Door-to-door teams visited all households to administer vitamin A and mebendazole, and to give a coupon to redeem later for an LLIN. METHODS: A nationwide community-based two-stage cluster survey was conducted, with clusters selected within regions by probability proportional to size sampling, followed by GPS-assisted mapping, simple random selection of households in each cluster, and administration of a questionnaire using personal digital assistants (PDAs). The questionnaire followed the Malaria Indicator Survey format, with rosters of household members and bed nets, and questions on campaign participation. RESULTS: There were 3,280 households in 112 clusters representing 33,993 people. Most (92.1%) guardians of eligible children had heard about the campaign, the primary sources being health workers (33.7%), neighbours (26.2%), and radio (22.0%). Of eligible children, 82.4% received mebendazole, 83.8% received vitamin A, and 75.4% received LLINs. Almost all (91.4%) LLINs received during the campaign remained in the household; of those not remaining, 74.4% had been given away and none were reported sold. At least one insecticide-treated net (ITN) was present in 82.3% of all households, 89.2% of households with a child < 5 years and 57.5% of households without a child < 5 years. Just over half (52.4%) of ITNs had been received during the campaign. Considering possible indicators of universal coverage, 39.8% of households owned at least one ITN per two people, 21.6% owned at least one ITN per sleeping space and 34.7% of the general population slept under an ITN the night before the survey. In addition, 45.6% of children < 5 years, and 49.2% of pregnant women had slept under an ITN. CONCLUSIONS: The nationwide integrated LLIN distribution campaign allowed household ITN ownership of one or more ITNs to surpass the RBM target of 80% set for 2010, though additional distribution strategies are needed to reach populations missed by the targeted campaign and to reach the universal coverage targets of one ITN per sleeping space and 80% of the population using an ITN. |
Uses of youth risk behavior survey and school health profiles data: applications for improving adolescent and school health
Foti K , Balaji A , Shanklin S . J Sch Health 2011 81 (6) 345-54 BACKGROUND: To monitor priority health risk behaviors and school health policies and practices, respectively, the Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) and the School Health Profiles (Profiles). CDC is often asked about the use and application of these survey data to improve adolescent and school health. The purpose of this article is to describe the importance and potential impact of Youth Risk Behavior Survey (YRBS) and Profiles data based on examples from participating sites. METHODS: The authors spoke with representatives from 25 state and 8 local agencies funded by CDC to learn how data from the YRBS, Profiles, and other data sources are used. The authors identified common themes in the responses and categorized the responses accordingly. RESULTS: Representatives indicated survey data are used to describe risk behaviors and school health policies and practices, inform professional development, plan and monitor programs, support health-related policies and legislation, seek funding, and garner support for future surveys. Examples presented highlight the range of possible uses of survey data. CONCLUSIONS: State and local agencies use YRBS and Profiles data in many ways to monitor and address issues related to adolescent and school health. Innovative uses of survey data are encouraged, although it is also crucial to continue the more fundamental uses of survey data. If the data are not disseminated, the current health needs of students may not be adequately addressed. |
Impact of a malaria-control project in Benin that included the Integrated Management of Childhood Illness strategy
Rowe A , Onikpo F , Lama M , Osterholt D , Deming M . Am J Public Health 2011 101 (12) 2333-41 OBJECTIVES: To estimate the impact of the Integrated Management of Childhood Illness (IMCI) strategy on early-childhood mortality, we evaluated a malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets (ITNs). METHODS: We conducted a before-and-after intervention study that included a nonrandomized comparison group. We used the preceding birth technique to measure early-childhood mortality (risk of dying before age 30 months), and we used health facility surveys and household surveys to measure process indicators. RESULTS: Most process indicators improved in the area covered by the intervention. Notably, because ITNs were also promoted in the comparison area children's ITN use increased by about 20 percentage points in both areas. Regarding early-childhood mortality, the trend from baseline (1999-2001) to follow-up (2002-2004) for the intervention area (13.0% decrease; P<.001) was 14.1% (P<.001) lower than was the trend for the comparison area (1.3% increase; P=.46). CONCLUSIONS: Mortality decreased in the intervention area after IMCI and ITN promotion. ITN use increased similarly in both study areas, so the mortality impact of ITNs in the 2 areas might have canceled each other out. Thus, the mortality reduction could have been primarily attributable to IMCI's effect on health care quality and care-seeking. (Am J Public Health. Published online ahead of print May 12, 2011: e1-e9. doi:10.2105/AJPH.2010.300068). |
Scientific evidence and policy change: lowering the legal blood alcohol limit for drivers to 0.08% in the USA
Sleet DA , Mercer SL , Cole KH , Shults RA , Elder RW , Nichols JL . Glob Health Promot 2011 18 (1) 23-26, 115, 150 The United States (US) Centers for Disease Control and Prevention (CDC), and key partners conducted a systematic review of the effectiveness of 0.08% blood alcohol concentration (BAC) laws on alcohol-related traffic mortality. Review findings of strong evidence of effectiveness were presented by partners during US Congressional hearings contributing to the passage of a bill requiring states to lower the legal BAC limit to 0.08% (80 mg of alcohol/100 ml of blood) or lose a portion of their federal highway funds. The bill was signed into law, making 0.08 the new national standard. Extensive and targeted dissemination of the evidence and recommendations to key stakeholders and partners built support for policy change at the state level. |
Understanding physicians' attitudes toward people with Down syndrome
Pace JE , Shin M , Rasmussen SA . Am J Med Genet A 2011 155A (6) 1258-63 Understanding attitudes of physicians toward people with Down syndrome is important because of the influence physicians have on the future of individuals with Down syndrome. However, few previous studies have assessed these attitudes. Using data from the 2008 DocStyles(c) survey, an annual online survey conducted in the United States, we assessed attitudes of physicians toward people with Down syndrome using a survey that included questions about opinions toward inclusive educational settings and workplaces, previous relationships with people with Down syndrome, and comfort in providing them with medical care. Approximately 20% of participants agreed that students with Down syndrome should go to special schools, and nearly a quarter agreed that including students with Down syndrome in regular classrooms is distracting. While 76.0% of respondents felt comfortable providing medical care to people with Down syndrome, 9.8% reported feeling uncomfortable, and 14.3% reported feeling neutral. Results showed that attitudes that supported inclusion and comfort with providing medical care were more commonly reported among non-Hispanic white physicians, those who had previous relationships with people with Down syndrome, pediatricians, and physicians working in a group or hospital setting. These data are helpful to guide the development of training materials and curricula for healthcare providers regarding Down syndrome. Published 2011 Wiley-Liss, Inc. |
Wireless substitution: state-level estimates from the National Health Interview Survey, January 2007-June 2010
Blumberg SJ , Luke JV , Ganesh N , Davern ME , Boudreaux MH , Soderberg K . Natl Health Stat Report 2011 (39) 1-26, 28 OBJECTIVES: This report presents state-level estimates of the percentage of adults and children living in households that did not have a landline telephone but did have at least one wireless telephone. National estimates for the 12-month time period from July 2009 through June 2010 indicate that 23.9% of adults and 27.5% of children were living in these wireless-only households. Estimates are also presented for selected U.S. counties and groups of counties, for other household telephone service use categories (e.g., those that had only landlines and those that had landlines yet received all or almost all calls on wireless telephones), and for 12-month time periods since January-December 2007. METHODS: Small-area statistical modeling techniques were used to estimate the prevalence of adults and children living in households with various household telephone service types for 93 disjoint geographic areas that make up the entire United States. This modeling was based on January 2007-June 2010 data from the National Health Interview Survey, 2006-2009 data from the American Community Survey, and auxiliary information on the number of listed telephone lines per capita in 2007-2010. RESULTS: The prevalence of wireless-only adults and children varied substantially across states. State-level estimates for July 2009-June 2010 ranged from 12.8% (Rhode Island and New Jersey) to 35.2% (Arkansas) of adults and from 12.6% (Connecticut and New Jersey) to 46.2% (Arkansas) of children. For adults, the magnitude of the increase from 2007 to 2010 was lowest in New Jersey (7.2 percentage points) and highest in Arkansas (14.5 percentage points). |
Residential light and risk for depression and falls: results from the LARES study of eight European cities
Brown MJ , Jacobs DE . Public Health Rep 2011 126 Suppl 1 131-40 OBJECTIVES: We examined the relationship between self-reported inadequate residential natural light and risk for depression or falls among adults aged 18 years or older. METHODS: Generalized estimating equations were used to calculate the odds of depression or falls in participants with self-reported inadequate natural residential light vs. those reporting adequate light (n = 6,017) using data from the World Health Organization's Large Analysis and Review of European Housing and Health Survey, a large cross-sectional study of housing and health in representative populations from eight European cities. RESULTS: Participants reporting inadequate natural light in their dwellings were 1.4 times (95% confidence interval [CI] 1.2,1.7) as likely to report depression and 1.5 times (95% CI 1.2, 1.9) as likely to report a fall compared with those satisfied with their dwelling's light. After adjustment for major confounders, the likelihood of depression changed slightly, while the likelihood of a fall increased to 2.5 (95% CI 1.5, 4.2). CONCLUSION: Self-reported inadequate light in housing is independently associated with depression and falls. Increasing light in housing, a relatively inexpensive intervention, may improve two distinct health conditions. |
Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth
Chandra A , Mosher WD , Copen C , Sionean C . Natl Health Stat Report 2011 (36) 1-36 OBJECTIVE: This report presents national estimates of several measures of sexual behavior, sexual attraction, and sexual identity among males and females aged 15-44 years in the United States, based on the 2006-2008 National Survey of Family Growth (NSFG). These data are relevant to demographic and public health concerns, including fertility and sexually transmitted infections among teenagers and adults. Data from the 2006-2008 NSFG are compared with data from the 2002 NSFG and other national surveys. METHODS: Data for 2006-2008 were collected through in-person interviews with a national sample of 13,495 males and females in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The overall response rate for the 2006-2008 NSFG was 75%. RESULTS: Sexual behaviors among males and females aged 15-44 based on the 2006-2008 NSFG were generally similar to those reported based on the 2002 NSFG. Among adults aged 25-44, about 98% of women and 97% of men ever had vaginal intercourse, 89% of women and 90% of men ever had oral sex with an opposite-sex partner, and 36% of women and 44% of men ever had anal sex with an opposite-sex partner. Twice as many women aged 25-44 (12%) reported any same-sex contact in their lifetimes compared with men (5.8%). Among teenagers aged 15-19, 7% of females and 9% of males have had oral sex with an opposite-sex partner, but no vaginal intercourse. Sexual attraction and identity correlates closely but not completely with reports of sexual behavior. Sexual behaviors, attraction, and identity vary by age, marital or cohabiting status, education, and race and Hispanic origin. |
Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections
Hood JE , Friedman AL . Sex Health 2011 8 (2) 159-70 Stigma has long accompanied sexually transmissible infections (STI) and hindered prevention and control efforts. It not only acts as a formidable barrier to STI testing, treatment and disclosure, but has a multitude of consequences for the health and quality of life of infected individuals. This review summarises the literature related to STI stigma and offers practical approaches to counter STI-associated stigma through multi-level efforts. Specifically, it describes the key sources that breed and perpetuate stigma, outlines how STI-associated stigma has been conceptualised and measured in the literature, documents the impact of stigma on infected and uninfected individuals, and summarises the stigma reduction strategies recommended in the literature. Gaps in the literature are identified and areas for further research are suggested, along with practical strategies for moving forward. |
Examining functional content in widely used Health-Related Quality of Life scales
Hall T , Krahn GL , Horner-Johnson W , Lamb G . Rehabil Psychol 2011 56 (2) 94-9 PURPOSE: Assess extent to which generic Quality of Life (QOL) and Health-Related Quality of Life (HRQOL) scales include function in assessment of health, and identify health assessment items that are free of functional content. METHODS: An expert panel on measurement of health and disability reached consensus on definitions of health, disability, and function. They assessed all items of all generic (non-condition-specific) scales in the 2006 ProQolid database for being important to measuring health as distinct from function. Ratings were summarized as content validity ratios. Retained items were written into standard format and reviewed again by the expert panel and a validity panel with expertise in specific disabilities. RESULTS: Of 85 scales, 21 were retained as containing items important for assessing health. Scales ranged from 100% (BRFSS HRQOL, WHO-5) to only 4% of items rated as important. In further review of "important" items, functional content was identified in many of the items, particularly with regard to mental functioning. CONCLUSIONS: Popular generic scales of QOL and HRQOL vary greatly in the degree to which they include content on function. A pool of items can be identified that are relatively free of function. Distinguishing measurement of function and health is particularly important for people with long-standing functional limitations and for assessing the relationship of health with function. |
Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: evidence from a national probability survey
Griffiths C , Johnson AM , Fenton KA , Erens B , Hart GJ , Wellings K , Mercer CH . Int J STD AIDS 2011 22 (3) 131-9 We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians. |
Hazards of illicit methamphetamine production and efforts at reduction: data from the Hazardous Substances Emergency Events Surveillance system
Melnikova N , Welles WL , Wilburn RE , Rice N , Wu J , Stanbury M . Public Health Rep 2011 126 Suppl 1 116-23 OBJECTIVES: Methamphetamine (meth) is a highly addictive drug of abuse that can easily be made in small illegal laboratories from household chemicals that are highly toxic and dangerous. Meth labs have been found in locations such as homes, outbuildings, motels, and cars. Its production endangers the "cook," neighbors, responders, and the environment. This article describes surveillance data used to examine the emergence and public health impacts of illicit clandestine meth labs, as well as two states' efforts to thwart lab operations and prevent responder injuries. METHODS: We analyzed data collected from 2001 to 2008 by 18 states participating in the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) Program to examine the occurrence and public health impacts of clandestine meth production. RESULTS: HSEES data indicate that the majority of clandestine meth lab events occurred in residential areas. About 15% of meth lab events required evacuation. Nearly one-fourth of these events resulted in injuries, with 902 reported victims. Most victims (61%) were official responders, and one-third were members of the general public. Since 2004, with the implementation of local and federal laws and prevention activities, the number of meth lab events has declined. Increased education and training of first responders has led to decreased injuries among police officers, firefighters, and emergency medical personnel. CONCLUSIONS: HSEES data provided a good data source for monitoring the emergence of domestic clandestine meth production, the associated public health effects, and the results of state and federal efforts to promote actions to address the problem. |
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