Prevalence of clinical hip abnormalities in haemophilia A and B: an analysis of the UDC database
Kelly D , Zhang QC , Soucie JM , Manco-Johnson M , Dimichele D . Haemophilia 2013 19 (3) 426-31 Clinical hip abnormalities, secondary to recurrent joint and/or muscle bleeding in persons with haemophilia, have not been well characterized and have the potential for significant morbidity. We aimed to examine the prevalence of clinical hip abnormalities in the US haemophilia population and to explore associations between these findings and putative risk factors. We conducted a study of hip abnormalities of 8192 subjects aged 2-69 years with haemophilia A and haemophilia B (54% of haemophilia A and haemophilia B are severe) currently enrolled in the Universal Data Collection (UDC) database. Associations between hip abnormality and type/severity of haemophilia A/B, current age, history of high-titre (≥5 BU) inhibitor (HTinh), concomitant ankle (AA) and knee arthropathy (KA), overweight and obesity and prophylaxis were examined using logistic regression. Overall prevalence of hip abnormality at the last recorded UDC visit for all subjects was 16.7%. Haemophilia A (aOR = 1.3, 1.0-1.4), severe haemophilia (aOR = 1.3, 1.0-1.5), a history of HTinh (aOR = 1.4, 1.1-1.7), and concomitant AA (aOR = 1.7, 1.4-1.9) were each independently associated with hip abnormality. Older age (45-69 years) was significantly associated with hip abnormality prevalence only in subjects with KA (aOR = 3.4, 1.9-5.9). The presence of overweight (aOR = 1.4, 1.1-1.8) and obesity (aOR = 2.1, 1.6-2.8) was associated with hip abnormality only among subjects without KA. Hip abnormality prevalence was not influenced by prophylaxis (aOR = 0.9, 0.8-1.1). These data suggest that hip abnormalities in US patients with haemophilia are associated with haemophilia severity and type, HTinh, concomitant AA and, depending on the presence or absence of KA, advancing age and obesity. |
Preventing skin cancer through reduction of indoor tanning: current evidence
Watson M , Holman DM , Fox KA , Guy GP , Seidenberg AB , Sampson BP , Sinclair C , Lazovich D . Am J Prev Med 2013 44 (6) 682-9 Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices. |
Role of intestinal mucosal integrity in HIV transmission to infants through breastfeeding: the BAN Study
Kourtis AP , Ibegbu CC , Wiener J , King CC , Tegha G , Kamwendo D , Kumwenda J , Pal KS , Flax V , Ellington S , Kacheche Z , Kayira D , Chasela C , van der Horst C , Jamieson DJ . J Infect Dis 2013 208 (4) 653-61 BACKGROUND: Increased intestinal permeability may be one of the mechanisms of transmission of HIV to the infant through breastfeeding. It correlates with microbial translocation, which can be measured through quantification of bacterial lipopolysaccharide (LPS). METHODS: We evaluated levels of plasma LPS (Limulus Amoebocyte Lysate assay), and immune activation markers in serial specimens of HIV-exposed uninfected and HIV-infected infants from the Breastfeeding, Antiretrovirals and Nutrition (BAN) Study. RESULTS: Plasma LPS levels increased after infants in BAN weaned from the breast at 24 weeks of age. Cotrimoxazole prophylaxis was associated with higher plasma LPS levels (p=0.004). Infants with HIV infection had higher LPS levels compared with uninfected infants (p= 0.004). Pre-infection plasma LPS levels were a significant predictor of infant HIV infection through breastfeeding (HR=1.60 for every unit increase in plasma LPS, p=0.01) and for lower infant length-for-age (p=0.02). CONCLUSIONS: These findings suggest that disruption in intestinal integrity is a mechanism of HIV transmission to the infant through breastfeeding. Weaning from breast milk and use of antibiotic prophylaxis was associated with increased levels of microbial translocation, which could facilitate HIV entry through the intestine. Complementary approaches to enhance intestinal mucosal integrity in the infant may further reduce breastfeeding transmission of HIV. |
Multiple independent emergences of type 2 vaccine-derived polioviruses during a large outbreak in northern Nigeria
Burns CC , Shaw J , Jorba J , Bukbuk D , Adu F , Gumede N , Pate MA , Abanida EA , Gasasira A , Iber J , Chen Q , Vincent A , Chenoweth P , Henderson E , Wannemuehler K , Naeem A , Umami RN , Nishimura Y , Shimizu H , Baba M , Adeniji A , Williams AJ , Kilpatrick DR , Oberste MS , Wassilak SG , Tomori O , Pallansch MA , Kew O . J Virol 2013 87 (9) 4907-22 Since 2005, a large poliomyelitis outbreak associated with type 2 circulating vaccine-derived poliovirus (cVDPV2) has occurred in northern Nigeria, where immunization coverage with trivalent oral poliovirus vaccine (tOPV) has been low. Phylogenetic analysis of P1/capsid region sequences of isolates from each of the 403 cases reported in 2005 to 2011 resolved the outbreak into 23 independent type 2 vaccine-derived poliovirus (VDPV2) emergences, at least 7 of which established circulating lineage groups. Virus from one emergence (lineage group 2005-8; 361 isolates) was estimated to have circulated for over 6 years. The population of the major cVDPV2 lineage group expanded rapidly in early 2009, fell sharply after two tOPV rounds in mid-2009, and gradually expanded again through 2011. The two major determinants of attenuation of the Sabin 2 oral poliovirus vaccine strain (A481 in the 5'-untranslated region [5'-UTR] and VP1-Ile143) had been replaced in all VDPV2 isolates; most A481 5'-UTR replacements occurred by recombination with other enteroviruses. cVDPV2 isolates representing different lineage groups had biological properties indistinguishable from those of wild polioviruses, including efficient growth in neuron-derived HEK293 cells, the capacity to cause paralytic disease in both humans and PVR-Tg21 transgenic mice, loss of the temperature-sensitive phenotype, and the capacity for sustained person-to-person transmission. We estimate from the poliomyelitis case count and the paralytic case-to-infection ratio for type 2 wild poliovirus infections that approximately 700,000 cVDPV2 infections have occurred during the outbreak. The detection of multiple concurrent cVDPV2 outbreaks in northern Nigeria highlights the risks of cVDPV emergence accompanying tOPV use at low rates of coverage in developing countries. |
Influenza: propagation, quantification, and storage
Balish AL , Katz JM , Klimov AI . Curr Protoc Microbiol 2013 Chapter 15 Unit15G 1 Influenza viruses are negative-sense, single-stranded, enveloped RNA viruses belonging to the family Orthomyxoviridae. Three types exist, influenza A, B, and C. All infect humans, but only A and B are major human pathogens. Influenza type A viruses are divided into subtypes based on genetic and antigenic differences in the two surface spike proteins, hemagglutinin (HA) and neuraminidase (NA). The appropriate cell lines to be used for isolation of influenza A or B viruses depend on the clinical information and the host of origin. MDCK cells are the preferred cell line for isolation of human influenza viruses from clinical specimens. (Curr. Protoc. Microbiol. 29:15G.1.1-15G.1.24. (c) 2013 by John Wiley & Sons, Inc.) |
Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study
Kotloff KL , Nataro JP , Blackwelder WC , Nasrin D , Farag TH , Panchalingam S , Wu Y , Sow SO , Sur D , Breiman RF , Faruque AS , Zaidi AK , Saha D , Alonso PL , Tamboura B , Sanogo D , Onwuchekwa U , Manna B , Ramamurthy T , Kanungo S , Ochieng JB , Omore R , Oundo JO , Hossain A , Das SK , Ahmed S , Qureshi S , Quadri F , Adegbola RA , Antonio M , Hossain MJ , Akinsola A , Mandomando I , Nhampossa T , Acacio S , Biswas K , O'Reilly CE , Mintz ED , Berkeley LY , Muhsen K , Sommerfelt H , Robins-Browne RM , Levine MM . Lancet 2013 382 (9888) 209-22 BACKGROUND: Diarrhoeal diseases cause illness and death among children younger than 5 years in low-income countries. We designed the Global Enteric Multicenter Study (GEMS) to identify the aetiology and population-based burden of paediatric diarrhoeal disease in sub-Saharan Africa and south Asia. METHODS: The GEMS is a 3-year, prospective, age-stratified, matched case-control study of moderate-to-severe diarrhoea in children aged 0-59 months residing in censused populations at four sites in Africa and three in Asia. We recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three randomly selected matched community control children without diarrhoea. From patients with moderate-to-severe diarrhoea and controls, we obtained clinical and epidemiological data, anthropometric measurements, and a faecal sample to identify enteropathogens at enrolment; one follow-up home visit was made about 60 days later to ascertain vital status, clinical outcome, and interval growth. FINDINGS: We enrolled 9439 children with moderate-to-severe diarrhoea and 13,129 control children without diarrhoea. By analysing adjusted population attributable fractions, most attributable cases of moderate-to-severe diarrhoea were due to four pathogens: rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli producing heat-stable toxin (ST-ETEC; with or without co-expression of heat-labile enterotoxin), and Shigella. Other pathogens were important in selected sites (eg, Aeromonas, Vibrio cholerae O1, Campylobacter jejuni). Odds of dying during follow-up were 8.5-fold higher in patients with moderate-to-severe diarrhoea than in controls (odd ratio 8.5, 95% CI 5.8-12.5, p<0.0001); most deaths (167 [87.9%]) occurred during the first 2 years of life. Pathogens associated with increased risk of case death were ST-ETEC (hazard ratio [HR] 1.9; 0.99-3.5) and typical enteropathogenic E coli (HR 2.6; 1.6-4.1) in infants aged 0-11 months, and Cryptosporidium (HR 2.3; 1.3-4.3) in toddlers aged 12-23 months. INTERPRETATION: Interventions targeting five pathogens (rotavirus, Shigella, ST-ETEC, Cryptosporidium, typical enteropathogenic E coli) can substantially reduce the burden of moderate-to-severe diarrhoea. New methods and accelerated implementation of existing interventions (rotavirus vaccine and zinc) are needed to prevent disease and improve outcomes. FUNDING: The Bill & Melinda Gates Foundation. |
Reductions in serum lipids with a 4-year decline in serum perfluorooctanoic acid and perfluorooctanesulfonic acid
Fitz-Simon N , Fletcher T , Luster MI , Steenland K , Calafat AM , Kato K , Armstrong B . Epidemiology 2013 24 (4) 569-76 BACKGROUND: Several epidemiological cross-sectional studies have found positive associations between serum concentrations of lipids and perfluorooctanoic acid (PFOA, or C8). A longitudinal study should be less susceptible to biases from uncontrolled confounding or reverse causality. METHODS: We investigated the association between within-individual changes in serum PFOA and perfluorooctanesulfonic acid (PFOS) and changes in serum lipid levels (low-density lipoprotein [LDL] cholesterol, high-density lipoprotein cholesterol, total cholesterol, and triglycerides) over a 4.4-year period. The study population consisted of 560 adults living in parts of Ohio and West Virginia where public drinking water had been contaminated with PFOA. They had participated in a cross-sectional study in 2005-2006, and were followed up in 2010, by which time exposure to PFOA had been substantially reduced. RESULTS: Overall serum concentrations of PFOA and PFOS fell by half from initial geometric means of 74.8 and 18.5 ng/mL, respectively, with little corresponding change in LDL cholesterol (mean increase 1.8%, standard deviation 26.6%). However, there was a tendency for people with greater declines in serum PFOA or PFOS to have greater LDL decrease. For a person whose serum PFOA fell by half, the predicted fall in LDL cholesterol was 3.6% (95% confidence interval = 1.5-5.7%). The association with a decline in PFOS was even stronger, with a 5% decrease in LDL (2.5-7.4%). CONCLUSIONS: Our findings from this longitudinal study support previous evidence from cross-sectional studies of positive associations between PFOA and PFOS in serum and LDL cholesterol. |
The role of physicians in promoting healthier built environments
Dannenberg AL , Wu P , Frumkin H . Am J Prev Med 2013 44 (6) e67-9 The normal physician treats the problem; the good physician treats the person; the best physician treats the community. | —Chinese proverb | | Most physicians work in clinical settings, providing one-to-one care to their patients. However, physicians long have recognized that involvement with community-level concerns can be necessary and appropriate to help address broad health-related issues. Some of the most important health advances, such as smoking restrictions, seat belt requirements, bicycle helmets, and environmental lead reduction, have grown out of collaboration between health and community sectors. Physician advocacy has been a key part of these strategies. | Involvement at the community level requires physicians to use a different set of skills than those practiced in the exam room, including advocacy in the community and collaboration with nonmedical disciplines. In exercising these skills, physicians expand their focus from a single patient to all families in the community. More than 90% of physicians in a nationwide survey endorsed community participation, political involvement, and collective advocacy by physicians.1 The current paper presents discussion of what physicians can do to influence the physical design of their communities to yield health benefits for both their patients and all families in their community. Individual motivation and choice are critical in behaviors such as healthy eating and being physically active, but equally important is the concept that “place” makes these behaviors possible. |
Healthy and safe swimming: pool chemical-associated health events
Hlavsa M , Beach M . J Environ Health 2013 75 (9) 42-44 Chemicals are added to the water in | treated recreational water venues | (e.g., pools, hot tubs/spas, and interactive fountains) to inactivate pathogens, | maximize the efficacy of the disinfection process (e.g., pH control), improve water quality, | stop corrosion and scaling of equipment, and | protect against algal growth. Each year, however, pool chemical–associated health events | lead to 3,000–5,000 visits to emergency departments across the U.S. (National Electronic Injury Surveillance System, 2013). The | most common diagnoses are poisoning (i.e., | ingestion of pool chemicals or inhalation of | dust or fumes) and dermatitis or conjunctivitis, which result from chemical splashes | onto skin or into the eyes. The injured include pool operators, other aquatics staff, and | the general public; however, those under 18 | years of age are disproportionately affected. | Pool chemical–associated health events occur | in both residential and public settings, and | they most frequently occur during the summer and on the weekends |
Infectious disease surveillance by medical examiners and coroners
Blau DM , Clark SC , Nolte KB . Emerg Infect Dis 2013 19 (5) 821-822 Medical examiners and coroners (ME/C) investigate ≈20% of all deaths in the United States (1); these include persons who die outside the health care system or die precipitously without a confirmed diagnosis. Surveillance through ME/C offices for unexplained deaths that might have infectious causes can serve as a sentinel system to identify new agents, identify notifiable diseases missed by traditional surveillance systems, recognize unique signs and symptoms of known pathogens, and detect bioterrorism (1). This surveillance model, called Med-X, is based on standards for autopsy performance, diagnostic testing, and public health reporting and is currently being performed locally in a small number of offices. | To assess more widely the capacity of ME/C offices to conduct infectious disease surveillance, the National Association of Medical Examiners distributed an Internet-based questionnaire to 155 ME/C offices in the United States that serve populations >300,000; the questionnaires were completed during August–September 2009. Survey questions addressed interest in and physical, personnel, and logistical capacities for conducting surveillance for deaths that could have resulted from infectious diseases. Because many infections can be transmitted during autopsy, specific biosafety features for the autopsy suite were also assessed. |
Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention
Holman DM , Fox KA , Glenn JD , Guy GP Jr , Watson M , Baker K , Cokkinides V , Gottlieb M , Lazovich D , Perna FM , Sampson BP , Seidenberg AB , Sinclair C , Geller AC . Am J Prev Med 2013 44 (6) 672-81 Exposure to ultraviolet radiation from indoor tanning device use is associated with an increased risk of skin cancer, including risk of malignant melanoma, and is an urgent public health problem. By reducing indoor tanning, future cases of skin cancer could be prevented, along with the associated morbidity, mortality, and healthcare costs. On August 20, 2012, the CDC hosted a meeting to discuss the current body of evidence on strategies to reduce indoor tanning as well as research gaps. Using the Action Model to Achieve Healthy People 2020 Overarching Goals as a framework, the current paper provides highlights on the topics that were discussed, including (1) the state of the evidence on strategies to reduce indoor tanning; (2) the tools necessary to effectively assess, monitor, and evaluate the short- and long-term impact of interventions designed to reduce indoor tanning; and (3) strategies to align efforts at the national, state, and local levels through transdisciplinary collaboration and coordination across multiple sectors. Although many challenges and barriers exist, a coordinated, multilevel, transdisciplinary approach has the potential to reduce indoor tanning and prevent future cases of skin cancer. |
National agenda for prevention of healthcare-associated infections in dialysis centers
Gupta N , Cannon M , Srinivasan A . Semin Dial 2013 26 (4) 376-83 Healthcare-associated infections (HAIs) are among the leading causes of morbidity and mortality in dialysis patients. To coordinate HAI prevention efforts, the U.S. Department of Health and Human Services established the National Action Plan to Prevent Healthcare Associated Infections in End-Stage Renal Disease Facilities. This comprehensive plan prioritizes HAI prevention practices and 5-year evaluation targets based on the burden of disease, level of scientific evidence, and anticipated impact from the recommended intervention. As such, the Plan focuses primarily on interventions to reduce vascular access-related complications and infections with hepatitis B and hepatitis C virus. Over the last decade, there have been several efforts to expand HAI surveillance and prevention efforts, including coordination of HAI reporting metrics across multiple national agencies, changes in financial incentives by the Centers for Medicare & Medicaid Services (CMS), and federal funding for expansion of state-based HAI prevention programs. As a result, a paradigm shift in HAI prevention has developed. Public health officials have assumed greater responsibility in reducing the burden of HAIs and healthcare providers have become more involved in HAI prevention. Since the Plan was initially drafted, several collaborative efforts in dialysis facilities have reported a reduction in HAIs through implementation of these interventions. These early successes highlight the potential impact of coordinated action to combat HAIs in dialysis settings and this National Action Plan provides evidence-based strategies on how best to achieve this. |
Contaminated ventilator air flow sensor linked to Bacillus cereus colonization of newborns
Turabelidze G , Gee JE , Hoffmaster AR , Manian F , Butler C , Byrd D , Schildknecht S , Hauser LC , Duncan M , Ferrett R , Evans D , Talley C . Emerg Infect Dis 2013 19 (5) 781-3 We investigated Bacillus cereus-positive tracheal aspirates from infants on ventilators in a neonatal intensive care unit. Multilocus sequence typing determined a genetic match between strains isolated from samples from a case-patient and from the air flow sensor in the ventilator. Changing the sterilization method for sensors to steam autoclaving stopped transmission. |
Teen driving in rural North Dakota: a qualitative look at parental perceptions
Gill SK , Shults RA , Cope JR , Cunningham TJ , Freelon B . Accid Anal Prev 2013 54 114-21 Motor vehicle crashes are the leading cause of death among teens in the United States. Graduated driver licensing (GDL) programs allow new drivers to gain driving experience while protecting them from high-risk situations. North Dakota was one of the last states to implement GDL, and the current program does not meet all of the best practice recommendations. This study used qualitative techniques to explore parents' perceptions of the role teen driving plays in the daily lives of rural North Dakota families, their understanding of the risks faced by their novice teen drivers, and their support for GDL. A total of 28 interviews with parents of teens aged 13-16 years were conducted in four separate rural areas of the state. During the face-to-face interviews, parents described their teens' daily lives as busy, filled with school, sports, and other activities that often required traveling considerable distances. Participation in school-sponsored sports and other school-related activities was highly valued. There was nearly unanimous support for licensing teens at age 14(1/2), as was permitted by law at the time of the interviews. Parents expressed that they were comfortable supervising their teen's practice driving, and few reported using resources to assist them in this role. Although few parents expressed concerns over nighttime driving, most parents supported a nighttime driving restriction with exemptions for school, work or sports-related activities. Despite many parents expressing concern over distracted driving, there was less consistent support among parents for passenger restrictions, especially if there would be no exemptions for family members or school activities. These findings can assist in planning policies and programs to reduce crashes among novice, teen drivers, while taking into account the unique perspectives and lifestyles of families living in rural North Dakota. |
Homicide-followed-by-suicide incidents involving child victims
Logan JE , Walsh S , Patel N , Hall JE . Am J Health Behav 2013 37 (4) 531-542 OBJECTIVES: To describe homicide-followed-by-suicide incidents involving child victims. METHODS: Using 2003-2009 National Violent Death Reporting System data, we characterized 129 incidents based on victim and perpetrator demographic information, their relationships, the weapons/mechanisms involved, and the perpetrators' health and stress-related circumstances. RESULTS: These incidents accounted for 188 child deaths; 69% were under 11 years old, and 58% were killed with a firearm. Approximately 76% of perpetrators were males, and 75% were parents/caregivers. Eighty-one percent of incidents with paternal perpetrators and 59% with maternal perpetrators were preceded by parental discord. Fifty-two percent of incidents with maternal perpetrators were associated with maternal psychiatric problems. CONCLUSIONS: Strategies that resolve parental conflicts rationally and facilitate detection and treatment of parental mental conditions might help prevention efforts. |
The health-system benefits and cost-effectiveness of using Mycobacterium tuberculosis direct nucleic acid amplification testing to diagnose tuberculosis disease in the United States.
Marks SM , Cronin W , Venkatappa T , Maltas G , Chon S , Sharnprapai S , Gaeddert M , Tapia J , Dorman SE , Etkind S , Crosby C , Blumberg HM , Bernardo J . Clin Infect Dis 2013 57 (4) 532-42 BACKGROUND: The utility of Mycobacterium tuberculosis Direct nucleic acid amplification testing (MTD) for pulmonary tuberculosis disease diagnosis in the U.S. has not been well described. METHODS: We analyzed a retrospective cohort of reported patients with suspected active pulmonary tuberculosis in 2008-2010 from Georgia, Hawaii, Maryland, and Massachusetts to assess MTD use, effectiveness, health-system benefits, and cost-effectiveness. RESULTS: Among 2140 patients in whom pulmonary tuberculosis was suspected, 799 (37%) were Mycobacterium-tuberculosis-culture-positive. Eighty percent (680/848) of patients having acid-fast-bacilli-smear-positive specimens had MTD performed; MTD positive-predictive value (PPV) was 98% and negative-predictive value (NPV) was 94%. Nineteen percent (240/1292) of patients having smear-negative specimens had MTD; MTD PPV was 90% and NPV was 88%. Among patients suspected of tuberculosis but not having MTD, smear PPV for lab-confirmed tuberculosis was 77% and NPV 78%. Compared with no MTD, MTD significantly decreased time to diagnosis in patients with smear-positive/MTD(+) specimens, decreased respiratory isolation for patients having smear-positive/MTD(-)/culture-negative specimens, decreased outpatient days of unnecessary tuberculosis medications, and reduced resources expended on contact investigation. While MTD generally cost more than no MTD, incremental cost savings occurred in patients with HIV or homelessness to diagnose or to exclude tuberculosis, and in patients with substance abuse having smear-negative specimens to exclude tuberculosis. CONCLUSIONS: MTD improved diagnostic accuracy and timeliness, and reduced unnecessary respiratory isolation, treatment, and contact investigations. It was cost saving in patients with HIV, homelessness, or substance abuse, but not in others. |
Laboratory and field evaluation of a new rapid test for detecting Wuchereria bancrofti antigen in human blood
Weil GJ , Curtis KC , Fakoli L , Fischer K , Gankpala L , Lammie PJ , Majewski AC , Pelletreau S , Won KY , Bolay FK , Fischer PU . Am J Trop Med Hyg 2013 89 (1) 11-15 Global Program to Eliminate Lymphatic Filariasis (GPELF) guidelines call for using filarial antigen testing to identify endemic areas that require mass drug administration (MDA) and for post-MDA surveillance. We compared a new filarial antigen test (the Alere Filariasis Test Strip) with the reference BinaxNOW Filariasis card test that has been used by the GPELF for more than 10 years. Laboratory testing of 227 archived serum or plasma samples showed that the two tests had similar high rates of sensitivity and specificity and > 99% agreement. However, the test strip detected 26.5% more people with filarial antigenemia (124/503 versus 98/503) and had better test result stability than the card test in a field study conducted in a filariasis-endemic area in Liberia. Based on its increased sensitivity and other practical advantages, we believe that the test strip represents a major step forward that will be welcomed by the GPELF and the filariasis research community. |
Purification and sidewall functionalization of multiwalled carbon nanotubes and resulting bioactivity in two macrophage models
Hamilton RF Jr , Xiang C , Li M , Ka I , Yang F , Ma D , Porter DW , Wu N , Holian A . Inhal Toxicol 2013 25 (4) 199-210 This study examined the consequences of surface carboxylation of multiwalled carbon nanotubes (MWCNT) on bioactivity. Since commercial raw MWCNT contain impurities that may affect their bioactivity, HCl refluxing was exploited to purify raw "as-received" MWCNT by removing the amorphous carbon layer on the MWCNT surface and reducing the metal impurities (e.g. Ni). The removal of amorphous carbon layer was confirmed by Raman spectroscopy and thermogravimetric analysis. Furthermore, the HCl-purified MWCNT provided more available reaction sites, leading to enhanced sidewall functionalization. The sidewall of HCl-purified MWCNT was further functionalized with the -COOH moiety by HNO(3) oxidation. This process resulted in four distinct MWCNT: raw, purified, -COOH-terminated raw MWCNT, and -COOH-terminated purified MWCNT. Freshly isolated alveolar macrophages from C57Bl/6 mice were exposed to these nanomaterials to determine the effects of the surface chemistry on the bioactivity in terms of cell viability and inflammasome activation. Inflammasome activation was confirmed using inhibitors of cathepsin B and Caspase-1. Purification reduced the cell toxicity and inflammasome activation slightly compared to raw MWCNT. In contrast, functionalization of MWCNT with the -COOH group dramatically reduced the cytotoxicity and inflammasome activation. Similar results were seen using THP-1 cells supporting their potential use for high-throughput screening. This study demonstrated that the toxicity and bioactivity of MWCNT were diminished by removal of the Ni contamination and/or addition of -COOH groups to the sidewalls. |
Use of calorie information at fast food and chain restaurants among US youth aged 9-18 years, 2010
Wethington H , Maynard LM , Blanck HM . J Public Health (Oxf) 2013 35 (3) 354-60 BACKGROUND: To examine whether youth use calorie information when it is available at fast food/chain restaurants and what factors are associated with using this information to make their food selection. METHODS: A cross-sectional analysis was conducted on a sample of 721 youth (9-18 years) using the 2010 YouthStyles and HealthStyles surveys. The outcome measure was reported use of calorie information at fast food/chain restaurants. Multivariable logistic regression was used to examine the associations between sociodemographic variables and the use of calorie information at fast food/chain restaurants. RESULTS: Of those who visited fast food/chain restaurants, 42.4% reported using calorie information at least sometimes. Girls were more likely than boys (adjusted odds ratio (aOR) = 1.8, 95% confidence interval (CI) = 1.2-2.5) and youth who were obese were more likely than those at a healthy weight (aOR = 1.7, 95% CI = 1.04-2.9) to use calorie information, and youth eating at a fast food/chain restaurant twice a week or more versus once a week or less were half as likely to report using calorie information (aOR = 0.5, 95% CI = 0.4-0.8). CONCLUSION: Public health education efforts can benefit from research to determine how to increase usage among youth so that their food choices are appropriate for their caloric needs. |
Lipid-based nutrient supplements are feasible as a breastmilk replacement for HIV-exposed infants from 24 to 48 weeks of age
Flax VL , Bentley ME , Chasela CS , Kayira D , Hudgens MG , Kacheche KZ , Chavula C , Kourtis AP , Jamieson DJ , van der Horst CM , Adair LS . J Nutr 2013 143 (5) 701-7 The Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study randomized HIV-infected mothers and their infants to receive either maternal lipid-based nutrient supplements (LNS) during lactation or no LNS and then to 1 of 3 antiretroviral drug (ARV) arms (maternal, infant, or no drugs). Assigned interventions were provided from 0 to 28 wk and all infants (n = 1619) were given LNS during (24-28 wk) and following (28-48 wk) weaning. This paper assesses the feasibility of infant LNS as a breastmilk replacement and uses longitudinal random effects models to examine associations of interventions, morbidity, and season with weight-for-age (WAZ), length-for-age (LAZ), and BMI-for-age (BMIZ) Z-scores from 24 to 48 wk. Infant LNS adherence was high (94.1% ate it daily). From 24 to 48 wk, mean WAZ (-0.42 to -0.76 SD; P < 0.001) and LAZ (-0.93 to -1.56 SD; P < 0.001) steadily declined, whereas BMIZ remained >0 throughout. A higher LAZ was associated with assignment to the maternal LNS arm (beta=0.19; P < 0.05). Lower WAZ and BMIZ were associated with seasonal food insecurity (beta=-0.08 and -0.09, respectively; both P < 0.001), fever (beta=-0.07 and -0.13; both P < 0.001), diarrhea (beta=-0.19 and -0.23; both P < 0.001), and assignment to the infant ARV arm (beta=-0.17 and -0.17; both P < 0.05). The magnitude of the season and morbidity effects was small and BAN infants had higher weights and lengths than their counterparts in the general population. High LNS adherence and the modest impact of morbidity on growth indicate that LNS is a feasible breastmilk replacement for HIV-exposed infants weaned early, but controlled trials are needed to quantify the effects of LNS on growth in this population. |
ROS evaluation for a series of CNTs and their derivatives using an ESR method with DMPO
Tsuruoka S , Takeuchi K , Koyama K , Noguchi T , Endo M , Tristan F , Terrones M , Matsumoto H , Saito N , Usui Y , Porter DW , Castranova V . J Phys Conf Ser 2013 429 (1) 012029 Carbon nanotubes (CNTs) are important materials in advanced industries. It is a concern that pulmonary exposure to CNTs may induce carcinogenic responses. It has been recently reported that CNTs scavenge ROS though non-carbon fibers generate ROS. A comprehensive evaluation of ROS scavenging using various kinds of CNTs has not been demonstrated well. The present work specifically investigates ROS scavenging capabilities with a series of CNTs and their derivatives that were physically treated, and with the number of commercially available CNTs. CNT concentrations were controlled at 0.2 through 0.6 wt%. The ROS scavenging rate was measured by ESR with DMPO. Interestingly, the ROS scavenging rate was not only influenced by physical treatments, but was also dependent on individual manufacturing methods. Ratio of CNTs to DMPO/ hydrogen peroxide is a key parameter to obtain appropriate ROS quenching results for comparison of CNTs. The present results suggest that dangling bonds are not a sole factor for scavenging, and electron transfer on the CNT surface is not clearly determined to be the sole mechanism to explain ROS scavenging. |
A single-item global job satisfaction measure is associated with quantitative bliood immune indices in white-collar employees
Nakata A , Irie Masahiro , Takahashi M . Ind Health 2013 51 (2) 193-201 Although a single-item job satisfaction measure has been shown to be reliable and inclusive as multiple-item scales in relation to health, studies including immunological data are few. The purpose of this study was to evaluate the validity of single-item job and family life satisfaction based on its association with immune indices. A total of 189 white-collar employees (70% men) underwent a blood draw for the measurement of natural killer (NK), total T, and B cell counts as well as plasma immunoglobulin (Ig) G concentrations and completed single-item job and family life satisfaction measures, respectively. The response options for satisfaction measures were 'dissatisfied' (coded 1) to ‘satisfied’ (coded 4). Spearman’s partial correlations controlling for cofactors revealed that increased job satisfaction was positively associated with NK cells (rsp=.201, p=.007) and IgG (rsp=.178, p=.018), while family life satisfaction was unrelated to immune indices. Those who reported a combination of low job/low family life satisfaction had significantly lower NK and higher B cell counts than those with a high job/high family life satisfaction. Our study suggests that the single-item summary measure of job satisfaction, but not family life satisfaction, may be a valid tool to evaluate immune status in healthy white-collar employees. |
Workplace racial/ethnic similarity, job satisfaction, and lumbar back health among warehouse workers: asymmetric reactions across racial/ethnic groups
Hoppe A , Fujishiro K , Heaney C . J Organ Behav 2013 35 (2) 172-193 Racial and ethnic minority employees constitute a significant proportion of the U.S. workforce. The literature on demographic similarity in the workplace suggests that the proportion of co-workers who share the same racial/ethnic background (racial/ethnic similarity) can influence job attitudes and employee well-being and that the reactions to racial/ethnic similarity may differ between the racially dominant and subordinate groups. This study applies status construction theory to examine the extent to which racial/ethnic similarity is associated with job satisfaction and lumbar back health among warehouse employees. We surveyed 361 warehouse workers (204 whites, 94 African-Americans, and 63 Latino workers) in 68 jobs in nine distribution centers in the United States. Multilevel analyses indicate that white and racial/ethnic minority groups react differently to racial/ethnic similarity. For job satisfaction, white employees experience higher job satisfaction when they are highly racially/ethnically similar to their colleagues, whereas Latino employees experience higher job satisfaction when they are racially/ethnically dissimilar to others. As for lumbar back health, among Latino and African-American employees, higher racial/ethnic similarity is associated with better lumbar back health whereas for white employees, the association is the opposite. Across all groups, moderate levels of racial/ethnic similarity were associated with the best lumbar back health. Copyright © 2013 John Wiley & Sons, Ltd. |
Occupational exposures to respirable crystalline silica during hydraulic fracturing
Esswein EJ , Breitenstein M , Snawder J , Kiefer M , Sieber WK . J Occup Environ Hyg 2013 10 (7) 347-56 This report describes a previously uncharacterized occupational health hazard: work crew exposures to respirable crystalline silica during hydraulic fracturing. Hydraulic fracturing involves high pressure injection of large volumes of water and sand, and smaller quantities of well treatment chemicals, into a gas or oil well to fracture shale or other rock formations, allowing more efficient recovery of hydrocarbons from a petroleum-bearing reservoir. Crystalline silica ("frac sand") is commonly used as a proppant to hold open cracks and fissures created by hydraulic pressure. Each stage of the process requires hundreds of thousands of pounds of quartz-containing sand; millions of pounds may be needed for all zones of a well. Mechanical handling of frac sand creates respirable crystalline silica dust, a potential exposure hazard for workers. Researchers at the National Institute for Occupational Safety and Health collected 111 personal breathing zone samples at 11 sites in five states to evaluate worker exposures to respirable crystalline silica during hydraulic fracturing. At each of the 11 sites, full-shift samples exceeded occupational health criteria (e.g., the Occupational Safety and Health Administration calculated permissible exposure limit, the NIOSH recommended exposure limit, or the ACGIH threshold limit value), in some cases, by 10 or more times the occupational health criteria. Based on these evaluations, an occupational health hazard was determined to exist for workplace exposures to crystalline silica. Seven points of dust generation were identified, including sand handling machinery and dust generated from the work site itself. Recommendations to control exposures include product substitution (when feasible), engineering controls or modifications to sand handling machinery, administrative controls, and use of personal protective equipment. To our knowledge, this represents the first systematic study of work crew exposures to crystalline silica during hydraulic fracturing. Companies that conduct hydraulic fracturing using silica sand should evaluate their operations to determine the potential for worker exposure to respirable crystalline silica and implement controls as necessary to protect workers. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing controls and recommendations to limit worker exposures to respirable crystalline silica at hydraulic fracturing work sites.]. |
Overview of risk management for engineered nanomaterials
Schulte PA , Geraci CL , Hodson LL , Zumwalde RD , Kuempel ED , Murashov V , Martinez KF , Heidel DS . J Phys Conf Ser 2013 429 (1) 012062 Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective. |
Examination of potential sources of bias in the US Coal Workers' Health Surveillance Program
Laney AS , Attfield MD . Am J Public Health 2013 104 (1) 165-70 OBJECTIVES: We examined the potential influences of certain selection factors on the utility of the Coal Workers' Health Surveillance Program (CWHSP) data for tracking disease distribution and trends. METHODS: We combined data from the CWHSP and the Energy Information Administration to examine any influence of variable worker participation on observed disease prevalence. We evaluated effects of differential participation by coal mining region, temporal changes in employment, and active surveillance efforts. RESULTS: The published findings of pneumoconiosis distribution and trends from the CWHSP were robust compared with the various participation factors that might have affected their validity for population-based estimates of disease burden. Exploration of factors that could potentially bias the findings generally led to small increases in the primary estimates, mostly for the early years of the program. CONCLUSIONS: We confirmed previously reported findings that there was a high prevalence of coal worker pneumoconiosis (CWP) around 1970-1974, a substantial decline in 1995-1999, and indications of an increase since then. Overall our findings suggest that the previously reported distribution and trends in CWP prevalence were broadly accurate. (Am J Public Health. Published online ahead of print May 16, 2013: e1-e6. doi:10.2105/AJPH.2012.301051). |
Job strain, effort-reward imbalance and neck, shoulder and wrist symptoms among Chinese workers
Yu S , Nakata A , Gu G , Swanson NG , He L , Zhou W , Wang S . Ind Health 2013 51 (2) 193-201 The purpose of this study was to examine the association between psychosocial job stress (by the Job Control-Demand (JCD) model and Effort-Reward imbalance (ERI) model) and musculoskeletal (MS) symptoms among workers in China. Overall, 3,632 male and 1,706 female workers from 13 factories/companies participated in this study. Perceived job stress was evaluated by the Chinese version of the Job Content Questionnaire (JCQ) and ERI Questionnaire. Neck, shoulder and wrist symptoms were assessed by self-report during the past year. Workers reporting high job demands and low job control or high effort and low rewards had moderately increased risk for all MS symptoms. Odds ratios (ORs) were higher in workers reporting both high effort and low rewards. The combination of high physical job demands with low job control showed significant associations with MS symptoms. The effects of psychological demands on symptoms in women, effort and effort-reward imbalance on symptoms among both genders were increased as the number of regions with symptoms increased. These results suggest that high job strain and ERI are associated with neck, shoulder and wrist symptoms in Chinese factory workers independent of individual factors, physical factors, and other psychological variables. |
The consequences of nursing stress and need for integrated solutions
Roberts RK , Grubb PL . Rehabil Nurs 2013 39 (2) 62-9 PURPOSE: In a 2011 survey sponsored by the American Nurses Association (ANA), nurses identified the acute and chronic effects of stress and overwork as one of their two top safety and health concerns. DESIGN/METHODS: A review of the literature was conducted to investigate the impact that job stress has on the health and safety of nursing professionals and the role that working conditions and job characteristics play in fostering job stress. FINDINGS: Strong evidence supporting links between job stress, safety and health in general and within different types of nursing populations exists. Working conditions also contribute to the development of job stress. CONCLUSION: Combining and integrating "person-focused" strategies designed to build nurses' ability to manage stress at the individual level with "organization-focused" strategies that eliminate stressful working conditions is critical to the reduction and prevention of job stress among nursing professionals. |
Current employment status, occupational category, occupational hazard exposure and job stress in relation to telomere length: the Multiethnic Study of Atherosclerosis (MESA)
Fujishiro K , Diez-Roux AV , Landsbergis PA , Jenny NS , Seeman T . Occup Environ Med 2013 70 (8) 552-60 OBJECTIVE: Telomere length has been proposed as a biomarker of cell senescence, which is associated with a wide array of adverse health outcomes. While work is a major determinant of health, few studies have investigated the association of telomere length with various dimensions of occupation. Accelerated cellular aging could be a common pathway linking occupational exposure to several health outcomes. METHODS: Leukocyte telomere length was assessed using quantitative PCR in a community-based sample of 981 individuals (age: 45-84 years). Questionnaires were used to collect information on current employment status, current or main occupation before retirement and job strain. The Occupational Resource Network (O*NET) database was linked to the questionnaire data to create five exposure measures: physical activity on the job, physical hazard exposure, interpersonal stressors, job control and job demands. Linear regression was used to estimate associations of occupational characteristics with telomere lengths after adjustment for age, sex, race, socioeconomic position and several behavioural risk factors. RESULTS: There were no mean differences in telomere lengths across current employment status, occupational category, job strain categories or levels of most O*NET exposure measures. There was also no evidence that being in lower status occupational categories or being exposed to higher levels of adverse physical or psychosocial exposures accelerated the association between age and telomere shortening. CONCLUSIONS: Cellular aging as reflected by shorter telomeres does not appear to be an important pathway linking occupation to various health outcomes. |
A decision process for determining whether to conduct responder health research following large disasters
Decker JA , Keifer M , Reissman DB , Funk R , Halpin J , Bernard B , Ehrenberg RL , Schuler CR , Whelan E , Myers K , Howard J . Am J Disaster Med 2013 8 (1) 25-33 Disasters often set the stage for scientific inquiry within the fieid of occupational safety and health. This is especially true when the long-term consequences of exposures associated with a particular disaster are unclear. However, a responder research study can be costly and difficult to design, and researchers must consider whether the proposed study will produce useful, reliable results and is a prudent public health investment. The decision process can be segregated into various components, including scientific rationale that should be formally recognized as critical to efficiently and effectively determine whether a research study is warranted. The scientific rationale includes certain controlling or "gatekeeper" factors that should be present to proceed with research. |
A success story: Togo is moving toward becoming the first sub-Saharan African nation to eliminate lymphatic filariasis through mass drug administration and countrywide morbidity alleviation
Sodahlon YK , Dorkenoo AM , Morgah K , Nabiliou K , Agbo K , Miller R , Datagni M , Seim A , Mathieu E . PLoS Negl Trop Dis 2013 7 (4) e2080 Lymphatic filariasis (LF) is a debilitating vector-borne disease predominantly caused by the helminths Wuchereria bancrofti and Brugia malayi [1], [2]. Endemic in 72 countries, LF is responsible for 5.9 million DALYs lost and is implicated as the second leading cause of disability worldwide by the World Health Organization (WHO) [3]–[5]. Although 70% of those infected do not exhibit symptoms, almost all persons infected have subclinical damage to the lymphatic vessels [6], [7]. An estimated 40 million people are symptomatic with the predominant morbidities associated with LF: lymphedema and/or hydrocele [8]. | In recognition of the worldwide burden of LF, in 1997, the World Health Assembly passed the resolution WHA 50.29 calling for collaborative efforts by member states to eliminate the disease as a public health problem [9]. In 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) was formed in response to the WHA resolution and aimed to eliminate the disease by 2020. The program adopted a two-pronged strategy: (1) to interrupt transmission of the causal parasite and (2) to alleviate morbidities associated with the disease [10]. The two pillars of the GPELF's strategy form the basic framework for any successful LF program. | Togo is one of the 34 African countries endemic for lymphatic filariasis and is surrounded by the endemic countries of Benin, Ghana, and Burkina Faso [11]. The National Program to Eliminate Lymphatic Filariasis (NPELF) was founded in 2000 and is one of the few LF programs that address the dual goals of the global elimination program on a national scale. Togo is the first sub-Saharan country to achieve probable interruption of transmission and to move to the post-MDA surveillance phase as defined by the WHO [12]. Here we describe the elements that proved successful in the national strategy to address LF in Togo. |
Opportunities to investigate the effects of ivermectin mass drug administration on scabies
Engelman D , Martin DL , Hay RJ , Chosidow O , McCarthy JS , Fuller LC , Steer AC . Parasit Vectors 2013 6 106 The recent article by Mohammed et al. demonstrates an impressive effect of ivermectin mass drug administration for lymphatic filariasis on the burden of scabies. Partnering scabies research within the evaluation and monitoring of Neglected Tropical Disease programmes could potentially increase our understanding of the epidemiology and control of scabies and its important bacterial complications. |
It is possible: availability of lymphedema case management in each health facility in Togo: program description, evaluation, and lessons learned
Mathieu E , Dorkenoo AM , Morgah K , Datagni M , Cantey PT , Morgah K , Harvey K , Ziperstein J , Drexler N , Chapleau G , Sodahlon Y . Am J Trop Med Hyg 2013 89 (1) 16-22 Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each health facility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities. |
Challenges for malaria elimination in Zanzibar: pyrethroid resistance in malaria vectors and poor performance of long-lasting insecticide nets
Haji KA , Khatib BO , Smith S , Ali AS , Devine GJ , Coetzee M , Majambere S . Parasit Vectors 2013 6 (1) 82 BACKGROUND: Long-lasting insecticide treated nets (LLINs) and indoor residual house spraying (IRS) are the main interventions for the control of malaria vectors in Zanzibar. The aim of the present study was to assess the susceptibility status of malaria vectors against the insecticides used for LLINs and IRS and to determine the durability and efficacy of LLINs on the island. METHODS: Mosquitoes were sampled from Pemba and Unguja islands in 2010--2011 for use in WHO susceptibility tests. One hundred and fifty LLINs were collected from households on Unguja, their physical state was recorded and then tested for efficacy as well as total insecticide content. RESULTS: Species identification revealed that over 90% of the Anopheles gambiae complex was An. arabiensis with a small number of An. gambiae s.s. and An. merus being present. Susceptibility tests showed that An. arabiensis on Pemba was resistant to the pyrethroids used for LLINs and IRS. Mosquitoes from Unguja Island, however, were fully susceptible to all pyrethroids tested. A physical examination of 150 LLINs showed that two thirds were damaged after only three years in use. All used nets had a significantly lower (p < 0.001) mean permethrin concentration of 791.6 mg/m2 compared with 944.2 mg/m2 for new ones. Their efficacy decreased significantly against both susceptible An. gambiae s.s. colony mosquitoes and wild-type mosquitoes from Pemba after just six washes (p < 0.001). CONCLUSION: The sustainability of the gains achieved in malaria control in Zanzibar is seriously threatened by the resistance of malaria vectors to pyrethroids and the short-lived efficacy of LLINs. This study has revealed that even in relatively well-resourced and logistically manageable places like Zanzibar, malaria elimination is going to be difficult to achieve with the current control measures. |
Allostatic load may not be associated with chronic stress in pregnant women, NHANES 1999-2006
Morrison S , Shenassa ED , Mendola P , Wu T , Schoendorf K . Ann Epidemiol 2013 23 (5) 294-7 PURPOSE: Pregnant women are generally excluded from studies that measure allostatic load (AL) because there is concern that the changing levels of AL-related biomarkers during pregnancy do not reflect a woman's true AL. The goal of this study was to determine whether AL can be measured in a meaningful way during pregnancy. METHODS: The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey of the U.S. civilian population. AL was based on the distributions of 10 biomarkers in pregnant (n=1138) and nonpregnant (n=4993) women aged 15 to 44 from NHANES (1999-2006). RESULTS: The distribution of each AL-related biomarker differed significantly between pregnant and nonpregnant women (P<.01). Among nonpregnant women, high AL findings were consistent with previous studies (e.g., higher AL in women who are black, are older, and who have lower incomes). However, these associations were not seen in pregnant women. CONCLUSIONS: Our results suggest that the various biomarkers that comprise AL may reflect proximal factors in pregnancy more strongly than they represent exposure to chronic stress over a woman's lifetime. Therefore, our approach to measuring AL may not provide meaningful information about chronic stress in pregnant women without further consideration of pregnancy-related factors. |
Using a discrete choice experiment to elicit time trade-off and willingness-to-pay amounts for influenza health-related quality of life at different ages
Prosser LA , Payne K , Rusinak D , Shi P , Messonnier M . Pharmacoeconomics 2013 31 (4) 305-15 BACKGROUND: Recent research suggests that values for health-related quality of life may vary with the age of the patient. Traditional health state valuation questions and discrete choice experiments are two approaches that could be used to value health. OBJECTIVE: To measure whether public values for health vary with the age of the affected individual. METHODS: A discrete choice experiment was administered via the Internet in December 2007 to measure preferences for different attributes of influenza-related health-related quality of life: age of hypothetical affected individual (range 1-85 years), length of episode (days of illness), severity of illness (workdays lost) and time trade-off or willingness-to-pay amounts. Each respondent answered identical choice questions for a hypothetical family member and for himself/herself. Data on sociodemographic characteristics and influenza illness experience were also collected. Respondents were US adults randomly sampled from an Internet survey panel (n = 1,012). The relative value of attributes was estimated using generalized estimating equations and controlling for sociodemographic characteristics and illness experience. Marginal time traded and marginal willingness to pay using discrete choice and traditional time trade-off or willingness-to-pay questions were compared. RESULTS: Respondents preferred shorter influenza episodes but did not significantly prefer fewer workdays lost if episode length was held constant. Respondents were more likely to choose to avert uncomplicated illness in children and less likely to choose to avert uncomplicated illness in working-age adults. Marginal time trade-off and willingness-to-pay amounts elicited using discrete choice questions were larger than those elicited using direct valuation questions. CONCLUSIONS: Approaches that assume values for health-related quality of life do not vary with the age of a patient may bias economic analyses that use these values. If patient age could affect valuations, then age should be included in the valuation exercise. Additional research should evaluate the effect of patient age on values for other conditions. |
Changes in self-rated health and subjective social status over time in a cohort of healthcare personnel
Thompson MG , Gaglani MJ , Naleway A , Thaker S , Ball S . J Health Psychol 2013 19 (9) 1185-96 As part of a prospective cohort study of 1354 female and 347 male healthcare personnel, we examined the stability of subjective social status over ~7 months and the prospective association between subjective social status and self-rated health status. Most (82%) subjective social status ratings were stable (within +/-1 point). Lower baseline subjective social status among healthcare personnel was associated with more subsequent reports of fatigue and headache and worsening global self-rated health status. Healthcare personnel who placed themselves on the bottom half of the subjective social status ladder were four times more likely to experience a decline in global self-rated health status and half as likely to improve to excellent self-rated health status. |
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