Racial/ethnic disparities in self-reported short sleep duration among US-born and foreign-born adults
Cunningham TJ , Wheaton AG , Ford ES , Croft JB . Ethn Health 2016 21 (6) 628-38 OBJECTIVE: Racial/ethnic health disparities are infrequently considered by nativity status in the United States, although the immigrant population has practically doubled since 1990. We investigated the modifying role of nativity status (US- vs. foreign-born) on racial/ethnic disparities in short sleep duration (<7 h), which has serious health consequences. DESIGN: Cross-sectional data from 23,505 US-born and 4,326 foreign-born adults aged ≥ 18 years from the 2012 National Health Interview Survey and multivariable log-linear regression were used to estimate prevalence ratios (PR) for reporting short sleep duration and their corresponding 95% confidence intervals (CI). RESULTS: After controlling for sociodemographic covariates, short sleep was more prevalent among blacks (PR 1.29, 95% CI: 1.21-1.37), Hispanics (PR 1.18, 95% CI: 1.08, 1.29), and Asians (PR 1.37, 95% CI: 1.16-1.61) than whites among US-born adults. Short sleep was more prevalent among blacks (PR 1.71, 95% CI: 1.38, 2.13) and Asians (PR 1.23, 95% CI: 1.02, 1.47) than whites among the foreign-born. CONCLUSION: Among both US- and foreign-born adults, blacks and Asians had a higher likelihood of short sleep compared to whites. US-born Hispanics, but not foreign-born Hispanics, had a higher likelihood than their white counterparts. Future research should aim to uncover mechanisms underlying these disparities. |
Falls among persons aged ≥65 years with and without severe vision impairment - United States, 2014
Crews JE , Chou CF , Stevens JA , Saaddine JB . MMWR Morb Mortal Wkly Rep 2016 65 (17) 433-7 In 2014, an estimated 2.8 million persons aged ≥65 years in the United States reported severe vision impairment defined as being blind or having severe difficulty seeing, even with eyeglasses. Good vision is important for maintaining balance as well as for identifying low-contrast hazards, estimating distances, and discerning spatial relationships. Conversely, having poor vision increases the risk for falls (1,2). Falls among older adults are common and can cause serious injuries, disabilities, and premature death (1,3). To date, no state-level investigations have examined the annual prevalence of falls among persons with and without severe vision impairment. CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the state-specific annual prevalence of falls among persons aged ≥65 years with and without self-reported severe vision impairment. Overall, 46.7% of persons with, and 27.7% of older adults without, self-reported severe vision impairment reported having fallen during the previous year. The state-specific annual prevalence of falls among persons aged ≥65 years with severe vision impairment ranged from 30.8% (Hawaii) to 59.1% (California). In contrast, the prevalence of falls among persons aged ≥65 years without severe vision impairment ranged from 20.4% (Hawaii) to 32.4% (Alaska). Developing fall-prevention interventions intended for persons with severe vision impairment will help states manage the impact of vision impairment and falls on health care resources, and can inform state-specific fall prevention initiatives. |
The association of health-related quality of life with severity of visual impairment among people aged 40-64 years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System
Crews JE , Chou CF , Zack MM , Zhang X , Bullard KM , Morse AR , Saaddine JB . Ophthalmic Epidemiol 2016 23 (3) 145-53 PURPOSE: To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years. METHODS: We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS: Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001). CONCLUSION: Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years. |
Changes in urinary bisphenol A concentrations associated with placement of dental composite restorations in children and adolescents
Maserejian NN , Trachtenberg FL , Wheaton OB , Calafat AM , Ranganathan G , Kim HY , Hauser R . J Am Dent Assoc 2016 147 (8) 620-30 BACKGROUND: Bisphenol A-glycidyl methacrylate (bis-GMA)-based dental composite restorations may release bisphenol A (BPA). The authors assessed changes in urinary BPA concentrations over a 6-month follow-up period in children and adolescents who received bis-GMA-based restorations. METHODS: The authors collected data from 91 study participants aged 3 to 17 years who needed composite restorations. Participants provided urine samples and information on BPA-related exposures before and at approximately 1 day, 14 days, and 6 months after treatment. The authors used multivariable linear regression models to test associations between the number of surface restorations placed and the changes in urinary BPA concentrations. RESULTS: Participants had a mean (standard deviation [SD]) of 1.4 (1.0) for surfaces restored with composite at the first treatment visit and 2.3 (1.6) for surfaces restored during the entire study period. Mean (SD) change in urinary BPA concentrations between pretreatment and day 1 was 1.71 (9.94) nanograms per milliliter overall and 0.87 (5.98) after excluding 1 participant who had 8 surfaces restored at the visit. Overall, the authors observed an association between a greater number of composite surface restorations placed and higher urinary BPA concentrations in the 1-day sample (posterior-occlusal exponentiated coefficients [ebeta] = 1.47; 95% confidence interval [CI], 1.18-1.83; P < .001), but the association was attenuated after the authors restricted the sample to the 88 participants who had up to 4 restorations (ebeta = 1.19; 95% CI, 0.86-1.64), and they did not observe any association using 14-day (ebeta = 0.94; 95% CI, 0.75-1.18) or 6-month (ebeta = 0.88; 95% CI, 0.74-1.04) samples. CONCLUSIONS: Placement of bis-GMA-based restorations in children and adolescents may produce transient increases in urinary BPA concentrations that are no longer detectable in urine samples taken approximately 14 days or 6 months after treatment. After placement of a few restorations, increases in urinary BPA concentrations may not be detectable, owing to a high level of variation in background BPA exposure. PRACTICAL IMPLICATIONS: These results suggest that leaching of BPA from newly placed composite restorations ceases to be detectable in urine within 2 weeks after restoration placement. The potential human health impact of such short-term exposure remains uncertain. |
The changing face of diabetes complications
Gregg EW , Sattar N , Ali MK . Lancet Diabetes Endocrinol 2016 8587 (16) 30010-9 The global increase in type 2 diabetes prevalence is well documented, but international trends in complications of type 2 diabetes are less clear. The available data suggest large reductions in classic complications of type 2 diabetes in high-income countries over the past 20 years, predominantly reductions in myocardial infarction, stroke, amputations, and mortality. These trends might be accompanied by less obvious, but still important, changes in the character of morbidity in people with diabetes. In the USA, for example, substantial reductions in macrovascular complications in adults aged 65 years or older mean that a large proportion of total complications now occur among adults aged 45-64 years instead, rates of renal disease could persist more than other complications, and obesity-related type 2 diabetes could have increasing effect in youth and adults under 45 years of age. Additionally, the combination of decreasing mortality and increasing diabetes prevalence has increased the overall mean years lived with diabetes and could lead to a diversification of diabetes morbidity, including continued high rates of renal disease, ageing-related disability, and cancers. Unfortunately, data on trends in diabetes-related complications are limited to only about a dozen countries, most of which are high income, leaving the changing character for countries of low and middle income ambiguous. |
County health factors associated with avoidable deaths from cardiovascular disease in the United States, 2006-2010
Greer S , Schieb LJ , Ritchey M , George M , Casper M . Public Health Rep 2016 131 (3) 438-448 Objective. Many cardiovascular deaths can be avoided through primary prevention to address cardiovascular disease (CVD) risk factors or better access to quality medical care. In this cross-sectional study, we examined the relationship between four county-level health factors and rates of avoidable death from CVD during 2006–2010. Methods. We defined avoidable deaths from CVD as deaths among U.S. residents younger than 75 years of age caused by the following underlying conditions, using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes: ischemic heart disease (I20–I25), chronic rheumatic heart disease (I05–I09), hypertensive disease (I10–I15), or cerebrovascular disease (I60–I69). We stratified county-level death rates by race (non-Hispanic white or non-Hispanic black) and age-standardized them to the 2000 U.S. standard population. We used County Health Rankings data to rank county-level z scores corresponding to four health factors: health behavior, clinical care, social and economic factors, and physical environment. We used Poisson rate ratios (RRs) and 95% confidence intervals (CIs) to compare rates of avoidable death from CVD by health-factor quartile. Results. In a comparison of worst-ranked and best-ranked counties, social and economic factors had the strongest association with rates of avoidable death per 100,000 population from CVD for the total population (RR51.49; 95% CI 1.39, 1.60) and for each racial/ethnic group (non-Hispanic white: RR51.37; 95% CI 1.29, 1.45; non-Hispanic black: RR51.54; 95% CI 1.42, 1.67). Among the non-Hispanic white population, health behaviors had the next strongest association, followed by clinical care. Among the non-Hispanic black population, we observed a significant association with clinical care and physical environment in a comparison of worst-ranked and best-ranked counties. Conclusion. Social and economic factors have the strongest association with rates of avoidable death from CVD by county, which reinforces the importance of social and economic interventions to address geographic disparities in avoidable deaths from CVD. |
Dental caries and periodontal disease among U.S. pregnant women and nonpregnant women of reproductive age, National Health and Nutrition Examination Survey, 1999-2004
Azofeifa A , Yeung LF , Alverson CJ , Beltran-Aguilar E . J Public Health Dent 2016 76 (4) 320-329 OBJECTIVES: This study assessed and compared the prevalence and severity of dental caries and the prevalence of periodontal disease among pregnant and nonpregnant women of reproductive age (15-44 years) using data from the National Health and Nutrition Examination Survey, NHANES (1999-2004). METHODS: Estimates were derived from a sample of 897 pregnant women and 3,971 nonpregnant women. Chi-square and two-sample t-tests were used to assess differences between groups stratified by age, race/ethnicity, education, and poverty. Bonferroni method was applied to adjust for multiple comparisons. RESULTS: In general, there were no statistically significant differences in the prevalence estimates of dental caries and periodontal disease between pregnant women and nonpregnant women. However, results showed significant differences when stratified by sociodemographic characteristics. For example, the prevalence of untreated dental caries among women aged 15-24 years was significantly higher in pregnant women than in nonpregnant women (41 percent versus 24 percent, P = 0.001). Regardless of their pregnancy status, racial/ethnic minorities or women with less education or lower family income had higher prevalence of untreated dental caries, severity of dental caries, and periodontal disease compared to the respective reference groups of non-Hispanic whites or women with more education or higher family income. CONCLUSION: Results of this study show few clinical differences in dental caries and periodontal disease between pregnant and nonpregnant women but persistent disparities by sociodemographic characteristics. In order to reduce oral health disparities in the United States, it is important to improve access to oral health care particularly among vulnerable groups. Integrating oral health into the overall health care could benefit and improve women's oral health outcomes. |
Hepatitis B Reverse Seroconversion and Transmission in a Hemodialysis Center: A Public Health Investigation and Case Report.
Rhea S , Moorman A , Pace R , Mobley V , MacFarquhar J , Robinson E , Hayden T , Thai H , Drobeniuc J , Brooks JT , Moore Z , Patel PR . Am J Kidney Dis 2016 68 (2) 292-295 In March 2013, public health authorities were notified of a new hepatitis B virus (HBV) infection in a patient receiving hemodialysis. We investigated to identify the source and prevent additional infections. We reviewed medical records, interviewed the index patient regarding hepatitis B risk factors, performed HBV molecular analysis, and observed infection control practices at the outpatient hemodialysis facility where she received care. The index patient's only identified hepatitis B risk factor was hemodialysis treatment. The facility had no other patients with known active HBV infection. One patient had evidence of a resolved HBV infection. Investigation of this individual, who was identified as the source patient, indicated that HBV reverse seroconversion and reactivation had occurred in the setting of HIV (human immunodeficiency virus) infection and a failed kidney transplant. HBV whole genome sequences analysis from the index and source patients indicated 99.9% genetic homology. Facility observations revealed multiple infection control breaches. Inadequate dilution of the source patient's sample during HBV testing might have led to a false-negative result, delaying initiation of hemodialysis in isolation. In conclusion, HBV transmission occurred after an HIV-positive hemodialysis patient with transplant-related immunosuppression experienced HBV reverse seroconversion and reactivation. Providers should be aware of this possibility, especially among severely immunosuppressed patients, and maintain stringent infection control. |
Protocol for a population-based molecular epidemiology study of tuberculosis transmission in a high HIV-burden setting: the Botswana Kopanyo study.
Zetola NM , Modongo C , Moonan PK , Click E , Oeltmann JE , Shepherd J , Finlay A . BMJ Open 2016 6 (5) e010046 INTRODUCTION: Mycobacterium tuberculosis (Mtb) is transmitted from person to person via airborne droplet nuclei. At the community level, Mtb transmission depends on the exposure venue, infectiousness of the tuberculosis (TB) index case and the susceptibility of the index case's social network. People living with HIV infection are at high risk of TB, yet the factors associated with TB transmission within communities with high rates of TB and HIV are largely undocumented. The primary aim of the Kopanyo study is to better understand the demographic, clinical, social and geospatial factors associated with TB and multidrug-resistant TB transmission in 2 communities in Botswana, a country where 60% of all patients with TB are also infected with HIV. This manuscript describes the methods used in the Kopanyo study. METHODS AND ANALYSIS: The study will be conducted in greater Gaborone, which has high rates of HIV and a mobile population; and in Ghanzi, a rural community with lower prevalence of HIV infection and home to the native San population. Kopanyo aims to enrol all persons diagnosed with TB during a 4-year study period. From each participant, sputum will be cultured, and for all Mtb isolates, molecular genotyping (24-locus mycobacterial interspersed repetitive units-variable number of tandem repeats) will be performed. Patients with matching genotype results will be considered members of a genotype cluster, a proxy for recent transmission. Demographic, behavioural, clinical and social information will be collected by interview. Participant residence, work place, healthcare facilities visited and social gathering venues will be geocoded. We will assess relationships between these factors and cluster involvement to better plan interventions for reducing TB transmission. ETHICS: Ethical approval from the Independent Review Boards at the University of Pennsylvania, US Centers for Disease Control and Prevention, Botswana Ministry of Health and University of Botswana has been obtained. |
Improving Screening Methods for Hepatitis C Among People Who Inject Drugs: Findings from the HepTLC Initiative, 2012-2014.
Blackburn NA , Patel RC , Zibbell JE . Public Health Rep 2016 131 91-97 OBJECTIVE: People who inject drugs (PWID) are at increased risk for hepatitis C virus (HCV) infection. We examined HCV testing outcomes among PWID through CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites during 2012-2014. Ten grantees in nine geographically diverse cities conducted HCV testing among PWID. METHODS: Among those testing positive for HCV antibody (anti-HCV), we calculated the proportion who were offered a confirmatory HCV ribonucleic acid (RNA) test, positively diagnosed, and referred to a specialist for care. We stratified anti-HCV-positive people who completed each step by same-day testing (i.e., an HCV RNA test administered on the same date as an anti-HCV test) vs. person not receiving same-day testing to evaluate whether the need for follow-up testing affected diagnosis of chronic infection and linkage to care. RESULTS: A total of 15,274 people received an anti-HCV test at 84 testing sites targeting PWID. Of those, 11,159 (73%) reported having injected drugs in their lifetime, 7,789 (51%) reported injecting drugs in the past 12 months, and 3,495 (23%) tested anti-HCV positive. A total of 1,630 people received testing for HCV RNA, of whom 1,244 (76%) were HCV RNA positive. When not receiving both tests on the same day, 601 of 2,465 (24%) anti-HCV-positive people received an HCV RNA test. CONCLUSION: Strategies to diagnose PWID for HCV infection are needed to reduce associated morbidity and mortality. Agencies can substantially increase the number of PWID who are diagnosed and informed of their HCV infection by administering both anti-HCV and HCV RNA tests during a single testing event. |
Results of hepatitis C birth-cohort testing and linkage to care in selected U.S. sites, 2012-2014
Patel RC , Vellozzi C , Smith BD . Public Health Rep 2016 131 12-19 OBJECTIVE: Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014. METHODS: As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment. RESULTS: Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment. CONCLUSION: Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum. |
Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013
Epson EE , Cronquist A , Lamba K , Kimura AC , Hassan R , Selvage D , McNeil CS , Varan AK , Silvaggio JL , Fan L , Tong X , Spradling PR . Public Health 2016 136 144-51 OBJECTIVES: To assess hospitalisation risk factors and economic effects associated with a multistate hepatitis A outbreak in 2013. STUDY DESIGN: Retrospective case series. METHODS: Eligible outbreak-related cases confirmed by September 1, 2013, were defined as acute hepatitis symptoms and positive IgM anti-hepatitis A during March 15-August 12 among patients who consumed the food vehicle or had the outbreak genotype. We reviewed medical records, comparing demographic and clinical characteristics among hospitalized and non-hospitalized patients; we used logistic regression analysis to identify factors associated with hospitalization. We interviewed patients regarding symptom duration and healthcare usage and estimated per-patient and total costs. Health departments reported outbreak-related personnel hours. RESULTS: Medical records were reviewed for 147/159 (92%) eligible patients; median age was 48 (range: 1-84) years, and 64 (44%) patients were hospitalized. Having any chronic medical condition was independently associated with hospitalisation (odds ratio, 3.80; 95% confidence interval, 1.68-8.62). Interviews were completed for 114 (72%) eligible patients; estimated per-patient cost of healthcare and productivity loss was $13,467 for hospitalized and $2138 for non-hospitalized patients and $1,304,648 for all 165 outbreak-related cases. State and local public health personnel expenditures included 82 h and $3221/outbreak-related case. CONCLUSIONS: Hospitalisations in this outbreak were associated with chronic medical conditions and resulted in substantial healthcare usage and lost productivity. These data can be used to inform future evaluation of expansion of hepatitis A vaccination recommendations to include adults with chronic medical conditions. |
The role of structural barriers in risky sexual behavior, victimization and readiness to change HIV/STI-related risk behavior among transgender women
Raiford JL , Hall GJ , Taylor RD , Bimbi DS , Parsons JT . AIDS Behav 2016 20 (10) 2212-2221 This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p = .002), victimization (p = .000) and a decreased readiness to change HIV-related risk behavior (p = .014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population. |
Staphylococcus aureus community-acquired pneumonia: Prevalence, clinical characteristics, and outcomes
Self WH , Wunderink RG , Williams DJ , Zhu Y , Anderson EJ , Balk RA , Fakhran SS , Chappell JD , Casimir G , Courtney DM , Trabue C , Waterer GW , Bramley A , Magill S , Jain S , Edwards KM , Grijalva CG . Clin Infect Dis 2016 63 (3) 300-9 BACKGROUND: Prevalence of Staphylococcus aureus community-acquired pneumonia (CAP) and its clinical features remain incompletely understood, complicating empirical selection of antibiotics. METHODS: Using a multicenter prospective surveillance study of adults hospitalized with CAP, we calculated the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) among all CAP episodes. We compared the epidemiologic, radiographic and clinical characteristics of S. aureus CAP (per respiratory or blood culture) with those of pneumococcal (per respiratory or blood culture, or urine antigen) and all-cause non-S. aureus CAP using descriptive statistics. RESULTS: Among 2,259 adults hospitalized for CAP, 37 (1.6%) had S. aureus identified, including 15 (0.7%) with MRSA and 22 (1.0%) with MSSA, and 115 (5.1%) had S. pneumoniae Vancomycin or linezolid was administered to 674 (29.8%) patients within the first three days of hospitalization. Chronic hemodialysis use was more common among patients with MRSA (20.0%) than pneumococcal (2.6%) and all-cause non-S. aureus (3.7%) CAP. Otherwise, clinical features at admission were similar, including concurrent influenza infection, hemoptysis, multilobar infiltrates, and pre-hospital antibiotics. Patients with MRSA CAP had more severe clinical outcomes than pneumococcal CAP, including ICU admission (86.7% vs 34.8%) and in-patient mortality (13.3% vs 4.4%). CONCLUSIONS: Despite very low prevalence of S. aureus, and specifically MRSA, nearly one-third of adults hospitalized with CAP received anti-MRSA antibiotics. The clinical presentation of MRSA CAP overlapped substantially with pneumococcal CAP, highlighting the challenge of accurately targeting empirical anti-MRSA antibiotics with currently-available clinical tools and the need for new diagnostic strategies. |
Strategies for expanding access to HBV and HCV testing and care in the United States: The CDC Hepatitis Testing and Linkage to Care Initiative, 2012-2014
Ward JW . Public Health Rep 2016 131 1-4 As many as 5.7 million people in the United States are living with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.1,2 Both infections are leading causes of liver cancer and infectious disease-related mortality.3 Therapies are available to suppress replication of HBV and eliminate or cure HCV infection, thereby dramatically decreasing the risk for liver cancer and death associated with these infections. However, at least half of the people living with HCV infection are unaware of their infection.4 Because most infected people develop few or no symptoms or signs of infection until their liver disease is far advanced, testing people for HBV and HCV is the critical first step toward identifying infected people and linking them to recommended care and treatment. As such, preventing HBV- and HCV-associated morbidity and mortality hinges on identifying effective testing strategies. | In 2011, the U.S. Department of Health and Human Services (HHS) released an action plan with goals for increasing the number of people living with HBV or HCV infection who are aware of their infection.5 Guided by the HHS action plan, the U.S. Centers for Disease Control and Prevention (CDC) developed the Hepatitis Testing and Linkage to Care (HepTLC) initiative to implement the agency's recommendations for HBV and HCV testing.4,6 In 2012, CDC received an appropriation from the Prevention and Public Health Fund (PPHF) for improvements in HBV and HCV testing. The PPHF is the nation's first mandatory funding stream dedicated to improving the U.S. public health system.7 With these funds, the U.S. Senate directed the CDC Division of Viral Hepatitis to increase the number of HBV- and HCV-infected people who are aware of their infection and receiving care.8 In 2013, CDC received resources from HHS to extend the PPHF-supported projects for another year. |
Testing and linking foreign-born people with chronic hepatitis B virus infection to care at nine U.S. programs, 2012-2014
Harris AM , Schoenbachler BT , Ramirez G , Vellozzi C , Beckett GA . Public Health Rep 2016 131 20-28 OBJECTIVE: Hepatitis B virus (HBV) infection continues to be a public health threat in the United States. As many as 2.2 million people are infected, approximately 70% of whom are foreign-born, and fewer than one-third are aware of their infection. We launched an HBV testing and linkage-to-care initiative among foreign-born people. METHODS: As part of the Hepatitis Testing and Linkage to Care (HepTLC) initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, nine U.S. programs in seven states conducted HBV screening from October 2012 to September 2014. The nine programs partnered with health-care centers and community-based organizations to recruit foreign-born people recommended for HBV testing. We assessed patient characteristics, region of origin, risk factors, hepatitis B surface antigen (HBsAg) status, and referral to medical care. RESULTS: Of 23,144 participants tested for HBV, 1,317 (5.7%) were HBsAg positive. Of these, the median age was 47 years, 1,205 (91%) had at least one risk factor for HBV infection, 1,117 (85%) received posttest counseling, 1,098 (83%) were referred to care, and 606 (46%) attended a first medical appointment. The proportion of HBsAg-positive participants by region of origin included Africa (10%, 206/2,129), Western Pacific (6%, 616/9,673), Eastern Mediterranean (5%, 174/3,337), Southeast Asia (5%, 191/3,891), South America (2%, 6/252), Eastern Europe (2%, 6/262), and North America (1%, 17/1,936). CONCLUSION: Community-based HBV testing initiatives can identify substantial numbers of people with chronic HBV infection, inform them of their infection status, and provide posttest counseling and linkage to care. However, strategies are needed to improve linkage to HBV-directed medical care for foreign-born individuals living with chronic HBV infection. |
Utility of keywords from chest radiograph reports for pneumonia surveillance among hospitalized patients with influenza: The CDC Influenza Hospitalization Surveillance Network, 2008–2009
Bramley AM , Chaves SS , Dawood FS , Doshi S , Reingold A , Miller L , Yousey-Hindes K , Farley MM , Ryan P , Lynfield R , Baumbach J , Zansky S , Bennett N , Thomas A , Schaffner W , Finelli L , Jain S . Public Health Rep 2016 131 (3) 483-490 Objective. Transcripts from admission chest radiographs could aid in identification of pneumonia cases for public health surveillance. We assessed the reliability of radiographic data abstraction and performance of radiographic key terms to identify pneumonia in patients hospitalized with laboratory-confirmed influenza virus infection. Methods. We used data on patients hospitalized with laboratory-confirmed influenza virus infection from October 2008 through December 2009 from 10 geographically diverse U.S. study sites participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET). Radiographic key terms (i.e., bronchopneumonia, consolidation, infiltrate, airspace density, and pleural effusion) were abstracted from final impressions of chest radiograph reports. We assessed the reliability of radiographic data abstraction by examining the percent agreement and Cohen’s κ statistic between clinicians and surveillance staff members. Using a composite reference standard for presence or absence of pneumonia based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and discharge summary data, we calculated sensitivity, specificity, positive predictive value (PPV), and percent agreement for individual and combined radiographic key terms. Results. For each radiographic key term, the percent agreement between clinicians and surveillance staff members ranged from 89.4% to 98.6% and Cohen’s κ ranged from 0.46 (moderate) to 0.84 (almost perfect). The combination of bronchopneumonia or consolidation or infiltrate or airspace density terms had sensitivity of 66.5%, specificity of 89.2%, PPV of 80.4%, and percent agreement of 80.1%. Adding pleural effusion did not result in significant changes in sensitivity, specificity, PPV, or percent agreement. Conclusion. Radiographic key terms abstracted by surveillance staff members from final impressions of chest radiograph reports had moderate to almost perfect reliability and could be used to identify pneumonia among patients hospitalized with laboratory-confirmed influenza virus infection. This method can inform pneumonia surveillance and aid in public health response. |
Parents' reactions to testing for herpes simplex virus type 2 as a biomarker of sexual activity in Botswana junior secondary school students
Cham HJ , Lasswell SM , Miller KS . Sex Health 2016 13 (2) 148-154 Background: Use of sexual activity biomarkers in HIV prevention trials has been widely supported to validate self-reported data. When such trials involve minors, researchers may face challenges in obtaining parental buy-in, especially if return of results procedures uphold the confidentiality and privacy rights of minors and preclude parental access to test results. In preparation for a randomised controlled trial (RCT) with junior secondary school (JSS) students in Botswana, a formative assessment was conducted to assess parents' opinions and concerns about testing for herpes simplex virus type 2 (HSV-2) (biomarker of sexual activity) as part of the RCT. Methods: Six focus groups were held with parents (n≤32) of JSS students from urban, peri-urban and rural communities. Parents were asked their opinions of students being tested for HSV-2 and procedures for blood sample collection and return of results. Results: Overall, parents were supportive of HSV-2 testing, which they thought was a beneficial sexual health resource for adolescents and parents, and a motivation for parent-child communication about HSV-2, sexual activity and sexual abuse. Some parents supported the proposed plan to disclose HSV-2 test results to adolescents only, citing the importance of adolescent privacy and the possibility of HSV-2 positive adolescents being stigmatised by family members. Conversely, opposing parents requested parental access to results. These parents were concerned that adolescents may experience distress following a positive result and withhold this information thereby reducing parents' abilities to provide support. Parents were also concerned about support for victims of sexual abuse. Conclusion: Although the present study demonstrates that parents can be accepting of sexual activity biomarker testing of adolescents, more research is needed to identify best approaches for returning test results. |
Early identification and linkage to care for people with chronic HBV and HCV infection: The HepTLC Initiative
Ramirez G , Cabral R , Patterson M , Schoenbachler BT , Bedell D , Smith BD , Vellozzi C , Beckett GA . Public Health Rep 2016 131 5-11 OBJECTIVE: In 2012, CDC's Division of Viral Hepatitis launched a public health initiative to increase hepatitis B virus (HBV) and hepatitis C virus (HCV) infection testing for those at risk and to improve linkage to medical care for those infected. We describe testing outcomes of previously unidentified people at risk for HBV and HCV infection and the lessons learned while linking patients to care. METHODS: CDC's Hepatitis Testing and Linkage to Care (HepTLC) initiative provided 34 financial awards to U.S. organizations that serve people at risk for viral hepatitis, 25 of which focused on HCV and nine of which focused on HBV. Grantees offered testing and test result notification to people at risk for HBV and/or HCV infection, as well as counseling, referral, and verification or notification of linkage to care for people with positive test results. We entered demographic data, self-reported risk factors, country of origin (for HBV), and testing outcomes into a confidential database. RESULTS: The 34 grantees tested 87,860 people at more than 260 sites in 17 states. Of the 23,144 people tested for HBV, 1,317 (6%) were positive. Of the 64,716 people tested for HCV, 57,570 (89%) received an HCV antibody (anti-HCV) test, of whom 7,580 (13%) tested anti-HCV positive. Of the 4,765 people who received an HCV RNA test, 3,449 (72%) tested positive. Of the 4,766 people who tested positive for either HBV or HCV infection, 2,116 (44%) were linked to care. CONCLUSION: Interventions targeting people at risk for HBV and HCV infection reached a substantial number of people for whom testing is recommended and identified a large proportion of those who had previously unrecognized infection. Patient navigation was critical for follow-up and linkage to care. |
Early syphilis among men who have sex with men in the US Pacific Northwest, 2008-2013: Clinical management and implications for prevention
Petrosky E , Fanfair RN , Toevs K , DeSilva M , Schafer S , Hedberg K , Braxton J , Walters J , Markowitz L , Hariri S . AIDS Patient Care STDS 2016 30 (3) 134-140 Substantial increases in syphilis during 2008-2013 were reported in the US Pacific Northwest state of Oregon, especially among men who have sex with men (MSM). The authors aimed to characterize the ongoing epidemic and identify possible gaps in clinical management of early syphilis (primary, secondary, and latent syphilis <=1 year) among MSM in Multnomah County, Oregon to inform public health efforts. Administrative databases were used to examine trends in case characteristics during 2008-2013. Medical records were abstracted for cases occurring in 2013 to assess diagnosis, treatment, and screening practices. Early syphilis among MSM increased from 21 cases in 2008 to 229 in 2013. The majority of cases occurred in HIV-infected patients (range: 55.6%-69.2%) diagnosed with secondary syphilis (range: 36.2%-52.4%). In 2013, 119 (51.9%) cases were diagnosed in public sector medical settings and 110 (48.0%) in private sector settings. Over 80% of HIV-infected patients with syphilis were in HIV care. Although treatment was adequate and timely among all providers, management differed by provider type. Among HIV-infected patients, a larger proportion diagnosed by public HIV providers than private providers were tested for syphilis at least once in the previous 12 months (89.6% vs. 40.0%; p<0.001). The characteristics of MSM diagnosed with early syphilis in Multnomah County remained largely unchanged during 2008-2013. Syphilis control measures were well established, but early syphilis among MSM continued to increase. The results suggest a need to improve syphilis screening among private clinics, but few gaps in clinical management were identified. |
Factors associated with recent human immunodeficiency virus testing among men who have sex with men in Puerto Rico, National Human Immunodeficiency Virus Behavioral Surveillance System, 2011
Chapin-Bardales J , Sanchez T , Paz-Bailey G , Hageman K , Spiller MW , Rolon-Colon Y , Miranda de Leon S . Sex Transm Dis 2016 43 (6) 346-52 BACKGROUND: Annual human immunodeficiency virus (HIV) testing is considered a key strategy for HIV prevention for men who have sex with men (MSM). In Puerto Rico, HIV research has primarily focused on injection drug use, yet male-to-male sexual transmission has been increasing in recent years. METHODS: Cross-sectional data from the National HIV Behavioral Surveillance system collected in 2011 in San Juan, Puerto Rico, were analyzed to identify factors associated with HIV testing in the past 12 months (recent testing). RESULTS: Overall, 50% of participants were tested recently. In the multivariate analysis, testing recently was associated with having multiple partners in the past 12 months (adjusted prevalence ratio [aPR] [≥4 vs 1 partner] = 1.5; 95% confidence interval [95% CI], 1.2–2.0), visiting a health care provider in the past 12 months (aPR, 1.4; 95% CI, 1.04–1.8), and disclosing male-male attraction/sex to a health care provider (aPR< 1.4; 95% CI, 1.1–1.7). CONCLUSIONS: Human immunodeficiency virus testing was suboptimal among MSM in San Juan. Strategies to increase HIV testing among MSM may include promoting HIV testing for all sexually active MSM including those with fewer partners, increasing utilization of the healthcare system, and improving patient-provider communication. |
Frequency of enterovirus in patients with suspected bacterial meningitis in Turkey
Kuzdan C , Soysal A , Steven Oberste M , Bakır M . Nobel Medicus 2016 12 (1) 49-54 Objective: Enteroviruses are responsible for the majority of cases of aseptic meningitis. Among these, the human parechoviruses (HPeV) have recently been recognised as important contributors. Discrimination between bacterial and viral meningitis is important for proper treatment and prognosis; however, this distinction is not always possible based on clinical presentation because viral meningitis can mimic bacterial meningitis. The aim of this study was to investigate the frequency of enterovirus and HPeV infection in cerebrospinal fluid (CSF) samples collected from children diagnosed with bacterial meningitis but negative for bacteria in Turkey between 2006 and 2009. Material and Method: CSF samples were collected from children with suspected bacterial meningitis from 37 clinical centres in Turkey. Among 1,460 CSF samples available, 1,184 were negative for bacteria and were included in the study. Enteroviral and HPeV RNA were detected in CSF samples by rRT-PCR, and specific genotypes were identified by direct sequencing of the VP1 region. Results: Enteroviruses were detected in 13 (1%) of the 1,184 CSF specimens analysed and included echovirus 14 (n=1), echovirus 9 (n=1), coxsackievirus B4 (n=1), and unknown serotype (n=10). No HPeVs were detected. Conclusion: Neither clinical nor CSF laboratory criteria routinely used to diagnose bacterial meningitis can definitively rule out viral aetiology, so viral infections should be considered during meningitis surveillance and in patient care. © 2016, Nobelmedicus. All rights reserved. |
Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study
null , Carlo DD , Bester PA , Reyes-Teran G , Romero K , Avila-Rios S , Gregson J , Tang M , Rhee SY , Shafer RW , Ndembi N , Hamers RL , de Wit TFR , Marconi VC , Diero L , Brooks K , Theys K , Camacho R , Kantor R , Arruda M , Garcia F , Monge S , Gunthard HF , Hoffmann CJ , Kanki PJ , Kumarasamy N , Kerschberger B , Mor O , Charpentier C , Todesco E , Rokx C , Gras L , Halvas EK , Sunpath H , Di Carlo D , Santoro MM , Antinori A , Andreoni M , Latini A , Mussini C , Aghokeng A , Sonnerborg A , Neogi U , Fessel WJ , Agolory S , Raizes E , Yang C , Blanco JL , Juma JM , Smit E , Schmidt D , Watera C , Asio J , Kirungi W , Tostevin A , Dunn D , El-Hay T , Clumeck N , Goedhals D , van Vuuren C , Sabin C , Mukui I , Perno CF , Hunt G , Morris L , de Oliveira T , Pillay D , Gupta RK , Schulter E , Murakami-Ogasawara A , Sirivichayakul S , Ruxrungtham K , Mekprasan S , Kaleebu P . Lancet Infect Dis 2016 16 (5) 565-575 BACKGROUND: Antiretroviral therapy (ART) is crucial for controlling HIV-1 infection through wide-scale treatment as prevention and pre-exposure prophylaxis (PrEP). Potent tenofovir disoproxil fumarate-containing regimens are increasingly used to treat and prevent HIV, although few data exist for frequency and risk factors of acquired drug resistance in regions hardest hit by the HIV pandemic. We aimed to do a global assessment of drug resistance after virological failure with first-line tenofovir-containing ART. METHODS: The TenoRes collaboration comprises adult HIV treatment cohorts and clinical trials of HIV drug resistance testing in Europe, Latin and North America, sub-Saharan Africa, and Asia. We extracted and harmonised data for patients undergoing genotypic resistance testing after virological failure with a first-line regimen containing tenofovir plus a cytosine analogue (lamivudine or emtricitabine) plus a non-nucleotide reverse-transcriptase inhibitor (NNRTI; efavirenz or nevirapine). We used an individual participant-level meta-analysis and multiple logistic regression to identify covariates associated with drug resistance. Our primary outcome was tenofovir resistance, defined as presence of K65R/N or K70E/G/Q mutations in the reverse transcriptase (RT) gene. FINDINGS: We included 1926 patients from 36 countries with treatment failure between 1998 and 2015. Prevalence of tenofovir resistance was highest in sub-Saharan Africa (370/654 [57%]). Pre-ART CD4 cell count was the covariate most strongly associated with the development of tenofovir resistance (odds ratio [OR] 1.50, 95% CI 1.27-1.77 for CD4 cell count <100 cells per muL). Use of lamivudine versus emtricitabine increased the risk of tenofovir resistance across regions (OR 1.48, 95% CI 1.20-1.82). Of 700 individuals with tenofovir resistance, 578 (83%) had cytosine analogue resistance (M184V/I mutation), 543 (78%) had major NNRTI resistance, and 457 (65%) had both. The mean plasma viral load at virological failure was similar in individuals with and without tenofovir resistance (145 700 copies per mL [SE 12 480] versus 133 900 copies per mL [SE 16 650; p=0.626]). INTERPRETATION: We recorded drug resistance in a high proportion of patients after virological failure on a tenofovir-containing first-line regimen across low-income and middle-income regions. Effective surveillance for transmission of drug resistance is crucial. FUNDING: The Wellcome Trust. |
Hepatitis C in North Carolina: Two epidemics with one public health response
Rhea S , Fleischauer A , Foust E , Davies M . N C Med J 2016 77 (3) 190-2 Hepatitis C virus (HCV) infection, the most common blood-borne infection in the United States, is most | frequently transmitted through injection drug use [1]. | Although HCV infection can be acute and self-limiting, | approximately 75%–85% of infected persons will develop | chronic illness. Of the estimated 3.5 million persons in the | United States with chronic HCV infection, approximately | 75% were born during the period 1945–1965 (ie, baby | boomers) [1-3]. Chronic HCV infection has been referred | to as a silent epidemic. Approximately 50% of those | with chronic infection are unaware of their status and do | not receive recommended medical care and treatment, | increasing the possibility of progression to liver disease, | cirrhosis, liver cancer, and death [1, 2]. |
Hepatitis C virus testing and linkage to care in North Carolina and South Carolina jails, 2012-2014
Schoenbachler BT , Smith BD , Sena AC , Hilton A , Bachman S , Lunda M , Spaulding AC . Public Health Rep 2016 131 98-104 OBJECTIVE: We evaluated a hepatitis C virus (HCV) testing and linkage-to-care post-release program among detainees of small- to medium-sized jails in North Carolina and South Carolina as part of the Hepatitis Testing and Linkage to Care initiative. METHODS: An HCV testing and linkage-to-care program was implemented in selected jails in North Carolina and South Carolina from December 2012 to March 2014. Health-care workers not affiliated with the jails conducted HCV antibody (anti-HCV) and HCV ribonucleic acid (RNA) testing and linkage-to-care activities. The North Carolina jail provided universal opt-out testing for HCV; South Carolina jails initially targeted high-risk individuals before expanding to routine testing. RESULTS: Of 669 detainees tested for HCV in North Carolina, 88 (13.2%) tested anti-HCV positive, of whom 81 (92.0%) received an HCV RNA test, 66 (81.5%) of whom tested HCV RNA positive (i.e., currently infected). Of the 66 detainees with current HCV infection, 18 were referred to HCV medical care post-release and 10 attended their first appointment. Of 224 detainees tested for HCV in South Carolina, 18 (8.0%) tested anti-HCV positive, of whom 13 received an HCV RNA test. Nine of 13 detainees tested HCV RNA positive, seven detainees were referred to post-release medical care, and two detainees attended their first appointment. Overall, 106 of 893 (11.9%) detainees were anti-HCV positive. CONCLUSION: This study demonstrated that HCV testing, identification of infection, and linkage to care are feasible among jail populations. The rate of anti-HCV positivity was lower than that found in national studies of incarcerated populations, suggesting that HCV infection prevalence in jails may vary across U.S. states or regions. |
Increased gonorrhea screening and case finding after implementation of expanded screening criteria—urban Indian Health Service facility in Phoenix, Arizona, 2011–2013
Patton ME , Kirkcaldy RD , Chang DC , Markman S , Yellowman M , Petrosky E , Adams L , Robinson C , Gupta A , Taylor MM . Sex Transm Dis 2016 43 (6) 396-401 BACKGROUND: Gonorrhea screening is recommended for women at risk and men who have sex with men; expanded screening is encouraged based on local epidemiology. In response to a substantial increase in gonorrhea cases at an urban medical center serving American Indians, gonorrhea screening of all sexually active patients aged 14 to 45 years was initiated in March 2013. We describe gonorrhea screening coverage and case finding before and after implementation of expanded screening. METHODS: In March 2013, provider training, electronic health record prompts, and bundled laboratory orders were implemented to facilitate gonorrhea screening of all sexually active patients aged 14 to 45 years. We assessed the proportions of patients screened and testing positive for gonorrhea in the 2 years before (March 2011–February 2012 [indicated as 2011], March 2012–February 2013 [2012]) and 1 year after (March 2013–February 2014 [2013]) expanded screening measures. RESULTS: Gonorrhea screening coverage increased from 22% (2012) to 38% (2013); coverage increased 50% among females and 202% among males. Screening coverage increased in nearly all clinics. Gonorrhea case finding increased 68% among females in 2013 (n = 104) compared with 2012 (n = 62), primarily among women aged 25 to 29 years. No corresponding increase in gonorrhea case finding occurred among males. Most increased case finding occurred in the emergency department. CONCLUSIONS: After introduction of expanded gonorrhea screening, there was a significant increase in gonorrhea screening coverage and a subsequent increase in gonorrhea case finding among females. Despite increased screening in all clinics, increased case finding only occurred in the emergency department. |
Increasing incidence of herpes zoster over 60-year period from a population-based study
Kawai K , Yawn BP , Wollan P , Harpaz R . Clin Infect Dis 2016 63 (2) 221-6 BACKGROUND: Temporal increases in the incidence of herpes zoster (HZ) have been reported but studies have examined short study periods, and the cause of the increase remains unknown. We examined the long-term trend of HZ. METHODS: A population-based cohort study was conducted in Olmsted County, Minnesota, using data from 1945-1960 and 1980-2007. Medical record review of possible cases was performed to confirm incident cases of herpes zoster, the patient's immune status, and prescribing of antivirals for the HZ. We examined the relative change in the temporal trend in the incidence rates before and after the introduction of the varicella vaccination program. RESULTS: Of the 8017 patients with HZ, 58.7% were females and 6.6% were immunocompromised. The age- and sex-adjusted incidence rate of HZ increased from 0.76 per 1000 person-years (95% confidence interval [CI]=0.63, 0.89) in 1945-49 to 3.15 per 1000 person-years (95% CI=3.04, 3.26) in 2000-07. The rate of increase across the time period was 2.5% per year after adjusting for age and sex (adjusted incidence rate ratio of 1.025; 95% CI=1.023, 1.026; p <0.001). The incidence of HZ significantly increased among all age groups and both sexes. We found no change in the rate of increase before versus after the introduction of the varicella vaccination program. CONCLUSIONS: The incidence of HZ increased more than 4-fold over the last 6 decades. This increase is unlikely to be due to the introduction of varicella vaccination, antiviral therapy, or change in the prevalence of immunocompromised individuals. |
"Know Hepatitis B:" a multilingual communications campaign promoting testing for hepatitis B among Asian Americans and Pacific Islanders
Jorgensen C , Chen S , Carnes CA , Block J , Chen D , Caballero J , Moraras K , Cohen C . Public Health Rep 2016 131 35-40 The "Know Hepatitis B" campaign was the first national, multilingual communications campaign to promote testing for hepatitis B virus (HBV) among Asian Americans and Pacific Islanders (AAPIs). This population comprises fewer than 5% of the total U.S. population but accounts for more than half of the up to 1.4 million Americans living with chronic HBV infection. To address this health disparity with a national campaign, CDC partnered with Hep B United, a national coalition of community-based partners working to educate AAPIs about hepatitis B and the need for testing. Guided by formative research, the "Know Hepatitis B" campaign was implemented in 2013 with a two-pronged communications strategy. CDC used available Chinese, Korean, and Vietnamese media outlets on a national level and relied on Hep B United to incorporate campaign materials into educational efforts at the local level. This partnership helped facilitate HBV testing among the priority population. |
"Know More Hepatitis:" CDC's national education campaign to increase hepatitis C testing among people born between 1945 and 1965
Jorgensen C , Carnes CA , Downs A . Public Health Rep 2016 131 29-34 In 2012, CDC issued recommendations calling for those born between 1945 and 1965, or baby boomers, to get tested for the hepatitis C virus. To help implement this recommendation, CDC developed "Know More Hepatitis," a multimedia national education campaign. Guided by behavioral science theories and formative research, the campaign used multiple strategies to reach baby boomers and health-care providers with messages encouraging baby boomers to get tested for hepatitis C. With a limited campaign budget, the "Know More Hepatitis" campaign relied mostly on donated time and space from broadcast and print outlets. Donated placements totaled approximately $14.7 million, which reflected a more than 12-to-1 return on the campaign investment. This effort was supplemented with a small, paid digital advertising campaign. Combining audience impressions from both paid and donated campaign efforts resulted in more than 1.2 billion audience impressions. |
Chikungunya virus outbreak expansion and microevolutionary events affecting epidemiology and epidemic potential
Powers AM . Res Rep Trop Med 2015 6 11-19 Chikungunya virus (CHIKV) is a mosquito-borne virus that is associated with severe and prolonged arthralgia. Starting in 2004, CHIKV reemerged in a series of outbreaks along the east coast of Africa and on several islands of the Indian Ocean. Over the subsequent 10 years, the virus spread throughout the globe and caused over three million cases. Molecular characterization of the genomes over time revealed changes that were associated with changes in epidemiology and transmission patterns. Monitoring and exploitation of these changes may lead to better understanding of viral movement and potential options for prevention and control. |
Surveillance, insecticide resistance and control of an invasive Aedes aegypti (Diptera: Culicidae) population in California
Cornel AJ , Holeman J , Nieman CC , Lee Y , Smith C , Amorino M , Brisco KK , Barrera R , Lanzaro GC , Mulligan Iii FS . F1000Res 2016 5 194 The invasion and subsequent establishment in California of Aedes aegypti in 2013 has created new challenges for local mosquito abatement and vector control districts. Studies were undertaken to identify effective and economical strategies to monitor the abundance and spread of this mosquito species as well as for its control. Overall, BG Sentinel (BGS) traps were found to be the most sensitive trap type to measure abundance and spread into new locations. Autocidal-Gravid-Ovitraps (AGO-B), when placed at a site for a week, performed equally to BGS in detecting the presence of female Ae. aegypti. Considering operational cost and our findings, we recommend use of BGS traps for surveillance in response to service requests especially in locations outside the known infestation area. We recommend AGO-Bs be placed at fixed sites, cleared and processed once a week to monitor mosquito abundance within a known infestation area. Long-term high density placements of AGO-Bs were found to show promise as an environmentally friendly trap-kill control strategy. California Ae. aegypti were found to be homozygous for the V1016I mutation in the voltage gated sodium channel gene, which is implicated to be involved in insecticide resistance. This strain originating from Clovis, California was resistant to some pyrethroids but not to deltamethrin in bottle bio-assays. Sentinel cage ultra-low-volume (ULV) trials using a new formulation of deltamethrin (DeltaGard(R)) demonstrated that it provided some control (average of 56% death in sentinel cages in a 91.4 m spray swath) after a single truck mounted aerial ULV application in residential areas. |
Lactational exposure to polybrominated diphenyl ethers and its relation to early childhood anthropometric measurements
Hoffman K , Mendez M , Siega-Riz AM , Herring AH , Sjodin A , Daniels JL . Environ Health Perspect 2016 124 (10) 1656-1661 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are ubiquitous environmental contaminants that may impact growth and development. We investigated the association between exposure to PBDEs via breast milk and anthropometric measurements in early childhood. METHODS: The Pregnancy Infection and Nutrition (PIN) Babies studies followed a cohort of North Carolina pregnant women and their children through 36 months of age. Breast milk samples obtained at 3 months postpartum were analyzed for PBDEs. We collected height and weight records from well-baby doctor visits and also measured children during study visits (n=246 children with >1400 anthropometric measurements). We assessed the relationship between breast milk concentrations of five PBDE congeners-BDE-28, 47, 99, 100, and 153-and child's weight-for-age, height-for-age, and weight-for-height z-scores (WAZ, HAZ, and WHZ, respectively), adjusting for age; maternal age, race, pre-pregnancy BMI; parity; smoking during pregnancy; and breastfeeding, and stratifying by sex. RESULTS: Overall PBDE exposures via breast milk were not associated with early life anthropometric measures in the PIN Babies cohort. When stratified by sex, PBDEs in milk were inversely associated with WHZ for boys; however, associations did not follow a consistent pattern across the concentration gradient and were imprecisely estimated. Among girls, PBDEs tended to be associated with increased WHZ, with the exception of BDE-153 which was inversely associated with WHZ, though all estimates were imprecisely estimated. CONCLUSIONS: We observed little evidence of associations between early-life PBDE exposures via breast milk and anthropometric measurements overall; however, our results prompt the need for sex-specific investigations in larger cohorts. |
Alkyl mercury-induced toxicity: Multiple mechanisms of action
Risher JF , Tucker P . Rev Environ Contam Toxicol 2016 240 105-149 There are a number of mechanisms by which alkylmercury compounds cause toxic action in the body. Collectively, published studies reveal that there are some similarities between the mechanisms of the toxic action of the mono-alkyl mercury compounds methylmercury (MeHg) and ethylmercury (EtHg). This paper represents a summary of some of the studies regarding these mechanisms of action in order to facilitate the understanding of the many varied effects of alkylmercurials in the human body. The similarities in mechanisms of toxicity for MeHg and EtHg are presented and compared. The difference in manifested toxicity of MeHg and EtHg are likely the result of the differences in exposure, metabolism, and elimination from the body, rather than differences in mechanisms of action between the two. |
Using hospital inpatient discharge data to supplement active surveillance for invasive pneumococcal disease: is the extract worth the exertion?
Nichols MC , Bareta J , Coyle A , Landen M . Public Health Rep 2016 131 (3) 404-410 Objective. Invasive pneumococcal disease (IPD) surveillance systems monitor morbidity, mortality, and vaccine impact; accurate surveillance is important to detect changes in epidemiology. We evaluated completeness of IPD reporting in New Mexico by comparing data from the Hospital Inpatient Discharge Database (HIDD) and the New Mexico Active Bacterial Core Surveillance (ABCs) program. Methods. We linked data from the HIDD and the ABCs program. We defined cases of IPD in the HIDD among New Mexico residents with hospitalizations during 2007–2009 as specific (320.1 or 038.2) or nonspecific (481, 320.2, or 041.2) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. To validate if HIDD records that could not be matched to ABCs data were true IPD cases, we reviewed laboratory data and determined if Streptococcus pneumoniae (S. pneumoniae) had been isolated from a sterile body site. Results. We examined 732 HIDD records for cases that were not matched in the ABCs database; of such records, S. pneumoniae was isolated from a sterile body site in 10 HIDD records. Conclusion. ABCs data detected the majority of IPD cases in New Mexico. Laboratory and medical record review is essential when using HIDD data because ICD-9-CM coding alone does not ensure data accuracy. The addition of IPD cases to the ABCs program from the HIDD was minimally beneficial to active surveillance and reporting completeness in New Mexico. States that rely exclusively on passive reporting and that have access to HIDD data might use linkages of pneumococcal and IPD-specific ICD-9-CM–coded HIDD data to improve IPD surveillance and case ascertainment. © 2016, Association of Schools of Public Health. All rights reserved. |
Quantity versus quality: A survey experiment to improve the network scale-up method
Feehan DM , Umubyeyi A , Mahy M , Hladik W , Salganik MJ . Am J Epidemiol 2016 183 (8) 747-57 The network scale-up method is a promising technique that uses sampled social network data to estimate the sizes of epidemiologically important hidden populations, such as sex workers and people who inject illicit drugs. Although previous scale-up research has focused exclusively on networks of acquaintances, we show that the type of personal network about which survey respondents are asked to report is a potentially crucial parameter that researchers are free to vary. This generalization leads to a method that is more flexible and potentially more accurate. In 2011, we conducted a large, nationally representative survey experiment in Rwanda that randomized respondents to report about one of 2 different personal networks. Our results showed that asking respondents for less information can, somewhat surprisingly, produce more accurate size estimates. We also estimated the sizes of 4 key populations at risk for human immunodeficiency virus infection in Rwanda. Our estimates were higher than earlier estimates from Rwanda but lower than international benchmarks. Finally, in this article we develop a new sensitivity analysis framework and use it to assess the possible biases in our estimates. Our design can be customized and extended for other settings, enabling researchers to continue to improve the network scale-up method. |
Harmonising summary measures of population health using global survey instruments
Berger N , Robine JM , Ojima T , Madans J , Van Oyen H . J Epidemiol Community Health 2016 70 (10) 1039-44 Summary measures of population health-health expectancies in particular-have become a standard for quantifying and monitoring population health. To date, cross-national comparability of health expectancies is limited, except within the European Union (EU). To advance international comparability, the European Joint Action on Healthy Life Years (JA: EHLEIS) set up an international working group. The working group discussed the conceptual basis of summary measures of population health and made suggestions for the development of comparable health expectancies to be used across the EU and Organisation for Economic Co-operation and Development (OECD) members. In this paper, which summarises the main results, we argue that harmonised health data needed for health expectancy calculation can best be obtained from 'global' survey measures, which provide a snapshot of the health situation using 1 or a few survey questions. We claim that 2 global measures of health should be pursued for their high policy relevance: a global measure of participation restriction and a global measure of functional limitation. We finally provide a blueprint for the future development and implementation of the 2 global measures. The blueprint sets the basis for subsequent international collaboration, having as a core group Member States of the EU, the USA and Japan. Other countries, in particular OECD members, are invited to join the initiative. |
Three Genome Sequences of Legionella pneumophila subsp. pascullei Associated with Colonization of a Health Care Facility.
Kozak-Muiznieks NA , Morrison SS , Sammons S , Rowe LA , Sheth M , Frace M , Lucas CE , Loparev VN , Raphael BH , Winchell JM . Genome Announc 2016 4 (3) e00335-16 Here, we report the complete genome sequences of three Legionella pneumophila subsp. pascullei strains (including both serogroup 1 and 5 strains) that were found in the same health care facility in 1982 and 2012. |
Convergence of Implementation Science, Precision Medicine, and the Learning Health Care System: A New Model for Biomedical Research.
Chambers DA , Feero WG , Khoury MJ . JAMA 2016 315 (18) 1941-2 Since the start of the Human Genome Project 25 years ago, basic discoveries related to genomics and other “-omic” fields have continued to advance exponentially. This progress has facilitated the 2015 launch of the US Precision Medicine Initiative (PMI). The PMI is intended to merge genomic, biological, behavioral, environmental, and other data on individuals to identify drivers of health that might support personalized healthcare decision making. In the cancer domain, for example, recognition of both inherited genetic susceptibility (eg, Lynch syndrome for colorectal cancer, and BRCA1/2 for breast cancer) and cancer genome sequence alterations that can pinpoint therapeutic agents (eg, National Cancer Institute’s MATCH trials) has the potential to make clinical decisions more personalized both in prevention and treatment. The “National Cancer Moonshot Initiative” seeks to rapidly scale up these efforts.1 | There has been a parallel increase in the availability of personal devices (eg, smartphones, activity monitors, wearable GPS units) and electronic data capture tools to monitor behavior. Access to such technology has the potential to improve accessibility of behavioral interventions and enable real-time assessment of influences on personal health. If implemented well, the precision medicine approach to health care combining personal biological and behavioral data could have a significant benefit in reducing unmet health care needs in the population. Yet biomedical science faces a considerable challenge in evaluating the clinical usefulness of PMI-related scientific breakthroughs efficiently and at low cost, particularly if modeled on the traditional model of intervention development, then efficacy and effectiveness studies, followed by implementation. |
Testing Rare-Variant Association without Calling Genotypes Allows for Systematic Differences in Sequencing between Cases and Controls.
Hu YJ , Liao P , Johnston HR , Allen AS , Satten GA . PLoS Genet 2016 12 (5) e1006040 Next-generation sequencing of DNA provides an unprecedented opportunity to discover rare genetic variants associated with complex diseases and traits. However, the common practice of first calling underlying genotypes and then treating the called values as known is prone to false positive findings, especially when genotyping errors are systematically different between cases and controls. This happens whenever cases and controls are sequenced at different depths, on different platforms, or in different batches. In this article, we provide a likelihood-based approach to testing rare variant associations that directly models sequencing reads without calling genotypes. We consider the (weighted) burden test statistic, which is the (weighted) sum of the score statistic for assessing effects of individual variants on the trait of interest. Because variant locations are unknown, we develop a simple, computationally efficient screening algorithm to estimate the loci that are variants. Because our burden statistic may not have mean zero after screening, we develop a novel bootstrap procedure for assessing the significance of the burden statistic. We demonstrate through extensive simulation studies that the proposed tests are robust to a wide range of differential sequencing qualities between cases and controls, and are at least as powerful as the standard genotype calling approach when the latter controls type I error. An application to the UK10K data reveals novel rare variants in gene BTBD18 associated with childhood onset obesity. The relevant software is freely available. |
Do as I say: using communication role-plays to assess sexual assertiveness following an intervention
Mercer Kollar LM , Davis TL , Monahan JL , Samp JA , Coles VB , Bradley EL , Sales JM , Comer SK , Worley T , Rose E , DiClemente RJ . Health Educ Behav 2016 43 (6) 691-698 Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET's efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one's sexual partner as an assertive communication behavior within sexual health contexts. |
Cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women
Xu J , Zhou F , Reed C , Chaves SS , Messonnier M , Kim IK . Vaccine 2016 34 (27) 3149-3155 OBJECTIVE: To evaluate the cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women using data from three recent influenza seasons in the United States. DESIGN, SETTING, AND PARTICIPANTS: We developed a decision-analytic model following a cohort of 5.2 million pregnant women and their infants aged <6 months to evaluate the cost-effectiveness of vaccinating women against seasonal influenza during pregnancy from a societal perspective. The main outcome measures were quality-adjusted life-year (QALY) gained and cost-effectiveness ratios. Data sources included surveillance data, epidemiological studies, and published vaccine cost data. Sensitivity analyses were also performed. All costs and outcomes were discounted at 3% annually. MAIN OUTCOME MEASURES: Total costs (direct and indirect), effects (QALY gains, averted case numbers), and incremental cost-effectiveness of seasonal inactivated influenza vaccination among pregnant women (cost per QALY gained). RESULTS: Using a recent benchmark of 52.2% vaccination coverage among pregnant women, we studied a hypothetical cohort of 2,753,015 vaccinated pregnant women. With an estimated vaccine effectiveness of 73% among pregnant women and 63% among infants <6 months, QALY gains for each season were 305 (2010-2011), 123 (2011-2012), and 610 (2012-2013). Compared with no vaccination, seasonal influenza vaccination during pregnancy was cost-saving when using data from the 2010-2011 and 2012-2013 influenza seasons. The cost-effectiveness ratio was greater than $100,000/QALY with the 2011-2012 influenza season data, when CDC reported a low attack rate compared to other recent seasons. CONCLUSIONS: Influenza vaccination for pregnant women can reduce morbidity from influenza in both pregnant women and their infants aged <6 months. Seasonal influenza vaccination during pregnancy is cost-saving during moderate to severe influenza seasons. |
Serotypes and genotypes of Streptococcus pneumoniae isolates from Trinidad and Tobago.
Nurse-Lucas M , McGee L , Hawkins PA , Swanston WH , Akpaka PE . Int J Infect Dis 2016 46 100-106 OBJECTIVES: There are currently 94 known pneumococcal capsular polysaccharide serotypes and their prevalence differs by geographic region and the period studied. Streptococcus pneumoniae infections have been diagnosed clinically in Trinidad and Tobago and other Caribbean countries, however data on the serotype and sequence type distributions in this country are limited. The objective of this study was to determine serotypes and multilocus sequence types (MLSTs) of invasive and non-invasive pneumococcal isolates from Trinidad and Tobago. METHODS: Ninety-eight pneumococcal isolates from several regional hospitals in the country were analyzed using both standard microbiological methods and molecular analysis. These isolates included invasive (n=83) and selected non-invasive (n=15) strains recovered before (n=25) and after (n=73) the introduction of the pneumococcal conjugate vaccine. RESULTS: More than half of the isolates (54.1%) were recovered from children under 15 years of age, with the largest proportion being from children under 2 years of age (24.5%). The most prevalent serotypes were 19F (18.4%), 6B (15.3%), 23F (14.3%), 3 (11.2%), 19A (6.1%), 6A (5.1%), 14 (5.1%), and 9V (4.1%). The most common serotype/MLST combinations were 6B/ST138 (n=10, 10.2%), 3/ST180 (n=5, 5.1%), 23F/ST629 (n=5, 5.1%), 19F/ST8398 (n=4, 4.1%), and three each of 6B/ST145, 14/9V/ST156, 9V/ST162, 19A/320, and 3/ST10440. CONCLUSIONS: This report provides the first glimpse of the prevailing pneumococcal sequence types in the country. Most of the isolates represented serotypes in the 10-valent (61.2% of isolates) and 13-valent (83.7%) pneumococcal conjugate vaccines. A detailed population study is warranted to fully determine the circulating pneumococcal sequence types. Furthermore, the implementation of an effective and continuous surveillance system in Trinidad and Tobago is paramount to monitor vaccine impact. |
Cold Chain and Virus Free chloroplast-made Booster Vaccine to Confer Immunity Against Different Polio Virus Serotypes.
Chan HT , Xiao Y , Weldon WC , Oberste SM , Chumakov K , Daniell H . Plant Biotechnol J 2016 14 (11) 2190-2200 The WHO recommends complete withdrawal of Oral Polio Vaccine (OPV) Type 2 by April 2016 globally and replacing with at least one dose of Inactivated Poliovirus Vaccine (IPV). However, high-cost, limited supply of IPV, persistent circulating vaccine-derived polioviruses transmission and need for subsequent boosters remain unresolved. To meet this critical need, a novel strategy of a low cost cold-chain free plant-made viral protein 1 (VP1) subunit oral booster vaccine after single IPV dose is reported. Codon optimization of the VP1 gene enhanced expression by 50-fold in chloroplasts. Oral boosting of VP1 expressed in plant cells with plant-derived adjuvants after single priming with IPV significantly increased VP1-IgG1 and VP1-IgA titers when compared to lower IgG1 or negligible IgA titers with IPV injections. IgA plays a pivotal role in polio eradication because of its transmission through contaminated water or sewer systems. Neutralizing antibody titers (~3.17-10.17 log2 titer) and serpositivity (70-90%) against all three poliovirus Sabin serotypes were observed with two doses of IPV and plant-cell oral boosters but single dose of IPV resulted in poor neutralization. Lyophilized plant cells expressing VP1 stored at ambient temperature maintained efficacy and preserved antigen folding/assembly indefinitely, thereby eliminating cold-chain currently required for all vaccines. Replacement of OPV with this booster vaccine and the next steps in clinical translation of FDA approved antigens and adjuvants are discussed. |
Understanding non-completion of the human papillomavirus vaccine series: Parent-reported reasons for why adolescents might not receive additional doses, United States, 2012
Clark SJ , Cowan AE , Filipp SL , Fisher AM , Stokley S . Public Health Rep 2016 131 (3) 390-395 Completion rates of the human papillomavirus (HPV) vaccine series among U.S. adolescents are below public health targets. We explored parent-reported reasons for their children’s non-completion of the HPV vaccine series using a nationally representative online survey of parents of children aged 9–17 years, fielded in October 2012. Among the 1,653 parents who responded, the proportion reporting that their child would definitely continue with the HPV vaccine series among those who had started the series ranged from 28% to 54%. The most common reason cited by parents for non-completion of the series was their child’s fear of needles, followed by lack of awareness about additional doses and safety concerns. These findings demonstrate the need to encourage adoption of strategies addressing needle fears, utilize reminders for parents about subsequent doses, and emphasize recent HPV vaccine safety data in discussions with parents. |
Vaccine effectiveness of polysaccharide vaccines against clinical meningitis - Niamey, Niger, June 2015
Rondy M , Issifou D , Ibrahim AS , Maman Z , Kadade G , Omou H , Fati S , Kissling E , Meyer S , Ronveaux O . PLoS Curr 2016 8 INTRODUCTION: In 2015, a large outbreak of serogroup C meningococcal meningitis hit Niamey, Niger, in response to which a vaccination campaign was conducted late April. Using a case-control study we measured the vaccine effectiveness (VE) of tri - (ACW) and quadrivalent (ACYW) polysaccharide meningococcal vaccines against clinical meningitis among 2-15 year olds in Niamey II district between April 28th and June 30th 2015. METHODS: We selected all clinical cases registered in health centers and conducted a household- vaccination coverage cluster survey (control group). We ascertained vaccination from children/parent reports. Using odds of vaccination among controls and cases, we computed VE as 1-(Odds Ratio). To compute VE by day since vaccination, we simulated a density case control design randomly attributing recruitment dates to controls based on case dates of onset (3 controls per case). We calculated the number of days between vaccination and the date of onset/recruitment and computed VE by number of days since vaccination using a cubic-spline model. We repeated this simulated analysis 500 times and calculated the mean VE and the mean lower and upper bound of the 95% confidence interval (CI). RESULTS: Among 523 cases and 1800 controls, 57% and 92% were vaccinated respectively. Overall, VE at more than 10 days following vaccination was 84% (95%CI: 75-89) and 97% (94-99) for the tri- and quadrivalent vaccines respectively. VE at days 5 and 10 after trivalent vaccination was 84% (95% CI: 74-91) and 89% (95% CI: 83-93) respectively. It was 88% (95% CI: 75-94) and 95.8% (95% CI: 92 -98) respectively for the quadrivalent vaccine. CONCLUSION: Results suggest a high VE of the polysaccharide vaccines against clinical meningitis, an outcome of low specificity, and a rapid protection after vaccination. We identified no potential biases leading to VE overestimation. Measuring VE and rapidity of protection against laboratory confirmed meningococcal meningitis is needed. |
Employers' views on influenza and tetanus-diphtheria-pertussis vaccination in the workplace
Graves MC , Harris JR , Kohn M , Hannon PA , Lichiello PA , Martin DP , Ahmed F . J Occup Environ Med 2016 58 (4) e157-8 Readers are invited to submit letters for publication in this department. Submit letters online at http://joem.edmgr.com. Choose “Submit New Manuscript.” A signed copyright assignment and financial disclosure form must be submitted with the letter. Form available at www.joem.org under Author and Reviewer information. | The Centers for Disease Control and Prevention (CDC) recommends influenza vaccination for all those over 6 months of age, but recent adult vaccination rates are only about 40%.1,2 Likewise, although the CDC recommends vaccination with the tetanus, diphtheria, and pertussis (Tdap) vaccine for all adults,3–5 about 8.0% had ever received it 2010,6 with only modest increases reported through 2013.6 | Low adult vaccination rates for influenza and Tdap are missed opportunities to prevent disease, contain health care costs, and maintain employee productivity. For those 18 to 64 years of age, annual influenza-related health care costs are estimated at $4.6 billion7 and an estimated 16.8 million days of productivity are lost annually.7 Pertussis incidence is on the rise, with 10.4 cases per 100,000 in 2014.8 Between 65% and 78% of adults with pertussis miss work,5 missing 9.8 days on average.9 |
Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States
Zhao Z , Smith PJ , Hill HA . Vaccine 2016 34 (27) 3030-3036 BACKGROUND: Routine administration of all age-appropriate doses of vaccines during the same visit is recommended for children by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP). METHODS: Evaluate the potentially achievable vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) with simultaneous administration of all recommended childhood vaccines. Compare the potentially achievable vaccination coverage to the reported vaccination coverage for calendar years 2001 through 2013; by state in the United States and by selected socio-demographic factors in 2013. The potentially achievable vaccination coverage was defined as the coverage possible for the recommended 4+DTaP, 4+PCV, and Hib-FS if missed opportunities for simultaneous administration of all age-appropriate doses of vaccines for children had been eliminated. RESULTS: Compared to the reported vaccination coverage, the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS could have increased significantly (P<0.001), the vaccination coverage would have achieved the 90% target of Healthy People 2020 for the three vaccines beginning in 2005, 2008, and 2011 respectively. In 2013, the potentially achievable vaccination coverage increased significantly across all selected socio-demographic factors, potentially achievable vaccination coverage would have reached the 90% target for more than 51% of the states in the United States. CONCLUSIONS: The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for increasing vaccination coverage and improving timely vaccination for children. Encouraging providers to deliver all recommended vaccines that are due at each visit by implementing client reminder and recall systems might decrease missed opportunities for simultaneous administration of childhood vaccines. |
Global measles and rubella laboratory network support for elimination goals, 2010-2015
Mulders MN , Rota PA , Icenogle JP , Brown KE , Takeda M , Rey GJ , Ben Mamou MC , Dosseh AR , Byabamazima CR , Ahmed HJ , Pattamadilok S , Zhang Y , Gacic-Dobo M , Strebel PM , Goodson JL . MMWR Morb Mortal Wkly Rep 2016 65 (17) 438-42 In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP)* with the objective to eliminate measles and rubella in five World Health Organization (WHO) regions by 2020. In September 2013, countries in all six WHO regions had established measles elimination goals, and additional goals for elimination of rubella and congenital rubella syndrome were established in three regions (1). Capacity for surveillance, including laboratory confirmation, is fundamental to monitoring and verifying elimination. The 2012-2020 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative(dagger) calls for effective case-based surveillance with laboratory testing for case confirmation (2). In 2000, the WHO Global Measles and Rubella Laboratory Network (GMRLN) was established to provide high quality laboratory support for surveillance (3). The GMRLN is the largest globally coordinated laboratory network, with 703 laboratories supporting surveillance in 191 countries. During 2010-2015, 742,187 serum specimens were tested, and 27,832 viral sequences were reported globally. Expansion of the capacity of the GMRLN will support measles and rubella elimination efforts as well as surveillance for other vaccine-preventable diseases (VPDs), including rotavirus, and for emerging pathogens of public health concern. |
Sexual violence victimization and associations with health in a community sample of African American Women
Basile KC , Smith SG , Fowler DN , Walters ML , Hamburger ME . J Aggress Maltreat Trauma 2016 25 (3) 231-253 Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. In-person interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status. |
Tobacco-specific N-nitrosamines and polycyclic aromatic hydrocarbons in cigarettes smoked by the participants of the Shanghai Cohort Study
Yershova K , Yuan JM , Wang R , Valentin L , Watson C , Gao YT , Hecht S , Stepanov I . Int J Cancer 2016 139 (6) 1261-9 Our recent studies on tobacco smoke carcinogen and toxicant biomarkers and cancer risk among male smokers in the Shanghai Cohort Study showed that exposure to tobacco-specific nitrosamines (TSNA) and polycyclic aromatic hydrocarbons (PAH) is prospectively associated with the risk of cancer. These findings support the hypothesis that the smokers' cancer risk is a function of the dose of select tobacco carcinogens and highlight the importance of understanding the factors that affect the intake of these carcinogens by smokers. Given that tobacco constituent exposures are driven, at least in part, by the levels of these constituents in cigarette smoke, we measured mainstream smoke TSNA and PAH levels in 43 Chinese cigarette brands that participants of the Shanghai Cohort Study reported to smoke. In all brands analyzed here, mainstream smoke levels of NNN and NNK, the two carcinogenic TSNA, were generally relatively low, averaging (+/-SD) 16.8(+/-25.1) and 14.2(+/-9.5) ng/cigarette, respectively. The levels of PAH were comparable to those found in U.S. cigarettes, averaging 15(+/-9) ng/cigarette for benzo[a]pyrene, 119(+/-66) ng/cigarette for phenanthrene, and 37(+/-19) ng/cigarette for pyrene. Our findings indicate that the generally low levels of NNN and NNK are most likely responsible for the relatively low levels of the corresponding biomarkers in the urine of the Shanghai Cohort Study participants as compared to those found in the U.S. smokers, supporting the role of the levels of these constituents in cigarette smoke in smokers' exposures. Our findings also suggest that, in addition to smoking, other sources contribute to Chinese smokers' exposure to PAH. This article is protected by copyright. All rights reserved. |
Transcriptional pathways altered in response to vibration in a model of hand-arm vibration syndrome
Waugh S , Kashon ML , Li S , Miller GR , Johnson C , Krajnak K . J Occup Environ Med 2016 58 (4) 344-50 OBJECTIVE: The aim of this study was to use an established model of vibration-induced injury to assess frequency-dependent changes in transcript expression in skin, artery, and nerve tissues. METHODS: Transcript expression in tissues from control and vibration-exposed rats (4 h/day for 10 days at 62.5, 125, or 250 Hz; 49 m/s, rms) was measured. Transcripts affected by vibration were used in bioinformatics analyses to identify molecular- and disease-related pathways associated with exposure to vibration. RESULTS: Analyses revealed that cancer-related pathways showed frequency-dependent changes in activation or inhibition. Most notably, the breast-related cancer-1 pathway was affected. Other pathways associated with breast cancer type 1 susceptibility protein related signaling, or associated with cancer and cell cycle/cell survivability were also affected. CONCLUSION: Occupational exposure to vibration may result in DNA damage and alterations in cell signaling pathways that have significant effects on cellular division. |
Measurement and modeling of radio propagation from a primary tunnel to cross junctions
Zhou C , Jacksha R , Reyes M . Proc IEEE Radio Wirel Symp 2016 2016 70-72 In this paper, we propose a new model for predicting around-corner coupling loss associated with radio signals propagating from a primary tunnel to cross junctions. The proposed model is based on the classic modal method that has been widely used for predicting power distribution in straight tunnels. The uniform theory of diffraction (UTD) is applied to calculate mode coupling coefficients. Simulation results based on the proposed model are compared to measurement results taken in a concrete tunnel and show good agreement. |
Optimization of a nanotechnology based antimicrobial platform for food safety applications using Engineered Water Nanostructures (EWNS)
Pyrgiotakis G , Vedantam P , Cirenza C , McDevitt J , Eleftheriadou M , Leonard SS , Demokritou P . Sci Rep 2016 6 21073 A chemical free, nanotechnology-based, antimicrobial platform using Engineered Water Nanostructures (EWNS) was recently developed. EWNS have high surface charge, are loaded with reactive oxygen species (ROS), and can interact-with, and inactivate an array of microorganisms, including foodborne pathogens. Here, it was demonstrated that their properties during synthesis can be fine tuned and optimized to further enhance their antimicrobial potential. A lab based EWNS platform was developed to enable fine-tuning of EWNS properties by modifying synthesis parameters. Characterization of EWNS properties (charge, size and ROS content) was performed using state-of-the art analytical methods. Further their microbial inactivation potential was evaluated with food related microorganisms such as Escherichia coli, Salmonella enterica, Listeria innocua, Mycobacterium parafortuitum, and Saccharomyces cerevisiae inoculated onto the surface of organic grape tomatoes. The results presented here indicate that EWNS properties can be fine-tuned during synthesis resulting in a multifold increase of the inactivation efficacy. More specifically, the surface charge quadrupled and the ROS content increased. Microbial removal rates were microorganism dependent and ranged between 1.0 to 3.8 logs after 45 mins of exposure to an EWNS aerosol dose of 40,000 #/cm(3). |
Evaluation of early immune response-survival relationship in cynomolgus macaques after anthrax vaccine adsorbed vaccination and Bacillus anthracis spore challenge
Sivko GS , Stark GV , Tordoff KP , Taylor KL , Glaze E , VanRaden M , Schiffer JM , Hewitt JA , Quinn CP , Nuzum EO . Vaccine 2016 34 (51) 6518-6528 Anthrax vaccine adsorbed (AVA, BioThrax) is approved by the US Food and Drug Administration for post-exposure prophylaxis (PEP) of anthrax in adults. The PEP schedule is 3 subcutaneous (SC) doses (0, 14 and 28 days), in conjunction with a 60 day course of antimicrobials. The objectives of this study were to understand the onset of protection from AVA PEP vaccination and to assess the potential for shortening the duration of antimicrobial treatment (http://www.phe.gov/Preparedness/mcm/phemce/Documents/2014-phemce-sip.pdf). We determined the efficacy against inhalation anthrax in nonhuman primates (NHP) of the first two doses of the PEP schedule by infectious challenge at the time scheduled for receipt of the third PEP dose (Day 28). Forty-eight cynomolgus macaques were randomized to five groups and vaccinated with serial dilutions of AVA on Days 0 and 14. NHP were exposed to Bacillus anthracis Ames spores on Day 28 (target dose 200 LD50 equivalents). Anti-protective antigen (PA) IgG and toxin neutralizing antibody (TNA) responses to vaccination and in post-challenge survivors were determined. Post-challenge blood and selected tissue samples were assessed for B. anthracis at necropsy or end of study (Day 56). Pre-challenge humoral immune responses correlated with survival, which ranged from 24 to 100% survival depending on vaccination group. Surviving, vaccinated animals had elevated anti-PA IgG and TNA levels for the duration of the study, were abacteremic, exhibited no apparent signs of infection, and had no gross or microscopic lesions. However, survivors had residual spores in lung tissues. We conclude that the first two doses of the PEP schedule provide high levels of protection by the scheduled timing of the third dose. These data may also support consideration of a shorter duration PEP antimicrobial regimen. |
Improving the accuracy of smart devices to measure noise exposure
Roberts B , Kardous C , Neitzel R . J Occup Environ Hyg 2016 13 (11) 840-6 Occupational noise exposure is one of the most frequent hazards present in the workplace; up to 22 million workers have potentially hazardous noise exposures in the US. As a result, noise-induced hearing loss is one of the most common occupational injuries in the United States. Workers in manufacturing, construction, and the military are at the highest risk for hearing loss. Despite the large number of people exposed to high levels of noise at work, many occupations have not been adequately evaluated for noise exposure. The objective of this experiment was to investigate whether or not iOS smartphones and other smart devices (Apple iPhones and iPods) could be used as reliable instruments to measure noise exposures. For this experiment three different types of microphones were tested with a single model of iPod and three generations of iPhones: the internal microphones on the device, a low-end lapel microphone, and a high-end lapel microphone marketed as being compliant with the International Electrotechnical Commission's (IEC) standard for a Class 2-microphone. All possible combinations of microphones and noise measurement applications were tested in a controlled environment using several different levels of pink noise ranging from 60 to 100 dBA. Results were compared to simultaneous measurements made using a Type 1 sound level measurement system. Analysis of variance and Tukey's honest significant difference (HSD) test were used to determine if the results differed by microphone or noise measurement application. Levels measured with external microphones combined with certain noise measurement applications did not differ significantly from levels measured with the Type 1 sound measurement system. Results showed that it may be possible to use iOS smartphones and smart devices, with specific combinations of measurement applications and calibrated external microphones, to collect reliable, occupational noise exposure data under certain conditions and within the limitations of the device. Further research is needed to determine how these devices compare to traditional noise dosimeter under real-world conditions. |
Inhaled aerosol dosimetry: Some current research needs
Darquenne C , Hoover MD , Phalen RF . J Aerosol Sci 2016 99 1-5 After the presentation of 60 papers at the conference "Advancing Aerosol Dosimetry Research" (October 24-25, 2014 in Irvine, CA, USA), attendees submitted written descriptions of needed research. About 40 research needs were submitted. The suggestions fell into six broad categories: 1) Access to detailed anatomic data; 2) Access to subject-specific aerosol deposition datasets; 3) Improving current inhaled aerosol deposition models; 4) Some current experimental data needs and hot topics; 5) Linking exposure and deposition modeling to health endpoints; and 6) Developing guidelines for appropriate validation of dosimetry and risk assessment models. Summaries of suggestions are provided here as an update on research needs related to inhaled aerosol dosimetry modeling. Taken together, the recommendations support the overarching need for increased collaborations between dose modelers and those that use the models for risk assessments, aerosol medicine applications, design of toxicology experiments, and extrapolation across species. This paper is only a snapshot in time of perceived research needs from the conference attendees; it does not carry the approval of any agency or other group that plans research priorities or that funds research. |
Benchmarking vector arthropod culture: An example using the African malaria mosquito, Anopheles gambiae (Diptera: Culicidae)
Valerio L , Matilda Collins C , Lees RS , Benedict MQ . Malar J 2016 15 (1) 262 BACKGROUND: Numerous important characteristics of adult arthropods are related to their size; this is influenced by conditions experienced as immatures. Arthropods cultured in the laboratory for research, or mass-reared for novel control methods, must therefore be of a standard size range and known quality so that results are reproducible. METHODS: A simple two-step technique to assess laboratory culture methods was demonstrated using the mosquito Anopheles gambiae s.s. as a model. First, the ranges of key development outcomes were determined using various diet levels. The observed outcomes described the physiologically constrained limits. Secondly, the same outcomes were measured when using a standard operating procedure (SOP) for comparison with the determined ranges. RESULTS: The standard method resulted in similar development rates to those of high and medium diets, wing length between those resulting from the high and medium diets, and larval survival exceeding all benchmark diet level values. The SOP used to produce experimental material was shown to produces high-quality material, relative to the biologically constrained limits. CONCLUSIONS: The comparison between all possible phenotypic outcomes, as determined by biological constraints, with those outcomes obtained using a given rearing protocol is termed "benchmarking". A method is here demonstrated which could be easily adapted to other arthropods, to objectively assess important characters obtained, and methods used, during routine culture that may affect outcomes of research. |
Bridging the gap between exposure assessment and inhalation toxicology: Some insights from the carbon nanotube experience
Erdely A , Dahm MM , Schubauer-Berigan MK , Chen BT , Antonini JM , Hoover MD . J Aerosol Sci 2016 99 157-162 The early incorporation of exposure assessment can be invaluable to help design, prioritize, and interpret toxicological studies or outcomes. The sum total of the exposure assessment findings combined with preliminary toxicology results allows for exposure-informed toxicological study design and the findings can then be integrated, together with available epidemiologic data, to provide health effect relevance. With regard to engineered nanomaterial inhalation toxicology in particular, a single type of material (e.g. carbon nanotube, graphene) can have a vast array of physicochemical characteristics resulting in the potential for varying toxicities. To compound the matter, the methodologies necessary to establish a material adequate for in vivo exposure testing raises questions on the applicability of the outcomes. From insights gained from evaluating carbon nanotubes, we recommend the following integrated approach involving exposure-informed hazard assessment and hazard-informed exposure assessment especially for materials as diverse as engineered nanomaterials: 1) market-informed identification of potential hazards and potentially exposed populations, 2) initial toxicity screening to drive prioritized assessments of exposure, 3) development of exposure assessment-informed chronic and sub-chronic in vivo studies, and 4) conduct of exposure- and hazard-informed epidemiological studies. |
Reported wandering behavior among children with autism spectrum disorder and/or intellectual disability
Rice CE , Zablotsky B , Avila RM , Colpe LJ , Schieve LA , Pringle B , Blumberg SJ . J Pediatr 2016 174 232-239.e2 OBJECTIVE: To characterize wandering, or elopement, among children with autism spectrum disorder (ASD) and intellectual disability. STUDY DESIGN: Questions on wandering in the previous year were asked of parents of children with ASD with and without intellectual disability and children with intellectual disability without ASD as part of the 2011 Survey of Pathways to Diagnosis and Services. The Pathways study sample was drawn from the much larger National Survey of Children with Special Health Care Needs conducted in 2009-2010. RESULTS: For children with special healthcare needs diagnosed with either ASD, intellectual disability, or both, wandering or becoming lost during the previous year was reported for more than 1 in 4 children. Wandering was highest among children with ASD with intellectual disability (37.7%) followed by children with ASD without intellectual disability (32.7%), and then children with intellectual disability without ASD (23.7%), though the differences between these groups were not statistically significant. CONCLUSIONS: This study affirms that wandering among children with ASD, regardless of intellectual disability status, is relatively common. However, wandering or becoming lost in the past year was also reported for many children with intellectual disability, indicating the need to broaden our understanding of this safety issue to other developmental disabilities. |
Soft law and nanotechnology: sources of guidance for risk management.
Baker J , Barrie MD , Geraci CL , Hoover MD . Synergist (Akron) 2016 27 (4) 30-33 What should industrial hygienists do when the legislative and regulatory process can't keep pace with technology? Our profession is charged with protecting workers and public health. The industrial hygienists' Code of Ethics provides guidance that must be supplemented by new knowledge. If we act only when regulations are issued, we would be doing very little to promote safe and responsible development of the technology. This is especially true for an evolving and rapidly expanding field like nanotechnology. This article reviews current standards of behavior, guidance, regulations, and law related to nanomaterials. |
Suicide mortality among retired national football league players who played 5 or more seasons
Lehman EJ , Hein MJ , Gersic CM . Am J Sports Med 2016 44 (10) 2486-2491 BACKGROUND: There is current disagreement in the scientific literature about the relationship between playing football and suicide risk, particularly among professional players in the National Football League (NFL). While some research indicates players are at high risk of football-related concussions, which may lead to chronic traumatic encephalopathy and suicide, other research finds such a connection to be speculative and unsupported by methodologically sound research. PURPOSE: To compare the suicide mortality of a cohort of NFL players to what would be expected in the general population of the United States. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A cohort of 3439 NFL players with at least 5 credited playing seasons between 1959 and 1988 was assembled for statistical analysis. The vital status for this cohort was updated through 2013. Standardized mortality ratios (SMRs), the ratio of observed deaths to expected deaths, and 95% CIs were computed for the cohort; 95% CIs that excluded unity were considered statistically significant. For internal comparison purposes, standardized rate ratios were calculated to compare mortality results between players stratified into speed and nonspeed position types. RESULTS: Suicide among this cohort of professional football players was significantly less than would be expected in comparison with the United States population (SMR = 0.47; 95% CI, 0.24-0.82). There were no significant differences in suicide mortality between speed and nonspeed position players. CONCLUSION: There is no indication of elevated suicide risk in this cohort of professional football players with 5 or more credited seasons of play. Because of the unique nature of this cohort, these study results may not be applicable to professional football players who played fewer than 5 years or to college or high school players. |
Validation and dimensionality of the integration of health protection and health promotion score: Evidence rom the PULSE small business and VA Medical Center surveys
Williams JA , Schult TM , Nelson CC , Caban-Martinez AJ , Katz JN , Wagner GR , Pronk NP , Sorensen G , McLellan DL . J Occup Environ Med 2016 58 (5) 499-504 OBJECTIVE: To conduct validation and dimensionality analyses for an existing measure of the integration of worksite health protection and health promotion approaches. METHODS: A survey of small to medium size employers located in the United States was conducted between October 2013 and March 2014 (N = 115). A survey of Department of Veterans Affairs (VA) administrative parents was also conducted from June to July 2014 (N = 140). Exploratory factor analysis (EFA) was used to determine the dimensionality of the Integration Score in each sample. RESULTS: Using EFA, both samples indicated the presence of one unified factor. The VA survey indicated that customization improves the relevance of the Integration Score for different types of organizations. CONCLUSIONS: The Integration Score is a valid index for assessing the integration of worksite health protection and health promotion approaches and is customizable based on industry. CLINICAL SIGNIFICANCE: The Integration Score may be used as a single metric for assessing the integration of worksite health protection and health promotion approaches in differing work contexts. |
Prevalence of airflow obstruction among ever-employed US adults aged 18-79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007-2008
Kurth L , Doney B , Halldin C . Occup Environ Med 2016 73 (7) 482-6 OBJECTIVES: To estimate the prevalence of spirometry-defined airflow obstruction among ever-employed US adults. METHODS: Data from the 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) for adults 18-79 years with valid spirometry and longest held occupation were analysed. The age-standardised prevalence of spirometry-defined airflow obstruction was estimated overall and by smoking status. RESULTS: Age-standardised prevalence of airflow obstruction was 13.7% (95% CI 12.4% to 15.0%) and was highest in participants aged 60-79 years (17.4%, 95% CI 15.2% to 19.6%), males (14.8%, 95% CI 12.0% to 17.6%), non-Hispanic whites (15.4%, 95% CI 13.8% to 16.7%) and ever smokers (19.1%, 95% CI 16.6% to 21.5%). Age-standardised prevalence of airflow obstruction was >20% for installation, maintenance and repair occupations (p=22.1%, 95% CI 16.5% to 27.8%), and for construction and extraction occupations (20.7%, 95% CI 13.5% to 27.9%). CONCLUSIONS: Prevalence of airflow obstruction varied by demographic characteristics and occupational factors with a higher prevalence among ever smokers for most demographic characteristics and occupational factors. Study findings emphasise the importance of monitoring the lung function of workers in occupations with a high prevalence of airflow obstruction. |
Prevalence of injury in occupation and industry: role of obesity in the National Health Interview Survey 2004 to 2013
Gu JK , Charles LE , Fekedulegn D , Ma CC , Andrew ME , Burchfiel CM . J Occup Environ Med 2016 58 (4) 335-43 OBJECTIVES: The aim of this study was to estimate prevalence of injury by occupation and industry and obesity's role. METHODS: Self-reported injuries were collected annually for US workers during 2004 to 2013. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were obtained from fitted logistic regression models. RESULTS: Overall weighted injury prevalence during the previous three months was 77 per 10,000 workers. Age-adjusted injury prevalence was greatest for Construction and Extraction workers (169.7/10,000) followed by Production (160.6) among occupations, while workers in the Construction industry sector (147.9) had the highest injury prevalence followed by the Agriculture/Forestry/Fishing/Mining/Utilities sector (122.1). Overweight and obese workers were 26% to 45% more likely to experience injuries than normal-weight workers. CONCLUSION: The prevalence of injury, highest for Construction workers, gradually increased as body mass index levels increased in most occupational and industry groups. |
Heat Hazards: Protecting Workers in Hot Environments
Jacklitsch B . Synergist (Akron) 2016 27 (4) 24-28 Heat-related deaths, illnesses, and injuries continue to occur | in workplaces, despite efforts at prevention. Data from the Bureau | of Labor Statistics show that in 2010 there were 4,190 cases | of injury or illness arising from exposure to heat in the workplace | that resulted in one or more days of l?ost work. Both outdoor | and indoor workers who are exposed to heat or who work in hot | environments are at risk. To address the hazards of heat and | hot environments, NIOSH published the Criteria for a Recommended | Standard: Occupational Exposure to Heat and Hot Environments | in February. |
Impacts of chemical modification on the toxicity of diverse nanocellulose materials to developing zebrafish
Harper BJ , Clendaniel A , Sinche F , Way D , Hughes M , Schardt J , Simonsen J , Stefaniak AB , Harper SL . Cellulose (Lond) 2016 23 (3) 1763-1775 Cellulose is an abundant and renewable resource currently being investigated for utility in nanomaterial form for various promising applications ranging from medical and pharmaceutical uses to mechanical reinforcement and biofuels. The utility of nanocellulose and wide implementation ensures increasing exposure to humans and the environment as nanocellulose-based technologies advance. Here, we investigate how differences in aspect ratio and changes to surface chemistry, as well as synthesis methods, influence the biocompatibility of nanocellulose materials using the embryonic zebrafish. Investigations into the toxicity of neutral, cationic and anionic surface functionalities revealed that surface chemistry had a minimal influence on the overall toxicity of nanocellulose materials. Higher aspect ratio cellulose nanofibers produced by mechanical homogenization were, in some cases, more toxic than other cellulose-based nanofibers or nanocrystals produced by chemical synthesis methods. Using fluorescently labeled nanocellulose we were able to show that nanocellulose uptake did occur in embryonic zebrafish during development. We conclude that the benign nature of nanocellulose materials makes them an ideal platform to systematically investigate the inherent surface features driving nanomaterial toxicity in order to create safer design principles for engineered nanoparticles. © 2016 Springer Science+Business Media Dordrecht |
Short persistence of bendiocarb sprayed on pervious walls and its implication for the indoor residual spray program in Ethiopia
Yeebiyo Y , Dengela D , Tesfaye AG , Anshebo GY , Kolyada L , Wirtz R , Chibsa S , Fornadel C , George K , Belemvire A , Taffese HS , Lucas B . Parasit Vectors 2016 9 (1) 266 BACKGROUND: With the emergence and spread of vector resistance to pyrethroids and DDT in Africa, several countries have recently switched or are considering switching to carbamates and/or organophosphates for indoor residual spraying (IRS). However, data collected on the residual life of bendiocarb used for IRS in some areas indicate shorter than expected bio-efficacy. This study evaluated the effect of pH and wall type on the residual life of the carbamates bendiocarb and propoxur as measured by the standard World Health Organization (WHO) cone bioassay test. METHODS: In phase I of this study, bendiocarb and propoxur were mixed with buffered low pH (pH 4.3) local water and non-buffered high pH (pH 8.0) local water and sprayed on two types of wall surface, mud and dung, in experimental huts. In the six month phase II study, the two insecticides were mixed with high pH local water and sprayed on four different surfaces: painted, dung, mud and mud pre-wetted with water. The residual bio-efficacy of the insecticides was assessed monthly using standard WHO cone bioassay tests. RESULTS: In phase I, bendiocarb mixed with high pH water killed more than 80 % of susceptible Anopheles arabiensis mosquitoes for two months on both dung and mud surfaces. On dung surfaces, the 80 % mortality threshold was achieved for three months when the bendiocarb was mixed with low pH water and four months when it was mixed with high pH water. Propoxur lasted longer than bendiocarb on dung surfaces, staying above the 80 % mortality threshold for four and five months when mixed with high and low pH water, respectively. Phase II results also showed that the type of surface sprayed has a significant impact on the bio-efficacy of bendiocarb. Keeping the spray water constant at the same high pH of 8.0, bendiocarb killed 100 % of exposed mosquitoes on impervious painted surfaces for the six months of the study period compared with less than one month on mud surfaces. CONCLUSIONS: Mixing the insecticides in alkaline water did not reduce the residual bio-efficacy of bendiocarb. However, bendiocarb performed much better on impervious (painted) surfaces than on porous dung or mud ones. Propoxur was less affected by wall type than was bendiocarb. Studies on the interaction between wall materials, soil, humidity, temperature and pH and the residual bio-efficacy of new and existing insecticides are recommended prior to their wide use in IRS. |
Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria
Goldman-Yassen AE , Mony VK , Arguin PM , Daily JP . Pediatr Emerg Care 2016 32 (4) 227-31 OBJECTIVES: Despite the availability of effective antimalarial prophylaxis, imported adult and pediatric malaria occurs in the United States, and this can pose diagnostic issues. We examined the clinical characteristics and diagnostic challenges of imported malaria requiring adult or pediatric inpatient admission at Montefiore Medical Center in the Bronx which provides care for a large population of immigrants from malaria endemic areas. STUDY DESIGN: We conducted a retrospective single center review of patients admitted with a diagnosis of malaria at Montefiore Medical Center from 2005 through 2012. We extracted historical, clinical, and laboratory values from the electronic medical record and patient charts. RESULTS: We identified 95 patients who were diagnosed and hospitalized with malaria from 2005 to 2012, 33 (35%) of them were children and 17 (18%) were with severe malaria. Most patients contracted malaria while visiting friends and relatives in West Africa. Only 38% of travelers took prophylaxis, and fewer than half reported taking it as prescribed. Misdiagnosis by emergency room or primary care doctors was observed in almost one quarter of all of the patients. Misdiagnosis occurred significantly more frequently in children (43%) compared to adults (13%) (P = 0.002). Pediatric patients were more likely to present with abdominal pain (42% vs. 15%; P = 0.005). CONCLUSIONS: Pediatric patients admitted for imported malaria at Montefiore Medical Center had a higher rate of misdiagnosis and presented with more gastrointestinal symptoms than hospitalized adults. By describing the clinical characteristics of patients with imported malaria, we hope to improve diagnostic accuracy by health care workers and raise awareness that friends and relatives may require more intensive pretravel counseling. |
Assessing clinical research capacity in Vietnam: a framework for strengthening capability for clinical trials in developing countries
Kagan J , Giang DD , Iademarco MF , Phung VTT , Lau CY , Quang NN . Public Health Rep 2016 131 (3) 396-403 Although improving health systems promises important benefits, most developing nations lack the resources to support nationally driven clinical research. Strengthened clinical research capacity can advance national health goals by supporting greater autonomy in aligning research with national priorities. From March through June 2010, we assessed six elements of clinical research capacity in Vietnam: research agenda; clinical investigators and biostatisticians; donors and sponsors; community involvement; scientific, ethical, safety, and quality oversight; and clinical research institutions. Assessments were drawn from interviews with investigators, Ministry of Health staff members, nongovernment organizations, and U.S. Mission staff members, and document review. Observations and recommendations were shared with collaborators. Reassessment in 2015 found growth in the number of clinical trials, improved regulation in human subjects protection and community engagement, and modest advances in research agenda setting. Training and investment in institutions remain challenging. A framework for assessing clinical research capacity can affirm strengths and weaknesses and guide the coordination of capacity-building efforts. © 2016, Association of Schools of Public Health. All rights reserved. |
Safety of hormonal contraceptives among women with migraine: A systematic review
Tepper NK , Whiteman MK , Zapata LB , Marchbanks PA , Curtis KM . Contraception 2016 94 (6) 630-640 BACKGROUND: Migraine is common among women of reproductive age and is associated with an increased risk of ischemic stroke. Combined oral contraceptives (COCs) are also associated with an increased risk of ischemic stroke. Use of hormonal contraception among women with migraine might further elevate the risk of stroke among women of reproductive age. OBJECTIVE: To identify evidence regarding the risk of arterial thromboembolism (stroke or myocardial infarction) among women with migraine who use hormonal contraceptives. METHODS: We searched the PubMed database for all articles published from database inception through January 2016. We included studies that examined women with migraine overall or separated by subtype (with or without aura). Hormonal contraceptives of interest included combined hormonal methods (COCs, patch, and ring) and progestin-only methods (progestin-only pills, injectables, implants, and progestin intrauterine devices). RESULTS: Seven articles met inclusion criteria. All were case-control studies of fair to poor quality reporting on use of COCs or oral contraceptives (OCs) not further described and all reported stroke outcomes. Four studies demonstrated that, among women with migraine (not separated by subtype), COC use was associated with approximately 2-4 times the risk of stroke compared with non-use. The only study to examine specific migraine subtypes found an elevated risk of stroke among women with migraine with aura, and this risk was similar regardless of OC use, although these odds ratios were not reported. Two studies did not report risks among women with migraine and COC use combined, but both found increased risks of stroke with migraine and COC use independently. No evidence was found on other hormonal contraceptives or on risk of myocardial infarction. CONCLUSION: Limited evidence suggests a 2-4 fold increased risk of stroke among women with migraine who use COCs compared with non-use. Additional study is needed on the risks of hormonal contraceptives, including combined and progestin-only methods, among women with different migraine subtypes. |
Progestin-only contraception and thromboembolism: a systematic review
Tepper NK , Whiteman MK , Marchbanks PA , James AH , Curtis KM . Contraception 2016 94 (6) 678-700 BACKGROUND: Women with medical conditions associated with increased risk for thrombosis generally should not use estrogen-containing contraceptives, however less is known about progestin-only contraceptives (POCs) and thrombosis risk. OBJECTIVES: To identify evidence regarding the risk of venous thromboembolism (VTE) or arterial thromboembolism (stroke or acute myocardial infarction [AMI]) among women using POCs. METHODS: We searched the PubMed database for all articles published from database inception through January 2016 for studies examining thrombosis among women using POCs. We included studies which examined women with medical conditions associated with thrombosis risk, as well as studies of women in the general population (either without these conditions or who were not specified to have these conditions). Hormonal contraceptives of interest included progestin-only pills (POPs), injectables, implants, and levonorgestrel-releasing intrauterine devices (LNG-IUDs). Outcomes of interest included VTE, stroke and AMI. RESULTS: There were 26 articles of good to poor quality that met inclusion criteria; 9 studies examined women with medical conditions and 20 examined women in the general population. Two studies found that among smokers and women with certain thrombogenic mutations, use of depot medroxyprogesterone acetate (DMPA) had elevated odds of VTE compared with non-smokers or those without mutations, although confidence intervals were wide and overlapped with odds among non-users. One study found that among women with previous VTE, use of POCs (including DMPA) was associated with a non-significant increased odds of recurrent VTE (all of which were among DMPA users); two other studies that examined POCs other than DMPA did not observe an association with recurrent VTE. Two studies found that use of DMPA among healthy women was also associated with increased odds of VTE. Two studies found that use of POCs for therapeutic indications was associated with increased odds of VTE. Studies did not find increased odds of VTE with POPs for contraceptive purposes, implants or LNG-IUDs, nor were there increased odds of stroke or AMI with any POCs. CONCLUSION: The majority of evidence identified by this systematic review did not suggest an increase in odds for venous or arterial events with use of most POCs. Limited evidence suggested increased odds of VTE with use of injectables (three studies) and use of POCs for therapeutic indications (two studies, one with POCs unspecified and the other with POPs). Any increase in risk likely translates to a small increase in absolute numbers of thrombotic events at the population level. |
Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil - 2011
Mpofu JJ , de Moura L , Farr SL , Malta DC , Iser BM , Ivata Bernal RT , Robbins CL , Lobelo F . Prev Med Rep 2016 3 333-337 Background: Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil. Methods: We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18-44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates. Results: Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1-1.2)), smoking (aRR = 1.7 (1.3-2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6-2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1-1.2)), smoking (aRR = 1.4 (1.1-1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1-1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors. Conclusion: Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil. © 2016.Published by Elsevier Inc. |
Vital Signs: National and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2-5 Years - United States, 2008-2014
Visser SN , Danielson ML , Wolraich ML , Fox MH , Grosse SD , Valle LA , Holbrook JR , Claussen AH , Peacock G . MMWR Morb Mortal Wkly Rep 2016 65 (17) 443-50 BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is associated with adverse outcomes and elevated societal costs. The American Academy of Pediatrics (AAP) 2011 guidelines recommend "behavior therapy" over medication as first-line treatment for children aged 4-5 years with ADHD; these recommendations are consistent with current guidelines from the American Academy of Child and Adolescent Psychiatry for younger children. CDC analyzed claims data to assess national and state-level ADHD treatment patterns among young children. METHODS: CDC compared Medicaid and employer-sponsored insurance (ESI) claims for "psychological services" (the procedure code category that includes behavior therapy) and ADHD medication among children aged 2-5 years receiving clinical care for ADHD, using the MarketScan commercial database (2008-2014) and Medicaid (2008-2011) data. Among children with ESI, ADHD indicators were compared during periods preceding and following the 2011 AAP guidelines. RESULTS: In both Medicaid and ESI populations, the percentage of children aged 2-5 years receiving clinical care for ADHD increased over time; however, during 2008-2011, the percentage of Medicaid beneficiaries receiving clinical care was double that of ESI beneficiaries. Although state percentages varied, overall nationally no more than 55% of children with ADHD received psychological services annually, regardless of insurance type, whereas approximately three fourths received medication. Among children with ESI, the percentage receiving psychological services following release of the guidelines decreased significantly by 5%, from 44% in 2011 to 42% in 2014; the change in medication treatment rates (77% in 2011 compared with 76% in 2014) was not significant. CONCLUSIONS AND COMMENTS: Among insured children aged 2-5 years receiving clinical care for ADHD, medication treatment was more common than receipt of recommended first-line treatment with psychological services. Among children with ADHD who had ESI, receipt of psychological services did not increase after release of the 2011 guidelines. Scaling up evidence-based behavior therapy might lead to increased delivery of effective ADHD management without the side effects of ADHD medications. |
Reasons for electronic nicotine delivery system use and smoking abstinence at 6 months: A descriptive study of callers to employer and health plan-sponsored quitlines
Vickerman KA , Schauer GL , Malarcher AM , Zhang L , Mowery P , Nash CM . Tob Control 2016 26 (2) 126-134 OBJECTIVE: Describe cigarette smoking abstinence among employer and health plan-sponsored quitline registrants who were not using Electronic Nicotine Delivery Systems (ENDS), were using ENDS to quit smoking or were using ENDS for other reasons at the time of quitline registration. METHODS: We examined 6029 quitline callers aged ≥18 years who smoked cigarettes at registration, and completed ≥1 counselling calls, baseline ENDS use questions and a 6-month follow-up survey (response rate: 52.4%). 30-day point prevalence smoking quit rates (PPQRs) were assessed at 6-month follow-up (ENDS-only users were considered quit). Data were weighted for non-response bias. Logistic regression analyses controlled for participant characteristics and programme engagement. RESULTS: At registration, 13.8% of respondents used ENDS (7.9% to quit smoking, 5.9% for other reasons). 30-day PPQRs were: 55.1% for callers using ENDS to quit, 43.1% for callers using ENDS for other reasons, and 50.8% for callers not using ENDS at registration. Callers using ENDS for other reasons were less likely to quit than other groups (adjusted ORs=0.65-0.77); quit rates did not significantly differ between non-ENDS users and those using ENDS to quit. Among callers using ENDS to quit at baseline, 40% used ENDS regularly at follow-up. CONCLUSIONS: ENDS users not using ENDS to quit smoking were less successful at quitting at 6-month follow-up compared with callers using ENDS to quit smoking and callers who did not use ENDS at programme registration. Incorporating reasons for ENDS use may be important for future studies examining the role of ENDS in tobacco cessation. |
Temporal trends of secondhand smoke exposure: Nonsmoking workers in the United States (NHANES 2001-2010)
Wei B , Bernert JT , Blount BC , Sosnoff CS , Wang L , Richter P , Pirkle JL . Environ Health Perspect 2016 124 (10) 1568-1574 BACKGROUND: The workplace is one of the major locations outside of the home for nonsmokers' exposure to secondhand smoke (SHS). New policies in many states and localities restrict or prohibit smoking in the worksites and information on current trends in the exposure of nonsmokers to SHS across various occupational groups is therefore needed. OBJECTIVE: To evaluate temporal trends in SHS exposure among nonsmoking workers in the United States, and identify those occupations with workers with the highest levels of SHS exposure. METHODS: We combined serum cotinine (sCOT) measurements and questionnaire data from five survey cycles of the National Health and Nutrition Examination Survey (NHANES: 2001-2010). Trends of SHS exposure by occupations were examined by percent changes and least-squares geometric means (LSGMS) of sCOT concentrations computed using sample-weighted multiple regression models. RESULTS: Between NHANES 2001-02 and 2009-10, LSGMs of sCOT levels had changed -25% (95% CI: -39, -7%) in nonsmoking workers. The largest decrease was identified among food preparation workers -54% (95% CI: -74, -19%), followed by white collar (-40%, 95% CI: -56, -19%) and blue collar workers (-32%, 95% CI: -51, -5%). LSGMs of sCOT remained highest in food preparation workers in all survey cycles, but the gap between occupations narrowed in the latest survey cycle (2009-10). For instance, the gap in LSGMs of sCOT between food preparation and science/education workers dropped above 70% during 2000 to 2010. CONCLUSIONS: During the period from 2001 to 2010, the overall SHS exposure in nonsmoking workers has declined with substantial decline in food preparation/service and blue-collar workers. Although disparities persist in SHS exposure, the gap among occupations has narrowed. |
E-cigarette curiosity among U.S. middle and high school students: findings from the 2014 national youth tobacco survey
Margolis KA , Nguyen AB , Slavit WI , King BA . Prev Med 2016 89 1-6 Curiosity is a potential risk factor for electronic cigarette (e-cigarette) use, which has increased considerably among US youth in recent years. We examined the relationship between curiosity about e-cigarettes and perceived harm, comparative addictiveness, and e-cigarette advertisement exposure. Data came from the 2014 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students. In 2014, 2.5% of middle school and 9.2% of high school students currently used cigarettes, while 3.9% of middle school and 13.4% of high school students reported current e-cigarette use. Among never e-cigarette users (n=17,286), descriptive statistics assessed curiosity about e-cigarettes by combustible tobacco use, sex, race/ethnicity, and school level. Associations between curiosity and perceived harm (absolute and comparative to cigarettes), comparative addictiveness, and e-cigarette advertising exposure were explored using multivariate models in 2015. Among youth who never used e-cigarettes, 25.8% reported curiosity about e-cigarettes. Higher levels of perceived absolute harm and comparative harm were associated with lower levels of curiosity, while no association was observed between comparative addictiveness and curiosity. Among never combustible tobacco users, the odds of high curiosity were greater among non-Hispanic blacks (odds ratio (OR): 1.39; 95% confidence interval (CI):1.02-1.88), Hispanics (OR=1.79; 95% CI:1.48-2.16), and non-Hispanic 'Other' (OR=1.47; 95% CI:1.15-1.89) race/ethnicities than non-Hispanic whites. One-quarter of middle and high school students who have never used e-cigarettes are curious about the products, with greater curiosity among those with lower perceptions of harm from these products. These findings may help inform future strategies aimed at reducing curiosity about e-cigarettes among youth. |
Electron microscopic analysis of silicate and calcium particles in cigarette smoke tar
Pappas RS , Halstead MM , Watson CH . Int J Respir Pulm Med 2016 3 (1) Scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM-EDS) supplies information that is complementary to those data traditionally obtained using inductively coupled plasma-mass spectrometry for analysis of inorganic tobacco and tobacco smoke constituents. The SEM-EDS approach was used to identify select inorganic constituents of mainstream cigarette smoke "tar." The nature of SEM-EDS instrumentation makes it an ideal choice for microstructural analyses as it provides information relevant to inorganic constituents that could result from exposure to combusted tobacco products. Our analyses show that aluminum silicates, silica, and calcium compounds were common constituents of cigarette mainstream smoke "tar." Identifying inorganic tobacco smoke constituents is important because inhalation of fine inorganic particles could lead to inflammatory responses in the lung and systemic inflammatory responses. As cigarette smoking causes chronic inflammation in the respiratory tract, information on inorganic particulate in mainstream smoke informs efforts to determine causative agents associated with increased morbidity and mortality from tobacco use. |
Sentinel animals in a one health approach to harmful cyanobacterial and algal blooms
Backer LC , Miller M . Vet Sci 2016 3 (2) 8 People, domestic animals, and wildlife are all exposed to numerous environmental threats, including harmful algal blooms (HABs). However, because animals exhibit wide variations in diet, land use and biology, they are often more frequently or heavily exposed to HAB toxins than are people occupying the same habitat, making them sentinels for human exposures. Historically, we have taken advantage of unique physiological characteristics of animals, such as the sensitivity of canaries to carbon monoxide, to more quickly recognize threats and help protect human health. As HAB events become more severe and widespread worldwide, exposure and health outcome data for animals can be extremely helpful to predict, prevent, and evaluate human exposures and health outcomes. Applying a One Health approach to investigation of HABs means that lessons learned from animal sentinels can be applied to protect people, animals and our shared environment. |
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