Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61
Carroll DD , Blanck HM , Serdula MK , Brown DR . J Aging Health 2010 22 (3) 384-98 OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline. METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women ≥ 4, men ≥ 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status. RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998. DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression. |
Quantifying the association of radiographic osteoarthritis in knee or hip joints with other knees or hips: the Johnston County Osteoarthritis Project
Sayre EC , Jordan JM , Cibere J , Murphy L , Schwartz TA , Helmick CG , Renner JB , Rahman MM , Aghajanian J , Kang W , Badley EM , Kopec JA . J Rheumatol 2010 37 (6) 1260-5 OBJECTIVE: To quantify the association of radiographic osteoarthritis (ROA) in one knee or hip joint with other knee or hip joints. METHODS: We analyzed baseline data from the Johnston County Osteoarthritis Project (n = 3068). We fit 4 models for left/right knee/hip. The Kellgren-Lawrence (KL) radiographic grade severity scale was KL 0/1 (no/questionable ROA), 2 (mild ROA), or 3/4 (moderate/severe ROA). We estimated associations between KL grade in contralateral joints and other joint sites (e.g., worst hip in knee models), adjusting for sex, race/ethnicity (African American/white), age, and measured body mass index, using cumulative odds logistic regression models. Interactions were investigated: race/ethnicity by sex; race/ethnicity and sex by the 2 explanatory variables. RESULTS: Contralateral joint KL grade was strongly associated with KL grade, with OR ranging from 9.2 (95% CI 7.1, 11.9) to 225.0 (95% CI 83.6, 605.7). In the left knee model, the contralateral joint association was stronger among African Americans than whites, but for the other models the associations by race/ethnicity were identical. Models examining other joint sites showed weaker but mostly statistically significant associations (OR 1.4 to 1.8). CONCLUSION: We found a strong multivariable-adjusted association between KL grades in contralateral knees and hips, and a modest association with the other joint site (e.g., knees vs hips). These results suggest that diagnosis of ROA in 1 large joint may be a marker for risk of multijoint ROA, and warrant interventions to reduce the incidence or severity of ROA at these other joints. |
Differences in the prevalence and severity of arthritis among racial/ethnic groups in the United States, National Health Interview Survey, 2002, 2003, and 2006
Bolen J , Schieb L , Hootman JM , Helmick CG , Theis K , Murphy LB , Langmaid G . Prev Chronic Dis 2010 7 (3) A64 We describe the prevalence of doctor-diagnosed arthritis and its impact on activities, work, and joint pain for 6 racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, American Indians/Alaska Natives, Asians and Pacific Islanders, and multiracial or "other" respondents. We combined data from the 2002, 2003, and 2006 National Health Interview Survey (n = 85,784) and, after adjusting for age, sex, and body mass index, compared racial/ethnic differences. Arthritis-attributable activity limitation, arthritis-attributable work limitation, and severe joint pain were higher for non-Hispanic blacks, Hispanics, and multiracial or other respondents with arthritis compared with non-Hispanic whites with arthritis. Our finding that arthritis disproportionately affects certain racial/ethnic minorities may be useful for planning interventions. |
Treatment of latent tuberculosis infection: an update
Lobue P , Menzies D . Respirology 2010 15 (4) 603-22 Isoniazid (INH) has been the mainstay of treatment of latent tuberculosis infection for almost 50 years. The currently recommended preferred regimen is 9 months daily self-administered INH (9H); this has efficacy of more than 90% if completed properly. Unfortunately, INH is associated with serious adverse events, including hepatotoxicity. Although risk factors for this complication are well established, allowing for better selection of candidates for therapy, this complication still occurs, and is occasionally fatal. Hence close follow up of patients is necessary, increasing the cost and complexity of treatment. This problem, plus the lengthy duration, results in poor acceptance by patients and providers, and poor adherence by patients. As a result, many preventable cases of tuberculosis continue to occur, and the public health impact of latent tuberculosis infection treatment is suboptimal. These problems have spurred interest in finding shorter, safer and cheaper alternative regimens, with similar efficacy. Of the many regimens that have been examined, 2 months of rifampin and pyrazinamide has excellent efficacy-in experimental studies in mice and randomized trials, largely in HIV-infected persons. However, while the safety of 2 months of rifampin and pyrazinamide appears acceptable in HIV-infected persons and children, in non-HIV-infected adults this regimen is associated with an unacceptably high rate of severe liver toxicity. Three to four months of INH and rifampin has had equivalent effectiveness as 6 months INH in several randomized trials. However, completion of therapy and toxicity has been the same as with INH-possibly because two drugs are taken rather than one. The fourth commonly studied regimen is 4 months rifampin. This has been found to have significantly better completion than 9H, with significantly less toxicity, especially hepatotoxicity. However, only one trial has evaluated efficacy and effectiveness of mono-rifampin therapy. In this trial, 3 months rifampin had somewhat better efficacy than either 3 months of isoniazid and rifampin (3HR) or 6 months isoniazid. Two large scale trials are ongoing; one is comparing efficacy and effectiveness of 9H with 4 months rifampin (both daily and self-administered), while the second, which is nearing completion, compares daily self-administered 9H with 3 months directly observed once weekly INH combined with rifapentine. The results of these two trials will likely shape future recommendations substantially. |
Measles outbreak associated with an international youth sporting event in the United States, 2007
Chen TH , Kutty P , Lowe LE , Hunt EA , Blostein J , Espinoza R , Dykewicz CA , Redd S , Rota JS , Rota PA , Lute JR , Lurie P , Nguyen MD , Moll M , Reef SE , Sinclair JR , Bellini WJ , Seward JF , Ostroff SM . Pediatr Infect Dis J 2010 29 (9) 794-800 BACKGROUND: Despite elimination of endemic measles in the United States (US), outbreaks associated with imported measles continue to occur. In 2007, the initiation of a multistate measles outbreak was associated with an imported case occurring in a participant at an international youth sporting event held in Pennsylvania. METHODS: Case finding and contact tracing were conducted. Control measures included isolating ill persons and administering postexposure prophylaxis to exposed persons without documented measles immunity. Laboratory evaluation of suspected cases and contacts included measles serologic testing, viral culture, detection of viral RNA by reverse-transcription polymerase chain reaction, and viral genotyping. RESULTS: The index case occurred in a child from Japan aged 12 years. Contact tracing among 1250 persons in 8 states identified 7 measles cases; 5 (71%) cases occurred among persons without documented measles vaccination. Epidemiologic and laboratory investigation supported a single chain of transmission, linking the outbreak to contemporaneous measles virus genotype D5 transmission in Japan. Of the 471 event participants, 193 (41%) lacked documentation of presumed measles immunity, 94 (49%) of 193 were US-resident adults, 19 (10%) were non-US-resident adults (aged >18 years), and 80 (41%) were non-US-resident children. DISCUSSION: Measles outbreaks associated with imported disease are likely to continue in the US. Participants in international events, international travelers, and persons with routine exposure to such travelers might be at greater risk of measles. To reduce the impact of imported cases, high measles, mumps, and rubella vaccine coverage rates should be maintained throughout the US, and support should continue for global measles control and elimination. |
Methicillin-resistant Staphylococcus aureus carriage and risk factors for skin infections, Southwestern Alaska, USA
Stevens AM , Hennessy T , Baggett HC , Bruden D , Parks D , Klejka J . Emerg Infect Dis 2010 16 (5) 797-803 Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are common in southwestern Alaska. Outbreak strains have been shown to carry the genes for Panton-Valentine leukocidin (PVL). To determine if carriage of PVL-positive CA-MRSA increased the risk for subsequent soft tissue infection, we conducted a retrospective cohort study by reviewing the medical records of 316 persons for 3.6 years after their participation in a MRSA nasal colonization survey. Demographic, nasal carriage, and antimicrobial drug use data were analyzed for association with skin infection risk. Skin infections were more likely to develop in MRSA carriers than in methicillin-susceptible S. aureus carriers or noncarriers of S. aureus during the first follow-up year, but not in subsequent years. Repeated skin infections were more common among MRSA carriers. In an area where PVL-containing MRSA is prevalent, skin infection risk was increased among MRSA nasal carriers compared with methicillin-susceptible S. aureus carriers and noncarriers, but risk differential diminished over time. |
Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States
Siston AM , Rasmussen SA , Honein MA , Fry AM , Seib K , Callaghan WM , Louie J , Doyle TJ , Crockett M , Lynfield R , Moore Z , Wiedeman C , Anand M , Tabony L , Nielsen CF , Waller K , Page S , Thompson JM , Avery C , Springs CB , Jones T , Williams JL , Newsome K , Finelli L , Jamieson DJ . JAMA 2010 303 (15) 1517-25 CONTEXT: Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death. OBJECTIVE: To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States. DESIGN, SETTING, AND PATIENTS: Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009. MAIN OUTCOME MEASURES: Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset. RESULTS: We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC's continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%); CONCLUSIONS: Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths. |
Prevalence of transmitted drug resistance associated mutations and HIV-1 subtypes in new HIV-1 diagnoses, U.S.-2006
Wheeler WH , Ziebell RA , Zabina H , Pieniazek D , Prejean J , Bodnar UR , Mahle KC , Heneine W , Johnson JA , Hall HI . AIDS 2010 24 (8) 1203-12 OBJECTIVE: To determine the distribution of HIV-1 subtypes and the prevalence of transmitted drug resistance-associated mutations (TDRM) among persons newly diagnosed with HIV-1 infection in the United States. METHODS: We used sequence data from Variant, Atypical, and Resistant HIV Surveillance (VARHS) collected from newly diagnosed persons in 10 states and 1 county health department in 2006. To evaluate TDRM, we used a mutation list for surveillance of TDRM appropriate for the primarily subtype B HIV epidemic in the United States. RESULTS: Sequences were obtained from 2030 of 10 860 persons newly diagnosed with HIV in 11 surveillance areas. Mutations associated with transmitted drug resistance occurred in 292 (14.6%) persons; TDRM associated with a specific drug class occurred in 156 (7.8%) for non-nucleoside reverse transcriptase inhibitors, 111 (5.6%) for nucleoside reverse transcriptase inhibitors and 90 (4.5%) for protease inhibitors. There were no significant differences in prevalence of TDRM by demographic characteristic. The HIV-1 subtype B was the most prevalent subtype occurring in 1922 (96.2%) persons; subtype C (1.3%) was the most prevalent non-B subtype. CONCLUSION: We presented a clade B-optimized mutation list for evaluating surveillance of TDRM in the United States and analyzed the largest collection of sequence data obtained from individuals newly diagnosed with HIV. The prevalence of TDRM in persons newly diagnosed with HIV is higher than in previous U.S. studies; however, this is not necessarily a significant trend. Continued reporting of sequence data for public health purposes from all sources will improve representativeness and accuracy in analyzing trends in transmitted drug resistance and genetic diversity. |
Estimation of HIV-1 incidence among five focal populations in Dehong, Yunnan: a hard hit area along a major drug trafficking route
Duan S , Shen S , Bulterys M , Jia Y , Yang Y , Xiang L , Tian F , Lu L , Xiao Y , Wang M , Jia M , Jiang H , Vermund SH , Jiang Y . BMC Public Health 2010 10 180 BACKGROUND: Since 1989 when the first 146 HIV positives in China were identified, Dehong Prefecture had been one of the areas hardest-hit by HIV in China. The local and national governments have put substantial financial resources into tackling the HIV epidemic in Dehong from 2004. The objective of this study was to track dynamic changes in HIV-1 prevalence and incidence among five focal populations in Dehong and to assess the impact of HIV prevention and control efforts. METHODS: Consecutive cross-sectional surveys conducted in five focal populations between 2004 and 2008. Specimens seropositive for HIV were tested with the BED IgG capture enzyme immunoassay to identify recent seroconversions (median, 155 days) using normalized optical density of 0.8 and adjustments. RESULTS: From 2004 to 2008, estimated annual HIV incidence among injecting drug users (IDUs) decreased significantly [from 15.0% (95% CI = 11.4%-18.5%) in 2004 to 4.3% (95% CI = 2.4%-6.2%) in 2008; trend test P < 0.0001]. The incidence among other focal populations, such as HIV discordant couples (varying from 5.5% to 4.7%), female sex workers (varying from 1.4% to 1.3%), pregnant women (0.1%), and pre-marital couples (0.2 to 0.1%) remained stable. Overall, the proportion of recent HIV-1 infections was higher among females than males (P < 0.0001). CONCLUSIONS: The HIV epidemic in Dehong continued to expand during a five-year period but at a slowing rate among IDUs, and HIV incidence remains high among IDUs and discordant couples. Intensive prevention measures should target sub-groups at highest risk to further slow the epidemic and control the migration of HIV to other areas of China, and multivariate analysis is needed to explore which measures are more effective for different populations. |
Association of 2009 pandemic influenza A (H1N1) infection and increased hospitalization with parapneumonic empyema in children in Utah
Ampofo K , Herbener A , Blaschke AJ , Heyrend C , Poritz M , Korgenski K , Rolfs R , Jain S , Carvalho MD , Pimenta FC , Daly J , Mason EO , Byington CL , Pavia AT . Pediatr Infect Dis J 2010 29 (10) 905-9 BACKGROUND: During previous influenza pandemics, many deaths were associated with secondary bacterial infection. In April 2009, a previously unknown 2009 influenza A virus (2009 H1N1) emerged, causing a global influenza pandemic. We examined the relationship between circulating 2009 H1N1 and the occurrence of secondary bacterial parapneumonic empyema in children. METHODS: Children hospitalized with parapneumonic empyema from August 2004 to July 2009, including a period when the 2009 H1N1 circulated in Utah, were identified using International Classification of Diseases, Ninth Revision codes. We compared the average number of children diagnosed with influenza A and the number of admissions for empyema per month for the previous 4 seasons to rates of empyema during the 2009 H1N1 outbreak. We identified causative bacteria using culture and polymerase chain reaction (PCR). RESULTS: We observed an increase in hospitalization of children with pneumonia complicated by empyema during a severe outbreak of 2009 H1N1 during the spring and summer of 2009, compared with historical data for the previous 4 seasons. Streptococcus pneumoniae and Streptococcus pyogenes were the predominant bacteria identified. CONCLUSIONS: Similar to previous pandemics, secondary bacterial infection with S. pneumoniae and S. pyogenes were associated with the 2009 H1N1 outbreak. There is an urgent need to better understand bacterial complications of pandemic influenza. In the interim, influenza vaccines, antiviral agents, and pneumococcal vaccines should be used to prevent cases of secondary bacterial pneumonia whenever possible. |
Deaths from seasonal influenza among pregnant women in the United States, 1998-2005
Callaghan WM , Chu SY , Jamieson DJ . Obstet Gynecol 2010 115 (5) 919-23 OBJECTIVE: To estimate pregnancy-related mortality caused by seasonal influenza in the United States for comparison with the current 2009 influenza A H1N1 pandemic. METHODS: Pregnancy-related deaths were identified in the U.S. Centers for Disease Control and Prevention's (CDC) Pregnancy Mortality Surveillance System (PMSS) database for the years 1998-2005. PMSS collects de-identified copies of vital records supplied by all 50 states, the District of Columbia, and New York City for women who died during or within 1 year after pregnancy. Records in the database broadly classified under deaths due to respiratory infections were identified, and the corresponding archived death certificates were individually reviewed to classify the cause of death as pneumonia or influenza. RESULTS: Between 1998 and 2005, 4,693 pregnancy-related deaths were reported to CDC. Of these, 78 women died from influenza or pneumonia; 40 of these deaths occurred during an influenza season. Nearly 75% of deaths occurred during or within 2 weeks of the end of the pregnancy. CONCLUSION: On average, five possible influenza-related deaths among pregnant women were reported per year before the emergence of pregnancy-related deaths due to the current H1N1 pandemic compared with the 28 laboratory-confirmed, pregnancy-related deaths reported for the first 4 months of the 2009 pandemic. This highlights the excess mortality among pregnant women resulting from this pandemic influenza virus. |
Increasing colorectal cancer screening in South Dakota
Seeff L , Schmidt N . S D Med 2010 Spec No 49-51 Colorectal cancer is the second-leading cause of cancer | deaths among U.S. adults among cancers that affect both | men and women, and primarily affects persons age 50 and | older.1 In 2005, more than 141,000 new cases of colorectal | cancer were diagnosed across the U.S., and 53,000 people | died from the disease.1 | Screening for colorectal cancer has a tremendous potential | to save lives. It is estimated that 76 to 90 percent of new | colorectal cancer cases would be reduced, and 70 to 90 percent | of colorectal cancer deaths reduced if all precancerous | colorectal polyps were identified and removed.2,3 Most | colorectal cancers develop from precancerous polyps, or | growths inside the colon, which slowly develop into | colorectal cancer. Screening tests can identify and remove | polyps, preventing the development of colorectal cancer | altogether, and can also detect early cancers, which can be | treated more effectively and at a lesser cost. Unrealized | financial savings are also possible through the prevention | and earlier detection of colorectal cancer. |
Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study
Johnson VR , Jacobson KL , Gazmararian JA , Blake SC . Patient Educ Couns 2010 79 (1) 14-24 OBJECTIVE: To explore whether social support helps patients with limited health literacy adhere to their medication regimens. METHODS: We interviewed 275 pharmacy patients and assessed social support's influence on medication adherence for those with limited vs. adequate health literacy. We talked with patients (n=26) and pharmacists (n=7) to explore possible explanations for the quantitative findings. RESULTS: Social support was associated with better medication adherence for patients with adequate health literacy but not those with limited health literacy (p<0.05). When individual subscales for social support were analyzed, having a trusted confidant was the only type of social support associated with better medication adherence for limited-literacy patients (p<0.05). Comments from patients and pharmacists suggest that limited-literacy patients were less likely to ask the pharmacists questions and infrequently brought relatives with them to the pharmacy. CONCLUSION: Unless they have a trusted confidant, limited-literacy patients might be reluctant to ask others for the kind of help needed to take their medicines correctly. PRACTICE IMPLICATIONS: Pharmacists need training to increase their awareness of limited health literacy and to communicate effectively with all patients, regardless of their literacy skills. To succeed, pharmacists also need the support of the health care systems where they work. |
Schistosomiasis among recreational users of Upper Nile River, Uganda, 2007
Morgan OW , Brunette G , Kapella BK , McAuliffe I , Katongole-Mbidde E , Li W , Marano N , Okware S , Olsen SJ , Secor WE , Tappero JW , Wilkins PP , Montgomery SP . Emerg Infect Dis 2010 16 (5) 866-8 After recreational exposure to river water in Uganda, 12 (17%) of 69 persons had evidence of schistosome infection. Eighteen percent self-medicated with praziquantel prophylaxis immediately after exposure, which was not appropriate. Travelers to schistosomiasis-endemic areas should consult a travel medicine physician. |
Outbreak of giardiasis associated with a community drinking-water source
Daly ER , Roy SJ , Blaney DD , Manning JS , Hill VR , Xiao L , Stull JW . Epidemiol Infect 2010 138 (4) 491-500 Giardiasis is a common waterborne gastrointestinal illness. In 2007, a community giardiasis outbreak occurred in New Hampshire, USA. We conducted a cohort study to identify risk factors for giardiasis, and stool and environmental samples were analysed. Consuming tap water was significantly associated with illness (risk ratio 4.7, 95% confidence interval 1.5-14.4). Drinking-water samples were coliform-contaminated and a suspect Giardia cyst was identified in a home water filter. One well was coliform-contaminated, and testing indicated that it was potentially under the influence of surface water. The well was located 12.5 m from a Giardia-contaminated brook, although the genotype differed from clinical specimens. Local water regulations require well placement at least 15 m from surface water. This outbreak, which caused illness in 31 persons, represents the largest community drinking-water-associated giardiasis outbreak in the USA in 10 years. Adherence to well placement regulations might have prevented this outbreak. |
PM2.5 and CO concentrations inside an indoor go-kart facility
Kim T , Wagner J . J Occup Environ Hyg 2010 7 (7) 397-406 Three acute cardiovascular events within a 4-month period among drivers at an indoor go-kart arena prompted a visit to assess the magnitude of potentially hazardous air pollutant levels within the facility and help identify control measures. Carbon monoxide (CO) and particulate matter with aerodynamic diameters < 2.5 microm (PM2.5) were measured with personal, continuous-reading instruments to capture their spatial and temporal variability. Average driver and track CO levels during the sampling visit were comparable to state standards for worker exposures and exceeded some health-based guidelines. Average PM2.5 levels were low compared with regulatory standards, but transient PM2.5 peaks of unknown health impact were observed. Driver exposures were modestly but significantly higher than track concentrations measured by stationary monitors and substantially higher than outdoor concentrations. Driver exposures were partitioned into three components, attributed to (1) outdoor pollutants that were drawn unfiltered into the facility, (2) the persistent track cloud from previous races, and (3) proximity to the exhausts of other go-karts while driving in a race. Track cloud and tailpipe proximity components were the dominant contributors to driver CO exposure. The track cloud component lagged the number of go-karts on the track by 10-15 min. The dominant contributor to driver PM2.5 exposure was either the track cloud or outdoor component, depending on how many go-karts were racing simultaneously on the track. Transient spikes in PM2.5 were caused by proximity to other karts' tailpipes during passing events. Recommended methods for decreasing the track cloud component include modifying the ventilation system, race schedules, and number of go-karts racing simultaneously. The tailpipe proximity component can be reduced only by modifying go-kart exhausts or engines. This work represents a brief, limited sampling visit to a single facility, but it demonstrates the levels that are possible on a fairly high-usage afternoon. Future studies should be conducted to assess representative go-kart facility exposures at multiple facilities on multiple days. |
Postmortem blood cadmium, lead, and mercury concentrations: comparisons with regard to sampling location and reference ranges for living persons
Schier JG , Heninger M , Wolkin A , Kieszak S , Caldwell KL , Fajardo GC , Jones R , Rubin C , Hanzlick R , Osterloh JD , McGeehin MA . J Anal Toxicol 2010 34 (3) 129-34 This study's goal was to determine cadmium (Cd), lead (Pb), total mercury (THg), and inorganic mercury (IHg) levels in human cadavers to compare measured levels with established reference ranges for living persons and to determine whether blood levels varied with time from death to sample collection or by body collection site. Subjects (n = 66) recruited from the Fulton County Medical Examiner's Office in Atlanta, GA, were 20 years of age or older, had no penetrating trauma, no obvious source of environmental contamination of the vasculature, and had whole blood accessible from the femoral (F) site, the cardiac (C) site, or both. Geometric mean results were as follows: 2.59 microg/L F-Cd; 11.81 microg/L C-Cd; 1.03 microg/L F-THg; 2.01 microg/L C-THg; 0.29 microg/L F-IHg; 0.49 microg/L C-IHg; 1.78 microg/dL F-Pb; and 1.87 microg/dL C-Pb. Both F- and C-Cd levels as well as C-THg levels were significantly higher than reference values among living persons (C- and F-Cd, p < 0.0001 and C-THg, p = 0.0001, respectively). Based on regression modeling, as the postmortem interval increased, blood Cd levels increased (p < 0.006). Postmortem blood Cd concentrations were elevated compared to population values and varied with respect to sampling location and postmortem interval. |
Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995-2004
Zhang X , Decker FH , Luo H , Geiss LS , Pearson WS , Saaddine JB , Gregg EW , Albright A . J Am Geriatr Soc 2010 58 (4) 724-30 OBJECTIVES: To estimate trends in the prevalence and comorbidities of diabetes mellitus (DM) in U.S. nursing homes from 1995 to 2004. DESIGN: SAS callable SUDAAN was used to adjust for the complex sample design and assess changes in prevalence of DM and comorbidities during the study period in the National Nursing Home Surveys. Trends were assessed using weighted least squares linear regression. Multiple logistic regressions were used to calculate predictive margins. SETTING: A continuing series of two-stage, cross-sectional probability national sampling surveys. PARTICIPANTS: Residents aged 55 and older: 1995 (n=7,722), 1997 (n=7,717), 1999 (n=7,809), and 2004 (n=12,786). MEASUREMENTS: DM and its comorbidities identified using a standard set of diagnosis codes. RESULTS: The estimated crude prevalence of DM increased from 16.9% in 1995 to 26.4% in 2004 in male nursing home residents and from 16.1% to 22.2% in female residents (all P<.05). Male and female residents aged 85 and older and those with high functional impairment showed a significant increasing trend in DM (all P<.05). In people with DM, multivariate-adjusted prevalence of cardiovascular disease increased from 59.6% to 75.4% for men and from 68.1% to 78.7% for women (all P<.05). Prevalence of most other comorbidities did not increase significantly. CONCLUSION: The burden of DM in residents of U.S. nursing homes has increased since 1995. This could be due to increasing DM prevalence in the general population or to changes in the population that nursing homes serve. Nursing home care practices may need to change to meet residents' changing needs. |
Quantitative analysis and molecular fingerprinting of methicillin-resistant Staphylococcus aureus nasal colonization in different patient populations: a prospective, multicenter study
Mermel LA , Eells SJ , Acharya MK , Cartony JM , Dacus D , Fadem S , Gay EA , Gordon S , Lonks JR , Perl TM , McDougal LK , McGowan JE , Maxey G , Morse D , Tenover FC . Infect Control Hosp Epidemiol 2010 31 (6) 592-7 OBJECTIVES: To better understand the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in different patient populations, to perform quantitative analysis of MRSA in nasal cultures, and to characterize strains using molecular fingerprinting. DESIGN: Prospective, multicenter study. SETTING: Eleven different inpatient and outpatient healthcare facilities. PARTICIPANTS: MRSA-positive inpatients identified in an active surveillance program; inpatients and outpatients receiving hemodialysis; inpatients and outpatients with human immunodeficiency virus (HIV) infection; patients requiring cardiac surgery; and elderly patients requiring long-term care. METHODS: Nasal swab samples were obtained from January 23, 2006, through July 27, 2007; MRSA strains were quantified and characterized by molecular fingerprinting. RESULTS: A total of 444 nares swab specimens yielded MRSA (geometric mean quantity, 794 CFU per swab; range, 3-15,000,000 CFU per swab). MRSA prevalence was 20% for elderly residents of long-term care facilities (25 of 125 residents), 16% for HIV-infected outpatients (78 of 494 outpatients), 15% for outpatients receiving hemodialysis (31 of 208 outpatients), 14% for inpatients receiving hemodialysis (86 of 623 inpatients), 3% for HIV-infected inpatients (5 of 161 inpatients), and 3% for inpatients requiring cardiac surgery (6 of 199 inpatients). The highest geometric mean quantity of MRSA was for inpatients requiring cardiac surgery (11,500 CFU per swab). An association was found between HIV infection and colonization with the USA300 or USA500 strain of MRSA ([Formula: see text]). The Brazilian clone was found for the first time in the United States. Pulsed-field gel electrophoresis patterns for 11 isolates were not compatible with known USA types or clones. CONCLUSION: Nasal swab specimens positive for MRSA had a geometric mean quantity of 794 CFU per swab, with great diversity in the quantity of MRSA at this anatomic site. Outpatient populations at high risk for MRSA carriage were elderly residents of long-term care facilities, HIV-infected outpatients, and outpatients receiving hemodialysis. |
Geospatial distribution and determinants of child mortality in rural western Kenya 2002-2005
Ombok M , Adazu K , Odhiambo F , Bayoh N , Kiriinya R , Slutsker L , Hamel MJ , Williamson J , Hightower A , Laserson KF , Feikin DR . Trop Med Int Health 2010 15 (4) 423-33 OBJECTIVE: To describe local geospatial variation and geospatial risk factors for child mortality in rural western Kenya. METHODS: We calculated under-5 mortality rates (U5MR) in 217 villages in a Health and Demographic Surveillance System (HDSS) area in western Kenya from 1 May 2002 through 31 December 2005. U5MRs by village were mapped. Geographical positioning system coordinates of residences at the time of death and distances to nearby locations were calculated. Multivariable Poisson regression accounting for clustering at the compound level was used to evaluate the association of geospatial factors and mortality for infants and children aged 1-4 years. RESULTS: Among 54 057 children, the overall U5MR was 56.5 per 1000 person-years and varied by village from 21 to 177 per 1000 person-years. High mortality villages occurred in clusters by location and remained in the highest mortality quintile over several years. In multivariable analysis, controlling for maternal age and education as well as household crowding, higher infant mortality was associated with living closer to streams and further from public transport roads. For children 1-4 years, living at middle elevations (1280-1332 metres), living within lower population densities areas, and living in the northern section of the HDSS were associated with higher mortality. CONCLUSIONS: Childhood mortality was significantly higher in some villages. Several geospatial factors were associated with mortality, which might indicate variability in access to health care or exposure and transmission of infectious diseases. These results are useful in prioritising areas for further study and implementing directed public health interventions. |
Capacity of public health surveillance to comply with revised international health regulations, USA
Armstrong KE , McNabb SJ , Ferland LD , Stephens T , Muldoon A , Fernandez JA , Ostroff S . Emerg Infect Dis 2010 16 (5) 804-8 Public health surveillance is essential for detecting and responding to infectious diseases and necessary for compliance with the revised International Health Regulations (IHR) 2005. To assess reporting capacities and compliance with IHR of all 50 states and Washington, DC, we sent a questionnaire to respective epidemiologists; 47 of 51 responded. Overall reporting capacity was high. Eighty-one percent of respondents reported being able to transmit notifications about unknown or unexpected events to the Centers for Disease Control and Prevention (CDC) daily. Additionally, 80% of respondents reported use of a risk assessment tool to determine whether CDC should be notified of possible public health emergencies. These findings suggest that most states have systems in place to ensure compliance with IHR. However, full state-level compliance will require additional efforts. |
Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review
Toblin RL , Paulozzi LJ , Logan JE , Hall AJ , Kaplan JA . J Clin Psychiatry 2010 71 (4) 491-6 OBJECTIVE: Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes. METHOD: In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program. RESULTS: Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug. CONCLUSIONS: Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered. |
Changes in receiving preventive care services among US adults with diabetes, 1997-2007
Harris CD , Pan L , Mukhtar Q . Prev Chronic Dis 2010 7 (3) A56 INTRODUCTION: Diabetes is a chronic disease that requires complex continuing medical care and patient self-management to reduce the risk of long-term complications. Receipt of multiple recommended preventive care services can prevent or delay diabetes-related complications such as blindness and lower-extremity amputations. METHODS: We analyzed 1997 and 2007 Behavioral Risk Factor Surveillance System data to examine change in rates of adults with diabetes receiving 4 essential preventive care services (influenza and pneumococcal vaccinations and annual foot and eye examinations). RESULTS: The overall age-adjusted rate of receiving all 4 of the preventive care services was 10% in 1997 but increased to 20% in 2007. Rates for receiving all 4 services increased significantly in all demographic subgroups except Hispanics. CONCLUSION: Use of preventive care services is increasing, but most US adults with diabetes do not meet recommendations, and the problem is particularly pronounced among Hispanics. The need to receive preventive care services should continue to be emphasized in clinical and community settings to increase the percentage of adults with diabetes who receive them. |
Reduction in acute gastroenteritis hospitalizations among US children after introduction of rotavirus vaccine: analysis of hospital discharge data from 18 US states
Curns AT , Steiner CA , Barrett M , Hunter K , Wilson E , Parashar UD . J Infect Dis 2010 201 (11) 1617-24 BACKGROUND: In 2006, RotaTeq (RV5) was recommended for routine vaccination of United States (US) infants. We compared hospitalization rates for acute gastroenteritis among US children aged <5 years during pre-RV5 rotavirus seasons from 2000 through 2006 with those during the post-RV5 2007 and 2008 seasons. METHODS: Using 100% hospital discharge data from 18 states, accounting for 49% of the US population, we calculated acute gastroenteritis hospitalization rates for children aged <5 years by rotavirus season, 8 age groups (0-2, 3-5, 6-11, 12-17, 18-23, 24-35, 36-47, and 48-59 months), and state. RESULTS: Compared with the median rate for the 2000-2006 rotavirus seasons (101.1 hospitalizations per 10,000 children), the rates for 2007 and 2008 (85.5 and 55.5 hospitalizations per 10,000 children) were 16% and 45% lower, respectively. Children aged 0-2 months had a 28% reduction, those aged 6-23 months had a reduction of 50%, and children aged 3-5 months and 24-59 months had reductions ranging between 42% and 45% during the 2008 rotavirus season, compared with the median rate for 2000-2006 rotavirus seasons. CONCLUSIONS: The introduction of the RV5 vaccine was associated with a dramatic reduction in hospitalizations for acute gastroenteritis among US children during the 2008 rotavirus season. |
Changing farm injury trends by sex for youth living on US farms, 1998-2006
Hendricks KJ , Hendricks SA . J Rural Health 2010 26 (2) 182-188 PURPOSE: To estimate the number and rate of on-farm injuries to youth living on farms in the United States by sex from 1998 to 2006 and compare the trends in youth injury by sex. METHODS: Data from 4 childhood agricultural injury surveys for the years 1998, 2001, 2004, and 2006 were analyzed using a Poisson regression model utilizing generalized estimating equations. Rate ratios with corresponding 95% confidence intervals were calculated from the model, which compared the estimated rates of injury in 2001, 2004, and 2006 to the estimated rate of injury in the baseline year, 1998. RESULTS: There was an overall decline in the estimated number and rate of injuries to youth living on farms from 1998 to 2006, with a linear decline of the rate ratios for all youth on farms that was found to be significant. By sex, the trend in injury rate ratios for male youth significantly declined, while the trend for female youth for the same time period initially increased then returned to the baseline. Nonhomogeneity in trends by age group, work versus nonwork injury, and source of injury was also identified. CONCLUSIONS: Additional surveillance is needed to determine if injury trends to youth living on farms will continue to differ by sex. More detailed data on exposure to hazards for these youth by sex are needed to determine what factors are associated with these disparate injury trends and to design and implement effective interventions to further reduce injuries to youth living on farms. |
Dogs and cats as environmental fall hazards
Stevens JA , Teh SL , Haileyesus T . J Safety Res 2010 41 (1) 69-73 PROBLEM: Falls are the leading cause of non-fatal injuries in the United States. This study assessed the prevalence of fall injuries associated with cats and dogs in the United States and describes the types of injuries sustained, the location, activity, and circumstances under which they occurred. METHODS: Data were from a nationally representative sample of emergency department visits from January 1, 2001 to December 31, 2006, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). RESULTS: Based on 7,456 cases, an estimated 86,629 fall injuries each year were associated with cats and dogs, for an injury rate of 29.7. There were 7.5 times as many injuries involving dogs as cats and females were 2.1 times more likely to be injured than males. Injury rates were highest among people aged ≥75, but pets were a fall hazard for all ages. Fractures and contusions or abrasions were the most common injuries; the highest rates were for injuries to the extremities. About 66.4% of falls associated with cats and 31.3 % of falls associated with dogs were caused by falling or tripping over the pet. An additional 21.2% of falls related to dogs were caused by being pushed or pulled. SUMMARY: Although pets were associated with fall injuries, this risk can be reduced by increasing public awareness about situations that can lead to falls, such as dog-walking and chasing pets, and by calling attention to the importance of obedience training for dogs to minimize hazardous behaviors such as pulling and pushing. IMPACT ON INDUSTRY: Fall injuries represent a burden to individuals, our society and our health care system. Increasing public awareness and implementing basic prevention strategies can help people of all ages enjoy their pets, reduce their chances of experiencing pet-related falls, and lessen the impact of fall injuries on our health care system. |
Rapid analysis of lewisite metabolites in urine by high-performance liquid chromatography-inductively coupled plasma-mass spectrometry
Stanelle RD , McShane WJ , Dodova EN , Pappas RS , Kobelski RJ . J Anal Toxicol 2010 34 (3) 122-8 A high-throughput method has been developed for determining Lewisite [dichloro(2-chlorovinyl)arsine] exposure by measuring the urine metabolite 2-chlorovinylarsonous acid (CVAA) and the oxidized metabolite 2-chlorovinylarsonic acid (CVAOA). The rapid sample preparation included a simple dilution of 400 microL of urine with 40 microL of water and 1 mL of buffer containing an internal standard and brief centrifugation prior to analysis by high-performance liquid chromatography-inductively coupled plasma-mass spectrometry (ICP-MS). CVAOA and CVAA were eluted isocratically with retention factors of approximately 3.0 and 4.2, respectively, from a reversed-phase polar embedded column with a cycle time of 5 min per sample. The dynamic reaction cell, typically used to remove polyatomic isobaric interferences, was not required for ICP-MS analysis because of the resolution of chloride from arsenical peaks of interest. This method was used to detect CVAA and CVAOA in the urine of a rat administered Lewisite up to 24 h after exposure. The method demonstrated linearity over at least three orders of magnitude and had a method detection limit of 1.3 microg/L as CVAA (1.4 microg/L CVAOA). The relative standard deviations for quality control samples ranged from 3 to 6%. The method was sensitive and selective with no false positives in 100 different urine samples collected from individuals with no known exposure to Lewisite. Ninety-six samples could be analyzed in an 8-h day. |
Rapid and simple kinetics screening assay for electrophilic dermal sensitizers using nitrobenzenethiol
Chipinda I , Ajibola RO , Morakinyo MK , Ruwona TB , Simoyi RH , Siegel PD . Chem Res Toxicol 2010 23 (5) 918-25 The need for alternatives to animal-based skin sensitization testing has spurred research on the use of in vitro, in silico, and in chemico methods. Glutathione and other select peptides have been used to determine the reactivity of electrophilic allergens to nucleophiles, but these methods are inadequate to accurately measure rapid kinetics observed with many chemical sensitizers. A kinetic spectrophotometric assay involving the reactivity of electrophilic sensitizers to nitrobenzenethiol was evaluated. Stopped-flow techniques and conventional UV spectrophotometric measurements enabled the determination of reaction rates with half-lives ranging from 0.4 ms (benzoquinone) to 46.2 s (ethyl acrylate). Rate constants were measured for seven extreme, five strong, seven moderate, and four weak/nonsensitizers. Seventeen out of the 23 tested chemicals were pseudo-first order, and three were second order. In three out of the 23 chemicals, deviations from first and second order were apparent where the chemicals exhibited complex kinetics whose rates are mixed order. The reaction rates of the electrophiles correlated positively with their EC3 values within the same mechanistic domain. Nonsensitizers such as benzaldehyde, sodium lauryl sulfate, and benzocaine did not react with nitrobenzenethiol. Cyclic anhydrides, select diones, and aromatic aldehydes proved to be false negatives in this assay. The findings from this simple and rapid absorbance model show that for the same mechanistic domain, skin sensitization is driven mainly by electrophilic reactivity. This simple, rapid, and inexpensive absorbance-based method has great potential for use as a preliminary screening tool for skin allergens. |
Rapid detection and differentiation of antibodies to HIV-1 and HIV-2 using multivalent antigens and magnetic immunochromatography testing (MICT)
Granade TC , Workman S , Wells SK , Holder AN , Owen SM , Pau CP . Clin Vaccine Immunol 2010 17 (6) 1034-9 A simplified lateral flow assay for the detection of antibodies to HIV using magnetic bead conjugates and multi-branched peptides from both HIV-1 and HIV-2 was developed. Magnetic immunochromatography testing (MICT) uses a standard lateral-flow platform that incorporates magnetic bead conjugates for quantitative measurement of the magnetic field distortion associated with the bound magnetic conjugate (reported as adjusted magnetic units, MAR). The results of the optimized MICT assay were compared to standard enzyme immunoassay (EIA) and Western blot (WB) results using a blinded 649-member panel of specimens from the US, Cameroon, and West Africa. The panel was comprised of samples from individuals infected with various HIV-1 subtypes (n=234), HIV-2 (n=65) and HIV-seronegative specimens (n=350). Additionally, thirteen HIV-1 sero-conversion panels (total specimens=85), a worldwide panel containing seven of the major circulating HIV-1 subtypes (n=18), an HIV-2 panel, an HIV-1/HIV-2 mixed panel, and 100 prospective specimens were tested with completely concordant results. Assay reproducibility (observed MAR) for both intra- and inter-run testing was excellent with coefficients of variation <12%. MICT can provide a rapid, low-cost method of determining HIV antibody status requiring no subjective interpretations. |
Shift in oligosaccharide specificities of hemagglutinin and neuraminidase of influenza B viruses resistant to neuraminidase inhibitors
Mochalova L , Bright R , Xu X , Korchagina E , Chinarev A , Bovin N , Klimov A . Glycoconj J 2010 27 (3) 321-7 Influenza virus neuraminidase inhibitors (NAIs), currently used as anti-influenza drugs, can lead to the appearance of drug-resistant variants. Resistance to NAIs appears due to mutations in the active site of the neuraminidase (NA) molecule that decrease the NA enzymatic activity and sometimes in the hemagglutinin (HA) that decrease its affinity for cell receptors and, therefore, reduce the requirement for NA activity in releasing mature virions from infected cells. Using a set of sialo-oligosaccharides, we evaluated changes in the receptor-binding specificity of the HA and substrate specificity of the NA of influenza B viruses that had acquired resistance to NAIs. The oligosaccharide specificity of two pairs of field influenza B viruses, namely: i) B/Memphis/20/96 and its NAI-resistant variant, B/Memphis/20-152K/96, containing mutation R152K in the NA and 5 amino acid substitutions in the HA1, and ii) B/Hong Kong/45/2005 and its NAI-resistant variant B/Hong Kong/36/2005, containing a single R371K mutation in the NA, was evaluated. Wild type viruses bound strictly to a "human type" receptor, alpha2-6-sialo-oligosaccharide 6;SLN, but desialylated it is approximately 8 times less efficiently than the alpha2-3 sialosaccharides. Both drug-resistant viruses demonstrated the ability to bind to "avian type" receptors, alpha2-3 sialo-oligosaccharides (such as 3;SLN), whereas their affinity for 6;SLN was noticeably reduced in comparison with corresponding wild type viruses. Thus, the development of the NAI resistance in the studied influenza B viruses was accompanied by a readjustment of HA-NA oligosaccharide specificities. |
Little evidence for reversibility of trimethoprim resistance after a drastic reduction in trimethoprim use
Sundqvist M , Geli P , Andersson DI , Sjolund-Karlsson M , Runehagen A , Cars H , Abelson-Storby K , Cars O , Kahlmeter G . J Antimicrob Chemother 2010 65 (2) 350-60 OBJECTIVES: The worldwide rapid increase in antibiotic-resistant bacteria has made efforts to prolong the lifespan of existing antibiotics very important. Antibiotic resistance often confers a fitness cost in the bacterium. Resistance may thus be reversible if antibiotic use is discontinued or reduced. To examine this concept, we performed a 24 month voluntary restriction on the use of trimethoprim-containing drugs in Kronoberg County, Sweden. METHODS: The intervention was performed on a 14 year baseline of monthly data on trimethoprim resistance and consumption. A three-parameter mathematical model was used to analyse the intervention effect. The prerequisites for reversion of resistance (i.e. fitness cost, associated resistance and clonal composition) were studied on subsets of consecutively collected Escherichia coli from urinary tract infections. RESULTS: The use of trimethoprim-containing drugs decreased by 85% during the intervention. A marginal but statistically significant effect on the increase in trimethoprim resistance was registered. There was no change in the clonal composition of E. coli and there was no measurable fitness cost associated with trimethoprim resistance in clinical isolates. The frequency of associated antibiotic resistances in trimethoprim-resistant isolates was high. CONCLUSIONS: A lack of detectable fitness cost of trimethoprim resistance in vitro together with a strong co-selection of other antibiotics could explain the rather disappointing effect of the intervention. The result emphasizes the low possibility of reverting antibiotic resistance once established and the urgent need for the development of new antibacterial agents. |
Phosphatidylinositol-3-kinase/akt regulates bleomycin-induced fibroblast proliferation and collagen production
Lu Y , Azad N , Wang L , Iyer AK , Castranova V , Jiang BH , Rojanasakul Y . Am J Respir Cell Mol Biol 2010 42 (4) 432-41 Abnormal repair and dysregulated angiogenesis have been implicated in the pathogenesis of pulmonary fibrosis, but the underlying mechanisms of regulation are not well understood. The present study investigated the role of phosphatidylinositol-3-kinase (PI3K)/Akt in fibrogenesis of human lung fibroblasts and its regulation by reactive oxygen species (ROS). Exposure of lung fibroblasts to bleomycin, a known inducer of fibrosis, resulted in rapid activation of PI3K/Akt and a parallel increase in fibroblast proliferation and collagen production, characteristics of lung fibrosis. Bleomycin had no significant effect on total Akt protein expression but induced phosphorylation of the protein at threonine 308 and serine 473 positions. Inhibition of this phosphorylation by PI3K inhibitors or by dominant-negative Akt (T308A/S473A) expression abrogated the effects of bleomycin on fibroblast proliferation and collagen production, suggesting the role of PI3K/Akt in the fibrogenic process. Activation of PI3K/Akt by bleomycin also led to transcriptional activation and protein expression of hypoxia-inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor, which contributed to the fibroproliferative and collagen-inducing effects of bleomycin. The fibrogenic effects of bleomycin were dependent on ROS generation, particularly superoxide anion and hydrogen peroxide, which were induced by bleomycin. Inhibition of ROS generation by antioxidant enzymes, catalase and superoxide dismutase mimetic MnTBAP, abrogated the fibrogenic effects of bleomycin as well as its induction of PI3K/Akt and HIF-1alpha activation. Together, our results indicate a novel role of PI3K/Akt in fibrogenesis of human lung fibroblasts and its regulation by ROS, which could be exploited for the treatment of pulmonary fibrosis and related disorders. |
Allergen content of patient problem and nonproblem gloves: relationship to allergen-specific patch-test findings
Siegel PD , Fowler Jr JF , Storrs FJ , Sasseville D , Pratt M , Bledsoe TA , Law BF , Beezhold D , Zug K , Fowler LM . Dermatitis 2010 21 (2) 77-83 BACKGROUND: Identification of putative contact allergen and source material is often done by a combination of patch testing and manufacturer-supplied product information. The accuracy of the identification of allergen-source material and level of allergen in that allergen-source material is not known. OBJECTIVE: The objectives of the study were to survey the chemical allergen content of glove allergic contact dermatitis (ACD) patient-identified problem and nonproblem gloves and to evaluate the ability of the patient to discriminate between problem and nonproblem gloves. METHODS: Gloves from patch-tested rubber allergen-positive ACD patients were analyzed for species and amount of rubber allergen. RESULTS: Approximately half the subjects were able to correctly identify their problem and nonproblem gloves. Correct association of a glove with ACD was directly related to patch-test reaction severity and inversely related to the number of glove brands being used by the patient. Of note, thiurams were not detected in any of the gloves examined. CONCLUSIONS: Although patch testing is invaluable in identifying individual allergen sensitivities, the identification of the ACD-causative specific chemical allergen and source material remains problematic. All glove brands used within days prior to and during an ACD episode should be considered potential sources of the contact allergen. |
Biofilm formation is not required for early-phase transmission of Yersinia pestis
Vetter SM , Eisen RJ , Schotthoefer AM , Monteneri JA , Holmes JL , Bobrov AG , Bearden SW , Perry RD , Gage KL . Microbiology (Reading) 2010 156 2216-2225 Our study investigated whether hms-mediated biofilm formation was necessary for early-phase transmission (EPT) of Yersinia pestis. In addition to the biofilm-dependent blockage model of plague transmission from flea to mammal, an EPT model of transmission, has been described where fleas transmit Y. pestis to a host up to 4 days post infection, which is insufficient time for blockages to form in flea foreguts. An artificial feeding system was used to feed Xenopsylla cheopis and Oropsylla montana rat blood spiked with either the parental Y. pestis strain KIM5(pCD1)+, two different biofilm-mutants (DeltahmsT , DeltahmsR), or a biofilm-overproducer mutant (DeltahmsP ). Infected fleas were then allowed to feed on naive Swiss Webster mice 1-4 days after infection and the mice were monitored for signs of infection up to three weeks post-exposure. The biofilm-defective mutants were transmitted from X. cheopis and O. montana as efficiently as the parent strain, whereas the transmission efficiency of fleas fed the biofilm-overproducer was significantly less than either the parent or biofilm-deficient strains. The bacterial loads in fleas infected with a biofilm-deficient strain harbored lower bacterial loads 4 days post infection when compared to fleas infected with the parent strain. Thus defects in biofilm formation did not prevent flea-borne transmission of Y. pestis in our EPT model and biofilm over-production inhibited efficient EPT, however biofilm may play a role in infection persistence in the flea. |
Defining the utility of a commercial NS1 antigen capture kit as a dengue virus (DENV) diagnostic tool
Bessoff K , Phoutrides E , Delorey M , Acosta LN , Hunsperger E . Clin Vaccine Immunol 2010 17 (6) 949-53 Annually, over 2.5 billion people are at risk for infection by dengue virus (DENV), while between 50 and 100 million people contract the disease. There is an urgent need for alternative diagnostic tools that can detect DENV during acute infection. Recent studies have shown that dengue nonstructural protein 1 (NS1) is detectable in the blood as early as the onset of symptoms and persist well into the convalescent phase of the infection. We evaluated the utility of the BioRad Platelia Dengue NS1 Antigen Capture(R) kit in combination with real time reverse transcriptase polymerase chain reaction (RT-PCR) and IgM antibody capture enzyme linked immunosorbent assay (MAC ELISA) for refining a new diagnostic algorithm for the diagnosis of an acute or convalescent DENV from a single clinical sample. We tested the BioRad kit in three panels of sera. These panels were designed to evaluate the sensitivity of the NS1 kit in (1) early convalescent samples, (2) PCR false negative acute samples, and (3) confirmed secondary dengue infections with IgM negative convalescent samples. Results show that the NS1 can be detected in 22% serum collected after 10 days post onset of illness and in 22% of samples that did not elicit an IgM response. Additionally, NS1 was detected in 37% of the PCR false negative acute samples tested suggesting that NS1 detection may be valuable in increasing the sensitivity of current acute phase diagnostics. These results will improve diagnosis in a single acute or early convalescent sample for disease surveillance and clinical diagnosis. |
Percentage of gestational diabetes mellitus attributable to overweight and obesity
Kim SY , England L , Wilson HG , Bish C , Satten GA , Dietz P . Am J Public Health 2010 100 (6) 1047-52 OBJECTIVES: We calculated the percentage of gestational diabetes mellitus (GDM) attributable to overweight and obesity. METHODS: We analyzed 2004 through 2006 data from 7 states using the Pregnancy Risk Assessment Monitoring System linked to revised 2003 birth certificate information. We used logistic regression to estimate the magnitude of the association between prepregnancy body mass index (BMI) and GDM and calculated the percentage of GDM attributable to overweight and obesity. RESULTS: GDM prevalence rates by BMI category were as follows: underweight (13-18.4 kg/m(2)), 0.7%; normal weight (18.5-24.9 kg/m(2)), 2.3%; overweight (25-29.9 kg/m(2)), 4.8%; obese (30-34.9 kg/m(2)), 5.5%; and extremely obese (35-64.9 kg/m(2)), 11.5%. Percentages of GDM attributable to overweight, obesity, and extreme obesity were 15.4% (95% confidence interval [CI]=8.6, 22.2), 9.7% (95% CI=5.2, 14.3), and 21.1% (CI=15.2, 26.9), respectively. The overall population-attributable fraction was 46.2% (95% CI=36.1, 56.3). CONCLUSIONS: If all overweight and obese women (BMI of 25 kg/m(2) or above) had a GDM risk equal to that of normal weight women, nearly half of GDM cases could be prevented. Public health efforts to reduce prepregnancy BMI by promoting physical activity and healthy eating among women of reproductive age should be intensified. |
Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism: findings from health insurance claims data
Kemper AR , Ouyang L , Grosse SD . BMC Pediatr 2010 10 9 BACKGROUND: Thyroid hormone treatment in children with congenital hypothyroidism can prevent intellectual disability. Guidelines recommend that children diagnosed with congenital hypothyroidism through newborn screening remain on treatment to at least 3 years of age, after which a trial off therapy can determine which children have transient hypothyroidism. The purpose of this study was to describe the rate at which children with congenital hypothyroidism in the United States discontinue thyroid hormone treatment in early childhood. METHODS: Retrospective analysis of the 2002-2006 MarketScan(R) Commercial Claims and Encounters research databases and the 2001-2005 MarketScan Multi-State Medicaid databases. Children were classified as having congenital hypothyroidism based on billing codes and having filled a prescription for thyroid hormone treatment. Kaplan-Meier curve analysis was used to determine discontinuation rates. RESULTS: There were a total of 412 Medicaid-enrolled children and 292 privately-insured children with presumed congenital hypothyroidism included in this study. The overall birth prevalence of congenital hypothyroidism across both datasets was about 1 per 2,300. By 36 months, the percentage who had discontinued thyroid replacement treatment was 38% (95% Confidence Interval: 32%-44%). Medicaid-enrolled children had a more rapid decline in the first 24 months of treatment compared to those with private insurance (P = 0.02). CONCLUSIONS: More than one-third of children treated for congenital hypothyroidism discontinued treatment within 36 months, which is inconsistent with current guidelines. It is not known how many of these children required continued treatment or experience adverse effects from discontinuation. These findings emphasize the critical need for follow-up systems to monitor the outcome of newborn screening. |
Prevalence of roll-over protective structure (ROPS)-equipped tractors on Hispanic-operated farms in the United States
Myers JR . J Agromedicine 2010 15 (2) 137-47 Roll-over protective structures (ROPS) are known to prevent tractor overturn deaths, but not enough tractors are equipped with them in the United States to reduce the rate of these deaths to levels seen in several European countries. Recent literature has defined the use of ROPS on US farms in general, but little is known about ROPS use on Hispanic farm operations. Data from a national survey for the calendar year 2003 were used to assess the prevalence of ROPS use on Hispanic-operated farms. Farm characteristics previously identified to be associated with low ROPS prevalence rates on other farming operations were examined for these Hispanic farming operations. The overall ROPS prevalence rate on Hispanic farms was 52.2%. Adjusted odds ratios of potential risk factors found that the region where the farm was located and the acreage of the farm appeared to be the most significant indicators of the prevalence of ROPS on Hispanic farms. In addition, the age of the farm operator, the farm status as a full- or part-time operation, and the type of farm operation were also important factors. These findings were similar to those seen for racial minority farms and the general farming population. These results can be used to target ROPS promotion programs for Hispanic farmers across the United States. |
Gene expression in benzene-exposed workers by microarray analysis of peripheral mononuclear blood cells: induction and silencing of CYP4F3A and regulation of DNA-dependent protein kinase catalytic subunit in DNA double strand break repair
Bi Y , Li Y , Kong M , Xiao X , Zhao Z , He X , Ma Q . Chem Biol Interact 2010 184 207-11 Benzene causes hematotoxicity and leukemia in humans. To analyze benzene-caused aberrant gene expression, we examined differential gene expression by microarray analysis of peripheral mononuclear blood cells from seven workers diagnosed with benzene poisoning and seven matched controls. Twenty-two genes were found up-regulated and 18 down-regulated in benzene patients compared with controls. Here we report the characterization of two benzene-regulated genes. CYP4F3A, which encodes the leukotriene B(4) (LTB(4)) omega-hydroxylase, is important for inactivation of LTB(4) in neutrophils. CYP4F3A mRNA was found elevated in all patients; moreover, CYP4F3A mRNA and protein were induced by benzene metabolite phenol in HL-60 and K562 cells as well as ex vivo in human peripheral neutrophils. Silencing of CYP4F3A in HL-60 cells by lentiviral delivery of CYP4F3A-specific siRNA reduced cell survival to 56%, 44%, 22%, 14%, and 3% at 3, 4, 5, 6, and 7 days, respectively; the results suggest that CYP4F3A is a critical positive regulator of HL-60 proliferation. DNA-dependent protein kinase catalytic subunit (DNA-PKcs) regulates non-homologous end joining (NHEJ) in DNA double strand break (DSB) repair. DNA-PKcs mRNA was found consistently increased in the patients and DNA-PKcs mRNA and protein were induced by hydroquinone in HL-60 cells. In a DSB model, hydroquinone induced the formation of gamma-H2AX foci, a marker of DSBs, in HL-60 cells. The findings indicate that hydroquinone induces DSBs and induction correlates with elevated levels of DNA-PKcs and NHEJ. Similar results were obtained in K562 cells treated with phenol. Since NHEJ is error-prone, induction of DNA-PKcs and NHEJ may contribute to mutagenesis and leukemia by benzene. To our knowledge, the study demonstrated for the first time that benzene and metabolites induce CYP4F3A and DNA-PKcs both in vivo and in vitro. Induction of the genes may play a role in the pathogenesis of benzene hematotoxicity and serve as biomarkers of benzene exposure. |
Identification and safe handling of hazardous drugs
Connor TH . Pharm Purch Prod 2010 7 (3) 10-13 Over the past 30 years, we have been investigating the risks hazardous drugs pose to health care workers to determine how to minimize them. With current analytical techniques, we can assess the level of environmental contamination for about 10% of the hazardous drugs currently in use. Several dozen studies have shown that workplace contamination is common with these drugs. We can extrapolate that the other 90% of hazardous drugs handled in the same manner, although not yet measured, probably pose the same risk. Until safer drugs become the mainstay, health care workers need to be vigilant about their work practices for their protection and the protection of their coworkers. |
Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation
Jagger J , Berguer R , Phillips EK , Parker G , Gomaa AE . J Am Coll Surg 2010 210 (4) 496-502 BACKGROUND: The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. STUDY DESIGN: We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. RESULTS: Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. CONCLUSIONS: Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers. |
Involving farmers in preventing work-related injuries and illnesses: the NIOSH Research-to-Practice initiative
Huy J . J Agromedicine 2010 15 (2) 98-100 This plenary talk at the eighth annual Midwest Rural Agricultural Safety and Health Forum, November 2009, focused on the value of having those who can benefit from, or who will use research findings (that is, partners), being involved throughout the research process. At the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), the Research-to-Practice (r2p) initiative was established to ensure that NIOSH-funded research is used in the workplace to prevent disease, injury, and fatality. Central to these efforts is the commitment to involve partners and stakeholders throughout the research process, from conceptualization of the research idea through the conduct of the research to the evaluation of the effectiveness of the research. Through partnerships and scientific integrity, NIOSH strives to ensure that our research contributes to improving the lives of all workers. In this presentation, mechanisms for and examples of how to identify and include appropriate partners in research and dissemination efforts for the agriculture sector were explored. |
Characterizing exposures to airborne metals and nanoparticle emissions in a refinery
Miller A , Drake PL , Hintz P , Habjan M . Ann Occup Hyg 2010 54 (5) 504-13 An air quality survey was conducted at a precious metals refinery in order to evaluate worker exposures to airborne metals and to provide detailed characterization of the aerosols. Two areas within the refinery were characterized: a furnace room and an electro-refining area. In line with standard survey practices, both personal and area air filter samples were collected on 37-mm filters and analyzed for metals by inductively coupled plasma-atomic emission spectroscopy. In addition to the standard sampling, measurements were conducted using other tools, designed to provide enhanced characterization of the workplace aerosols. The number concentration and number-weighted particle size distribution of airborne particles were measured with a fast mobility particle sizer (FMPS). Custom-designed software was used to correlate particle concentration data with spatial location data to generate contour maps of particle number concentrations in the work areas. Short-term samples were collected in areas of localized high concentrations and analyzed using transmission electron microscopy (TEM) and energy dispersive spectroscopy (EDS) to determine particle morphology and elemental chemistry. Analysis of filter samples indicated that all of the workers were exposed to levels of silver above the Occupational Safety and Health Administration permissible exposure limit of 0.01 mg m(-3) even though the localized ventilation was functioning. Measurements with the FMPS indicated that particle number concentrations near the furnace increased up to 1000-fold above the baseline during the pouring of molten metal. Spatial mapping revealed localized elevated particle concentrations near the furnaces and plumes of particles rising into the stairwells and traveling to the upper work areas. Results of TEM/EDS analyses confirmed the high number of nanoparticles measured by the FMPS and indicated the aerosols were rich in metals including silver, lead, antimony, selenium, and zinc. Results of the survey were used to deduce appropriate strategies for mitigation of worker exposure to airborne metals. |
Quality of spirometry performed by 13,599 participants in the World Trade Center Worker and Volunteer Medical Screening Program
Enright PL , Skloot GS , Cox-Ganser JM , Udasin IG , Herbert R . Respir Care 2010 55 (3) 303-9 OBJECTIVE: To determine the ability of spirometry technicians in the World Trade Center Worker and Volunteer Medical Screening Program to meet American Thoracic Society spirometry quality goals. METHODS: Spirometry technicians were trained centrally and performed spirometry sessions at 6 sites in the greater New York City area. We reviewed and graded the spirometry results for quality every month. RESULTS: About 80% (range 70-88%) of the spirometry sessions met the American Thoracic Society spirometry goals. In general, the spirometry technicians with the most experience were more successful in meeting the quality goals. Participant characteristics explained very little of the quality variability. CONCLUSIONS: The overall spirometry quality in this multicenter program was very good. Efforts to improve spirometry quality should focus on the performance of individual spirometry technicians. |
Intravaginal practices among female sex workers in Kibera, Kenya
Gallo MF , Sharma A , Bukusi EA , Njoroge B , Nguti R , Jamieson DJ , Bell AJ , Eschenbach DA . Sex Transm Infect 2010 86 (4) 318-22 OBJECTIVES: To assess vaginal cleansing and lubricant use among female sex workers (FSW) in Kenya participating in a 6-month, prospective study of the acceptability of the use of the diaphragm. METHODS: The study is based on 140 FSW in Nairobi, who completed 140 baseline visits and 390 bi-monthly follow-up visits. Participants were instructed to wear the diaphragm for all coital acts during follow-up and to refrain from vaginal cleansing while wearing the diaphragm. Logistic regression was used to identify predictors of recent vaginal cleansing to 'tighten' the vagina reported at baseline; recent vaginal cleansing to prevent infection reported at baseline; recent vaginal cleansing with the diaphragm in place reported during follow-up; and recent use of oil-based lubricant during coitus reported at baseline. RESULTS: At baseline, 99% of women reported vaginal cleansing in the previous 2 weeks for purposes of hygiene or to remove evidence of past coitus. Approximately 41% of women also reported cleansing in the past 2 weeks to 'tighten' the vagina. Women reported vaginal cleansing with the diaphragm in place in the past 2 weeks at 14% of follow-up visits in which the diaphragm was used. Predictors of such cleansing included young age, 6-month study visit, being divorced or widowed and higher educational level. CONCLUSIONS: While vaginal cleansing is a modifiable behaviour, given that cleansing for hygiene was almost universal among this study population at baseline and that more women reported cleansing while wearing the diaphragm as the study progressed, the complete eradication of the practice would probably be difficult. |
Health-related outcomes of adverse childhood experiences in Texas, 2002
Dube SR , Cook ML , Edwards VJ . Prev Chronic Dis 2010 7 (3) A52 INTRODUCTION: We assessed the prevalence of 7 childhood adversities (psychological, physical, and sexual abuse; household mental illness; household substance abuse; maternal battery; and incarceration of a household member) and the associations of those adversities with health outcomes. METHODS: Using data from 5,378 people who responded to the 2002 Texas Behavioral Risk Factor Surveillance System survey (which included questions about childhood adversity), we created 4 groups: no childhood abuse or household dysfunction, childhood abuse only, household dysfunction only, and both childhood abuse and household dysfunction. We examined groups by sociodemographic variables and the association with current smoking, obesity, and self-rated health. RESULTS: Among adult respondents, 46% reported at least 1 childhood adversity. Reports of both household dysfunction and abuse were significantly lower for college graduates than for people with less education. For those with both abuse and household dysfunction, the odds of current smoking were 1.9 and for obesity were 1.3. Compared to people without childhood adversities, people who experienced childhood adversities more frequently reported having fair or poor general health status. CONCLUSION: Childhood adversities are common among Texas adults. People with childhood adversities are more likely to be socioeconomically disadvantaged, less educated, and have difficulties maintaining employment in adulthood compared to people with no adversities. Moreover, childhood adversities appear to be associated with health problems such as current smoking, obesity, and poor or fair general health among Texas adults. |
Changes in tobacco use among 13-15-year-olds between 1999 and 2007: findings from the Eastern Mediterranean Region
El-Awa F , Warren CW , Jones NR . East Mediterr Health J 2010 16 (3) 266-273 This report focuses on change over time in tobacco use among adolescents in countries included in the Eastern Mediterranean Region (EMR) of the World Health Organization. The Global Youth Tobacco Survey (GYTS) was conducted in each site at least twice between 1999 and 2007. Results indicate that for students aged 13-15 years tobacco use is a major public health problem. Increase in the use of water pipe, the likely initiation of smoking by never smokers, and a potential increase in tobacco use among young girls was found in most of the EMR sites. The results from the GYTS can be used by all of the EMR countries involved to set their tobacco control programme and policy agenda. |
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