No interactions between previously associated 2-hour glucose gene variants and physical activity or BMI on 2-hour glucose levels.
Scott RA , Chu AY , Grarup N , Manning AK , Hivert MF , Shungin D , Tonjes A , Yesupriya A , Barnes D , Bouatia-Naji N , Glazer NL , Jackson AU , Kutalik Z , Lagou V , Marek D , Rasmussen-Torvik LJ , Stringham HM , Tanaka T , Aadahl M , Arking DE , Bergmann S , Boerwinkle E , Bonnycastle LL , Bornstein SR , Brunner E , Bumpstead SJ , Brage S , Carlson OD , Chen H , Chen YD , Chines PS , Collins FS , Couper DJ , Dennison EM , Dowling NF , Egan JS , Ekelund U , Erdos MR , Forouhi NG , Fox CS , Goodarzi MO , Grässler J , Gustafsson S , Hallmans G , Hansen T , Hingorani A , Holloway JW , Hu FB , Isomaa B , Jameson KA , Johansson I , Jonsson A , Jørgensen T , Kivimaki M , Kovacs P , Kumari M , Kuusisto J , Laakso M , Lecoeur C , Lévy-Marchal C , Li G , Loos RJ , Lyssenko V , Marmot M , Marques-Vidal P , Morken MA , Müller G , North KE , Pankow JS , Payne F , Prokopenko I , Psaty BM , Renström F , Rice K , Rotter JI , Rybin D , Sandholt CH , Sayer AA , Shrader P , Schwarz PE , Siscovick DS , Stancáková A , Stumvoll M , Teslovich TM , Waeber G , Williams GH , Witte DR , Wood AR , Xie W , Boehnke M , Cooper C , Ferrucci L , Froguel P , Groop L , Kao WH , Vollenweider P , Walker M , Watanabe RM , Pedersen O , Meigs JB , Ingelsson E , Barroso I , Florez JC , Franks PW , Dupuis J , Wareham NJ , Langenberg C . Diabetes 2012 61 (5) 1291-6 Gene-lifestyle interactions have been suggested to contribute to the development of type 2 diabetes. Glucose levels 2 h after a standard 75-g glucose challenge are used to diagnose diabetes and are associated with both genetic and lifestyle factors. However, whether these factors interact to determine 2-h glucose levels is unknown. We meta-analyzed single nucleotide polymorphism (SNP) x BMI and SNP x physical activity (PA) interaction regression models for five SNPs previously associated with 2-h glucose levels from up to 22 studies comprising 54,884 individuals without diabetes. PA levels were dichotomized, with individuals below the first quintile classified as inactive (20%) and the remainder as active (80%). BMI was considered a continuous trait. Inactive individuals had higher 2-h glucose levels than active individuals (beta = 0.22 mmol/L [95% CI 0.13-0.31], P = 1.63 x 10(-6)). All SNPs were associated with 2-h glucose (beta = 0.06-0.12 mmol/allele, P ≤ 1.53 x 10(-7)), but no significant interactions were found with PA (P > 0.18) or BMI (P ≥ 0.04). In this large study of gene-lifestyle interaction, we observed no interactions between genetic and lifestyle factors, both of which were associated with 2-h glucose. It is perhaps unlikely that top loci from genome-wide association studies will exhibit strong subgroup-specific effects, and may not, therefore, make the best candidates for the study of interactions. |
Recommendations and proposed guidelines for assessing the cumulative evidence on joint effects of genes and environments on cancer occurrence in humans.
Boffetta P , Winn DM , Ioannidis JP , Thomas DC , Little J , Davey Smith G , Cogliano VJ , Hecht SS , Seminara D , Vineis P , Khoury MJ . Int J Epidemiol 2012 41 (3) 686-704 We propose guidelines to evaluate the cumulative evidence of gene-environment (G x E) interactions in the causation of human cancer. Our approach has its roots in the HuGENet and IARC Monographs evaluation processes for genetic and environmental risk factors, respectively, and can be applied to common chronic diseases other than cancer. We first review issues of definitions of G x E interactions, discovery and modelling methods for G x E interactions, and issues in systematic reviews of evidence for G x E interactions, since these form the foundation for appraising the credibility of evidence in this contentious field. We then propose guidelines that include four steps: (i) score the strength of the evidence for main effects of the (a) environmental exposure and (b) genetic variant; (ii) establish a prior score category and decide on the pattern of interaction to be expected; (iii) score the strength of the evidence for interaction between the environmental exposure and the genetic variant; and (iv) examine the overall plausibility of interaction by combining the prior score and the strength of the evidence and interpret results. We finally apply the scheme to the interaction between NAT2 polymorphism and tobacco smoking in determining bladder cancer risk. |
Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey
Gregg EW , Cheng YJ , Saydah S , Cowie C , Garfield S , Geiss L , Barker L . Diabetes Care 2012 35 (6) 1252-7 OBJECTIVE: To determine whether all-cause and cardiovascular disease (CVD) death rates declined between 1997 and 2006, a period of continued advances in treatment approaches and risk factor control, among U.S. adults with and without diabetes. RESEARCH DESIGN AND METHODS: We compared 3-year death rates of four consecutive nationally representative samples (1997-1998, 1999-2000, 2001-2002, and 2003-2004) of U.S. adults aged 18 years and older using data from the National Health Interview Surveys linked to National Death Index. RESULTS: Among diabetic adults, the CVD death rate declined by 40% (95% CI 23-54) and all-cause mortality declined by 23% (10-35) between the earliest and latest samples. There was no difference in the rates of decline in mortality between diabetic men and women. The excess CVD mortality rate associated with diabetes (i.e., compared with nondiabetic adults) decreased by 60% (from 5.8 to 2.3 CVD deaths per 1,000) while the excess all-cause mortality rate declined by 44% (from 10.8 to 6.1 deaths per 1,000). CONCLUSIONS: Death rates among both U.S. men and women with diabetes declined substantially between 1997 and 2006, reducing the absolute difference between adults with and without diabetes. These encouraging findings, however, suggest that diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed. |
Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008
May AL , Kuklina EV , Yoon PW . Pediatrics 2012 129 (6) 1035-41 OBJECTIVE: Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents. METHODS: The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES. RESULTS: Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period. CONCLUSIONS: The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese. |
The Jamaican historical experience of the impact of educational interventions on sickle cell disease child mortality
Grosse SD , Atrash HK , Odame I , Amendah D , Piel FB , Williams TN . Am J Prev Med 2012 42 (6) e101-3 We welcome the opportunity to provide additional support for the assertion in our paper on sickle cell disease (SCD) in Africa that newborn screening can result in substantially reduced mortality even in the absence of specifıc interventions such as penicillin prophylaxis or pneumococcal conjugate vaccines (PCVs).1 Three references were cited describing reductions in SCD mortality that occurred prior to the availability of those interventions.2–4 In one U.S. study, the rate of mortality among infants with sickle cell anemia diagnosed as newborns in a pilot screening study during 1975–1985 was 1.8% compared with 8% among infants diagnosed after age 3 months, a difference attributed to better follow-up and education.2 The subsequent introduction of oral penicillin prophylaxis in the U.S. was associated with a 36% reduction in SCD mortality in children aged <4 years between 1983–1986 and 1987–1990.5 The administration of PCV-7 to U.S. infants beginning in 2000, which eliminated many deaths from invasive pneumococcal disease (IPD) due to incomplete adherence to penicillin prophylaxis, was accompanied by a further 42% drop in SCD mortality in children aged <4 years between 1995–1998 and 1999–2002.5 | In Jamaica, King et al. and others documented sharp reductions in SCD mortality among infants born between 1973 and 1981 who were enrolled in the Jamaican Sickle Cell Cohort Study (JSCCS).4,6 The rate of death in the fırst 2 years of life fell by 71% from 14% in the 1973–1975 birth cohort to 4% in the 1979–1981 birth cohort. One specific intervention, parental education on the detection of enlarged spleens and need for medical attention, was shown to result in a 74% decrease in the death rate from acute splenic sequestration (ASS) from 1.3 per 100 patient-years during 1974–1978 to 0.3 per 100 patient-years during 1979–1983, calculated from data on incidence and case-fatality of ASS.4,7 |
Racial residential segregation and rates of gonorrhea in the United States, 2003-2007
Biello KB , Kershaw T , Nelson R , Hogben M , Ickovics J , Niccolai L . Am J Public Health 2012 102 (7) 1370-7 OBJECTIVES: In the United States, Black persons are disproportionately affected by sexually transmitted infections (STIs), including gonorrhea. Individual behaviors do not fully explain these racial disparities. We explored the association of racial residential segregation with gonorrhea rates among Black persons and hypothesized that specific dimensions of segregation would be associated with gonorrhea rates. METHODS: We used 2003 to 2007 national STI surveillance data and 2000 US Census Bureau data to examine associations of 5 dimensions of racial residential segregation and a composite measure of hypersegregation with gonorrhea rates among Black persons in 257 metropolitan statistical areas, overall and by sex and age. We calculated adjusted rate ratios with generalized estimating equations. RESULTS: Isolation and unevenness were significantly associated with gonorrhea rates. Centralization was marginally associated with gonorrhea. Isolation was more strongly associated with gonorrhea among the younger age groups. Concentration, clustering, and hypersegregation were not associated with gonorrhea. CONCLUSIONS: Certain dimensions of segregation are important in understanding STI risk among US Black persons. Interventions to reduce sexual risk may need to account for racial residential segregation to maximize effectiveness and reduce existent racial disparities. (Am J Public Health. Published online ahead of print May 17, 2012: e1-e8. doi:10.2105/AJPH.2011.300516). |
Trends in decline of antiretroviral resistance among ARV-experienced patients in the HIV Outpatient Study: 1999-2008
Buchacz K , Baker R , Ward DJ , Palella FJ , Chmiel JS , Young B , Yangco BG , Novak RM , Brooks JT . AIDS Res Treat 2012 2012 230290 BACKGROUND: Little is known about temporal trends in frequencies of clinically relevant ARV resistance mutations in HIV strains from U.S. patients undergoing genotypic testing (GT) in routine HIV care. METHODS: We analyzed cumulative frequency of HIV resistance among patients in the HIV Outpatient Study (HOPS) who, during 1999-2008 and while prescribed antiretrovirals, underwent GT with plasma HIV RNA >1,000 copies/mL. Exposure ≥4 months to each of three major antiretroviral classes (NRTI, NNRTI and PI) was defined as triple-class exposure (TCE). RESULTS: 906 patients contributed 1,570 GT results. The annual frequency of any major resistance mutations decreased during 1999-2008 (88% to 79%, P = 0.05). Resistance to PIs decreased among PI-exposed patients (71% to 46%, P = 0.010) as exposure to ritonavir-boosted PIs increased (6% to 81%, P < 0.001). Non-significant declines were observed in resistance to NRTIs among NRTI-exposed (82% to 67%), and triple-class-resistance among TCE patients (66% to 41%), but not to NNRTIs among NNRTI-exposed. CONCLUSIONS: HIV resistance was common but declined in HIV isolates from subgroups of ARV-experienced HOPS patients during 1999-2008. Resistance to PIs among PI-exposed patients decreased, possibly due to increased representation of patients whose only PI exposures were to boosted PIs. |
Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study
Cherutich P , Kaiser R , Galbraith J , Williamson J , Shiraishi RW , Ngare C , Mermin J , Marum E , Bunnell R . PLoS One 2012 7 (5) e36797 BACKGROUND: We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007. METHODS: KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15-64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons. RESULTS: Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5-7.7). Among ever sexually active persons, 27.4% (95% CI 25.6-29.2) of men and 44.2% (95% CI 42.5-46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2-91.0) were unaware of their HIV infection. Among sexually active women aged 15-49 years, 48.7% (95% CI 46.8-50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ≥35 versus 15-19 years was 0.2 (95% CI: 0.1-0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2-2.0; p = 0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3-2.5; p = 0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing. CONCLUSIONS: The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations. |
Aging population and future burden of pneumococcal pneumonia in the United States
Wroe PC , Finkelstein JA , Ray GT , Linder JA , Johnson KM , Rifas-Shiman S , Moore MR , Huang SS . J Infect Dis 2012 205 (10) 1589-92 Pneumococcal pneumonia is concentrated among the elderly. Using a decision analytic model, we projected the future incidence of pneumococcal pneumonia and associated healthcare utilization and costs accounting for an aging US population. Between 2004 and 2040, as the population increases by 38%, pneumococcal pneumonia hospitalizations will increase by 96% (from 401,000 to 790,000), because population growth is fastest in older age groups experiencing the highest rates of pneumococcal disease. Absent intervention, the total cost of pneumococcal pneumonia will increase by $2.5 billion annually, and the demand for healthcare services for pneumococcal pneumonia, especially inpatient capacity, will double in coming decades. |
Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India
Thacker N , Choudhury P , Gargano LM , Weiss PS , Pazol K , Bahl S , Jafari HS , Arora M , Dubey AP , Vashishtha VM , Agarwal R , Kumar A , Orenstein WA , Omer SB , Hughes JM . Int J Infect Dis 2012 16 (6) e417-23 OBJECTIVES: The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease, immunization, and eradication, and to identify barriers to polio eradication. METHODS: PHC physicians from blocks with at least one confirmed polio case during January 2006 to June 2009 were selected for an in-person survey. Pediatricians were members of the Indian Academy of Pediatrics and were selected from a national directory of members for telephone or mail survey. RESULTS: A higher percentage of PHC physicians than pediatricians reported that an unvaccinated child was susceptible to polio (82.1% vs. 63.0%, p<0.0001) and that polio disease was severe in a child aged 1-5 years (77.7% vs. 62.2%, p<0.0001). PHC physicians and pediatricians expressed confidence in the protectiveness and safety of oral polio vaccine and cited parents' lack of awareness of the importance of polio eradication as an important barrier to eradication. Strengthening routine immunization efforts was reported as the leading intervention required to eradicate polio. CONCLUSIONS: PHC physicians and pediatricians support and have confidence in the success of polio eradication efforts. These findings will be useful for policy-makers involved in the planning of eradication strategies. Providers and parents need to maintain confidence in polio vaccination if polio is to be eradicated. |
Young men's preferences for sexually transmitted disease and reproductive health services in San Francisco, California
Saadatmand HJ , Bernstein KT , McCright J , Gallaread A , Philip SS , Lippman SA . Sex Transm Dis 2012 39 (6) 421-3 We explored STD (sexually transmitted disease) service preferences among 108 African-American adolescent males recruited from a high-morbidity neighborhood. Participants largely preferred to seek care at traditional STD testing venues (86.5%) rather than nontraditional venues. Additionally, most males preferred receiving STD test results from a clinician (61.1%) rather than online (11.1%) or through email or text message (12.0%). These results highlight the need for continued strengthening of traditional public health clinics to ensure capacity to meet young men's health needs and to improve outreach and access to traditional STD services for young men. |
Effects of the 1997-1998 El Nino episode on community rates of diarrhea
Bennett A , Epstein LD , Gilman RH , Cama V , Bern C , Cabrera L , Lescano AG , Patz J , Carcamo C , Sterling CR , Checkley W . Am J Public Health 2012 102 (7) e63-9 OBJECTIVES: To improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for future climate change scenarios, we examined whether the El Nino climate pattern is associated with increased rates of diarrhea among Peruvian children. METHODS: We analyzed daily surveillance data for 367 children aged 0 to 12 years from 2 cohorts in a peri-urban shantytown in Lima, Peru, 1995 through 1998. We stratified diarrheal incidence by 6-month age categories, season, and El Nino, and modeled between-subject heterogeneity with random effects Poisson models. RESULTS: Spring diarrheal incidence increased by 55% during El Nino compared with before El Nino. This increase was most acute among children older than 60 months, for whom the risk of a diarrheal episode during the El Nino spring was nearly 100% greater (relative risk = 1.96; 95% confidence interval = 1.24, 3.09). CONCLUSIONS: El Nino-associated climate variability affects community rates of diarrhea, particularly during the cooler seasons and among older children. Public health officials should develop preventive strategies for future El Nino episodes to mitigate the increased risk of diarrheal disease in vulnerable communities. (Am J Public Health. Published online ahead of print May 17, 2012: e1-e7. doi:10.2105/AJPH.2011.300573). |
The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009.
Reveille JD , Hirsch R , Dillon CF , Carroll MD , Weisman MH . Arthritis Rheum 2012 64 (5) 1407-11 OBJECTIVE: To carry out the first large-scale population study of the prevalence of HLA-B27 in the US, which is needed for public health planning purposes because of recent improvements in medical therapy and diagnostic testing for ankylosing spondylitis (AS). METHODS: The national prevalence of HLA-B27 was determined as part of the 2009 US National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey monitoring the health and nutritional status of the US civilian, noninstitutionalized population. DNA polymerase chain reaction analysis was conducted in samples from 2,320 adults ages 20-69 years from this nationally representative sample. RESULTS: The age-adjusted US prevalence of B27 was 6.1% (95% confidence interval [95% CI] 4.6-8.2). By race/ethnicity, the prevalence of B27 was 7.5% (95% CI 5.3-10.4) among non-Hispanic whites and 3.5% (95% CI 2.5-4.8) among all other US races/ethnicities combined. In Mexican Americans, the prevalence was 4.6% (95% CI 3.4-6.1). The prevalence of B27 could not be reliably estimated for other US racial/ethnic groups because of the low number of B27-positive individuals in those groups. For adults 50-69 years of age, the prevalence of B27 was 3.6% (95% CI 2.2-5.8), which suggested a decrease in B27 with age. These prevalence estimates took into account the NHANES survey design and are reviewed with respect to data from the medical literature. CONCLUSION: Our findings provide the first US national prevalence estimates for HLA-B27. A decline in the prevalence of HLA-B27 with age is suggested by these data but must be confirmed by additional studies. |
Using near real-time morbidity data to identify heat-related illness prevention strategies in North Carolina
Rhea S , Ising A , Fleischauer AT , Deyneka L , Vaughan-Batten H , Waller A . J Community Health 2012 37 (2) 495-500 Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1 degrees F (degree Fahrenheit) increase from 90 degrees F to 98 degrees F and by 15.8 for each 1 degrees F increase from 98 degrees F to 100 degrees F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98 degrees F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions. |
Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel
Graham SM , Ahmed T , Amanullah F , Browning R , Cardenas V , Casenghi M , Cuevas LE , Gale M , Gie RP , Grzemska M , Handelsman E , Hatherill M , Hesseling AC , Jean-Philippe P , Kampmann B , Kabra SK , Lienhardt C , Lighter-Fisher J , Madhi S , Makhene M , Marais BJ , McNeeley DF , Menzies H , Mitchell C , Modi S , Mofenson L , Musoke P , Nachman S , Powell C , Rigaud M , Rouzier V , Starke JR , Swaminathan S , Wingfield C . J Infect Dis 2012 205 Suppl 2 S199-208 There is a critical need for improved diagnosis of tuberculosis in children, particularly in young children with intrathoracic disease as this represents the most common type of tuberculosis in children and the greatest diagnostic challenge. There is also a need for standardized clinical case definitions for the evaluation of diagnostics in prospective clinical research studies that include children in whom tuberculosis is suspected but not confirmed by culture of Mycobacterium tuberculosis. A panel representing a wide range of expertise and child tuberculosis research experience aimed to develop standardized clinical research case definitions for intrathoracic tuberculosis in children to enable harmonized evaluation of new tuberculosis diagnostic technologies in pediatric populations. Draft definitions and statements were proposed and circulated widely for feedback. An expert panel then considered each of the proposed definitions and statements relating to clinical definitions. Formal group consensus rules were established and consensus was reached for each statement. The definitions presented in this article are intended for use in clinical research to evaluate diagnostic assays and not for individual patient diagnosis or treatment decisions. A complementary article addresses methodological issues to consider for research of diagnostics in children with suspected tuberculosis. |
Evaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel
Cuevas LE , Browning R , Bossuyt P , Casenghi M , Cotton MF , Cruz AT , Dodd LE , Drobniewski F , Gale M , Graham SM , Grzemska M , Heinrich N , Hesseling AC , Huebner R , Jean-Philippe P , Kabra SK , Kampmann B , Lewinsohn D , Li M , Lienhardt C , Mandalakas AM , Marais BJ , Menzies HJ , Montepiedra G , Mwansambo C , Oberhelman R , Palumbo P , Russek-Cohen E , Shapiro DE , Smith B , Soto-Castellares G , Starke JR , Swaminathan S , Wingfield C , Worrell C . J Infect Dis 2012 205 Suppl 2 S209-15 Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children. In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children. |
Black-white differences in receipt and completion of adjuvant chemotherapy among breast cancer patients in a rural region of the US
Lipscomb J , Gillespie TW , Goodman M , Richardson LC , Pollack LA , Ryerson AB , Ward KC . Breast Cancer Res Treat 2012 133 (1) 285-96 Recent breast cancer treatment studies conducted in large urban settings have reported racial disparities in the appropriate use of adjuvant chemotherapy. This article presents the first focused evaluation of black-white differences in receipt and completion of chemotherapy for breast cancer in a primarily rural region of the United States. We performed chart abstraction on initial therapy received by 868 women diagnosed with Stages I, IIA, IIB, or IIIA breast cancer in 2001-2003 in southwest Georgia (SWGA). For chemotherapy, information collected included treatment plan, dates of delivery, concordance between therapy planned and received, and date and reasons for end of treatment. The patient's age at diagnosis, race, marital status, insurance coverage, hormone receptor status, comorbidities, socioeconomic status, urban/rural status, treatment site, and distance to the site were also collected. Following univariate analyses, we used multivariable logistic regression modeling to examine the impact of race on the likelihood of (1) receiving chemotherapy and (2) completing planned chemotherapy. For patients terminating chemotherapy prematurely, the reasons were documented. The results showed that the unadjusted black-white difference in receipt of chemotherapy (48.3 vs. 36.0%) was significant, but in the multivariable analysis the black-white odds ratio (OR = 1.18) was not. While the unadjusted black-white difference (92.0 vs. 87.8%) in completing chemotherapy was not significant, in multivariable models black race was positively associated with completing care (p ranging from 0.032 to 0.087 and OR, correspondingly, from 2.16 to 2.64). The impact of race on completing chemotherapy was influenced by marital status, with a significant black-white difference for patients not married (OR = 4.67), but no difference for those married (OR = 1.06). We find compelling racial differences in this largely rural region-with black breast cancer patients receiving or completing chemotherapy at rates that equal or exceed white patients. Further investigation is warranted, both in SWGA and in other rural regions. |
Foodborne toxoplasmosis
Jones JL , Dubey JP . Clin Infect Dis 2012 55 (6) 845-51 Toxoplasmosis can be due to congenital infection or acquired infection after birth and is one of the leading illnesses associated with foodborne hospitalizations and deaths. Undercooked meat, especially pork, lamb, and wild game meat, and soil contaminated with cat feces on raw fruits and vegetables are the major sources of foodborne transmission for humans. The new trend in the production of free-range organically raised meat could increase the risk of Toxoplasma gondii contamination of meat. Foodborne transmission can be prevented by production practices that reduce T. gondii in meat, adequate cooking of meat, washing of raw fruits and vegetables, prevention of cross contamination in the kitchen, and measures that decrease spread of viable oocysts into the environment. |
Molecular characterization of diarrheagenic Escherichia coli from Libya.
Ali MM , Mohamed ZK , Klena JD , Ahmed SF , Moussa TA , Ghenghesh KS . Am J Trop Med Hyg 2012 86 (5) 866-71 Diarrheagenic Escherichia coli (DEC) are important enteric pathogens that cause a wide variety of gastrointestinal diseases, particularly in children. Escherichia coli isolates cultured from 243 diarrheal stool samples obtained from Libyan children and 50 water samples were screened by polymerase chain reaction (PCR) for genes characteristic of enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC). The DEC were detected in 21 (8.6%) children with diarrhea; 10 (4.1%) cases were identified as EAEC, 3 (1.2%) as EPEC, and 8 (3.3%) were ETEC; EHEC, and EIEC were not detected. All DEC were grouped phylogenetically by PCR with the majority (> 70%) identified as phylogenetic groups A and B1. The EAEC isolates were also tested for eight genes associated with virulence using PCR. Multi-virulence (≥ 3 virulence factors) was found in 50% of EAEC isolates. Isolated EAEC possessed different virulence traits and belonged to different phylogenetic groups indicating their heterogeneity. |
A genome-wide association study of total bilirubin and cholelithiasis risk in sickle cell anemia.
Milton JN , Sebastiani P , Solovieff N , Hartley SW , Bhatnagar P , Arking DE , Dworkis DA , Casella JF , Barron-Casella E , Bean CJ , Hooper WC , Debaun MR , Garrett ME , Soldano K , Telen MJ , Ashley-Koch A , Gladwin MT , Baldwin CT , Steinberg MH , Klings ES . PLoS One 2012 7 (4) e34741 Serum bilirubin levels have been associated with polymorphisms in the UGT1A1 promoter in normal populations and in patients with hemolytic anemias, including sickle cell anemia. When hemolysis occurs circulating heme increases, leading to elevated bilirubin levels and an increased incidence of cholelithiasis. We performed the first genome-wide association study (GWAS) of bilirubin levels and cholelithiasis risk in a discovery cohort of 1,117 sickle cell anemia patients. We found 15 single nucleotide polymorphisms (SNPs) associated with total bilirubin levels at the genome-wide significance level (p value <5x10(-8)). SNPs in UGT1A1, UGT1A3, UGT1A6, UGT1A8 and UGT1A10, different isoforms within the UGT1A locus, were identified (most significant rs887829, p = 9.08x10(-25)). All of these associations were validated in 4 independent sets of sickle cell anemia patients. We tested the association of the 15 SNPs with cholelithiasis in the discovery cohort and found a significant association (most significant p value 1.15x10(-4)). These results confirm that the UGT1A region is the major regulator of bilirubin metabolism in African Americans with sickle cell anemia, similar to what is observed in other ethnicities. |
Detectable clonal mosaicism and its relationship to aging and cancer.
Jacobs KB , Yeager M , Zhou W , Wacholder S , Wang Z , Rodriguez-Santiago B , Hutchinson A , Deng X , Liu C , Horner MJ , Cullen M , Epstein CG , Burdett L , Dean MC , Chatterjee N , Sampson J , Chung CC , Kovaks J , Gapstur SM , Stevens VL , Teras LT , Gaudet MM , Albanes D , Weinstein SJ , Virtamo J , Taylor PR , Freedman ND , Abnet CC , Goldstein AM , Hu N , Yu K , Yuan JM , Liao L , Ding T , Qiao YL , Gao YT , Koh WP , Xiang YB , Tang ZZ , Fan JH , Aldrich MC , Amos C , Blot WJ , Bock CH , Gillanders EM , Harris CC , Haiman CA , Henderson BE , Kolonel LN , Le Marchand L , McNeill LH , Rybicki BA , Schwartz AG , Signorello LB , Spitz MR , Wiencke JK , Wrensch M , Wu X , Zanetti KA , Ziegler RG , Figueroa JD , Garcia-Closas M , Malats N , Marenne G , Prokunina-Olsson L , Baris D , Schwenn M , Johnson A , Landi MT , Goldin L , Consonni D , Bertazzi PA , Rotunno M , Rajaraman P , Andersson U , Freeman LE , Berg CD , Buring JE , Butler MA , Carreon T , Feychting M , Ahlbom A , Gaziano JM , Giles GG , Hallmans G , Hankinson SE , Hartge P , Henriksson R , Inskip PD , Johansen C , Landgren A , McKean-Cowdin R , Michaud DS , Melin BS , Peters U , Ruder AM , Sesso HD , Severi G , Shu XO , Visvanathan K , White E , Wolk A , Zeleniuch-Jacquotte A , Zheng W , Silverman DT , Kogevinas M , Gonzalez JR , Villa O , Li D , Duell EJ , Risch HA , Olson SH , Kooperberg C , Wolpin BM , Jiao L , Hassan M , Wheeler W , Arslan AA , Bueno-de-Mesquita HB , Fuchs CS , Gallinger S , Gross MD , Holly EA , Klein AP , LaCroix A , Mandelson MT , Petersen G , Boutron-Ruault MC , Bracci PM , Canzian F , Chang K , Cotterchio M , Giovannucci EL , Goggins M , Hoffman Bolton JA , Jenab M , Khaw KT , Krogh V , Kurtz RC , McWilliams RR , Mendelsohn JB , Rabe KG , Riboli E , Tjønneland A , Tobias GS , Trichopoulos D , Elena JW , Yu H , Amundadottir L , Stolzenberg-Solomon RZ , Kraft P , Schumacher F , Stram D , Savage SA , Mirabello L , Andrulis IL , Wunder JS , Patiño García A , Sierrasesúmaga L , Barkauskas DA , Gorlick RG , Purdue M , Chow WH , Moore LE , Schwartz KL , Davis FG , Hsing AW , Berndt SI , Black A , Wentzensen N , Brinton LA , Lissowska J , Peplonska B , McGlynn KA , Cook MB , Graubard BI , Kratz CP , Greene MH , Erickson RL , Hunter DJ , Thomas G , Hoover RN , Real FX , Fraumeni JF Jr , Caporaso NE , Tucker M , Rothman N , Pérez-Jurado LA , Chanock SJ . Nat Genet 2012 44 (6) 651-8 In an analysis of 31,717 cancer cases and 26,136 cancer-free controls from 13 genome-wide association studies, we observed large chromosomal abnormalities in a subset of clones in DNA obtained from blood or buccal samples. We observed mosaic abnormalities, either aneuploidy or copy-neutral loss of heterozygosity, of >2 Mb in size in autosomes of 517 individuals (0.89%), with abnormal cell proportions of between 7% and 95%. In cancer-free individuals, frequency increased with age, from 0.23% under 50 years to 1.91% between 75 and 79 years (P = 4.8 x 10(-8)). Mosaic abnormalities were more frequent in individuals with solid tumors (0.97% versus 0.74% in cancer-free individuals; odds ratio (OR) = 1.25; P = 0.016), with stronger association with cases who had DNA collected before diagnosis or treatment (OR = 1.45; P = 0.0005). Detectable mosaicism was also more common in individuals for whom DNA was collected at least 1 year before diagnosis with leukemia compared to cancer-free individuals (OR = 35.4; P = 3.8 x 10(-11)). These findings underscore the time-dependent nature of somatic events in the etiology of cancer and potentially other late-onset diseases. |
Multilevel research and the challenges of implementing genomic medicine.
Khoury MJ , Coates RJ , Fennell ML , Glasgow RE , Scheuner MT , Schully SD , Williams MS , Clauser SB . J Natl Cancer Inst Monogr 2012 2012 (44) 112-20 Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum. |
Nationwide integrated mapping of three neglected tropical diseases in Togo: countrywide implementation of a novel approach
Dorkenoo AM , Bronzan RN , Ayena KD , Anthony G , Agbo YM , Sognikin KS , Dogbe KS , Amza A , Sodahlon Y , Mathieu E . Trop Med Int Health 2012 17 (7) 896-903 OBJECTIVE: To conduct a nationwide integrated neglected tropical disease (NTD) prevalence survey to define the need for public health interventions using an innovative mapping protocol. METHODS: Two villages were selected in every peripheral health unit in endemic districts: 29 districts for schistosomiasis and STH, 15 of them for trachoma. In each village, 15 children aged 6-9 years at a randomly selected school were tested. An additional convenience sample of 35 children aged 1-5 years underwent an eye examination for trachoma. This integrated mapping was followed by a 20-cluster trachoma survey in each district that surpassed the WHO-defined threshold of 10% prevalence of trachomatous inflammation-follicular (TF). RESULTS: A total of 1096 villages were surveyed in <6 weeks. The district prevalence of schistosomiasis ranged from 2 to 49% and of STH from 5 to 70%, with prevalence at the village level ranging from 0 to 100% for both diseases. Two districts passed the threshold of 10% for active trachoma, but the cluster survey indicated this was because of misclassification bias and that the real prevalence was <1%. CONCLUSION: Results of this mapping were used by the MoH and partners to plan integrated mass drug administration (MDA). Mass drug administration for trachoma was not implemented as no district passed the threshold requiring public health intervention. |
Health beliefs among individuals at increased familial risk for type 2 diabetes: implications for prevention.
Dorman JS , Valdez R , Liu T , Wang C , Rubinstein WS , O'Neill SM , Acheson LS , Ruffin MT4th , Khoury MJ . Diabetes Res Clin Pract 2012 96 (2) 156-62 AIM: To evaluate perceived risk, control, worry, and severity about diabetes, coronary heart disease (CHD) and stroke among individuals at increased familial risk of diabetes. METHODS: Data analyses were based on the Family Healthware Impact Trial. Baseline health beliefs were compared across three groups: (1) no family history of diabetes, CHD or stroke (n=836), (2) family history of diabetes alone (n=267), and (3) family history of diabetes and CHD and/or stroke (n=978). RESULTS: After adjusting for age, gender, race, education and BMI, scores for perceived risk for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001) were lowest in Group 1 and highest in Group 3. Similar results were observed about worry for diabetes (p<0.0001), CHD (p<0.0001) and stroke (p<0.0001). Perceptions of control or severity for diabetes, CHD or stroke did not vary across the three groups. CONCLUSIONS: Among individuals at increased familial risk for diabetes, having family members affected with CHD and/or stroke significantly influenced perceived risk and worry. Tailored lifestyle interventions for this group that assess health beliefs and emphasize approaches for preventing diabetes, as well as its vascular complications, may be an effective strategy for reducing the global burden of these serious but related chronic disorders. |
Using a digital frame and pictorial information to enhance the SafeCare(R) parent-infant interactions module with a mother with intellectual disabilities: results of a pilot study
Gaskin EH , Lutzker JR , Crimmins DB , Robinson L . J Ment Health Res Intellect Disabil 2012 5 (2) 187-202 Parents with intellectual disabilities (ID) are disproportionately represented in the child welfare system. Parents with ID can be better served by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, interactive, and self-instructional. SafeCare(R) is an evidence-based parenting program with flexibility to adapt its curricula while maintaining fidelity. This research presents the results of a pilot study that examined the effectiveness of an adaptation to the SafeCare(R) parent-infant interactions (PII) module for a mother with ID by using a digital picture frame with pictures of the mother and her infant engaged in skills that met the performance criteria for PII. A multiple-probe design across behaviors was used with the mother and her infant, showing a dramatic increase in PII skills that was maintained across 3 monthly follow-ups. Although further research is necessary, the preliminary data suggest the digital picture frame enhancement to the SafeCare(R) PII module may be a promising instructional tool for parents with ID. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). |
Moderation and mediation of an effective HIV risk-reduction intervention for South African adolescents
O'Leary A , Jemmott JB 3rd , Jemmott LS , Bellamy S , Ngwane Z , Icard L , Gueits L . Ann Behav Med 2012 44 (2) 181-91 BACKGROUND: "Let Us Protect Our Future" is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period. PURPOSE: The present analyses were conducted to identify moderators of the intervention's efficacy as well as, which theory-based variables mediated the intervention's effects. METHODS: Intervention efficacy over the 3-, 6-, and 12-month follow-up was tested using generalized estimating equation models. RESULTS: Living with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention's effect on abstinence. CONCLUSIONS: This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents. |
Perceived impact of the Medicare policy to adjust payment for health care-associated infections
Lee GM , Hartmann CW , Graham D , Kassler W , Dutta Linn M , Krein S , Saint S , Goldmann DA , Fridkin S , Horan T , Jernigan J , Jha A . Am J Infect Control 2012 40 (4) 314-9 BACKGROUND: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. METHODS: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. RESULTS: Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005). CONCLUSION: Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear. |
Current practices and evaluation of screening solid organ donors for West Nile virus
Nett RJ , Kuehnert MJ , Ison MG , Orlowski JP , Fischer M , Staples JE . Transpl Infect Dis 2012 14 (3) 268-77 The first cases of West Nile virus (WNV) transmitted through solid organ transplantation (SOT) were identified in 2002. Subsequently, 5 additional clusters have been reported to public health officials in the United States. Based upon a limited number of known cases, patients who acquire WNV from infected donor organs might be at higher risk for severe neurologic disease and death, compared with patients infected through mosquito bites. In response, some organ procurement organizations (OPOs) have instituted pre-transplant screening of organ donors for WNV infection. We evaluated the current practices, concerns, and challenges related to screening organ donors for WNV in the United States by reviewing the relevant medical literature and interviewing key stakeholders. Screening organ donors for WNV is not required by national policy. In 2008, 11 (19%) of 58 OPOs performed WNV screening using nucleic acid amplification testing (NAT). These OPOs differ in their screening strategies, NAT performed, and logistical challenges. Concerns of delays in receiving NAT results before transplant and potential false-positive results leading to organ wasting are limitations to more widespread screening. Furthermore, it is unknown if WNV screening practices decrease SOT-related morbidity and mortality, or if screening is cost-effective. Additional data are needed to assess and improve transplant outcomes related to WNV. |
Withdrawn: Trends in vaccination coverage disparities among children, United States, 2001-2010
Zhao Z , Smith PJ . Vaccine 2012 This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. |
Effects of immunizing school children with 2009 influenza A (H1N1) monovalent vaccine on absenteeism among students and teachers in Maine
Graitcer SB , Dube NL , Basurto-Davila R , Smith PF , Ferdinands J , Thompson M , Uzicanin A , Gargiullo P , Chaves SS , Robinson S , Sears S , Tipton M , Monto AS , Mills D , Shay DK . Vaccine 2012 30 (32) 4835-41 The overall and indirect effects of immunizing school children with influenza A (H1N1) 2009 pandemic virus vaccine prior to and during the peak of virus circulation were evaluated on student and teacher school absenteeism. We used records collected from late 2009 through early 2010 from schools in four Maine counties. Mixed logistic regression models were used to estimate the daily association between school-level immunization coverage and absenteeism by level of influenza activity, after adjusting for the proportion of students receiving reduced-cost lunches, student minority status, absences adjacent to weekends and Thanksgiving, rural school location, and the circulation of other respiratory viruses. Increasing student immunization coverage was associated with reduced absenteeism during periods of high influenza activity. For example, as immunization coverage during the peak week of pandemic virus circulation increased from 38% to 69% (the 10th and 90th percentiles of observed coverage, respectively), relative reductions in daily absenteeism among all students, unimmunized students, and teachers were 8.2% (95% confidence interval [CI]: 6.5, 9.9), 5.7% (95% CI: 4.2, 7.3), and 8.7% (95% CI: 1.3, 16), respectively. Increased vaccination coverage among school-aged Maine children had modest overall and indirect effects on student and teacher absenteeism, despite vaccination occurring just prior and during peak pandemic virus circulation. |
Self-reported fever and measured temperature in emergency department records used for syndromic surveillance
Kass-Hout TA , Buckeridge D , Brownstein J , Xu Z , McMurray P , Ishikawa CK , Gunn J , Massoudi BL . J Am Med Inform Assoc 2012 19 (5) 775-6 Many public health agencies monitor population health using syndromic surveillance, generally employing information from emergency department (ED) visit records. When combined with other information, objective evidence of fever may enhance the accuracy with which surveillance systems detect syndromes of interest, such as influenza-like illness. This study found that patient chief complaint of self-reported fever was more readily available in ED records than measured temperature and that the majority of patients with an elevated temperature recorded also self-reported fever. Due to its currently limited availability, we conclude that measured temperature is likely to add little value to self-reported fever in syndromic surveillance for febrile illness using ED records. |
Estimating the prevalence of active Helicobacter pylori infection in a rural community with global positioning system technology-assisted sampling
Melius EJ , Davis SI , Redd JT , Lewin M , Herlihy R , Henderson A , Sobel J , Gold B , Cheek JE . Epidemiol Infect 2012 141 (3) 1-9 We investigated a possible outbreak of H. pylori in a rural Northern Plains community. In a cross-sectional survey, we randomly sampled 244 households from a geocoded emergency medical system database. We used a complex survey design and global positioning system units to locate houses and randomly selected one eligible household member to administer a questionnaire and a 13C-urea breath test for active H. pylori infection (n=166). In weighted analyses, active H. pylori infection was detected in 55.0% of the sample. Factors associated with infection on multivariate analysis included using a public drinking-water supply [odds ratio (OR) 12.2, 95% confidence interval (CI) 2.9-50.7] and current cigarette smoking (OR 4.1, 95% CI 1.7-9.6). People who lived in houses with more rooms, a possible indicator of decreased crowding in the home, were less likely to have active H. pylori infections (OR 0.7, 95% CI 0.5-0.9 for each additional room). |
HIV type 1 gag genetic diversity among antenatal clinic attendees in North Rift Valley, Kenya.
Nyagaka B , Kiptoo MK , Lihana RW , Khamadi SA , Makokha EP , Kinyua JG , Mwangi J , Osman S , Lagat NJ , Muriuki J , Okoth V , Gicheru M , Ng'ang'a Z , Songok EM . AIDS Res Hum Retroviruses 2012 28 (5) 523-6 HIV genetic recombination and high mutation rate increase diversity allowing it to escape from host immune response or antiretroviral drugs. This diversity has enabled specific viral subtypes to be predominant in specific regions. To determine HIV-1 subtypes among seropositive antenatal clinic attendees in Kenya's North Rift Valley, a cross-sectional study was carried out on 116 HIV-1-positive blood samples. Proviral DNA was extracted from peripheral blood mononuclear cells by DNAzol lysis and ethanol precipitation. Polymerase chain reactions using specific primers for HIV-1 gag and population sequencing on resulting amplicons were carried out. Phylogenetic analysis revealed that 81 (70%) were subtype A1, 13 (11%) subtype D, 8 (7%) subtype C, 3 (3%) subtype A2, 1 (1%) subtype G, and 10 showed possible recombinants: 5 (4%) subtype A1D, 4 (3%) subtype A1C, and 1 (1%) subtype A2C. These data support the need to establish circulating subtypes for better evaluation of effective HIV diagnostic and treatment options in Kenya. |
Standardization and international multicenter validation of a PulseNet pulsed-field gel electrophoresis protocol for subtyping Shigella flexneri isolates
Pichel M , Brengi SP , Cooper KL , Ribot EM , Al-Busaidy S , Araya P , Fernandez J , Vaz TI , Kam KM , Morcos M , Nielsen EM , Nadon C , Pimentel G , Perez-Gutierrez E , Gerner-Smidt P , Binsztein N . Foodborne Pathog Dis 2012 9 (5) 418-24 Shigella flexneri is one of the agents most frequently linked to diarrheal illness in developing countries and often causes outbreaks in settings with poor hygiene or sanitary conditions. Travel is one of the means by which S. flexneri can be imported into developed countries, where this pathogen is not commonly seen. A robust and discriminatory subtyping method is needed for the surveillance of S. flexneri locally and regionally, and to aid in the detection and investigation of outbreaks. The PulseNet International network utilizes standardized pulsed-field gel electrophoresis (PFGE) protocols to carry out laboratory-based surveillance of foodborne pathogens in combination with epidemiologic data. A multicenter validation was carried out in nine PulseNet laboratories located in North and South America, Europe, and Asia, and it demonstrated that a new protocol is highly robust and reproducible for subtyping of S. flexneri. This protocol, already approved for PulseNet laboratories, applies NotI and XbaI as primary and secondary restriction enzymes, respectively, under electrophoresis conditions of initial switch time of 5 s to final switch time of 35 s, at 6 volts/cm. |
Update: Recommendations for diagnosis of Shiga toxin-producing Escherichia coli infections by clinical laboratories
Gould LH . Clin Microbiol Newsl 2012 34 (10) 75-83 Shiga toxin-producing Escherichia coli (STEC) are a leading cause of bacterial enteric infections in the United States. Prompt laboratory identification of STEC strains is essential for detecting new and emerging serotypes, for effective and timely outbreak responses and control measures, for monitoring trends in disease epidemiology, and to ensure accurate diagnosis and treatment. Guidelines for laboratory identification of STEC infections by clinical laboratories were published in 2006 and 2009 (CDC, MMWR Morb. Mortal. Wkly. Rep. 55:1042-1045, 2006; MMWR Recomm. Rep. 58[RR-12], 1-14, 2009). We summarize these recent recommendations for STEC testing by clinical laboratories to emphasize the recommendation that all stools submitted for routine testing from patients with acute community-acquired diarrhea (regardless of patient age, season of the year, or presence or absence of blood in the stool) be simultaneously cultured for . E. coli O157:H7 (O157 STEC) and tested with an assay that detects Shiga toxins to detect non-O157 STEC. (2012 Elsevier Inc.) |
Induction of pulmonary fibrosis by cerium oxide nanoparticles
Ma JY , Mercer RR , Barger M , Schwegler-Berry D , Scabilloni J , Ma JK , Castranova V . Toxicol Appl Pharmacol 2012 262 (3) 255-64 Cerium compounds have been used as a diesel engine catalyst to lower the mass of diesel exhaust particles, but are emitted as cerium oxide (CeO(2)) nanoparticles in the diesel exhaust. In a previous study, we have demonstrated a wide range of CeO(2)-induced lung responses including sustained pulmonary inflammation and cellular signaling that could lead to pulmonary fibrosis. In this study, we investigated the fibrogenic responses induced by CeO(2) in a rat model at various time points up to 84days post-exposure. Male Sprague Dawley rats were exposed to CeO(2) by a single intratracheal instillation. Alveolar macrophages (AM) were isolated by bronchial alveolar lavage (BAL). AM-mediated cellular responses, osteopontin (OPN) and transform growth factor (TGF)-beta1 in the fibrotic process were investigated. The results showed that CeO(2) exposure significantly increased fibrotic cytokine TGF-beta1 and OPN production by AM above controls. The collagen degradation enzymes, metrix metalloproteinase (MMP)-2 and -9 and the tissue inhibitor of MMP were markedly increased in the BAL fluid at 1day- and subsequently declined at 28days after exposure, but remained much higher than the controls. CeO(2) induced elevated phospholipids in BAL fluid and increased hydrooxyproline content in lung tissue in a dose- and time-dependent manner. Immunohistochemical analysis showed MMP-2, MMP-9 and MMP-10 expressions in fibrotic regions. Morphological analysis noted collagen fibers in the lungs exposed to a single dose of 3.5mg/kg CeO(2) and sacrificed at 28days post-exposure. Collectively, our studies show that CeO(2) induced fibrotic lung injury in rats, suggesting it may cause potential health effects. |
Analysis of defined combinations of monoclonal antibodies in anthrax toxin neutralization assays and their synergistic action
Ngundi MM , Meade BD , Little SF , Quinn CP , Corbett CR , Brady RA , Burns DL . Clin Vaccine Immunol 2012 19 (5) 731-9 Antibodies against the protective antigen (PA) component of anthrax toxin play an important role in protection against disease caused by Bacillus anthracis. In this study, we examined defined combinations of PA-specific monoclonal antibodies for their ability to neutralize anthrax toxin in cell culture assays. We observed additive, synergistic, and antagonistic effects of the antibodies depending on the specific antibody combination examined and the specific assay used. Synergistic toxin-neutralizing antibody interactions were examined in more detail. We found that one mechanism that can lead to antibody synergy is the bridging of PA monomers by one antibody, with resultant bivalent binding of the second antibody. These results may aid in optimal design of new vaccines and antibody therapies against anthrax. |
A population approach to precision medicine.
Khoury MJ , Gwinn ML , Glasgow RE , Kramer BS . Am J Prev Med 2012 42 (6) 639-45 The term P4 medicine is used to denote an evolving field of medicine that uses systems biology approaches and information technologies to enhance wellness rather than just treat disease. Its four components include predictive, preventive, personalized, and participatory medicine. In the current paper, it is argued that in order to fulfill the promise of P4 medicine, a "fifth P" must be integrated -the population perspective- into each of the other four components. A population perspective integrates predictive medicine into the ecologic model of health; applies principles of population screening to preventive medicine; uses evidence-based practice to personalize medicine; and grounds participatory medicine on the three core functions of public health: assessment, policy development, and assurance. Population sciences-including epidemiology; behavioral, social, and communication sciences; and health economics, implementation science, and outcomes research- are needed to show the value of P4 medicine. Balanced strategies that implement both population- and individual-level interventions can best maximize health benefits, minimize harm, and avoid unnecessary healthcare costs. |
A systematic review of the effectiveness of occupational health and safety training
Robson LS , Stephenson CM , Schulte PA , Amick BC , Irvin EL , Eggerth DE , Chan S , Bielecky AR , Wang AM , Heidotting TL , Peters RH , Clarke JA , Cullen K , Rotunda CJ , Grubb PL . Scand J Work Environ Health 2012 38 (3) 193-208 OBJECTIVES: Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS: Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on training's effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (ili) behaviors, and (iv) health using the US Centers for Disease Control and Prevention's Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS: Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS: The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected based on research evidence. |
Evaluation of 2009 pandemic influenza A (H1N1) exposures and illness among physicians in training
de Perio MA , Brueck SE , Mueller CA , Milne CK , Rubin MA , Gundlapalli AV , Mayer J . Am J Infect Control 2012 40 (7) 617-21 BACKGROUND: A cluster of influenza-like illness (ILI) among physicians in training during the 2009 influenza A (H1N1) pandemic (pH1N1) led to a health hazard evaluation. METHODS: We conducted a cross-sectional study to examine exposures, infection control practices, ILI prevalence, and transmission among physicians in training at 4 affiliated hospitals during the pandemic. We administered an electronic survey and met with physicians in training and hospital personnel. RESULTS: Of the 88 responding physicians, 85% reported exposure to pH1N1. Exposures occurred at work from patients or coworkers and outside of work from coworkers, household members, or the community. Thirteen cases of ILI were reported in May-June 2009; 10 respondents reported working while ill (duration, 1-4 days). Between 13% and 88% of respondents knew which personal protective equipment (PPE) was recommended when caring for influenza patients at the 4 hospitals. The most common reasons for not using PPE were not knowing that a patient had pH1N1 or ILI and not having PPE readily available. CONCLUSIONS: Physicians in training have gaps in their knowledge of and adherence to recommended PPE and compliance with work restrictions. Our findings underscore the importance of installing isolation precaution signage, making PPE readily available near patients with influenza, and facilitating work restrictions for ill health care personnel. |
Evaluation of the benefit of the user seal check on n95 filtering facepiece respirator fit
Viscusi DJ , Bergman MS , Zhuang Z , Shaffer RE . J Occup Environ Hyg 2012 9 (6) 408-16 The objective of this study was to better understand the benefit of the user seal check step for respirator test subjects in the N95 filtering facepiece respirator donning process. To qualify for the study, subjects were required to pass a standard quantitative fit test on at least one of the three N95 filtering facepiece respirator models: 3M 1860 (cup), 3M 1870 (flat-fold), and Kimberly Clark PFR95-270 (duckbill). Eleven subjects were enrolled and performed a series of abbreviated, quantitative fit tests where they were randomly asked either to perform or not perform a user seal check with 20 different respirator samples of each model. The experimental design included 3 respirator models x 10 subjects x 2 treatment levels with 10 replications. Geometric mean (GM) fit factors and percentages of times a fit factor ≥ 100 was achieved for a donning were compared for each subject with and without the user seal check across all models and for each model. Higher GM fit factors and smaller geometric standard deviations across all models were achieved for 10 of the 11 subjects when performing a user seal check compared with not performing a user seal check. Geometric mean fit factors of 148, 184, and 156, compared with 126, 187, and 115, respectively, were obtained for the 3M 1860, 3M 1870, and Kimberly Clark PFR95-270 models when the user seal check was performed vs. not performed. Differences in the GM fit factors for the 3M 1860 and Kimberly Clark PFR95-270 models were statistically significant (p < 0.05) when performing a user seal check vs. not performing a user seal check. These data suggest that there may be some benefit to performing the user seal check for at least some models during the filtering facepiece respirator donning process for workers who have previously passed a fit test for those respirator models. Additional research is needed with larger groups of subjects and respirator models/types. |
Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers
Luft BJ , Schechter C , Kotov R , Broihier J , Reissman D , Guerrera K , Udasin I , Moline J , Harrison D , Friedman-Jimenez G , Pietrzak RH , Southwick SM , Bromet EJ . Psychol Med 2012 42 (5) 1069-79 BACKGROUND: Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures. METHOD: Participants were 8508 police and 12,333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC). RESULTS: Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms. CONCLUSIONS: Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders. |
Impact of multiple consecutive donnings on filtering facepiece respirator fit
Bergman MS , Viscusi DJ , Zhuang Z , Palmiero AJ , Powell JB , Shaffer RE . Am J Infect Control 2012 40 (4) 375-80 BACKGROUND: A concern with reuse of National Institute for Occupational Safety and Health-certified N95 filtering facepiece respirators (FFRs) is that multiple donnings could stress FFR components, impairing fit. This study investigated the impact of multiple donnings on the facepiece fit of 6 N95 FFR models using a group of 10 experienced test subjects per model. METHODS: The TSI PORTACOUNT Plus and N95 Companion accessory were used for all tests. After qualifying by passing a standard Occupational Safety and Health Administration fit test, subjects performed up to 20 consecutive tests on an individual FFR sample using a modified protocol. Regression analyses were performed for the percentage of donnings resulting in fit factors (FFs) ≥100 for all 6 FFR models combined. RESULTS: Regression analyses showed statistical significance for donning groups 1-10, 1-15, and 1-20. The mean percentage of donnings with an FF ≥100 was 81%-93% for donning group 1-5, but dropped to 53%-75% for donning group 16-20. CONCLUSIONS: Our results show that multiple donnings had a model-dependent impact on fit for the 6 N95 models evaluated. The data suggest that 5 consecutive donnings can be performed before FFs consistently drop below 100. |
Detection of DNA damage in workers exposed to JP-8 jet fuel
Krieg Jr EF , Mathias PI , Toennis CA , Clark JC , Marlow KL , B'Hymer C , Singh NP , Gibson RL , Butler MA . Mutat Res 2012 747 (2) 218-27 The genotoxicity of jet propulsion fuel 8 (JP-8) was assessed in the leukocytes of archived blood specimens from U.S. Air Force personnel using the comet assay. No differences in mean comet assay measurements were found between low, moderate, and high exposure groups before or after a 4hour work shift. Before the work shift, mean tail DNA and mean tail (Olive) moment increased as the concentration of benzene measured in end-exhaled breath increased, indicating that prior environmental or work-related exposures to benzene produced DNA damage. The number of cells with highly damaged DNA decreased as the pre-shift benzene concentration in breath increased. It is not clear why the decrease is occurring. Mean tail DNA and mean tail (Olive) moment decreased as the concentrations of benzene and naphthalene measured in breath immediately after the work shift increased. These inverse relationships may reflect a slower rate of absorption or a faster rate of expiration of benzene in the lung. The number of cells with highly damaged DNA increased as the concentration of urinary (2-methoxyethoxy)acetic acid (MEAA) increased. This relationship was not seen in urinary MEAA adjusted for creatinine. MEAA is a metabolite of the deicing agent 2-(2-methoxyethoxy)ethanol contained in JP-8. MEAA or a component of JP-8 correlated with MEAA may have a toxic effect on DNA. |
Disposal of sharps medical waste in the United States: impact of recommendations and regulations, 1987-2007
Perry J , Jagger J , Parker G , Phillips EK , Gomaa A . Am J Infect Control 2012 40 (4) 354-8 BACKGROUND: To gauge the impact of regulatory-driven improvements in sharps disposal practices in the United States over the last 2 decades, we analyzed percutaneous injury (PI) data from a national surveillance network from 2 periods, 1993-1994 and 2006-2007, to see whether changes in disposal-related injury patterns could be detected. METHODS: Data were derived from the EPINet Sharps Injury Surveillance Research Group, established in 1993 and coordinated by the International Healthcare Worker Safety Center at the University of Virginia. For the period 1993-1994, 69 hospitals contributed data; the combined average daily census for the 2 years was 24,495, and the total number of PIs reported was 7,854. For the period 2006-2007, 33 hospitals contributed data; the combined average daily census was 6,800, and the total number of PIs reported was 1901. RESULTS: In 1992-1993, 36.8% of PIs reported were related to disposal of sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline. CONCLUSIONS: This comparison provides evidence that implementation of point-of-use, puncture-resistant sharps disposal containers, combined with large-scale use of safety-engineered sharp devices, has resulted in a marked decline in sharps disposal-related injury rates in the United States. The protocol for removing and replacing full sharps disposal containers remains a critical part of disposal safety. |
Fiscal and policy implications of selling pipe tobacco for roll-your-own cigarettes in the United States
Morris DS , Tynan MA . PLoS One 2012 7 (5) e36487 BACKGROUND: The Federal excise tax was increased for tobacco products on April 1, 2009. While excise tax rates prior to the increase were the same for roll-your-own (RYO) and pipe tobacco, the tax on pipe tobacco was $21.95 per pound less than the tax on RYO tobacco after the increase. Subsequently, tobacco manufacturers began labeling loose tobacco as pipe tobacco and marketing these products to RYO consumers at a lower price. Retailers refer to these products as "dual purpose" or "dual use" pipe tobacco. METHODS: Data on tobacco tax collections comes from the Alcohol and Tobacco Tax and Trade Bureau. Joinpoint software was used to identify changes in sales trends. Estimates were generated for the amount of pipe tobacco sold for RYO use and for Federal and state tax revenue lost through August 2011. RESULTS: Approximately 45 million pounds of pipe tobacco has been sold for RYO use from April 2009 to August 2011, lowering state and Federal revenue by over $1.3 billion. CONCLUSIONS: Marketing pipe tobacco as "dual purpose" and selling it for RYO use provides an opportunity to avoid paying higher cigarette prices. This blunts the public health impact excise tax increases would otherwise have on reducing tobacco use through higher prices. Selling pipe tobacco for RYO use decreases state and Federal revenue and also avoids regulations on flavored tobacco, banned descriptors, prohibitions on shipping, and reporting requirements. |
A national research agenda for public health services and systems
Van Wave TW , Monroe JA , Mattison S , Thomas C . Am J Prev Med 2012 42 S72-8 The field of public health services and systems research (PHSSR) has emerged over the past decade to produce the evidence needed to address critical uncertainties about how best to organize, finance, and deliver effective public health strategies to all Americans. To advance these efforts, a national PHSSR research agenda-setting process was used to identify a broad inventory of information needs and uncertainties that public health stakeholders face in the domains of public health workforce, public health system structure and performance, public health financing, and public health information and technology. This paper presents the results of an expert review process used to transform the identified information needs into a concise set of research questions that can be pursued through new scientific inquiry in PHSSR. Established research frameworks were used to specify the contexts, mechanisms of action, and outcomes within the public health system that require further study. A total of 72 research questions were developed from the 113 original items in the PHSSR inventory of information needs. The questions include both persistent problems and newly emerging needs in public health practice and policy. The resulting research agenda provides a starting point for mobilizing the public health scientific enterprise around contemporary, high-priority uncertainties identified by broad cross sections of public health stakeholders. Regular updates to this agenda will be required to achieve continuous improvements in both the science and practice of public health. |
Hypertension in women of reproductive age in the United States: NHANES 1999-2008
Bateman BT , Shaw KM , Kuklina EV , Callaghan WM , Seely EW , Hernandez-Diaz S . PLoS One 2012 7 (4) e36171 OBJECTIVE: To examine the epidemiology of hypertension in women of reproductive age. METHODS: Using NHANES from 1999-2008, we identified 5,521 women age 20-44 years old. Hypertension status was determined using blood pressure measurements and/or self-reported medication use. RESULTS: The estimated prevalence of hypertension in women of reproductive age was 7.7% (95% confidence interval (CI): 6.9%-8.5%). The prevalence of anti-hypertensive pharmacologic therapy was 4.2% (95% CI 3.5%-4.9%). The prevalence of hypertension was relatively stable across the study period; the age and race adjusted odds of hypertension in 2007-2008 did not differ significantly from 1999-2000 (odds ratio 1.2, CI 0.8 to 1.7, p = 0.45). Significant independent risk factors associated with hypertension included older age, non-Hispanic black race (compared to non-Hispanic whites), diabetes mellitus, chronic kidney disease, and higher body mass index. The most commonly used antihypertensive medications included diuretics, angiotensin-converting enzyme inhibitors (ACE), and beta blockers. CONCLUSION: Hypertension occurs in about 8% of women of reproductive age. There are remarkable differences in the prevalence of hypertension between racial/ethnic groups. Obesity is a risk factor of particular importance in this population because it affects over 30% of young women in the U.S., is associated with more than 4 fold increased risk of hypertension, and is potentially modifiable. |
Contraception for individuals with sickle cell disease: a systematic review of the literature
Haddad LB , Curtis KM , Legardy-Williams JK , Cwiak C , Jamieson DJ . Contraception 2012 85 (6) 527-37 BACKGROUND: Women with sickle cell disease have an increased risk of pregnancy-related complications and need safe, effective contraceptive methods to prevent unintended pregnancy. STUDY DESIGN: We conducted a systematic review to examine the safety of hormonal and intrauterine contraceptive use among women with sickle cell disease. RESULTS: Eight articles met the inclusion criteria. The evidence was of fair to poor quality and suggested that progestin-only and combined hormonal contraception had no effect on frequency of sickle crises or other adverse events and no effect on hematologic parameters associated with sickle crises. No studies examined the risk of thromboembolism in combined hormonal contraceptive users with sickle cell disease. There was insufficient evidence to comment on the safety of intrauterine contraception. CONCLUSION: While data are limited, there is no evidence to suggest that hormonal contraceptive use among women with sickle cell disease is associated with an increased risk of clinical complications. |
Binge drinking intensity: a comparison of two measures
Esser MB , Kanny D , Brewer RD , Naimi TS . Am J Prev Med 2012 42 (6) 625-9 BACKGROUND: Binge drinking (≥4 drinks for women; ≥5 drinks for men, per occasion) is responsible for more than half of the estimated 80,000 U.S. deaths annually and three-quarters of the $223.5 billion in costs in 2006. Binge drinking prevalence is assessed more commonly than binge drinking intensity (i.e., number of drinks consumed per binge episode). Risk of binge drinking-related harm increases with intensity, and thus it is important to monitor. The largest number of drinks consumed is assessed in health surveys, but its usefulness for assessing binge intensity is unknown. PURPOSE: To assess the agreement between two potential measures of binge drinking intensity: the largest number of drinks consumed by binge drinkers (maximum-drinks) and the total number of drinks consumed during their most recent binge episode (drinks-per-binge). METHODS: Data were analyzed from 7909 adult binge drinkers from 14 states responding to the 2008 Behavioral Risk Factor Surveillance System (BRFSS) binge drinking module. Mean and median drinks-per-binge from that module were compared to mean and median maximum-drinks. Analyses were conducted in 2010-2011. RESULTS: Mean (8.2) and median (5.9) maximum-drinks were strongly correlated with mean (7.4) and median (5.4) drinks-per-binge (r=0.57). These measures were also strongly correlated across most sociodemographic and drinking categories overall and within states. CONCLUSIONS: The maximum-drinks consumed by binge drinkers is a practical method for assessing binge drinking intensity and thus can be used to plan and evaluate Community Guide-recommended strategies for preventing binge drinking (e.g., increasing the price of alcoholic beverages and regulating alcohol outlet density). |
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