Population-level intervention strategies and examples for obesity prevention in children
Foltz JL , May AL , Belay B , Nihiser AJ , Dooyema CA , Blanck HM . Annu Rev Nutr 2012 32 391-415 With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention. (Expected final online publication date for the Annual Review of Nutrition Volume 32 is July 17, 2012. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.) |
Global prevalence and major risk factors of diabetic retinopathy
Yau JW , Rogers SL , Kawasaki R , Lamoureux EL , Kowalski JW , Bek T , Chen SJ , Dekker JM , Fletcher A , Grauslund J , Haffner S , Hamman RF , Ikram MK , Kayama T , Klein BE , Klein R , Krishnaiah S , Mayurasakorn K , O'Hare JP , Orchard TJ , Porta M , Rema M , Roy MS , Sharma T , Shaw J , Taylor H , Tielsch JM , Varma R , Wang JJ , Wang N , West S , Xu L , Yasuda M , Zhang X , Mitchell P , Wong TY . Diabetes Care 2012 35 (3) 556-64 OBJECTIVE: To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS: A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. RESULTS: A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS: There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics. |
Anxiety is more common than depression among US adults with arthritis
Murphy LB , Sacks JJ , Brady TJ , Hootman JM , Chapman DP . Arthritis Care Res (Hoboken) 2012 64 (7) 968-76 BACKGROUND: There has been limited characterization of the burden of anxiety and depression, especially the former, among US adults with arthritis in the general population. The study objective was to estimate the prevalence and correlates of anxiety and depression among US adults with doctor-diagnosed arthritis. METHODS: The study sample comprised US adults aged ≥ 45 years with doctor-diagnosed arthritis (n=1,793) from Arthritis Condition and Health Effects Survey (a cross-sectional, population based, random digit dialed telephone interview survey). Anxiety and depression were measured using separate and validated subscales of the Arthritis Impact Measurement Scales. Prevalence was estimated for the sample overall and stratified by subgroups. Associations between correlates and each condition were estimated with prevalence ratios and 95% confidence intervals using logistic regression models. RESULTS: Anxiety was more common than depression (31% and 18% respectively); overall, a third of respondents reported at least one of the two conditions. Most (84%) of those with depression also had anxiety. Multivariable logistic regression modeling failed to identify a distinct profile of characteristics of those with anxiety or/and depression. Only half of respondents with anxiety and/or depression had sought help for their mental health condition in the past year. CONCLUSIONS: Despite the clinical focus on depression among people with arthritis, anxiety was almost twice as common as depression. Given their high prevalence, profound impact on quality of life, and range of effective treatments available, we encourage health care providers to screen all people with arthritis for both anxiety and depression. (c) 2012 by the American College of Rheumatology. |
The association between major depressive disorder and obesity in US adolescents: results from the 2001-2004 National Health and Nutrition Examination Survey
Merikangas AK , Mendola P , Pastor PN , Reuben CA , Cleary SD . J Behav Med 2012 35 (2) 149-54 The association between major depressive disorder (MDD) and obesity was assessed in 4,150 US adolescents aged 12-19 years from the 2001-2004 National Health and Nutrition Examination Survey. Weight and height were measured by health professionals and MDD was based on a structured diagnostic interview. The prevalence of MDD in the past year among US adolescents was 3.2% and 16.8% of US adolescents were obese. After adjustment for sex, age, race/ethnicity and poverty, MDD was not significantly associated with obesity among adolescents overall (adjusted odds ratio (adjOR) = 1.6, 95% confidence interval (CI) = 0.9-2.9), but an increased odds of obesity was observed among males (adjOR = 2.7, 95% CI = 1.1-7.1) and non-Hispanic blacks (adjOR = 3.1, 95% CI = 1.1-8.3) with MDD. Future research on strategies that might reduce the risk of obesity in males and non-Hispanic black adolescents with MDD may be warranted. |
Breast and cervical cancer screening among women in Jordan: findings from the Behavioural Risk Factor Surveillance System - 2007
Al Nsour M , Brown DW , Tarawneh M , Haddadin R , Walk H . Open Breast Cancer J 2012 4 (1) 1-7 INTRODUCTION: Breast cancer is the most common cancer among women in Jordan. Age standardized incidence rate for cervical cancer has been estimated at 3.6 per 100,000 women. This report presents the results of breast and cervical cancer screening practices among a nationally representative sample of Jordanian women aged 35 years or above. METHOD: We used data from the third Jordan Behavioural Risk Factor Surveillance System (2007) among a nationally representative sample of Jordanian women aged >=35 years (n=1,157). Logistic regression was used to examine the associations between each of breast and cervical cancer screening practices and selected socio-demographic characteristics. RESULTS: Only 12.4% of women aged 35 years or older reported ever having a mammography. One fifth reported ever having a clinical breast examination at least once in their life time. Over one quarter (27.1%) of the women reported that they perform self-breast examination on monthly basis, and 41.7% reported ever having performed a self-breast examination. Among ever-married women aged 35 years or more, Pap smear test was performed by 27.8% during their life. The reported low practices have shown substantial differences across regions, age groups, level of education, family income, marital status, and source of medical services. CONCLUSION: The low reported cancer screening activities among women in Jordan calls for action. Data on current screening practices is a primary step to provide health professionals, and policy-makers with the information necessary to identify priorities and to facilitate cancer control, policy development, and planning. |
Reduced influenza antiviral treatment among children and adults hospitalized with laboratory-confirmed influenza infection in the year following the 2009 pandemic
Garg S , Chaves SS , Perez A , D'Mello T , Gershman K , Meek J , Yousey-Hindes K , Arnold KE , Farley MM , Tengelsen L , Ryan P , Sharangpani R , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Fowler B , Bradley K , Thomas A , Cooper T , Schaffner W , Boulton R , Finelli L , Fry A . Clin Infect Dis 2012 55 (3) e18-21 Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared to treatment during the 2009 pandemic (children: 56% versus 77%, p <0.01; adults 77% versus 82%, p<0.01). |
Research priorities for global measles and rubella control and eradication
Goodson JL , Chu SY , Rota PA , Moss WJ , Featherstone DA , Vijayaraghavan M , Thompson KM , Martin R , Reef S , Strebel PM . Vaccine 2012 30 (32) 4709-16 In 2010, an expert advisory panel convened by the World Health Organization to assess the feasibility of measles eradication concluded that (1) measles can and should be eradicated, (2) eradication by 2020 is feasible if measurable progress is made toward existing 2015 measles mortality reduction targets, (3) measles eradication activities should occur in the context of strengthening routine immunization services, and (4) measles eradication activities should be used to accelerate control and elimination of rubella and congenital rubella syndrome (CRS). The expert advisory panel also emphasized the critical role of research and innovation in any disease control or eradication program. In May 2011, a meeting was held to identify and prioritize research priorities to support measles and rubella/CRS control and potential eradication activities. This summary presents the questions identified by the meeting participants and their relative priority within the following categories: (1) measles epidemiology, (2) vaccine development and alternative vaccine delivery, (3) surveillance and laboratory methods, (4) immunization strategies, (5) mathematical modeling and economic analyses, and (6) rubella/CRS control and elimination. |
Sapovirus outbreaks in long-term care facilities, Oregon and Minnesota, USA, 2002-2009
Lee LE , Cebelinski EA , Fuller C , Keene WE , Smith K , Vinje J , Besser JM . Emerg Infect Dis 2012 18 (5) 873-6 We tested fecal samples from 93 norovirus-negative gastroenteritis outbreaks; 21 outbreaks were caused by sapovirus. Of these, 71% were caused by sapovirus genogroup IV and 66% occurred in long-term care facilities. Future investigation of gastroenteritis outbreaks should include multi-organism testing. |
Methicillin-resistant and susceptible Staphylococcus aureus bacteremia and meningitis in preterm infants
Shane AL , Hansen NI , Stoll BJ , Bell EF , Sanchez PJ , Shankaran S , Laptook AR , Das A , Walsh MC , Hale EC , Newman NS , Schrag SJ , Higgins RD . Pediatrics 2012 129 (4) e914-e922 BACKGROUND: Data are limited on the impact of methicillin-resistant Staphylococcus aureus (MRSA) on morbidity and mortality among very low birth weight (VLBW) infants with S aureus (SA) bacteremia and/or meningitis (B/M). METHODS: Neonatal data for VLBW infants (birth weight 401-1500 g) born January 1, 2006, to December 31, 2008, who received care at centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were collected prospectively. Early-onset (≤72 hours after birth) and late-onset (>72 hours) infections were defined by blood or cerebrospinal fluid cultures and antibiotic treatment of ≥5 days (or death <5 days with intent to treat). Outcomes were compared for infants with MRSA versus methicillin-susceptible S aureus (MSSA) B/M. RESULTS: Of 8444 infants who survived >3 days, 316 (3.7%) had SA B/M. Eighty-eight had MRSA (1% of all infants, 28% of infants with SA); 228 had MSSA (2.7% of all infants, 72% of infants with SA). No infant had both MRSA and MSSA B/M. Ninety-nine percent of MRSA infections were late-onset. The percent of infants with MRSA varied by center (P < .001) with 9 of 20 centers reporting no cases. Need for mechanical ventilation, diagnosis of respiratory distress syndrome, necrotizing enterocolitis, and other morbidities did not differ between infants with MRSA and MSSA. Mortality was high with both MRSA (23 of 88, 26%) and MSSA (55 of 228, 24%). CONCLUSIONS: Few VLBW infants had SA B/M. The 1% with MRSA had morbidity and mortality rates similar to infants with MSSA. Practices should provide equal focus on prevention and management of both MRSA and MSSA infections among VLBW infants. |
Emergency department visits for influenza A(H1N1)pdm09, Davidson County, Tennessee, USA
Self WH , Grijalva CG , Zhu Y , Talbot HK , Jules A , Widmer KE , Edwards KM , Williams JV , Shay DK , Griffin MR . Emerg Infect Dis 2012 18 (5) 863-5 To determine the number of emergency department visits attributable to influenza A(H1N1)pdm09 in Davidson County, Tennessee, USA, we used active, population-based surveillance and laboratory-confirmed influenza data. We estimated approximately 10 visits per 1,000 residents during the pandemic period. This estimate should help emergency departments prepare for future pandemics. |
Fatal human co-infection with Leptospira spp. and dengue virus, Puerto Rico, 2010
Sharp TM , Bracero J , Rivera A , Shieh WJ , Bhatnagar J , Rivera-Diez I , Hunsperger E , Munoz-Jordan J , Zaki SR , Tomashek KM . Emerg Infect Dis 2012 18 (5) 878-80 TO THE EDITOR: Leptospirosis, caused by Leptospira spp. bacteria, and dengue, caused by dengue viruses (DENVs), are potentially fatal acute febrile illnesses (AFI) endemic to the tropics (1,2). Because their clinical manifestations are similar (3), leptospirosis may be misidentified as dengue (4). We report a fatal case of co-infection with Leptospira spp. and DENV-1 in a man in Puerto Rico. |
HIV transmission rates in the United States, 2006-2008
Holtgrave DR , Hall HI , Prejean J . Open AIDS J 2012 6 26-8 National HIV incidence for a given year x [I(x)] equals prevalence [P(x)] times the transmission rate [T(x)]. Or, simply rearranging the terms, T(x) = [I(x)/P(x)]*100 (where T(x) is the number of HIV transmissions per 100 persons living with HIV in a given year). The transmission rate is an underutilized measure of the speed at which the epidemic is spreading. Here, we utilize recently updated information about HIV incidence and prevalence in the U.S. to estimate the national HIV transmission rate for 2006 through 2008, and present a novel method to express the level of uncertainty in these estimates. Transmission rate estimates for 2006 through 2008 are as follows (respectively): 4.39 (4.01 to 4.73); 4.90 (4.49 to 5.28); and 4.06 (3.70 to 4.38). Although there are methodological challenges inherent in making these estimates, they do give some indications that the U.S. HIV transmission rate is at a historically low level. |
Human infections with novel reassortant influenza A(H3N2)v viruses, United States, 2011
Lindstrom S , Garten R , Balish A , Shu B , Emery S , Berman L , Barnes N , Sleeman K , Gubareva L , Villanueva J , Klimov A . Emerg Infect Dis 2012 18 (5) 834-7 During July-December 2011, a variant virus, influenza A(H3N2)v, caused 12 human cases of influenza. The virus contained genes originating from swine, avian, and human viruses, including the M gene from influenza A(H1N1)pdm09 virus. Influenza A(H3N2)v viruses were antigenically distinct from seasonal influenza viruses and similar to proposed vaccine virus A/Minnesota/11/2010. |
Interleukin-10 and interferon-gamma patterns during tuberculosis treatment: possible association with recurrence
Lago PM , Boechat N , Migueis DP , Almeida AS , Lazzarini LC , Saldanha MM , Kritski AL , Ho JL , Lapa e Silva JR . Int J Tuberc Lung Dis 2012 16 (5) 656-9 Interleukin (IL) 10 and interferon-gamma (IFN-) levels in induced sputum supernatants of 21 tuberculosis (TB) patients at diagnosis and during chemotherapy were correlated to recurrence rates. IL-10 decreased until day 60 of treatment (T60), and between T60 and T180 it increased again in 7 cases (Pattern 1) and further decreased in 14 cases (Pattern 2). Follow-up of 69 months was performed in 20/21 cases; 6 had recurrence of TB, of which 5/7 (71%) had Pattern 1 and 1/13 (7.7%) Pattern 2 (OR 30.0, 95%CI 2.19411.3, P 0.0072). This was not observed for IFN-. High IL-10 levels at the end of treatment may function as a risk factor for TB recurrence. |
All cause gastroenteritis and rotavirus-coded hospitalizations among US children from 2000-2009
Desai R , Curns AT , Steiner CA , Tate JE , Patel MM , Parashar UD . Clin Infect Dis 2012 55 (4) e28-34 INTRODUCTION: Rotavirus vaccine was recommended for US infants in 2006. We estimated baseline, pre-vaccine burden and monitored post-vaccine trends in gastroenteritis-coded and rotavirus-coded hospitalizations among US children. METHODS: We analyzed data from the State Inpatient Databases (SID) for 29-44 US states over a 10-year period (2000-2009) to calculate gastroenteritis and rotavirus-coded hospitalization rates by age group, sex, and region, among children <5 years of age. By extrapolating observed pre- and post-vaccine gastroenteritis hospitalization rates to the US population <5 years and based on the 2009 cost of a diarrhea hospitalization, we estimated national reductions in diarrhea hospitalizations and associated treatment costs. RESULTS: The pre-vaccine (2000-2006) annual average gastroenteritis-coded hospitalization rate among children <5 years of age was 74 per 10,000 (annual range: 71-82 per 10,000), and declined to 51 and 50 per 10,000 in 2008 and 2009, respectively (p < 0.001). The pre-vaccine (2000-2006) annual average rotavirus-coded hospitalization rate among children <5 years of age was 15 per 10,000 (annual range: 13-18 per 10,000), and declined to 5 and 6 per 10,000 in 2008 and 2009, respectively (p < 0.001). The decreases in rotavirus-coded hospitalization rates in 2008 and 2009 compared with rates in pre-vaccine years were observed among all age-groups and US regions. Nationally, during 2008 and 2009 combined, we estimated a reduction of ~77,000 diarrhea hospitalizations and approximately $242 million in hospital costs. CONCLUSION: Since implementation of the US rotavirus vaccination program, a marked reduction in diarrhea hospitalizations and related hospital charges has occurred among US children. |
An analysis of 332 fatalities infected with pandemic 2009 influenza A (H1N1) in Argentina
Balanzat AM , Hertlein C , Apezteguia C , Bonvehi P , Camera L , Gentile A , Rizzo O , Gomez-Carrillo M , Coronado F , Azziz-Baumgartner E , Chavez PR , Widdowson MA . PLoS One 2012 7 (4) e33670 BACKGROUND: The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities. METHODS: We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group. RESULTS: Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001). CONCLUSION: Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic. |
Associations between radiographic findings and spirometry in a community exposed to Libby amphibole
Larson TC , Lewin M , Gottschall EB , Antao VC , Kapil V , Rose CS . Occup Environ Med 2012 69 (5) 361-6 BACKGROUND: Among asbestos-exposed individuals, abnormal spirometry is usually associated with parenchymal abnormalities or diffuse pleural thickening. Localised pleural thickening (LPT), the most common abnormality associated with asbestos exposure, is typically thought to be a marker of exposure with little clinical consequence. Our objective was to determine if abnormal spirometry is associated with LPT independent of other abnormalities, using data from community-based screening conducted in Libby, Montana. METHODS: Subjects were a subset of screening participants comprising persons with interpretable spirometry and chest radiograph results (n=6475). Chest radiographs were independently evaluated by two or three B readers, and participants were classified by mutually exclusive categories of spirometry outcome: normal, restriction, obstruction or mixed defect. RESULTS: Restrictive spirometry was strongly associated with parenchymal abnormalities (OR 2.9; 95% CI 1.4 to 6.0) and diffuse pleural thickening (OR 4.1; 95% CI 2.1 to 7.8). Controlling for the presence of these abnormalities as well as age, smoking status and other covariates, restrictive spirometry was also associated with LPT (OR 1.4; 95% CI 1.1 to 1.8). The risk of restrictive spirometric findings correlated with the severity of LPT. CONCLUSIONS: In this large community-based screening cohort, restrictive spirometry is significantly associated with LPT, indicating that this abnormality may result in lung function impairment. Physicians treating patients exposed to Libby amphibole should be aware that LPT may have functional consequences. |
National surveillance definitions for hypertension prevalence and control among adults
Crim MT , Yoon SS , Ortiz E , Wall HK , Schober S , Gillespie C , Sorlie P , Keenan N , Labarthe D , Hong Y . Circ Cardiovasc Qual Outcomes 2012 5 (3) 343-51 BACKGROUND: Clear and consistent definitions of hypertension and hypertension control are crucial to guide diagnosis, treatment, and surveillance. A variety of surveillance definitions are in frequent use, resulting in variation of reported hypertension prevalence and control, even when based on the same data set. METHODS AND RESULTS: To assess the variety of published surveillance definitions and rates, we performed a literature search for studies and reports that used National Health and Nutrition Examination Surveys (NHANES) data from at least as recent as the 2003 to 2004 survey cycle. We identified 19 studies that used various criteria for defining hypertension and hypertension control, as well as different parameters for age adjustment and inclusion of subpopulations. This resulted in variation of reported age-standardized hypertension prevalence from 28.9% to 32.1% and hypertension control from 35.1% to 64%. We then assessed the effects of varying the definitions of hypertension and hypertension control, parameters for age adjustment, and inclusion of subpopulations on NHANES data from both 2007 to 2008 (n=5645) and 2005 to 2008 (n=10 365). We propose standard surveillance definitions and age-adjustment parameters for hypertension and hypertension control. By using our recommended approach with NHANES 2007 to 2008 data, the age-standardized prevalence of hypertension in the United States was 29.8% (SE, 0.62%) and the rate of hypertension control was 45.8% (SE, 4.03%). CONCLUSIONS: Surveillance definitions of hypertension and hypertension control vary in the literature. We present standard definitions of hypertension prevalence and control among adults and standard parameters for age-adjustment and population composition that will enable meaningful population comparisons and monitoring of trends. |
Clostridium perfringens infections initially attributed to norovirus, North Carolina, USA, 2010
Dailey NJ , Lee N , Fleischauer AT , Moore ZS , Alfano-Sobsey E , Breedlove F , Pierce A , Ledford S , Greene S , Gomez GA , Talkington DF , Sotir MJ , Hall AJ , Sweat D . Clin Infect Dis 2012 55 (4) 568-70 We investigated an outbreak initially attributed to norovirus; however, Clostridium perfringens toxicoinfection was subsequently confirmed. C. perfringens is an underrecognized but frequently observed cause of foodborne disease outbreaks. This investigation illustrates the importance of considering epidemiologic and laboratory data together when evaluating potential etiologies that might require unique control measures. |
Implications of Internet availability of genomic information for public health practice.
Hesse BW , Arora NK , Khoury MJ . Public Health Genomics 2012 15 201-8 Tensions in the field have emerged over how best to communicate to the public about genomic discoveries in an era of direct-to-consumer (DTC) DNA testing services available through the Internet. Concerns over what the psychological and behavioral response might be to a nuanced, multiplex risk message have spurred some to offer caution in communicating to the public about personalized risk until the necessary research has been completed on how to communicate effectively. The popularization of DTC testing services, along with a spreading Internet culture on transparency for personal data, may make 'waiting to communicate' a moot point. To steer communication efforts in the midst of increasing access to personal genomic information, a self-regulation framework is presented. The framework emphasizes the importance of presenting a coherent message in all communiques about public health genomics. Coherence should be based on an evidence-based model of how the public processes information about health conditions and an emphasis on risk-to-action links. Recommendations from the President's Council of Advisors for Science and Technology are reviewed as a way of identifying targets of opportunity for structured communications both within the healthcare system and in the broader external ecosystem of publicly available health information technologies. |
Comprehensive research synopsis and systematic meta-analyses in Parkinson's disease genetics: The PDGene database.
Lill CM , Roehr JT , McQueen MB , Kavvoura FK , Bagade S , Schjeide BM , Schjeide LM , Meissner E , Zauft U , Allen NC , Liu T , Schilling M , Anderson KJ , Beecham G , Berg D , Biernacka JM , Brice A , DeStefano AL , Do CB , Eriksson N , Factor SA , Farrer MJ , Foroud T , Gasser T , Hamza T , Hardy JA , Heutink P , Hill-Burns EM , Klein C , Latourelle JC , Maraganore DM , Martin ER , Martinez M , Myers RH , Nalls MA , Pankratz N , Payami H , Satake W , Scott WK , Sharma M , Singleton AB , Stefansson K , Toda T , Tung JY , Vance J , Wood NW , Zabetian CP , Young P , Tanzi RE , Khoury MJ , Zipp F , Lehrach H , Ioannidis JP , Bertram L . PLoS Genet 2012 8 (3) e1002548 More than 800 published genetic association studies have implicated dozens of potential risk loci in Parkinson's disease (PD). To facilitate the interpretation of these findings, we have created a dedicated online resource, PDGene, that comprehensively collects and meta-analyzes all published studies in the field. A systematic literature screen of ~27,000 articles yielded 828 eligible articles from which relevant data were extracted. In addition, individual-level data from three publicly available genome-wide association studies (GWAS) were obtained and subjected to genotype imputation and analysis. Overall, we performed meta-analyses on more than seven million polymorphisms originating either from GWAS datasets and/or from smaller scale PD association studies. Meta-analyses on 147 SNPs were supplemented by unpublished GWAS data from up to 16,452 PD cases and 48,810 controls. Eleven loci showed genome-wide significant (P < 5 x 10(-8)) association with disease risk: BST1, CCDC62/HIP1R, DGKQ/GAK, GBA, LRRK2, MAPT, MCCC1/LAMP3, PARK16, SNCA, STK39, and SYT11/RAB25. In addition, we identified novel evidence for genome-wide significant association with a polymorphism in ITGA8 (rs7077361, OR 0.88, P = 1.3 x 10(-8)). All meta-analysis results are freely available on a dedicated online database (www.pdgene.org), which is cross-linked with a customized track on the UCSC Genome Browser. Our study provides an exhaustive and up-to-date summary of the status of PD genetics research that can be readily scaled to include the results of future large-scale genetics projects, including next-generation sequencing studies. |
Introduction to the 4th National Conference on Genomics and Public Health.
McBride CM , Bowen SM , Shully SD , Khoury MJ . Public Health Genomics 2012 15 117 This special issue of Public Health Genomics features a sampling of the | outstanding science presented at the 4th National Conference on Genomics | and Public Health: Using Genomic Information to Improve Health Now and | in the Future. The three-day conference sponsored by NIH and CDC and held | in December 2010 in Bethesda, Maryland, was attended by 700 participants. | The conference brought together public health scientists and practitioners | from around the world, who showcased the current state of the science and | considered future directions for applications of genomics to improve health. | The full breadth of these applications was highlighted, including interventions to prevent and control diseases, genetic services across the lifespan, | emerging genomic technologies that are anticipated in the near future and | the implications of globalization of public health for genomic applications. | The meeting sessions also offered a forum for the multiple constituencies | comprising the public health community to debate research and programmatic priorities for public health genomics as we look forward to 2020. | In this issue, we highlight twelve talks from the conference to exemplify | the controversies we face, promising opportunities to consider for potential | public health impact, genomics’ potential for intervention innovations, and | burning research questions to move the field forward. Opportunities abound | to consider whether and how emerging genomic discovery might be applied | to redress pressing public health problems. This is indeed an exciting time for | this young field. |
The impact of genomics on public health practice: the case for change.
Zimmern RL , Khoury MJ . Public Health Genomics 2012 15 118-24 Public health practice will not be able in the 21st century to ignore the impact of genomics, cell and molecular biology. It will need to take into consideration issues that include, among others: the complementary nature of social and biological models of disease, genetic exceptionalism, the readiness of public and patient to respond to genomic information, the relationship between individuals and populations, and concepts of population stratification. Health systems will need to adapt their practice and organisation to include new sequencing technologies, bioinformatic expertise and proper evaluation of genetic and molecular tests. Links with the commercial sector will increase in importance. The impact on developing countries cannot be ignored and will require special attention. |
Partner referral by HIV-infected persons to Partner Counseling and Referral Services (PCRS) - results from a demonstration project
Song B , Begley EB , Lesondak L , Voorhees K , Esquivel M , Merrick RL , Carrel J , Sebesta D , Vergeront J , Shrestha D , Oraka E , Walker A , Heffelfinger JD . Open AIDS J 2012 6 8-15 OBJECTIVE: The objectives of this article are to determine factors associated with refusal and agreement to provide partner information, and evaluate the effectiveness of referral approaches in offering PCRS. METHODS: Index clients from 5 sites that used 3 different PCRS approaches were interviewed to obtain demographic and risk characteristics and choice of partner referral method for PCRS. Logistic regression was used to assess factors associated with providing partner information. RESULTS: The percentage of index clients who refused to provide partner information varied by site (7% to 88%). Controlling for PCRS approach, index clients who were older than 25 years, male, or reported having male-male sex in the past 12 months were more likely (p <0.01) to refuse to provide partner information. Overall, 72% of named partners referred by index clients were located and offered PCRS. The proportion of partners who were located and offered PCRS differed by referral approach used, ranging from 38% using contract referral (index clients agree to notify their partners within a certain timeframe, else a disease intervention specialist or health care provider will notify them) to 98% using dual referral (index clients notify their partners with a disease intervention specialist or provider present). CONCLUSION: Success in obtaining partner information varied by the PCRS approach used and effectiveness in locating and notifying partners varied by the referral approach selected. These results provide valuable insights for enhancing partner services. |
Agents of change: peer mentorship as HIV prevention among HIV-positive injection drug users
Mackenzie S , Pearson C , Frye V , Gomez CA , Latka MH , Purcell DW , Knowlton AR , Metsch LR , Tobin KE , Valverde EE , Knight KR . Subst Use Misuse 2012 47 (5) 522-34 This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA). |
Health care-associated hepatitis C virus infections attributed to narcotic diversion
Hellinger WC , Bacalis LP , Kay RS , Thompson ND , Xia GL , Lin Y , Khudyakov YE , Perz JF . Ann Intern Med 2012 156 (7) 477-82 BACKGROUND: Three cases of genetically related hepatitis C virus (HCV) infection that were unattributable to infection control breaches were identified at a health care facility. OBJECTIVE: To investigate HCV transmission from an HCV-infected health care worker to patients through drug diversion. DESIGN: Cluster and look-back investigations. SETTING: Acute care hospital and affiliated multispecialty clinic. PATIENTS: Inpatients and outpatients during the period of HCV transmission. MEASUREMENTS: Employee work and narcotic dispensing records, blood testing for HCV antibody and RNA, and sequencing of the NS5B gene and the hypervariable region 1 of the E2 gene. RESULTS: 21 employees were recorded as being at work or as retrieving a narcotic from an automated dispensing cabinet in an area where a narcotic was administered to each of the 3 case patients; all employees provided blood samples for HCV testing. One employee was infected with HCV that had more than 95% NS5B sequence homology with the HCV strains of the 3 case patients. Quasi-species analysis showed close genetic relatedness with variants from each of the case patients and more than 97.9% nucleotide identity. The employee acknowledged parenteral opiate diversion. An investigation identified 6132 patients at risk for exposure to HCV because of the drug diversion. Of the 3929 living patients, 3444 (87.7%) were screened for infection. Two additional cases of genetically related HCV infection attributable to the employee were identified. LIMITATION: Of the living patients at risk for HCV exposure, 12.3% were not tested. CONCLUSION: Five cases of HCV infection occurring over 3 to 4 years were attributed to drug diversion by an HCV-infected health care worker. Studies of drug diversion and assessments of strategies to prevent narcotics tampering in all health care settings are needed. PRIMARY FUNDING SOURCE: None. |
A rare event: a measles outbreak in a highly vaccinated two-dose population
Seward JF , Orenstein WA . Clin Infect Dis 2012 55 (3) 403-5 Widespread global vaccination with highly effective measles vaccines, first licensed in 1963, has resulted in a decline in estimated global measles deaths, from 2.6 million in 1980 to 164 000 by 2008 [1, 2], and in measles elimination in many countries [3–6]. The World Health Organization (WHO) Region of the Americas has had no year-round endemic measles circulation since 2002 and may become the first region to achieve measles elimination [7]. Because measles is highly contagious, achieving and maintaining elimination requires extremely high population immunity through high 2-dose vaccine coverage. Measles postelimination epidemiology is characterized by importations and limited outbreaks, primarily in unvaccinated persons, provided population immunity remains high [8]. However, if population immunity declines, as occurred in the United Kingdom, when vaccination coverage declined because parents were deterred from vaccinating by misinformation about the safety of the measles, mumps, and rubella vaccine, endemic measles transmission can be rapidly reestablished, bringing with it preventable complications and deaths [9]. |
Reported adverse events in young women following quadrivalent human papillomavirus vaccination
Naleway AL , Gold R , Drew L , Riedlinger K , Henninger ML , Gee J . J Womens Health (Larchmt) 2012 21 (4) 425-32 PURPOSE: To assess and describe young women's experiences with their first dose of quadrivalent human papillomavirus vaccine (HPV4) (Gardasil(R)) in a large managed care organization. METHODS: We collected survey and electronic medical record (EMR) data for 899 young women aged 11-26 receiving their first HPV4 injection from February through September 2008. Survey items included questions about adverse events, interactions with healthcare providers, and knowledge and attitudes toward HPV disease and HPV4. RESULTS: Six hundred ninety-six (78%) participants reported pain at the injection site. Other common reactions included injection site bruising or discoloration (n=155, 17%) or swelling (n=127, 14%) and presyncope or syncope (n=134, 15%). Overall, preteens and teens were more likely than adult participants to report vaccine adverse events. Most respondents, particularly in the adult age group, reported that their healthcare provider reviewed important information about HPV infection and about the risks and benefits of receiving the vaccine. Knowledge and attitudes about HPV and HPV4 also varied by age, with older women generally exhibiting more accurate knowledge about HPV and perceived susceptibility to cervical cancer. CONCLUSIONS: There were significant age differences in young women's experiences with their first HPV4 injection. These findings highlight the importance of age-appropriate education and provider communications about HPV disease and vaccination. |
Research priorities regarding rotavirus vaccine and intussusception: a meeting summary
Tate JE , Steele AD , Bines JE , Zuber PL , Parashar UD . Vaccine 2012 30 Suppl 1 A179-84 Currently available rotavirus vaccines have been associated with a small increased risk of intussusception ( approximately 1-2 cases per 100,000 vaccinated infants) in some populations. In response to this newly emerging data on intussusception related to current rotavirus vaccines, a group of technical experts convened by the Program for Applied Technology in Health met to review the data, establish what gaps in knowledge exist, and identify what future research is needed. This manuscript outlines the evidence that is currently available and the research agenda that was generated during this meeting. It also highlights the need for countries that are using or considering introducing the rotavirus vaccine to evaluate both the benefits and risks of vaccination. |
Safety of the pentavalent rotavirus vaccine (PRV), RotaTeq(R), in Kenya, including among HIV-infected and HIV-exposed infants
Laserson KF , Nyakundi D , Feikin DR , Nyambane G , Cook E , Oyieko J , Ojwando J , Rivers SB , Ciarlet M , Neuzil KM , Breiman RF . Vaccine 2012 30 Suppl 1 A61-70 Two multicenter Phase III trials were conducted in five countries from March 2007 to March 2009 to evaluate the safety and efficacy of the pentavalent rotavirus vaccine (PRV), RotaTeq((R)), in Africa and Asia. In this report, we evaluate the safety of this vaccine, including among HIV-infected and HIV-exposed infants, in Kenya. 1308 Infants were randomized 1:1 to receive 3 doses of PRV/placebo at approximately 6, 10, and 14 weeks of age. HIV counseling and testing were offered to all participants. A positive PCR result indicated HIV infection; the presence of HIV antibody in PCR-negative children indicated HIV exposure without HIV infection. All serious adverse events (SAE) within 14 days of any dose, and vaccine-related SAEs, intussusception, and deaths occurring at any time during the study, were reported ("SAE surveillance"). In addition, 297 participants were followed for 42 days after any dose for any adverse event (AE), regardless of severity ("intensive safety surveillance"). The safety evaluation was stratified by HIV status. SAEs were reported in 20/649 vaccine recipients (3.1%) and 21/643 placebo recipients (3.3%) within 14 days following vaccination (p=0.9). The most common SAE in the vaccinated group was pneumonia (1.7%). No individual SAE was significantly more common among vaccine vs. placebo recipients. Seventy-two deaths were reported, 38 (5.9%) and 34 (5.3%) among vaccine and placebo recipients, respectively (p=0.66). No cases of intussusception were reported. During intensive safety surveillance, 137/147 (93.2%) vaccine recipients and 147/150 (98.0%) placebo recipients experienced one or more AEs (risk ratio=0.95; 95% CI: 0.91-1.0; p=0.05). 88.5% of the infants were tested for HIV infection; 21/581 (3.6%) children in the vaccine group and 17/577 (2.9%) in the placebo group were HIV-infected. Among the 37 HIV-infected infants with full safety follow-up, 5/21 (23.8%) vaccine recipients and 2/16 (12.5%) placebo recipients reported an SAE (p=0.67). In total, 12 deaths occurred among identified HIV-infected infants: 8 (38%) receiving vaccine vs. 4 (23.5%) receiving placebo (RR=1.6, 95% CI: 0.59-4.5). Among the 21 HIV-infected infants in the vaccine group, 2 of 8 deaths were gastroenteritis-related; among the 17 HIV-infected infants in the placebo group, 3 of 4 deaths were gastroenteritis-related. There were no significant differences in serious or non-serious AEs, including vaccine-related SAEs, between the 88 HIV-exposed vaccine recipients vs. the 89 HIV-exposed placebo recipients. PRV appears to be a safe intervention against rotavirus gastroenteritis among infants in Kenya. AEs, including serious AEs, were not associated with receipt of vaccine. Further, SAEs were not significantly more common among HIV-infected or HIV-exposed participants; however, the low number of HIV-infected infants did not provide sufficient power to fully assess safety in HIV- infected vaccine recipients. |
Seasonal trivalent inactivated influenza vaccine protects against 1918 Spanish influenza virus in ferrets
Pearce MB , Belser JA , Gustin KM , Pappas C , Houser KV , Sun X , Maines TR , Pantin-Jackwood MJ , Katz JM , Tumpey TM . J Virol 2012 86 (13) 7118-25 The influenza H1N1 pandemic of 1918 was one of the worst medical catastrophes in human history. Recent studies have demonstrated that the hemagglutinin (HA) protein of the 1918 virus and 2009 H1N1 pandemic virus [A(H1N1)pdm09], the latter now a component of the seasonal trivalent inactivated influenza vaccine (TIV), share cross-reactive antigenic determinants. In this study, we demonstrate that immunization with the 2010-11 seasonal TIV induces neutralizing antibodies that cross-react with the reconstructed 1918 pandemic virus in ferrets. TIV-immunized ferrets subsequently challenged with the 1918 virus displayed a significant reduction in fever, weight loss and virus shedding compared to non-immune control ferrets. Seasonal TIV was also effective in protecting against lung infection and severe lung pathology associated with 1918 virus infection. Our data demonstrate that prior immunization with contemporary TIV provides cross-protection against the 1918 virus in ferrets. These findings suggest that exposure to A(H1N1)pdm09 through immunization, may provide protection against the reconstructed 1918 virus which as a select agent is considered to pose both biosafety and biosecurity threats. |
Trends in intussusception hospitalizations among US infants before and after implementation of the rotavirus vaccination program, 2000-2009
Yen C , Tate JE , Steiner CA , Cortese MM , Patel MM , Parashar UD . J Infect Dis 2012 206 (1) 41-8 BACKGROUND: In 1999, a rotavirus vaccine was withdrawn due to an association with intussusception. While US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate a possible low risk, primarily after the first dose. METHODS: Among infants in 26 US states comprising 75% of the birth cohort, we conducted an ecological analysis to examine age-specific trends in population-level intussusception hospitalization rates before (2000-2005) and after (2007-2009) rotavirus vaccine introduction. RESULTS: Compared with 2000-2005 (35.3/100,000), the rate was greater in 2007 (39.0/100,000; rate ratio [RR]=1.10;95% confidence interval [CI]: 1.04-1.18), similar in 2008 (33.4/100,000; RR=0.95[0.89-1.01]), and lower in 2009 (32.9/100,000; RR=0.93[0.87-0.99]). Among 8-11 week-olds, compared with 2000-2005 (6.9/100,000), a small, significant increase was observed in each of 2007 (11.4/100,000; RR=1.64[1.08-2.50]), 2008 (12.2/100,000; RR=1.76[1.17-2.65]), and 2009 (11.0/100,000; RR=1.59[1.04-2.44]). CONCLUSIONS: Following rotavirus vaccine introduction, a small increase in intussusception rates was seen among US 8-11 week-olds who receive most first doses of vaccine; no sustained population-level change in overall rates was observed. While this ecologic analysis alone cannot establish an association between intussusception and rotavirus vaccination, even if a low risk with the first dose exists, it is outweighed by the well-documented benefits of vaccination among US infants. |
Uptake of pneumococcal polysaccharide vaccination among working-age adults with underlying medical conditions, United States, 2009
Lu PJ , Nuorti JP . Am J Epidemiol 2012 175 (8) 827-37 Since 1997, the Advisory Committee on Immunization Practices has recommended the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for nonelderly adults with certain medical conditions. In 2008, the Committee added asthma and cigarette smoking to the list of indications for PPSV23 vaccination. Using data from the 2009 National Health Interview Survey, the authors assessed PPSV23 uptake in people with established and new indications. To identify factors independently associated with receiving PPSV23, they used multivariable logistic regression and predictive marginal analyses. In 2009, a total of 35.2 million adults 18-64 years of age (18.6%) had established PPSV23 indications; adding asthma and smoking to the list of indications increased the high-risk population to 71.6 million people (37.9%). Overall, 26.1% of people with established indications for PPSV23 and 17.4% of people with any indication (those previously established, as well as asthma and smoking) had received the vaccine; overall coverage among persons 50-64 years of age was significantly higher than that among persons 18-49 years of age (34.6% vs. 16.7%; P < 0.001) and for all specific indications except cancer. For persons who had asthma or who smoked but had no other indications, rates of coverage were 12.3% and 8.5%, respectively. In persons who had established indications, being older, white, and unemployed and having more physician visits, a prior hospitalization, a regular physician, and health insurance were independently associated with PPSV23 receipt. PPSV23 uptake varies substantially by age and indication but remains low overall, with approximately 59 million unvaccinated high-risk working-age adults. Effective strategies to increase pneumococcal vaccination coverage among at-risk groups are needed. |
Efficacy of pentavalent rotavirus vaccine in a high HIV prevalence population in Kenya
Feikin DR , Laserson KF , Ojwando J , Nyambane G , Ssempijja V , Audi A , Nyakundi D , Oyieko J , Dallas MJ , Ciarlet M , Neuzil KM , Breiman RF . Vaccine 2012 30 Suppl 1 A52-60 BACKGROUND: Rotavirus gastroenteritis (RVGE) is a leading cause of death in African children. The efficacy of pentavalent rotavirus vaccine (PRV) against severe RVGE evaluated in Ghana, Kenya, and Mali in a randomized, double-blind, placebo-controlled trial, showed a combined regional efficacy of 39.3% (95% confidence interval [CI]: 19.1,54.7) in nearly 2 years of follow-up. This report concentrates on the Kenya findings. METHODS: Infants received 3 doses of PRV/placebo at approximately 6-, 10-, and 14-weeks of age. HIV testing was offered to all participants. Data on illness symptoms and signs were collected upon presentation to healthcare facilities, where stools were collected, and analyzed by rotavirus-specific enzyme-linked immunosorbent assay. The primary endpoint was severe RVGE (Vesikari score≥11), occurring ≥14 days following the third dose. At monthly home visits, symptoms of illnesses during the past 2 weeks were solicited and limited physical exams were performed; dehydration was defined by WHO's Integrated Management of Childhood Illness. FINDINGS: Vaccine efficacy (VE) against severe RVGE through nearly 2 years of follow-up among 1308 Kenyan children was 63.9% (95% CI: -5.9,89.8). Through the first year of life, VE against severe RVGE was 83.4% (95% CI: 25.5,98.2). From home visits, VE against all-cause gastroenteritis with severe dehydration was 34.4% (95% CI: 5.3,54.6) through the first year and 29.7% (95% CI: 2.5,49.3) through the entire follow-up period. The reduction in incidence of gastroenteritis with severe dehydration in the community during the first year of life (19.0 cases/100 person-years) was almost six times greater than the reduction in severe RVGE presenting to the clinic (3.3/100 person-years). Oral rehydration solution use was lower among PRV recipients (VE 23.1%, 95% CI: 8.8,35.1). An estimated 41% of gastroenteritis with severe dehydration in the first year reported at home was rotavirus-related. CONCLUSIONS: PRV significantly reduced severe RVGE in Kenya. The impact of PRV might be greatest in rural Africa in protecting the many children who develop severe gastroenteritis and cannot access health facilities. |
Impact of rotavirus vaccine on diarrhea-associated disease burden among American Indian and Alaska Native children
Desai R , Haberling D , Holman RC , Singleton RJ , Cheek JE , Groom AV , Steiner CA , Parashar UD , Esposito DH . Pediatrics 2012 129 (4) e907-13 OBJECTIVE: Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (AI/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among AI/AN children in the pre- and postrotavirus vaccine era. METHODS: Diarrhea-associated hospitalizations and outpatient visits among AI/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010. To account for secular declining trends observed in prevaccine years, expected diarrhea-associated hospitalization and outpatient rates for postvaccine years were generated by using Poisson regression analysis of the 2001-2006 annual rates. RESULTS: Coverage with at least 1 dose of rotavirus vaccine among AI/AN infants aged 3 to 5 months in the first half of 2008, 2009, and 2010 ranged from 48% to 80% in various IHS regions. The prevaccine average annual diarrhea-associated hospitalization rates among AI/AN children <5 years of age was 63 per 10,000 persons (range: 57-75 per 10,000), and declined to 39, 31, and 27 per 10,000 in 2008, 2009, and 2010, respectively. Observed 2008, 2009, and 2010 rates were 24%, 37%, and 44% lower than expected rates, respectively. Decreases in diarrhea-associated hospitalizations and outpatient visits were observed in all IHS regions. CONCLUSIONS: Diarrhea-associated hospitalization and outpatient visit rates among AI/AN children have declined after implementation of rotavirus vaccination in AI/AN populations. |
Influence of oral polio vaccines on performance of the monovalent and pentavalent rotavirus vaccines
Patel M , Steele AD , Parashar UD . Vaccine 2012 30 Suppl 1 A30-5 In recent years, two live, oral rotavirus vaccines have been successfully tested in developing and industrialized countries, and both vaccines are now recommended by the World Health Organization for all children worldwide. Both immunogenicity and efficacy of these rotavirus vaccines has been lower in developing compared to industrialized settings. We reviewed the data on the effect of trivalent OPV on the immunogenicity and efficacy of two rotavirus vaccines currently recommended by the WHO. While rotavirus vaccines have not affected immune responses to OPV, in general, the immune responses (i.e., antibody levels) to rotavirus vaccination were lower when rotavirus vaccines were co-administered with OPV. Limited data suggests that the interference is greater after the first dose of OPV, presumably because the first dose is associated with greatest intestinal replication of vaccine polio virus strains, and this interference is largely overcome with subsequent rotavirus vaccine doses. Despite the lower immunogenicity, one large efficacy study in middle income Latin American countries showed no decrease in protective efficacy of rotavirus vaccine in infants receiving concurrent OPV. While these data are encouraging and support simultaneous administration of rotavirus vaccines and OPV, additional evidence should be gathered as rotavirus vaccines are used more widely in developing country settings, where OPV is routinely used, rather than inactivated polio vaccine. |
Analyses of health outcomes from the 5 sites participating in the Africa and Asia clinical efficacy trials of the oral pentavalent rotavirus vaccine
Breiman RF , Zaman K , Armah G , Sow SO , Anh DD , Victor JC , Hille D , Ciarlet M , Neuzil KM . Vaccine 2012 30 Suppl 1 A24-9 BACKGROUND: Efficacy of the pentavalent rotavirus vaccine (PRV), RotaTeq((R)), against severe rotavirus gastroenteritis (RVGE) was evaluated in two double-blind, placebo-controlled, multicenter Phase III clinical trials conducted in GAVI-eligible countries in Africa (Ghana, Kenya, and Mali) and in Asia (Bangladesh and Vietnam) from March 2007 through March 2009. The findings from each continent have been analyzed and presented separately, according to a single identical protocol. Ad hoc analyses combining data from the five sites were performed to further assess the impact of PRV. METHODS: 6674 infants (4705 infants from Africa and 1969 infants from Asia), randomized 1:1 to receive 3 doses of PRV/placebo at approximately 6-, 10-, and 14-weeks of age according to each country's EPI schedule, were included in the per protocol efficacy analysis. Breastfeeding and concomitant administration of EPI vaccines, including OPV, were allowed. Episodes of gastroenteritis (GE) in infants who presented to study facilities were captured and scored using the 20-point Vesikari scale. Stool samples were analyzed by rotavirus-specific EIA to detect presence of rotavirus antigen and RT-PCR to determine the G/P genotypes. We assessed efficacy to prevent all-cause GE and RVGE at a variety of cut-off points (score≥11, severe; score≥15, very severe). RESULTS: Vaccine efficacy (VE) against RVGE, regardless of serotype, through the entire follow-up period for any severity, severe (score≥11), and very severe (score≥15) was 33.9%, 95% CI (22.7, 43.5), 42.5%, 95% CI (27.4, 54.6), and 51.2%, 95% CI (26.3, 68.2), respectively. Through the first year of life, VE against severe RVGE was 58.9%, 95% CI (40.0, 72.3) and against all-cause severe GE was 23.0%, 95% CI (5.4, 37.3). VE against severe RVGE caused by non-vaccine G serotypes, G8 and G9, through the entire follow-up period was 87.5%, 95% CI (6.8, 99.7) and 48.0%, 95% CI (-5.5, 75.6), respectively. All G8 strains were associated with P2A[6] (a P-type not contained in PRV), while the majority of the G9 strains were associated with P1A[8] (a P-type contained in PRV). CONCLUSIONS: Combining data from the 5 sites strengthens the precision of VE estimates and reveals rising VE with increased RVGE severity. Extrapolating data from VE against severe GE and RVGE suggest that 39% of severe GE episodes during the first year of life were due to rotavirus, highlighting substantial, potentially preventable, public health burden of RVGE. PRV provides protection against non-vaccine serotypes (G8P2A[6]). |
Does Tdap vaccination interfere with serodiagnosis of pertussis infection?
Pawloski LC , Kirkland KB , Baughman AL , Martin MD , Talbot EA , Messonnier NE , Tondella ML . Clin Vaccine Immunol 2012 19 (6) 875-80 BACKGROUND: An IgG anti-pertussis toxin (PT) enzyme-linked immunosorbent assay (ELISA) was analytically validated for diagnosis of pertussis, using the cut-off of 94 ELISA Units (EU)/mL. Little was known about the performance of this ELISA for diagnosis in adults recently vaccinated with tetanus-diphtheria-acellular pertussis (Tdap), which contains PT. The goal of this study was to determine when the assay can be used following Tdap vaccination. METHODS: A cohort of 102 asymptomatic health care personnel (HCP) vaccinated with Tdap (Adacel, Sanofi Pasteur) were aged 19 to 79 years (median 47 years) at vaccination. For each HCP, specimens were available for evaluation at 2-10 time points (pre-vaccination to 24 months post-vaccination), and geometric mean concentrations (GMC) for the cohort were calculated at each time point. Among 97 HCP who responded to vaccination, a mixed model analysis with prediction and tolerance intervals was performed to estimate the time at which serodiagnosis can be used following vaccination. RESULTS: The GMC was 8, 21, and 9 EU/mL at pre-vaccination, four, and 12 months post-vaccination, respectively. Eight of 102 (8%) HCP reached antibody titers ≥ 94 EU/mL during their peak response but none had these titers by six months post-vaccination. Calculated prediction and tolerance intervals were < 94 EU/mL by 45 and 75 days post-vaccination, respectively. CONCLUSIONS: Tdap vaccination six months prior to testing did not confound result interpretation. This seroassay remains a valuable diagnostic tool for adult pertussis. |
A structured vocabulary for indexing dietary supplements in databases in the United States
Saldanha LG , Dwyer JT , Holden JM , Ireland JD , Andrews KW , Bailey RL , Gahche JJ , Hardy CJ , Moller A , Pilch SM , Roseland JM . J Food Compost Anal 2012 25 (2) 226-233 Food composition databases are critical to assess and plan dietary intakes. Dietary supplement databases are also needed because dietary supplements make significant contributions to total nutrient intakes. However, no uniform system exists for classifying dietary supplement products and indexing their ingredients in such databases. Differing approaches to classifying these products make it difficult to retrieve or link information effectively. A consistent approach to classifying information within food composition databases led to the development of LanguaL (TM), a structured vocabulary. LanguaL (TM) is being adapted as an interface tool for classifying and retrieving product information in dietary supplement databases. This paper outlines proposed changes to the LanguaL (TM) thesaurus for indexing dietary supplement products and ingredients in databases. The choice of 12 of the original 14 LanguaL (TM) facets pertinent to dietary supplements, modifications to their scopes, and applications are described. The 12 chosen facets are: product type; product source; part of source; physical state, shape or form; ingredients; preservation method; packing medium; container or wrapping; contact surface; label claims/consumer group/dietary use; geographic places and regions; and adjunct characteristics of dietary supplements. (Published by Elsevier Inc.) |
A review of traumatic brain injury trauma center visits meeting physiologic criteria from the American College of Surgeons Committee on Trauma/Centers for Disease Control and Prevention Field Triage Guidelines
Pearson WS , Ovalle F Jr , Faul M , Sasser SM . Prehosp Emerg Care 2012 16 (3) 323-8 BACKGROUND: Traumatic brain injury (TBI) represents a serious subset of injuries among persons in the United States, and prehospital care of these injuries can mitigate both the morbidity and the mortality in patients who suffer from these injuries. Guidelines for triage of injured patients have been set forth by the American College of Surgeons Committee on Trauma (ACS-COT) in cooperation with the Centers for Disease Control and Prevention (CDC). These guidelines include physiologic criteria, such as the Glasgow Coma Scale (GCS) score, systolic blood pressure, and respiratory rate, which should be used in determining triage of an injured patient. OBJECTIVES: This study examined the numbers of visits at level I and II trauma centers by patients with a diagnosed TBI to determine the prevalence of those meeting physiologic criteria from the ACS-COT/CDC guidelines and to determine the extent of mortality among this patient population. METHODS: The data for this study were taken from the 2007 National Trauma Data Bank (NTDB) National Sample Program (NSP). This data set is a nationally representative sample of visits to level I and II trauma centers across the United States and is funded by the American College of Surgeons. Estimates of demographic characteristics, physiologic measures, and death were made for this study population using both chi-square analyses and adjusted logistic regression modeling. RESULTS: The analyses demonstrated that although many people who sustain a TBI and were taken to a level I or II trauma center did not meet the physiologic criteria, those who did meet the physiologic criteria had significantly higher odds of death than those who did not meet the criteria. After controlling for age, gender, race, Injury Severity Score (ISS), and length of stay in the hospital, persons who had a GCS score ≤13 were 17 times more likely to die than TBI patients who had a higher GCS score (odds ratio [OR] 17.4; 95% confidence interval [CI] 10.7-28.3). Other physiologic criteria also demonstrated significant odds of death. CONCLUSIONS: These findings support the validity of the ACS-COT/CDC physiologic criteria in this population and stress the importance of prehospital triage of patients with TBI in the hopes of reducing both the morbidity and the mortality resulting from this injury. |
Evaluation for West Nile Virus (WNV) RNA in urine of patients within 5 months of WNV infection.
Baty SA , Gibney KB , Staples JE , Patterson AB , Levy C , Lehman J , Wadleigh T , Feld J , Lanciotti R , Nugent CT , Fischer M . J Infect Dis 2012 205 (9) 1476-7 Gibney et al recently reported finding no West Nile virus (WNV) RNA in urine samples collected from 40 patients at 6.5–6.7 years after acute WNV disease [1]. These findings were in contrast to Murray et al, who detected WNV RNA in urine samples collected from 5 of 25 patients (20%) at 1.6–6.7 years after their initial infections [2]. We present results from a prospective evaluation of WNV RNA in urine specimens collected from 63 persons within 5 months after their acute WNV infection. | During the 2010 WNV outbreak in Maricopa County, Arizona, we identified persons with laboratory evidence of acute WNV infection, including detection of WNV immunoglobulin M antibodies in serum or cerebrospinal fluid samples from patients with a clinically compatible illness or WNV RNA in serum samples from asymptomatic blood donors. Information on demographic characteristics, medical history, current medications, and clinical illness was obtained by medical record review and interview with patients or their surrogate. A urine sample was collected during a site visit. The study was approved by the Centers for Disease Control and Prevention (CDC) and Arizona Department of Health Services (ADHS) human subjects review boards, and participants provided informed consent before enrollment. |
Rapid detection of microbial DNA by a novel isothermal genome exponential amplification reaction (GEAR) assay.
Prithiviraj J , Hill V , Jothikumar N . Biochem Biophys Res Commun 2012 420 (4) 738-42 In this study we report the development of a simple target-specific isothermal nucleic acid amplification technique, termed genome exponential amplification reaction (GEAR). Escherichia coli was selected as the microbial target to demonstrate the GEAR technique as a proof of concept. The GEAR technique uses a set of four primers; in the present study these primers targeted 5 regions on the 16S rRNA gene of E. coli. The outer forward and reverse Tab primer sequences are complementary to each other at their 5' end, whereas their 3' end sequences are complementary to their respective target nucleic acid sequences. The GEAR assay was performed at a constant temperature 60 degrees C and monitored continuously in a real-time PCR instrument in the presence of an intercalating dye (SYTO 9). The GEAR assay enabled amplification of as few as one colony forming units of E. coli per reaction within 30min. We also evaluated the GEAR assay for rapid identification of bacterial colonies cultured on agar media directly in the reaction without DNA extraction. Cells from E. coli colonies were picked and added directly to GEAR assay mastermix without prior DNA extraction. DNA in the cells could be amplified, yielding positive results within 15min. |
Molecular virology of the henipaviruses.
Rota PA , Lo MK . Curr Top Microbiol Immunol 2012 359 41-58 Nipah (NiV) and Hendra (HeV) viruses comprise the genus Henipavirus and are highly pathogenic paramyxoviruses, which cause fatal encephalitis and respiratory disease in humans. Since their respective initial outbreaks in 1998 and 1994, they have continued to cause sporadic outbreaks resulting in fatal disease. Due to their designation as Biosafety Level 4 pathogens, the level of containment required to work with live henipaviruses is available only to select laboratories around the world. This chapter provides an overview of the molecular virology of NiV and HeV including comparisons to other, well-characterized paramyxoviruses. This chapter also describes the sequence diversity present among the henipaviruses. |
The hepatitis E virus polyproline region is involved in viral adaptation.
Purdy MA , Lara J , Khudyakov YE . PLoS One 2012 7 (4) e35974 Genomes of hepatitis E virus (HEV), rubivirus and cutthroat virus (CTV) contain a region of high proline density and low amino acid (aa) complexity, named the polyproline region (PPR). In HEV genotypes 1, 3 and 4, it is the only region within the non-structural open reading frame (ORF1) with positive selection (4-10 codons with dN/dS>1). This region has the highest density of sites with homoplasy values >0.5. Genotypes 3 and 4 show approximately 3-fold increase in homoplastic density (HD) in the PPR compared to any other region in ORF1, genotype 1 does not exhibit significant HD (p<0.0001). PPR sequence divergence was found to be 2-fold greater for HEV genotypes 3 and 4 than for genotype 1. The data suggest the PPR plays an important role in host-range adaptation. Although the PPR appears to be hypervariable and homoplastic, it retains as much phylogenetic signal as any other similar sized region in the ORF1, indicating that convergent evolution operates within the major HEV phylogenetic lineages. Analyses of sequence-based secondary structure and the tertiary structure identify PPR as an intrinsically disordered region (IDR), implicating its role in regulation of replication. The identified propensity for the disorder-to-order state transitions indicates the PPR is involved in protein-protein interactions. Furthermore, the PPR of all four HEV genotypes contains seven putative linear binding motifs for ligands involved in the regulation of a wide number of cellular signaling processes. Structure-based analysis of possible molecular functions of these motifs showed the PPR is prone to bind a wide variety of ligands. Collectively, these data suggest a role for the PPR in HEV adaptation. Particularly as an IDR, the PPR likely contributes to fine tuning of viral replication through protein-protein interactions and should be considered as a target for development of novel anti-viral drugs. |
Investigation of the first laboratory-acquired human cowpox virus infection in the United States.
McCollum AM , Austin C , Nawrocki J , Howland J , Pryde J , Vaid A , Holmes D , Weil MR , Li Y , Wilkins K , Zhao H , Smith SK , Karem K , Reynolds MG , Damon IK . J Infect Dis 2012 206 (1) 63-8 BACKGROUND: Cowpox virus is an Orthopoxvirus that can cause infections in humans and a variety of animals. Infections occur in Eurasia; human nor animal infection has been reported in the United States. This report describes the occurrence of the first known human case of laboratory-acquired cowpox virus infection in the United States and ensuing investigation. METHODS: The patient and laboratory personnel were interviewed, and laboratory activities were reviewed. Real-time PCR and serologic assays were used to test the patient's specimens. PCR assays were used to test specimens obtained during the investigation. RESULTS: The patient's lesion tested positive for cowpox virus DNA. Genome sequencing revealed a recombinant region consistent with a strain of cowpox virus stored in the research laboratory's freezer. Cowpox virus contamination was detected in six additional laboratory stocks of viruses. Orthopoxvirus DNA was present in three of twenty environmental swabs taken from laboratory surfaces. CONCLUSIONS: The handling of contaminated reagents or contact with contaminated surfaces was likely the mode of transmission. Delays in recognition and diagnosis of this infection in a laboratory researcher underscore the importance of a thorough patient history--including occupational information--and laboratory testing to facilitate a prompt investigation and application of control and remediation measures. |
Measurement of Haemophilus influenzae type a capsular polysaccharide antibodies in cord blood sera
Schmidt DS , Bieging KT , Gomez-de-Leon P , Villasenor-Sierra A , Inostroza J , Robbins JB , Schneerson R , Carlone GM , Romero-Steiner S . Pediatr Infect Dis J 2012 31 (8) 876-8 We measured anti-Hia capsular polysaccharide serum immunoglobulin G (IgG) antibodies in cord blood sera from Mexican (n=68) and Chilean mothers (n=72) by ELISA. Measurable antibodies were found in 79.3% of samples. IgG antibodies correlated with serum bactericidal activity (r=0.66). This ELISA can be used for the evaluation of adaptive immune responses to Hia and sero-surveillance studies in populations at risk. |
Metabolomic profiling of fatty acid and amino acid metabolism in youth with obesity and type 2 diabetes: evidence for enhanced mitochondrial oxidation
Mihalik SJ , Michaliszyn SF , de las Heras J , Bacha F , Lee S , Chace DH , DeJesus VR , Vockley J , Arslanian SA . Diabetes Care 2012 35 (3) 605-11 OBJECTIVE: We compared acylcarnitine (AcylCN) species, common amino acid and fat oxidation (FOX) byproducts, and plasma amino acids in normal weight (NW; n = 39), obese (OB; n = 64), and type 2 diabetic (n = 17) adolescents. RESEARCH DESIGN AND METHODS: Fasting plasma was analyzed by tandem mass spectrometry, body composition by dual energy X-ray absorptiometry and computed tomography, and total-body lipolysis and substrate oxidation by [(2)H(5)]glycerol and indirect calorimetry, respectively. In vivo insulin sensitivity (IS) was assessed with a 3-h hyperinsulinemic-euglycemic clamp. RESULTS: Long-chain AcylCNs (C18:2-CN to C14:0-CN) were similar among the three groups. Medium- to short-chain AcylCNs (except C8 and C10) were significantly lower in type 2 diabetes compared with NW, and when compared with OB, C2-, C6-, and C10-CN were lower. Amino acid concentrations were lower in type 2 diabetes compared with NW. Fasting lipolysis and FOX were higher in OB and type 2 diabetes compared with NW, and the negative association of FOX to C10:1 disappeared after controlling for adiposity, Tanner stage, and sex. IS was lower in OB and type 2 diabetes with positive associations between IS and arginine, histidine, and serine after adjusting for adiposity, Tanner stage, and sex. CONCLUSIONS: These metabolomics results, together with the increased rates of in vivo FOX, are not supportive of defective fatty acid or amino acid metabolism in obesity and type 2 diabetes in youth. Such observations are consistent with early adaptive metabolic plasticity in youth, which over time-with continued obesity and aging-may become dysfunctional, as observed in adults. |
Potent antiviral HIV-1 protease inhibitor GRL-02031 adapts to the structures of drug resistant mutants with its P1'-pyrrolidinone ring
Chang YC , Yu X , Zhang Y , Tie Y , Wang YF , Yashchuk S , Ghosh AK , Harrison RW , Weber IT . J Med Chem 2012 55 (7) 3387-97 GRL-02031 (1) is an HIV-1 protease (PR) inhibitor containing a novel P1' (R)-aminomethyl-2-pyrrolidinone group. Crystal structures at resolutions of 1.25-1.55 A were analyzed for complexes of 1 with the PR containing major drug resistant mutations, PR(I47V), PR(L76V), PR(V82A), and PR(N88D). Mutations of I47V and V82A alter residues in the inhibitor-binding site, while L76V and N88D are distal mutations having no direct contact with the inhibitor. Substitution of a smaller amino acid in PR(I47V) and PR(L76V) and the altered charge of PR(N88D) are associated with significant local structural changes compared to the wild-type PR(WT), while substitution of alanine in PR(V82A) increases the size of the S1' subsite. The P1' pyrrolidinone group of 1 accommodates to these local changes by assuming two different conformations. Overall, the conformation and interactions of 1 with PR mutants resemble those of PR(WT) with similar inhibition constants in good agreement with the antiviral potency on multidrug resistant HIV-1. |
Quantitative analysis of unique deposition pattern of submicron Fe3O4 particles using computer-controlled scanning electron microscopy
Jaques PA , Hopke PK , Gao P . Aerosol Sci Technol 2012 46 (8) 905-912 This study was designed to optimize particle counting of a unique deposition pattern of iron oxide (Fe3O4) particles that were collected by a multidomain magnetic passive aerosol sampler (MPAS). Fe3O4 is paramagnetic with a high magnetic susceptibility, rendering high collection efficiencies. The MPAS was designed exclusively for measuring particle penetration through protective clothing. To quantify particle deposition by size, two counting methods were employed with a computer-controlled scanning electron microscope (CCSEM). Based on a sequential set of measurements at known coordinates, particles were quantified across particle clusters collected by individual magnets. Because all magnets were of equal dimensions and strength, the particle concentration per cluster across the entire MPAS substrate was expected to be relatively uniform. However, since individual CCSEM fields are extremely small compared with the full sample, a randomized counting approach was used to determine how many fields were needed to obtain a representative subsample. Results by the sequential method show that particle numbers were higher toward the edge of the cluster, dominated by smaller particles; moderate at the center, dominated by larger particles; and null at the corners. The results additionally show that counting by the random method was comparable with the sequential method and repeatable for particle counts ranging from 3 to 383 particles per field, or 409,565-52,287,826 particles per substrate, taking between 25 and 53 min, respectively. The results suggest that with the random method, the CCSEM provided a powerful tool for quantitative analyses of particle numbers with unique deposition patterns. (Copyright 2012 American Association for Aerosol Research.) |
Elucidating the role of the complement control protein in monkeypox pathogenicity
Hudson PN , Self J , Weiss S , Braden Z , Xiao Y , Girgis NM , Emerson G , Hughes C , Sammons SA , Isaacs SN , Damon IK , Olson VA . PLoS One 2012 7 (4) e35086 Monkeypox virus (MPXV) causes a smallpox-like disease in humans. Clinical and epidemiological studies provide evidence of pathogenicity differences between two geographically distinct monkeypox virus clades: the West African and Congo Basin. Genomic analysis of strains from both clades identified a approximately 10 kbp deletion in the less virulent West African isolates sequenced to date. One absent open reading frame encodes the monkeypox virus homologue of the complement control protein (CCP). This modulatory protein prevents the initiation of both the classical and alternative pathways of complement activation. In monkeypox virus, CCP, also known as MOPICE, is a approximately 24 kDa secretory protein with sequence homology to this superfamily of proteins. Here we investigate CCP expression and its role in monkeypox virulence and pathogenesis. CCP was incorporated into the West African strain and removed from the Congo Basin strain by homologous recombination. CCP expression phenotypes were confirmed for both wild type and recombinant monkeypox viruses and CCP activity was confirmed using a C4b binding assay. To characterize the disease, prairie dogs were intranasally infected and disease progression was monitored for 30 days. Removal of CCP from the Congo Basin strain reduced monkeypox disease morbidity and mortality, but did not significantly decrease viral load. The inclusion of CCP in the West African strain produced changes in disease manifestation, but had no apparent effect on disease-associated mortality. This study identifies CCP as an important immuno-modulatory protein in monkeypox pathogenesis but not solely responsible for the increased virulence seen within the Congo Basin clade of monkeypox virus. |
A gel-free proteomic-based method for the characterization of Bordetella pertussis clinical isolates
Williamson YM , Moura H , Simmons K , Whitmon J , Melnick N , Rees J , Woolfitt A , Schieltz DM , Tondella ML , Ades E , Sampson J , Carlone G , Barr JR . J Microbiol Methods 2012 90 (2) 119-33 Bordetella pertussis (Bp) is the etiologic agent of pertussis or whooping cough, a highly contagious respiratory disease occurring primarily in infants and young children. Although vaccine preventable, pertussis cases have increased over the years leading researchers to re-evaluate vaccine control strategies. Since bacterial outer membrane proteins, comprising the surfaceome, often play roles in pathogenesis and antibody-mediated immunity, three recent Bp circulating isolates were examined using proteomics to identify any potential changes in surface protein expression. Fractions enriched for outer membrane proteins were digested with trypsin and the peptides analyzed by nano liquid chromatography-electrospray ionization-mass spectrometry (nLC-ESI-MS), followed by database analysis to elucidate the surfaceomes of our three Bp isolates. Furthermore, a less labor intensive non-gel based antibody affinity capture technology in conjunction with MS was employed to assess each Bp strains' immunogenic outer membrane proteins. This novel technique is generally applicable allowing for the identification of immunogenic surface expressed proteins on pertussis and other pathogenic bacteria. |
Global laboratory initiative tool for a stepwise process towards tuberculosis laboratory accreditation
Datema TA , Oskam L , Engelberts MF , van Beers SM , Shinnick TM , Baker M , Ridderhof JC , Scholten J , van Deun A , Gilpin C , Klatser PR . Int J Tuberc Lung Dis 2012 16 (5) 704-5 Quality laboratory services are essential for high quality, cost-effective health care. The need to use a laboratory systems approach, focusing on quality management systems (QMS) and accreditation standards, | is now well recognized,1 as it can provide vital information for proper planning and utilization of health | resources, which is critical in resource-limited settings. Accreditation also provides the credibility necessary to assure program investments in laboratory | strengthening. | The Global Laboratory Initiative (GLI) of the Stop | TB Partnership has developed a tool to assist laboratories in implementing a QMS that meets ISO15189 | Medical Laboratory–Requirements for Quality and | Competence, the most widely used standard for laboratory accreditation. This standard defi nes the requirements for a laboratory QMS, but provides no | guidance on how to implement processes and procedures to meet these requirements. |
Influenza serological studies to inform public health action: best practices to optimise timing, quality and reporting
Laurie KL , Huston P , Riley S , Katz JM , Willison DJ , Tam JS , Mounts AW , Hoschler K , Miller E , Vandemaele K , Broberg E , Van Kerkhove MD , Nicoll A . Influenza Other Respir Viruses 2012 7 (2) 211-24 BACKGROUND: Serological studies can detect infection with a novel influenza virus in the absence of symptoms or positive virology, providing useful information on infection that goes beyond the estimates from epidemiological, clinical and virological data. During the 2009 A(H1N1) pandemic, an impressive number of detailed serological studies were performed, yet the majority of serological data were available only after the first wave of infection. This limited the ability to estimate the transmissibility and severity of this novel infection, and the variability in methodology and reporting limited the ability to compare and combine the serological data. OBJECTIVES: To identify best practices for conduct and standardisation of serological studies on outbreak and pandemic influenza to inform public policy. METHODS/SETTING: An international meeting was held in February 2011 in Ottawa, Canada, to foster the consensus for greater standardisation of influenza serological studies. RESULTS: Best practices for serological investigations of influenza epidemiology include the following: classification of studies as pre-pandemic, outbreak, pandemic or inter-pandemic with a clearly identified objective; use of international serum standards for laboratory assays; cohort and cross-sectional study designs with common standards for data collection; use of serum banks to improve sampling capacity; and potential for linkage of serological, clinical and epidemiological data. Advance planning for outbreak studies would enable a rapid and coordinated response; inclusion of serological studies in pandemic plans should be considered. CONCLUSIONS: Optimising the quality, comparability and combinability of influenza serological studies will provide important data upon emergence of a novel or variant influenza virus to inform public health action. |
A 95 kDa protein of Plasmodium vivax and P. cynomolgi visualized by three-dimensional tomography in the caveola-vesicle complexes (Schuffner's dots) of infected erythrocytes is a member of the PHIST family
Akinyi S , Hanssen E , Meyer EV , Jiang J , Korir CC , Singh B , Lapp S , Barnwell JW , Tilley L , Galinski MR . Mol Microbiol 2012 84 (5) 816-31 Plasmodium vivax and P. cynomolgi produce numerous caveola-vesicle complex (CVC) structures within the surface of the infected erythrocyte membrane. These contrast with the electron-dense knob protrusions expressed at the surface of Plasmodium falciparum-infected erythrocytes. Here we investigate the three-dimensional (3-D) structure of the CVCs and the identity of a predominantly expressed 95 kDa CVC protein. Liquid chromatography - tandem mass spectrometry analysis of immunoprecipitates by monoclonal antibodies from P. cynomolgi extracts identified this protein as a member of the Plasmodium helical interspersed subtelomeric (PHIST) superfamily with a calculated mass of 81 kDa. We named the orthologous proteins PvPHIST/CVC-81(95) and PcyPHIST/CVC-81(95) , analysed their structural features, including a PEXEL motif, repeated sequences and a C-terminal PHIST domain, and show that PHIST/CVC-81(95) is most highly expressed in trophozoites. We generated images of CVCs in 3-D using electron tomography (ET), and used immuno-ET to show PHIST/CVC-81(95) localizes to the cytoplasmic side of the CVC tubular extensions. Targeted gene disruptions were attempted in vivo. The pcyphist/cvc-81(95) gene was not disrupted, but parasites containing episomes with the tgdhfr selection cassette were retrieved by selection with pyrimethamine. This suggests that PHIST/CVC-81(95) is essential for survival of these malaria parasites. |
Women's knowledge, attitudes, and beliefs about Down syndrome: a qualitative research study
Levis DM , Harris S , Whitehead N , Moultrie R , Duwe K , Rasmussen SA . Am J Med Genet A 2012 158A (6) 1355-62 Women who are or may become pregnant need up-to-date information about Down syndrome (DS). Asking women about their knowledge, opinions, resources, and information needs on the topic of DS is an important precursor to develop effective strategies for education. We conducted 24 focus groups (N = 111) in two US cities with women who were recently pregnant (who had a child ≤3 years old without DS) and women who planned to have a child in the next year. Groups were further segmented by age and race-ethnicity. Questions explored women's knowledge, attitudes, and beliefs about DS; resources used to obtain information about health and DS; and information needs on the topic of DS. All participants reported having some knowledge of DS: facial features, chromosomal condition, and maternal age as a risk factor. Many participants had misconceptions, including the life expectancy for persons with DS, other maternal and paternal risk factors, and the idea that having a child with DS would disrupt their lives. Participants requested stories to help illustrate what life is like for families with DS. Many Hispanic and African American participants said they only saw or knew of Caucasian persons with DS and requested culturally diverse educational materials about DS. Participants said they would seek information on DS from the Internet and from their health care providers. Results suggest that women need tailored materials that contain clinical information about DS as well as information about living with a child with DS. (Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Maternal and infant antiretroviral regimens to prevent postnatal HIV-1 transmission: 48-week follow-up of the BAN randomised controlled trial
Jamieson DJ , Chasela CS , Hudgens MG , King CC , Kourtis AP , Kayira D , Hosseinipour MC , Kamwendo DD , Ellington SR , Wiener JB , Fiscus SA , Tegha G , Mofolo IA , Sichali DS , Adair LS , Knight RJ , Martinson F , Kacheche Z , Soko A , Hoffman I , van der Horst C . Lancet 2012 379 (9835) 2449-2458 BACKGROUND: In resource-limited settings where no safe alternative to breastfeeding exists, WHO recommends that antiretroviral prophylaxis be given to either HIV-infected mothers or infants throughout breastfeeding. We assessed the effect of 28 weeks of maternal or infant antiretroviral prophylaxis on postnatal HIV infection at 48 weeks. METHODS: The Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study was undertaken in Lilongwe, Malawi, between April 21, 2004, and Jan 28, 2010. 2369 HIV-infected breastfeeding mothers with a CD4 count of 250 cells per mcL or more and their newborn babies were randomly assigned with a variable-block design to one of three, 28-week regimens: maternal triple antiretroviral (n=849); daily infant nevirapine (n=852); or control (n=668). Patients and local clinical staff were not masked to treatment allocation, but other study investigators were. All mothers and infants received one dose of nevirapine (mother 200 mg; infant 2 mg/kg) and 7 days of zidovudine (mother 300 mg; infants 2 mg/kg) and lamivudine (mothers 150 mg; infants 4 mg/kg) twice a day. Mothers were advised to wean between 24 weeks and 28 weeks after birth. The primary endpoint was HIV infection by 48 weeks in infants who were not infected at 2 weeks and in all infants randomly assigned with censoring at loss to follow-up. This trial is registered with ClinicalTrials.gov, number NCT00164736. FINDINGS: 676 mother-infant pairs completed follow-up to 48 weeks or reached an endpoint in the maternal-antiretroviral group, 680 in the infant-nevirapine group, and 542 in the control group. By 32 weeks post partum, 96% of women in the intervention groups and 88% of those in the control group reported no breastfeeding since their 28-week visit. 30 infants in the maternal-antiretroviral group, 25 in the infant-nevirapine group, and 38 in the control group became HIV infected between 2 weeks and 48 weeks of life; 28 (30%) infections occurred after 28 weeks (nine in maternal-antiretroviral, 13 in infant-nevirapine, and six in control groups). The cumulative risk of HIV-1 transmission by 48 weeks was significantly higher in the control group (7%, 95% CI 5-9) than in the maternal-antiretroviral (4%, 3-6; p=0.0273) or the infant-nevirapine (4%, 2-5; p=0.0027) groups. The rate of serious adverse events in infants was significantly higher during 29-48 weeks than during the intervention phase (1.1 [95% CI 1.0-1.2] vs 0.7 [0.7-0.8] per 100 person-weeks; p<0.0001), with increased risk of diarrhoea, malaria, growth faltering, tuberculosis, and death. Nine women died between 2 weeks and 48 weeks post partum (one in maternal-antiretroviral group, two in infant-nevirapine group, six in control group). INTERPRETATION: In resource-limited settings where no suitable alternative to breastfeeding is available, antiretroviral prophylaxis given to mothers or infants might decrease HIV transmission. Weaning at 6 months might increase infant morbidity. FUNDING: US Centers for Disease Control and Prevention. |
Integrating the life course perspective into a local maternal and child health program
Pies C , Parthasarathy P , Posner SF . Matern Child Health J 2012 16 (3) 649-55 For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs. |
Is maternal parity an independent risk factor for birth defects?
Duong HT , Hoyt AT , Carmichael SL , Gilboa SM , Canfield MA , Case A , McNeese ML , Waller DK . Birth Defects Res A Clin Mol Teratol 2012 94 (4) 230-6 BACKGROUND: Although associations between maternal parity and birth defects have been observed previously, few studies have focused on the possibility that parity is an independent risk factor for birth defects. We investigated the relation between levels of parity and a range of birth defects, adjusting each defect group for the same covariates. METHODS: We included infants who had an estimated delivery date between 1997 and 2007 and participated in the National Birth Defects Prevention Study, a multisite case-control study. Cases included infants or fetuses belonging to 38 phenotypes of birth defects (n = 17,908), and controls included infants who were unaffected by a major birth defect (n = 7173). Odds ratios (ORs) were adjusted for 12 covariates using logistic regression. RESULTS: Compared with primiparous mothers, nulliparous mothers were more likely to have infants with amniotic band sequence, hydrocephaly, esophageal atresia, hypospadias, limb reduction deficiencies, diaphragmatic hernia, omphalocele, gastroschisis, tetralogy of Fallot, and septal cardiac defects, with significant ORs (1.2 to 2.3). Compared with primiparous mothers, multiparous mothers had a significantly increased risk of omphalocele, with an OR of 1.5, but had significantly decreased risk of hypospadias and limb reduction deficiencies, with ORs of 0.77 and 0.77. CONCLUSIONS: Nulliparity was associated with an increased risk of specific phenotypes of birth defects. Most of the phenotypes associated with nulliparity in this study were consistent with those identified by previous studies. Research into biologic or environmental factors that are associated with nulliparity may be helpful in explaining some or all of these associations. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Independent association of serum retinol and beta-carotene levels with hyperuricemia: a national population study
Choi WJ , Ford ES , Curhan G , Rankin JI , Choi HK . Arthritis Care Res (Hoboken) 2012 64 (3) 389-96 OBJECTIVE: Uses of synthetic vitamin A derivatives (e.g., isotretinoin used for severe acne) and high doses of preformed vitamin A have been implicated in the pathogenesis of hyperuricemia and gout, whereas a trial reported that beta-carotene may lower serum uric acid (UA) levels. We evaluated the potential population impact of these factors on serum UA in a nationally representative sample of US adults. METHODS: Using data from 14,349 participants ages ≥20 years in the Third National Health and Nutrition Examination Survey (1988-1994), we examined the relationship between serum retinol, beta-carotene, and UA levels using weighted linear regression. Additionally, we examined the relationship with hyperuricemia using weighted logistic regression. RESULTS: Serum UA levels increased linearly with increasing serum retinol levels, whereas serum UA levels decreased with increasing serum beta-carotene levels. After adjusting for age, sex, dietary factors, and other potential confounders, the serum UA level differences from the bottom (referent) to the top quintiles of serum retinol levels were 0, 0.16, 0.32, 0.43, and 0.71 mg/dl (P for trend <0.001), and for beta-carotene were 0, -0.15, -0.29, -0.27, and -0.40 mg/dl (P for trend <0.001), respectively. Similarly, the multivariate odds ratios of hyperuricemia from the bottom (referent) to top quintiles of serum retinol levels were 1.00, 1.30, 1.83, 2.09, and 3.22 (P for trend <0.001) and for beta-carotene were 1.00, 0.85, 0.68, 0.73, and 0.54 (P for trend <0.001), respectively. The graded associations persisted across subgroups according to cross-classification by both serum retinol and beta-carotene levels. CONCLUSION: These nationally representative data raise concerns that vitamin A supplementation and food fortification may contribute to the high frequency of hyperuricemia in the US population, whereas beta-carotene intake may be beneficial against hyperuricemia. The use of beta-carotene as a novel preventive treatment for gout deserves further investigation. |
Laboratory and field measurements and evaluations of vibration at the handles of riveting hammers
McDowell TW , Warren C , Welcome DE , Dong RG . Ann Occup Hyg 2012 56 (8) 911-24 The use of riveting hammers can expose workers to harmful levels of hand-transmitted vibration (HTV). As a part of efforts to reduce HTV exposures through tool selection, the primary objective of this study was to evaluate the applicability of a standardized laboratory-based riveting hammer assessment protocol for screening riveting hammers. The second objective was to characterize the vibration emissions of reduced vibration riveting hammers and to make approximations of the HTV exposures of workers operating these tools in actual work tasks. Eight pneumatic riveting hammers were selected for the study. They were first assessed in a laboratory using the standardized method for measuring vibration emissions at the tool handle. The tools were then further assessed under actual working conditions during three aircraft sheet metal riveting tasks. Although the average vibration magnitudes of the riveting hammers measured in the laboratory test were considerably different from those measured in the field study, the rank orders of the tools determined via these tests were fairly consistent, especially for the lower vibration tools. This study identified four tools that consistently exhibited lower frequency-weighted and unweighted accelerations in both the laboratory and workplace evaluations. These observations suggest that the standardized riveting hammer test is acceptable for identifying tools that could be expected to exhibit lower vibrations in workplace environments. However, the large differences between the accelerations measured in the laboratory and field suggest that the standardized laboratory-based tool assessment is not suitable for estimating workplace riveting hammer HTV exposures. Based on the frequency-weighted accelerations measured at the tool handles during the three work tasks, the sheet metal mechanics assigned to these tasks at the studied workplace are unlikely to exceed the daily vibration exposure action value (2.5 m s(-2)) using any of the evaluated riveting hammers. |
Long-term exposure to silica dust and risk of total and cause-specific mortality in Chinese workers: a cohort study
Chen W , Liu Y , Wang H , Hnizdo E , Sun Y , Su L , Zhang X , Weng S , Bochmann F , Hearl FJ , Chen J , Wu T . PLoS Med 2012 9 (4) e1001206 BACKGROUND: Human exposure to silica dust is very common in both working and living environments. However, the potential long-term health effects have not been well established across different exposure situations. METHODS AND FINDINGS: We studied 74,040 workers who worked at 29 metal mines and pottery factories in China for 1 y or more between January 1, 1960, and December 31, 1974, with follow-up until December 31, 2003 (median follow-up of 33 y). We estimated the cumulative silica dust exposure (CDE) for each worker by linking work history to a job-exposure matrix. We calculated standardized mortality ratios for underlying causes of death based on Chinese national mortality rates. Hazard ratios (HRs) for selected causes of death associated with CDE were estimated using the Cox proportional hazards model. The population attributable risks were estimated based on the prevalence of workers with silica dust exposure and HRs. The number of deaths attributable to silica dust exposure among Chinese workers was then calculated using the population attributable risk and the national mortality rate. We observed 19,516 deaths during 2,306,428 person-years of follow-up. Mortality from all causes was higher among workers exposed to silica dust than among non-exposed workers (993 versus 551 per 100,000 person-years). We observed significant positive exposure-response relationships between CDE (measured in milligrams/cubic meter-years, i.e., the sum of silica dust concentrations multiplied by the years of silica exposure) and mortality from all causes (HR 1.026, 95% confidence interval 1.023-1.029), respiratory diseases (1.069, 1.064-1.074), respiratory tuberculosis (1.065, 1.059-1.071), and cardiovascular disease (1.031, 1.025-1.036). Significantly elevated standardized mortality ratios were observed for all causes (1.06, 95% confidence interval 1.01-1.11), ischemic heart disease (1.65, 1.35-1.99), and pneumoconiosis (11.01, 7.67-14.95) among workers exposed to respirable silica concentrations equal to or lower than 0.1 mg/m(3). After adjustment for potential confounders, including smoking, silica dust exposure accounted for 15.2% of all deaths in this study. We estimated that 4.2% of deaths (231,104 cases) among Chinese workers were attributable to silica dust exposure. The limitations of this study included a lack of data on dietary patterns and leisure time physical activity, possible underestimation of silica dust exposure for individuals who worked at the mines/factories before 1950, and a small number of deaths (4.3%) where the cause of death was based on oral reports from relatives. CONCLUSIONS: Long-term silica dust exposure was associated with substantially increased mortality among Chinese workers. The increased risk was observed not only for deaths due to respiratory diseases and lung cancer, but also for deaths due to cardiovascular disease. |
Mesothelioma associated with commercial use of vermiculite containing Libby amphibole
Dunning KK , Adjei S , Levin L , Rohs AM , Hilbert T , Borton E , Kapil V , Rice C , Lemasters GK , Lockey JE . J Occup Environ Med 2012 54 (11) 1359-63 OBJECTIVES: To describe asbestos-related mortality among manufacturing workers who expanded and processed Libby vermiculite that contained amphibole fiber. METHODS: Standardized mortality ratio was calculated for 465 white male workers 31 years after last Libby vermiculite exposure. RESULTS: Two workers died from mesothelioma, resulting in a significantly increased standardized mortality ratio of 10.5 (95% confidence interval, 1.3 to 38.0). These workers were in the upper 10th percentile of cumulative fiber exposure, that is, 43.80 and 47.23 fiber-years/cm, respectively. One additional worker with cumulative fiber exposure of 5.73 fiber-years/cm developed mesothelioma but is not deceased. There were no other significantly increased standardized mortality ratios. CONCLUSIONS: Workers expanding and processing Libby vermiculite in a manufacturing setting demonstrated an increased risk for the development of mesothelioma following exposure to the amphibole fiber contained within this vermiculite ore source. |
Evaluation of the potential airborne release of carbon nanofibers during the preparation, grinding, and cutting of epoxy-based nanocomposite material
Methner M , Crawford C , Geraci C . J Occup Environ Hyg 2012 9 (5) 308-18 The National Institute for Occupational Safety and Health conducted an initial, task-based comparative assessment to determine the potential for release of carbon nanofibers (CNFs) during dry material handling, wet cutting, grinding, and sanding (by machine and hand) of plastic composite material containing CNFs. Using a combination of direct-reading instruments and filter-based air sampling methods for airborne mass and transmission electron microscopy (TEM), concentrations were measured and characterized near sources of particle generation, in the breathing zone of the workers, and in the general work area. Tasks such as surface grinding of composite material and manually transferring dry CNFs produced substantial increases in particle number concentration (range = 20,000-490,000 1-cm(-3)). Concomitant increases in mass concentration were also associated with most tasks. Nearly 90% of all samples examined via TEM indicated that releases of CNFs do occur and that the potential for exposure exists. These findings also indicate that improperly designed, maintained, or installed engineering controls may not be completely effective in controlling releases. Unprotected skin exposure to CNFs was noted in two instances and indicated the need for educating workers on the need for personal protective equipment. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a PDF file containing information on materials, evaluated processes, personal protective equipment, and existing ventilation/engineering controls.]. |
New public health services and systems research agenda: directions for the next decade
Scutchfield FD , Perez DJ , Monroe JA , Howard AF . Am J Prev Med 2012 42 S1-5 For years we have known the value of assessing the delivery and effectiveness of individual clinical services and how factors such as structure, organization, and finance influence the quality and quantity of clinical care. There is a comparable field in public health called public health services and systems research (PHSSR) that studies system-level factors and their association to public health delivery and the health of populations. Mays and colleagues1 have defined public health services and systems research as a field of study that examines the organization, finance, and delivery of public health services in communities and the impact of these services on public health. | Two more recent efforts2, 3 have focused on expanding and further enhancing that early definition. Scutchfield et al.2 suggested that PHSSR would benefit from an enhanced definition that emphasized the following: | • | PHSSR is closely related to its parent discipline of health services research. | • | Health services provided by categorical public health programs can be strengthened by an understanding of PHSSR. In a similar way, the understanding of public health infrastructure could be enhanced by an understanding of principles that can be learned from categorical public health programs and the direct patient care they deliver. | • | The nexus of clinical care and public health in an era where there is a renewed call for bridging public health and primary care, particularly in the wake of population health having become a component of health system reform. |
Quality improvement interventions in public health systems: a systematic review
Dilley JA , Bekemeier B , Harris JR . Am J Prev Med 2012 42 S58-71 CONTEXT: Public health leaders are making difficult decisions about how to maximize the effectiveness of public health services with diminishing funds. Quality improvement (QI) interventions seek to improve the efficiency and effectiveness of public health programs, services, or organizations. The purpose of this study was to review the literature to describe public health system QI interventions and their impact on public health practices and health outcomes. EVIDENCE ACQUISITION: A systematic review was conducted using PRISMA guidelines. Three databases were searched for peer-reviewed articles that included public health quality improvement-related terms in their abstracts. Articles published in 1990-2010 that described results from QI interventions conducted within the U.S. public health system were included. EVIDENCE SYNTHESIS: Fifteen studies were identified, reporting on 18 separate QI interventions. Studies fell naturally into three functional categories: organization-wide QI, program- or service-specific QI, and administrative or management function QI. Few of the studies linked their improvements directly to a health outcome or predictors of health outcomes. Studies generally were implemented in state-level or large local public health departments. CONCLUSIONS: Formally published QI interventions may not be representative of typical, smaller-scale QI activities. Collection and distribution of QI results associated with proven, effective public health interventions and that quantify the benefits of QI practices in public health should be a goal. More research is needed to definitively "connect the dots" between QI efforts, resulting practice improvements, and actual (or predictors of) health outcome improvements. Future studies should examine QI in diverse public health systems. |
Dual protection use to prevent STIs and unintended pregnancy
Sales JM , Whiteman MK , Kottke MJ , Madden T , Diclemente RJ . Infect Dis Obstet Gynecol 2012 2012 972689 Young women are at greatest risk for unintended pregnancy and contracting a variety of sexually transmitted infections (STIs). For over a decade, medical practitioners, researchers, and professional organizations have recommended comprehensive reproductive health counseling for young women which includes recommending dual protection strategies designed to enhance prevention of both unintended pregnancy and STI/HIV. Although recommended, dual protection is not commonly practiced, especially in the United States. Thus, this special issue presents research articles and review articles to identify and better understand factors influencing dual protection use. | This special issue contains eight papers. Three papers present findings on dual protection use among adolescents and adults in the United States, and two papers report findings on dual protection use among HIV-positive individuals in international settings (Zambia and India). In addition to research articles, three review papers report on biomedical approaches to dual protection, the potential impact of multiple risk messaging on condom use among women, and biological strategies to enhance the measurement of dual protection. |
Exposure to and deposition of fine and ultrafine particles in smokers of menthol and nonmenthol cigarettes
Brinkman MC , Chuang JC , Gordon SM , Kim H , Kroeger RR , Polzin GM , Richter PA . Inhal Toxicol 2012 24 (5) 255-69 INTRODUCTION: Research on the deposition of mainstream smoke particulate in the respiratory tract of smokers is needed to understand how exposure may vary based on cigarette menthol content. METHODS: We conducted a nine-participant crossover study in which smokers were randomly assigned to cigarettes differing primarily in menthol content. Participants smoked the test cigarettes ad libitum for one week, provided spot urine samples, and then smoked four test cigarettes in a laboratory session; this was repeated for the other test cigarette in week two. Fine and ultrafine particulate matter in exhaled breath were characterized, and smoking behavior was monitored. Participant-specific mainstream smoke, generated using each participant's topography data, was characterized. During home smoking, participants collected their spent test cigarette butts for estimates of mouth-level exposures (MLE) to mainstream nicotine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). RESULTS: Participant-specific mainstream smoke NNK was higher (39%) and daily MLE to NNK was also higher (52%) when participants smoked the menthol cigarette. Nicotine was not significantly different. Participants retained more ultrafine particulate (43%) and fine particulate benzo(a)pyrene (43%) when smoking the menthol cigarette. There were no significant differences in the levels of urinary biomarkers for nicotine, NNK, or pyrene. CONCLUSION: This study demonstrates the use of noninvasive real-time techniques to measure exposure differences between cigarettes differing primarily in menthol content. Differences between NNK exposure, ultrafine particle and benzo(a)pyrene deposition, and smoking behavior were observed. Additional research using these techniques with cigarettes that differ only in menthol content is required to unequivocally attribute the exposure differences to presence or absence of menthol. |
Hypersensitivity reactions to marijuana
Tessmer A , Berlin N , Sussman G , Leader N , Chung EC , Beezhold D . Ann Allergy Asthma Immunol 2012 108 (4) 282-4 Allergy to marijuana is generally considered to be rare. Cannabis sativa is an annual plant in the Cannabaceae family that pollinates during the summer months. Various parts of this plant are used for both commercial and recreational purposes. Psychoactive cannabinoid compounds, mainly Δ9-tetrahydrocannabinol (THC), are present in the flowers and, to a lesser extent, in the leaves, stems, and seeds of the plant. When derived as dried preparations of the plant parts (marijuana), the cannabinoids are consumed by smoking, vaporizing, and oral ingestion. Teas and ointments are also common preparations. | The first report of allergic reaction to C sativa was in 1971, when a 29-year-old woman, after smoking a marijuana cigarette for the first time, had symptoms consistent with an anaphylactic response.1 Hypersensitivity was confirmed via skin prick testing (SPT) and passive transfer studies, suggesting an immunologic response to the THC component of the marijuana plant.1 Since then, several case reports have been published describing allergic reactions to C sativa after exposures through inhalation, ingestion, or skin contact.[2], [3], [4] Reactions, including rhinoconjunctivitis, urticaria, and angioedema, have been reported. |
Caught between the "soft" and "hard" arms of the state: a conceptual apparatus for situating the formative role of drug user organizations in national policy-making and local service delivery--a commentary
Zibbell JE . Subst Use Misuse 2012 47 (5) 558-65 The purpose of this commentary is to develop a conceptual apparatus for understanding the role of drug user organizations in the development and implementation of national harm reduction initiatives by extrapolating some general trends and important lessons derived from the collection of essays found in this special issue. The development of such a framework will include the findings of this research, while also suggesting systemic trends within which the role of drug users as “change agents” can be more generally examined. | As these essays demonstrate, the formative role of drug user organizations in public policy can be evaluated from a number of perspectives. But rather than present a causal reason for why drug users become involved in policy-making and service delivery, I propose a structural framework that links the theme of drug users as “change agents” to the antagonism that exists between the state institutions of public health (PH) and law enforcement (LE) over the most efficient means to reduce injection-related harm. This approach, which is developed to a certain extent by the essays in this volume, will enable us to assess the strategies that characterize “drug user activism” as well as allowing us to examine the sources of power that become available to drug users when they organize their efforts collectively as civil organizations. |
Coxiella burnetii in northern fur seal (Callorhinus ursinus) placentas from St. Paul Island, Alaska
Duncan C , Kersh GJ , Spraker T , Patyk KA , Fitzpatrick KA , Massung RF , Gelatt T . Vector Borne Zoonotic Dis 2012 12 (3) 192-5 The decline in the number of northern fur seal (NFS; Callorhinus ursinus) pups on St. Paul Island, Alaska, has led to multidisciplinary research, including investigation into issues of reproductive health and success. Given the recent identification of Coxiella burnetii in the placenta of two other marine mammal species, NFS placentas were collected from Reef rookery on St. Paul Island, Alaska, during the 2010 pupping season, examined histologically, and tested for C. burnetii using polymerase chain reaction (PCR). Of 146 placentas examined, gram-negative intratrophoblastic bacteria that were positive for C. burnetii on immunohistochemistry were observed in 5 (3%) placentas. Placental infection was usually devoid of associated inflammation or significant ancillary pathology. One hundred nine (75%) of the placentas were positive for C. burnetii on PCR. C. burnetii is globally distributed and persists for long periods in the environment, providing ample opportunity for exposure of many species. The significance of this finding for the declining fur seal population, potential human exposure and infection, and impact on other sympatric marine mammal or terrestrial species is unclear; further investigation into the epidemiology of Coxiella in the marine ecosystem is warranted. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Public Health Leadership and Management
- Reproductive Health
- Substance Use and Abuse
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