Timeliness and quality of diagnostic care for medicare recipients with chronic lymphocytic leukemia
Friese CR , Earle CC , Magazu LS , Brown JR , Neville BA , Hevelone ND , Richardson LC , Abel GA . Cancer 2011 117 (7) 1470-7 BACKGROUND: Little is known about the patterns of care relating to the diagnosis of chronic lymphocytic leukemia (CLL), including the use of modern diagnostic techniques such as flow cytometry. METHODS: The authors used the SEER-Medicare database to identify subjects diagnosed with CLL from 1992 to 2002 and defined diagnostic delay as present when the number of days between the first claim for a CLL-associated sign or symptom and SEER diagnosis date met or exceeded the median for the sample. The authors then used logistic regression to estimate the likelihood of delay and Cox regression to examine survival. RESULTS: For the 5086 patients analyzed, the median time between sign or symptom and CLL diagnosis was 63 days (interquartile range [IQR] = 0-251). Predictors of delay included age ≥75 (OR 1.45 [1.27-1.65]), female gender (OR 1.22 [1.07-1.39]), urban residence (OR 1.46 [1.19 to 1.79]), ≥1 comorbidities (OR 2.83 [2.45-3.28]) and care in a teaching hospital (OR 1.20 [1.05-1.38]). Delayed diagnosis was not associated with survival (HR 1.11 [0.99-1.25]), but receipt of flow cytometry within thirty days before or after diagnosis was (HR 0.84 [0.76-0.91]). CONCLUSIONS: Sociodemographic characteristics affect diagnostic delay for CLL, although delay does not seem to impact mortality. In contrast, receipt of flow cytometry near the time of diagnosis is associated with improved survival. |
Proportions of Kaposi sarcoma, selected non-Hodgkin lymphomas, and cervical cancer in the United States occurring in persons with AIDS, 1980-2007
Shiels MS , Pfeiffer RM , Hall HI , Li J , Goedert JJ , Morton LM , Hartge P , Engels EA . JAMA 2011 305 (14) 1450-9 CONTEXT: Given the higher risk of AIDS-defining malignancies that include Kaposi sarcoma (KS), certain non-Hodgkin lymphomas (NHLs), and cervical cancer in persons with human immunodeficiency virus (HIV) infection, the HIV epidemic has likely contributed to the overall numbers of these cancers in the United States. OBJECTIVE: To quantify the proportions of KS, AIDS-defining NHLs, and cervical cancer in the United States that occurred among persons with AIDS from 1980 to 2007. DESIGN, SETTING, AND PARTICIPANTS: The HIV/AIDS Cancer Match Study (1980-2007) linked data from 16 US HIV/AIDS and cancer registries to identify cases with and without AIDS for KS, AIDS-defining NHLs (ie, diffuse large B-cell lymphoma [DLBCL], Burkitt lymphoma [BL], and central nervous system [CNS] lymphoma), and cervical cancer. Using linked data, we derived cancer rates for persons with and without AIDS. To estimate national counts, the rates were applied to national AIDS surveillance and US Census data. MAIN OUTCOME MEASURE: Proportion of AIDS-defining malignancies in the United States occurring in persons with AIDS. RESULTS: In the United States, an estimated 81.6% (95% confidence interval [CI], 81.2%-81.9%) of 83,252 KS cases, 6.0% (95% CI, 5.8%-6.1%) of 351,618 DLBCL cases, 19.9% (95% CI, 18.1%-21.7%) of 17,307 BL cases, 27.1% (95% CI, 26.1%-28.1%) of 27,265 CNS lymphoma cases, and 0.42% (95% CI, 0.37%-0.47%) of 375,452 cervical cancer cases occurred among persons with AIDS during 1980-2007. The proportion of KS and AIDS-defining NHLs in persons with AIDS peaked in the early 1990s (1990-1995: KS, 90.5% [95% CI, 90.2%-90.8%]; DLBCL, 10.2% [95% CI, 9.9%-10.5%]; BL, 27.8% [95% CI, 25.0%-30.5%]; and CNS lymphoma, 48.3% [95% CI, 46.7%-49.8%]; all P < .001 [compared with 1980-1989]) and then declined (2001-2007: KS, 70.5% [95% CI, 68.1%-73.0%]; DLBCL, 4.7% [95% CI, 4.3%-5.2%]; BL, 21.5% [95% CI, 17.7%-25.4%]; and CNS lymphoma, 12.9% [95% CI, 10.5%-15.3%]; all P < .001 [compared with 1990-1995]). The proportion of cervical cancers in persons with AIDS increased over time (1980-1989: 0.11% [95% CI, 0.09%-0.13%]; 2001-2007: 0.71% [95% CI, 0.51%-0.91%]; P < .001). CONCLUSIONS: In the United States, the estimated proportions of AIDS-defining malignancies that occurred among persons with AIDS were substantial, particularly for KS and some NHLs. Except for cervical cancer, the proportions of AIDS-defining malignancies occurring among persons with AIDS peaked in the mid-1990s and then declined. |
Health-related quality of life of U.S. adults with arthritis: analysis of data from the Behavioral Risk Factor Surveillance System, 2003, 2005, and 2007
Furner SE , Hootman JM , Helmick CG , Bolen J , Zack MM . Arthritis Care Res (Hoboken) 2011 63 (6) 788-99 OBJECTIVE: To describe the health-related quality of life (HRQOL) of persons with/without arthritis in the 50 states and the District of Columbia and to determine correlates of poor HRQOL in persons with arthritis. METHODS: Data from the Behavioral Risk Factor Surveillance System (BRFSS) are used. Descriptive analyses are age-standardized. Multivariate analyses used logistic regression. RESULTS: Of persons 18 and over with arthritis, 27% reported fair/poor health, compared to 12% without arthritis. Mean number of physically unhealthy, mentally unhealthy, and activity-limited days for persons with arthritis exceeded those for persons without arthritis. In regression analyses, black non-Hispanics reported better HRQOL than white non-Hispanics especially in the 14+ versus 0 days comparisons. Yet no difference existed in self-reported health status between these two groups. Having low family income and being unable to work were both strongly associated with poor HRQOL. Being physically active was associated with better HRQOL. Binge drinking was associated with poor HRQOL for some measures but was associated with better self reported health. Cost being a barrier to care and having diabetes were strongly associated with worse HRQOL. CONCLUSION: U. S. adults with arthritis had worse HRQOL than those without. Physical health and mental health were both affected by arthritis; thus efforts to alleviate the arthritis burden should address both domains. Given the current and projected high prevalence of arthritis, we face a significant burden of poor HRQOL. Increasing physical activity, reducing co-morbidities, and increasing access to healthcare could improve HRQOL of persons with arthritis. |
Associations of BMI and its fat-free and fat components with blood lipids in children: Project HeartBeat!
Dai S , Eissa MA , Steffen LM , Fulton JE , Harrist RB , Labarthe DR . Clin Lipidol 2011 6 (2) 235-244 AIM: This study aimed to distinguish between the roles of the two components of BMI, the fat mass (FM) index and the fat-free mass (FFM) index, in BMI's association with blood lipids in children and adolescents. METHODS: A total of 678 children (49.1% female, 79.9% non-black), initially aged 8, 11 and 14 years, were followed at 4-month intervals for up to 4 years (1991-1995). Total cholesterol (TC), LDL-C, HDL-C and triglycerides were determined in fasting blood samples. FFM index and FM index were calculated as FFM (kg)/height (m(2)) and FM (kg)/height (m(2)), respectively. Using a multilevel linear model, repeated measurements of blood lipids were regressed on concurrent measures of BMI or its components, adjusting for age, sex and race and, in a subsample, also for physical activity, energy intake and sexual maturity. RESULTS: Estimated regression coefficients for the relations of TC with BMI, FFM index and FM index were 1.539, -0.606 (p > 0.05) and 3.649, respectively. When FFM index and FM index were entered into the TC model simultaneously, regression coefficients were -0.855 and 3.743, respectively. An increase in BMI was related to an increase in TC; however, an equivalent increase in FM index was related to a greater increase in TC and, when FFM index was tested alone or with FM index, an increase in FFM index was related to a decrease in TC. Similar results were observed for LDL-C. FFM index and FM index were both inversely related to HDL-C and directly to triglycerides. Compared with FFM index, the equivalent increase in FM index showed a greater decrease in HDL-C. CONCLUSION: Greater BMI was related to adverse levels of blood lipids in children and adolescents, which was mainly attributable to BMI's fat component. It is important to identify weight management strategies to halt the childhood obesity epidemic and subsequently prevent heart disease in adulthood. 2011 Future Medicine Ltd. |
Reported cases of measles in international air travelers to the United States, August 2005-March 2008
Edelson PJ , Anderson JA . J Travel Med 2011 18 (3) 178-82 BACKGROUND: In countries with high rates of measles immunization, imported cases of measles represent an important continuing source of measles infection. METHODS: Airlines and state health departments report cases of suspected measles in international travelers to the Centers for Disease Control and Prevention Quarantine Stations. We reviewed these reports, maintained in an electronic database, to determine the demographic and epidemiologic characteristics of international air travelers infected with measles. RESULTS: We reviewed 35 confirmed cases of measles in air travelers and analyzed their demographic and epidemiologic characteristics. The median age of case travelers was 17 (range: 4 months-50 years). These travelers arrived from all regions of the world, including 10 countries with immunization rates of measles-containing vaccine below 90% and five others experiencing local outbreaks. Of 17 travelers for whom immunization status was known, 2 had been adequately immunized with at least two doses of a measles-virus containing vaccine, 9 were inadequately immunized, and an additional 6 infants had not been immunized because of age. CONCLUSIONS: Measles importations continue in the United States. Travelers should be aware of the importance of assuring up-to-date immunizations, especially when visiting countries experiencing a local measles outbreak. In addition, parents traveling with infants, and their physicians, should be aware of recommendations regarding the early administration of a dose of measles-containing vaccine for infants at least 6 months old traveling internationally. |
Taxonomy for strengthening the identification of core elements for evidence-based behavioral interventions for HIV/AIDS prevention
Galbraith JS , Herbst JH , Whittier DK , Jones PL , Smith BD , Uhl G , Fisher HH . Health Educ Res 2011 26 (5) 872-85 The concept of core elements was developed to denote characteristics of an intervention, such as activities or delivery methods, presumed to be responsible for the efficacy of evidence-based behavioral interventions (EBIs) for HIV/AIDS prevention. This paper describes the development of a taxonomy of core elements based on a literature review of theoretical approaches and characteristics of EBIs. Sixty-one categories of core elements were identified from the literature and grouped into three distinct domains: implementation, content and pedagogy. The taxonomy was tested by categorizing core elements from 20 HIV prevention EBIs disseminated by Centers for Disease Control and Prevention. Results indicated that core elements represented all three domains but several were difficult to operationalize due to vague language or the inclusion of numerous activities or constructs. A process is proposed to describe core elements in a method that overcomes some of these challenges. The taxonomy of core elements can be used to identify core elements of EBIs, strengthen the translation of EBIs from research to practice and guide future research seeking to identify essential core elements in prevention interventions. |
Lack of association of herpes simplex virus type 2 seropositivity with the progression of HIV infection in the HERS cohort
Hoots BE , Hudgens MG , Cole SR , King CC , Klein RS , Mayer KH , Rompalo AM , Sobel JD , Jamieson DJ , Smith JS . Am J Epidemiol 2011 173 (7) 837-44 Many studies have chronicled the "epidemiologic synergy" between human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV-2). HIV adversely affects the natural history of HSV-2 and results in more frequent and severe HSV-2 reactivation. Few longitudinal studies, however, have examined whether HSV-2 is associated with increased HIV plasma viral loads or decreased CD4 counts. The authors estimated the effect of HSV-2 seropositivity on HIV RNA viral load and on CD4 count over time among 777 HIV-seropositive US women not receiving suppressive HSV-2 therapy in the HIV Epidemiology Research Study (1993-2000). Linear mixed models were used to assess the effect of HSV-2 on log HIV viral load and CD4 count/mm(3) prior to widespread initiation of highly active antiretroviral therapy. Coinfection with HSV-2 was not associated with HIV RNA plasma viral loads during study follow-up. There was a statistically significant association between HSV-2 seropositivity and CD4 count over time, but this difference was small and counterintuitive at an increase of 8 cells/mm(3) (95% confidence interval: 2, 14) per year among HSV-2-seropositive women compared with HSV-2-seronegative women. These data do not support a clinically meaningful effect of baseline HSV-2 seropositivity on the trajectories of HIV plasma viral loads or CD4 counts. |
Probable non-vector-borne transmission of Zika virus, Colorado, USA
Foy BD , Kobylinski KC , Chilson Foy JL , Blitvich BJ , Travassos da Rosa A , Haddow AD , Lanciotti RS , Tesh RB . Emerg Infect Dis 2011 17 (5) 880-2 Clinical and serologic evidence indicate that 2 American scientists contracted Zika virus infections while working in Senegal in 2008. One of the scientists transmitted this arbovirus to his wife after his return home. Direct contact is implicated as the transmission route, most likely as a sexually transmitted infection. |
Factors associated with initiation of prolonged analgesic use among patients in the HIV Outpatient Study (HOPS)
Koeppe J , Lichtenstein K , Armon C , Chmiel JS , Buchacz K , Wood K , Brooks JT . Clin J Pain 2011 27 (8) 699-706 BACKGROUND: Analgesic use is common but remains poorly described among human immunodeficiency virus (HIV)-infected persons in the highly active antiretroviral therapy era. METHODS: We studied HIV Outpatient Study participants during 1996 to 2008. We used Cox proportional hazards regression to assess variables associated with initiation of prolonged analgesia (≥90 consecutive days of analgesics); logistic regression to explore variables associated with initiation of prolonged opioid analgesia among those taking any prolonged analgesia; and linear regression to determine temporal trends in prolonged analgesia. RESULTS: Among 4180 patients, 931 (22%) initiated prolonged analgesia. Factors independently associated (P<0.05) with prolonged analgesia included: age above 40 years (hazard ratio=1.20), female sex (1.43), injection drug use as an HIV risk factor (1.33), public healthcare payer (1.88), nadir CD4+ less than 200 cells/mm (1.29), tobacco use (1.43), prior opportunistic infection(s) (1.25), antidepressant use (1.76), and anxiolytic use (1.51). Independent correlates of prolonged opioid analgesia were white race (odds ratio=1.64), baseline CD4+ less than 350 cells/mm (1.88), and anxiolytic use (1.87). Prolonged analgesia ranged from 11% to 15% each year. CONCLUSIONS: In the highly active antiretroviral therapy era, up to 15% of HIV Outpatient Study patients used prolonged analgesic therapy each year. Variables associated with the initiation of prolonged analgesia included HIV and non-HIV-related factors. |
HIV prevalence rates among men who have sex with men in the southern United States: population-based estimates by race/ethnicity
Lieb S , Prejean J , Thompson DR , Fallon SJ , Cooper H , Gates GJ , Liberti TM , Friedman SR , Malow RM . AIDS Behav 2011 15 (3) 596-606 States across the U.S. lack effective ways to quantify HIV prevalence rates among men who have sex with men (MSM). We estimated population-based HIV prevalence rates among MSM in the 17 southern states by race/ethnicity. Through 2007, estimated HIV prevalence rates per 100,000 MSM ranged from 2,607.6 among white (non-Hispanic) MSM in Maryland to 41,512.9 among black (non-Hispanic) MSM in the District of Columbia. Black MSM rates significantly exceeded Hispanic and white MSM rates in each state. Significant racial/ethnic disparities in rates persisted in a sensitivity analysis examining the possibility that minority MSM populations had been underestimated in each state. Compared with black, Hispanic, and white non-MSM males, respectively, rates at the regional level were 25.2 times higher for black MSM, 43.0 times higher for Hispanic MSM, and 106.0 times higher for white MSM. State-level analysis of racial/ethnic-specific MSM HIV prevalence rates can help guide resource allocation and assist advocacy. |
Kyasanur Forest Disease virus Alkhurma subtype in ticks, Najran Province, Saudi Arabia.
Mahdi M , Erickson BR , Comer JA , Nichol ST , Rollin PE , Almazroa MA , Memish ZA . Emerg Infect Dis 2011 17 (5) 945-7 TO THE EDITOR: The lineage of Kyasanur Forest disease virus (KFDV) found in the Kingdom of Saudi Arabia is commonly referred to as Alkhurma hemorrhagic fever virus (AHFV). This virus was first isolated from a specimen collected in 1994 from a butcher living in Makkah Province, who was hospitalized for a hemorrhagic fever from which he died (1). The virus was assigned to the genus Flavivirus on the basis of reactivity with genus-specific monoclonal antibodies and sequencing of a fragment of the nonstructural 5 (NS5) gene, which showed >89% identity with KFDV. Ten other cases were confirmed among patients who had leukopenia, thrombocytopenia, and elevated liver enzymes. Observations of patients in the original study or in a subsequent analysis (2) suggested that Alkhurma hemorrhagic fever (AHF) disease was associated with contact with blood from infected animals, bites from infected ticks, or the drinking of raw milk. However, the exact mode of transmission to humans has still not been fully elucidated. More recently, AHFV RNA was detected in a single pool of sand tampans (Ornithodoros savignyi, soft ticks), collected in western Saudi Arabia (3), which suggests a link with these ticks. |
Vector-borne infections
Rosenberg R , Beard CB . Emerg Infect Dis 2011 17 (5) 769-70 Infections with vector-borne pathogens are a major source of emerging diseases. The ability of vectors to bridge spatial and ecologic gaps between animals and humans increases opportunities for emergence. Small adaptations of a pathogen to a vector can have profound effects on the rate of transmission to humans. |
Comparison of insecticide-treated nets and indoor residual spraying to control the vector of visceral leishmaniasis in Mymensingh District, Bangladesh
Chowdhury R , Dotson E , Blackstock AJ , McClintock S , Maheswary NP , Faria S , Islam S , Akter T , Kroeger A , Akhter S , Bern C . Am J Trop Med Hyg 2011 84 (5) 662-667 Integrated vector management is a pillar of the South Asian visceral leishmaniasis (VL) elimination program, but the best approach remains a matter of debate. Sand fly seasonality was determined in 40 houses sampled monthly. The impact of interventions on Phlebotomus argentipes density was tested from 2006-2007 in a cluster-randomized trial with four arms: indoor residual spraying (IRS), insecticide-treated nets (ITNs), environmental management (EVM), and no intervention. Phlebotomus argentipes density peaked in March with the highest proportion of gravid females in May. The EVM (mud plastering of wall and floor cracks) showed no impact. The IRS and ITNs were associated with a 70-80% decrease in male and female P. argentipes density up to 5 months post intervention. Vector density rebounded by 11 months post-IRS, whereas ITN-treated households continued to show significantly lower density compared with households without intervention. Our data suggest that both IRS and ITNs may help to improve VL control in Bangladesh. |
The crab hole mosquito blues
Johnson KM , Antczak DF , Dietz WH , Martin DH , Walton TE . Emerg Infect Dis 2011 17 (5) 923-7 Venezuelan equine encephalomyelitis (VEE) epizoodemics were reported at 6-10-year intervals in northern South America beginning in the 1920s. In 1937, epizootic VEE virus was isolated from infected horse brain and shown as distinct from the North American equine encephalomyelitis viruses. Subsequently, epizootic and sylvatic strains were isolated in distinct ecosystems; isolates were characterized serologically as epizootic subtype I, variants A/B and C; or sylvatic (enzootic) subtype I, variants D, E, and F, and subtypes II, III, and IV. In 1969, variant I-A/B virus was transported from a major outbreak in northern South America to the borders of El Salvador, Guatemala, and Honduras. This musical poem describes the history and ecology of VEE viruses and the epidemiology of an unprecedented 1969 movement of VEE viruses from South America to equids and humans in Central America from Costa Rica to Guatemala and Belize and in Mexico and the United States that continued until 1972. |
A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it
Paulozzi LJ , Weisler RH , Patkar AA . J Clin Psychiatry 2011 72 (5) 589-92 Both the usage of prescription drugs such as opioid analgesics and benzodiazepines and overdoses involving them have increased dramatically in the United States since the 1990s. Patients using these drugs often have a combination of painful conditions, substance abuse, and other forms of mental illness. Psychiatrists and many primary care physicians might not be familiar with existing evidence-based guidelines for opioid prescribing or with programs designed to reduce the abuse of prescription drugs such as state prescription drug monitoring programs. Psychiatrists need to be informed regarding this problem to partner effectively with both pain specialists and primary care providers in their community. |
Putting risk into perspective: the US medical eligibility criteria for contraceptive use
Curtis KM , Tepper NK , Marchbanks PA . Rev Endocr Metab Disord 2011 12 (2) 119-25 Unintended pregnancy remains a considerable problem in the United States, with health risks for both mother and infant. These risks may be increased among women with medical conditions, for whom pregnancy can lead to severe adverse outcomes. Highly effective and safe contraceptive methods are available to prevent unintended pregnancy. However, women with medical conditions and their providers also may be concerned about potential risks associated with contraceptive method use. Evidence-based guidance documents can be helpful tools for clinicians to efficiently use evidence and put risks into perspective. The US Medical Eligibility Criteria for Contraceptive Use, 2010, provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions and other characteristics. While some contraceptive methods pose risks for some women, these must be considered in context and weighed against such considerations as the absolute risk of adverse events and the risks associated with pregnancy. Most women, even women with medical conditions, can safely use highly effective methods of contraception and promoting their use will further efforts to reduce unintended pregnancy. |
Antimicrobial and antimotility agent use in persons with Shiga toxin-producing Escherichia coli O157 infection in FoodNet sites
Nelson JM , Griffin PM , Jones TF , Smith KE , Scallan E . Clin Infect Dis 2011 52 (9) 1130-2 Antimicrobial and antimotility agents are not recommended for the treatment of Shiga toxin-producing Escherichia coli O157 infection. In our study, many persons with Shiga toxin-producing E. coli O157 infection took antimicrobial (62%) and antimotility agents (32%); 43 (29%) of 146 reported commencing antimicrobial treatment after laboratory confirmation. Efforts are needed to promote practice guidelines. |
Prenatal Programming and Toxicity II (PPTOX II): role of environmental stressors in the developmental origins of disease
Darney S , Fowler B , Grandjean P , Heindel J , Mattison D , Slikker W Jr . Reprod Toxicol 2011 31 (3) 271 It has been over three years since Reproductive Toxicology produced a special issue: Fetal Basis of Adult Disease. That issue contained 22 articles which highlighted this emerging field. Now the field has matured significantly and to highlight the advances an international conference, PPTOX II was held in Miami Florida, December 7–10, 2009. This conference followed PPTOX I which was held in the Faroe Islands in 2007. Highlights of that meeting were published in Basic & Clinical Pharmacology & Toxicology 102: Number 2 February 2008. | The focus of the PPTOX II meeting was on the fact that fetal and early postnatal development constitutes the most vulnerable time period of human life, with regard to adverse effects of environmental hazards. Subtle effects during development can lead to functional deficits and increased disease risk later in life. Indeed there are now experimental data for the role of developmental exposures to environmental chemicals for male and female reproductive diseases/dysfunctions, prostate, breast and uterine cancers, cardiopulmonary diseases/dysfunctions, neurobehavioral problems, and neurodegenerative diseases and immune and autoimmune diseases. Exposure to environmental chemicals during prenatal and early postnatal environment affects gene expression and the resulting epigenetic changes may constitute an important mechanism for the programming effects. Since the epigenetic system is most vulnerable to disruption during specific times during development, timing of environmental exposures is critical for their effects on disease etiology. It is also apparent from animal studies that epigenetic changes due to environmental exposures during development can be used as biomarkers of both exposure and potential future disease or dysfunction. |
Control for confounding in case-control studies using the stratification score, a retrospective balancing score.
Allen AS , Satten GA . Am J Epidemiol 2011 173 (7) 752-60 The stratification score for a case-control study is the probability of disease modeled as a function of potential confounders. The authors show that the stratification score is a retrospective balancing score and thus plays a similar role in case-control studies as the propensity score plays in prospective studies. The authors further show how standardization using the stratification score can be used to compare the distributions of exposures that would be found among case and control participants if both groups had the same distribution of confounding covariables. The authors illustrate these results using data from a genome-wide association study, the GAIN (Genetic Association Information Network) study of schizophrenia among African Americans (2006-2008). |
Risk factors for non-adherence and loss to follow-up in a three-year clinical trial in Botswana
Gust DA , Mosimaneotsile B , Mathebula U , Chingapane B , Gaul Z , Pals SL , Samandari T . PLoS One 2011 6 (4) e18435 BACKGROUND: Participant non-adherence and loss to follow-up can compromise the validity of clinical trial results. An assessment of these issues was made in a 3-year tuberculosis prevention trial among HIV-infected adults in Botswana. METHODS AND FINDINGS: Between 11/2004-07/2006, 1995 participants were enrolled at eight public health clinics. They returned monthly to receive bottles of medication and were expected to take daily tablets of isoniazid or placebo for three years. Non-adherence was defined as refusing tablet ingestion but agreeing to quarterly physical examinations. Loss to follow-up was defined as not having returned for appointments in ≥60 days. Between 10/2008-04/2009, survey interviews were conducted with 83 participants identified as lost to follow-up and 127 identified as non-adherent. As a comparison, 252 randomly selected adherent participants were also surveyed. Multivariate logistic regression analysis was used to identify associations with selected risk factors. Men had higher odds of being non-adherent (adjusted odds ratio (AOR), 2.24; 95% confidence interval [95%CI] 1.24-4.04) and lost to follow-up (AOR 3.08; 95%CI 1.50-6.33). Non-adherent participants had higher odds of reporting difficulties taking the regimen or not knowing if they had difficulties (AOR 3.40; 95%CI 1.75-6.60) and lower odds associated with each year of age (AOR 0.95; 95%CI 0.91-0.98), but other variables such as employment, distance from clinic, alcohol use, and understanding study requirements were not significantly different than controls. Among participants who were non-adherent or lost to follow-up, 40/210 (19.0%) reported that they stopped the medication because of work commitments and 33/210 (15.7%) said they thought they had completed the study. CONCLUSIONS: Men had higher odds of non-adherence and loss to follow-up than women. Potential interventions that might improve adherence in trial participants may include:targeting health education for men, reducing barriers, clarifying study expectations, educating employers about HIV/AIDS to help reduce stigma in the workplace, and encouraging employers to support employee health. TRIAL REGISTRATION: ClinicalTrials.gov NCT00164281. |
Attitudes and behaviors of international air travelers toward pandemic influenza
Sharangpani R , Boulton KE , Wells E , Kim C . J Travel Med 2011 18 (3) 203-8 BACKGROUND: Air travelers play a significant role in the spread of novel strains of influenza viruses; however, little is understood about the knowledge, attitudes, and practices of international air travelers toward pandemic influenza in relation to public health interventions and personal protective behaviors at overseas destinations. METHODS: Prior to the 2009 H1N1 influenza pandemic, we surveyed a convenience sample of 404 departing international travelers at Detroit Metropolitan Wayne County Airport. Presented with a hypothetical pandemic influenza scenario occurring overseas, the participants predicted their anticipated protective behaviors while abroad and recorded their attitudes toward potential screening measures at US ports of entry (POE). The survey also qualitatively explored factors that would influence compliance with health entry screening at POE. RESULTS: Those who perceived pandemic influenza to be serious were more likely to state that they would be comfortable with screening (p = 0.006), and if they had influenza-like illness (ILI) overseas, would be more willing to see a physician and delay return travel (p = 0.006 and 0.002, respectively). Other demographic variables, including age and race, were associated with protective behaviors in response to ILI. Travelers also identified diverse information requirements which would influence their behavior in response to entry screening, including characteristics of the pandemic, severity of illness, and screening operations. CONCLUSIONS: Demographic characteristics and perceived severity of illness are important factors that may influence the protective behaviors of travelers overseas. Our results indicate that educational material and advice directed to international travelers could be differentially tailored to traveler subpopulations. |
Prevalence of parental concerns about childhood vaccines the experience of primary care physicians
Kempe A , Daley MF , McCauley MM , Crane LA , Suh CA , Kennedy AM , Basket MM , Stokley SK , Dong F , Babbel CI , Seewald LA , Dickinson LM . Am J Prev Med 2011 40 (5) 548-55 BACKGROUND: Little is known about the effects of increased parental vaccine safety concerns on physicians' vaccine communication attitudes and practices. PURPOSE: To assess among pediatricians and family medicine (FM) physicians: (1) prevalence of parental requests to deviate from recommended vaccine schedules; (2) responses to such requests; and (3) attitudes about the burden and success of vaccine communications with parents. METHODS: Survey of nationally representative samples of pediatricians and FM physicians (N=696) conducted during February to May 2009 with analysis in 2010. RESULTS: Response rates were 88% for pediatricians and 78% for FM physicians. Overall, 8% of physicians reported that ≥10% of parents refused a vaccine and 20% reported that ≥10% of parents requested to spread out vaccines in a typical month. More pediatricians than FM physicians reported always/often requiring parents to sign a form if they refused vaccination (53% vs 31%, p<0.0001); 64% of all physicians would agree to spread out vaccines in the primary series at least sometimes. When talking with parents with substantial concerns, 53% of physicians reported spending 10-19 minutes and 8% spending ≥20 minutes. Pediatricians were more likely than FM physicians to report their job less satisfying because of parental vaccine concerns (46% vs 21%, p<0.0001). Messages most commonly reported as "very effective" were personal statements such as what they would do for their own children. CONCLUSIONS: The burden of communicating with parents about vaccines is high, especially among pediatricians. Physicians report the greatest success convincing skeptical parents using messages that rely on their personal choices and experiences. |
How to ask effective questions and provide effective answers in a public forum
Krumm P . AMWA Journal 2011 26 (1) 21-22 We all have sat through countless meetings and conferences | where audience members asked long and winding questions and presenters gave even longer and more circuitous | answers. We also know that bad—or more precisely, badly | phrased—questions and answers impede communication | and understanding. | The successful exchange of information relies on asking | clear, pointed, and specific questions and giving focused, | precise, and accurate answers. Asking the right question in | the most effective manner to get the answer you need is an | art form unto itself. This article provides some techniques | that will help you communicate effectively, whether you | are on the giving or the receiving end of the question-andanswer equation. | Before discussing the specifics of effective questions and | answers, I will present different types of questions, as a better understanding of the types of questions commonly asked | in a meeting can help you formulate the right question |
Health care-associated measles outbreak in the United States after an importation: challenges and economic impact
Chen SY , Anderson S , Kutty PK , Lugo F , McDonald M , Rota PA , Ortega-Sanchez IR , Komatsu K , Armstrong GL , Sunenshine R , Seward JF . J Infect Dis 2011 203 (11) 1517-25 BACKGROUND: On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs. METHODS: Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals. RESULTS: Of 14 patients with confirmed cases, 7 (50%) were aged ≥18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities. CONCLUSIONS: Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs. (See the editorial commentary by Ostroff, on pages 1507-9.) |
Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students?
Eaton DK , Foti K , Brener ND , Crosby AE , Flores G , Kann L . Arch Suicide Res 2011 15 (2) 113-26 The objective of this study was to identify factors that may account for the disproportionately high prevalence of suicidal behaviors among Hispanic/Latina youth by examining whether associations of health risk behaviors with suicidal ideation and suicide attempts vary by race/ethnicity among female students. Data from the school-based 2007 national Youth Risk Behavior Survey were analyzed. Analyses were conducted among female students in grades 9 through 12 and included 21 risk behaviors related to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus; physical activity; obesity and weight control; and perceived health status. With the exception of physical activity behaviors and obesity, all risk behaviors examined were associated with suicidal ideation and suicide attempts. Associations of risk behaviors with suicidal ideation varied by race/ethnicity for 5 of 21 behaviors, and for 0 of 21 behaviors for suicide attempts. Stratified analyses provided little insight into factors that may account for the higher prevalence of suicidal behaviors among Hispanic/Latina female students. These results suggest that the increased risk of suicidal behaviors among Hispanic/Latina female students cannot be accounted for by differential associations with these selected risk behaviors. Other factors, such as family characteristics, acculturation, and the socio-cultural environment, should be examined in future research. |
Diallyl sulfide protects against ultraviolet B-induced skin cancers in SKH-1 hairless mouse: analysis of early molecular events in carcinogenesis.
Cherng JM , Tsai KD , Perng DS , Wang JS , Wei CC , Lin JC . Photodermatol Photoimmunol Photomed 2011 27 (3) 138-146 BACKGROUND: Diallyl sulfide (DAS) has been shown to have a preventive effect against various cancers. AIMS AND OBJECTIVES: We evaluated the protective effects of DAS in regression of ultraviolet B (UVB)-induced skin tumor formation in SKH-1 hairless mice and its underlying early molecular biomarkers. METHODS: We examined the efficacy of DAS in UVB light-induced skin lesion in SKH-1 hairless mice and the associated molecular events. RESULTS: Mice irradiated with UVB at 180 mJ/cm(2) twice per week elicited 100% tumor incidence at 20 weeks. The topical application of DAS before UVB irradiation caused a delay in tumor appearance, multiplicity, and size. The topical application of DAS before and immediately after a single UVB irradiation (180 mJ/cm(2) ) resulted in a significant decrease in UVB-induced thymine dimer-positive cells, expression of proliferative cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and apoptotic sunburn cells, together with an increase in p53 and p21/Cip1-positive cell population in the epidermis. Simultaneously, DAS also significantly inhibited nuclear factor-kappaB (NF-kappaB), cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), and nitric oxide (NO) levels. CONCLUSIONS: The protective effect of DAS against photocarcinogenesis is accompanied by the down-regulation of cell-proliferative controls, involving thymine dimer, PCNA, apoptosis, transcription factors NF-kappaB, and of inflammatory responses involving COX-2, PGE2, and NO, and up-regulation of p53, p21/Cip1 to prevent DNA damage and facilitate DNA repair. |
Reevaluation of the taxonomic status of recently described species of Enterococcus: evidence that E. thailandicus is a senior subjective synonym of "E. sanguinicola" and confirmation of E. caccae as a species distinct from E. silesiacus.
Shewmaker PL , Steigerwalt AG , Nicholson A , Carvalho MD , Facklam RR , Whitney A , Teixeira LM . J Clin Microbiol 2011 49 (7) 2676-9 Several of the more recently proposed new species of Enterococcus are nearly identical based on 16S rDNA sequence analysis and phenotypic traits. In the present study, DNA-DNA reassociation experiments, in conjunction with sequencing of the 16S rRNA and rpoB genes, provided evidence that "Enterococcus sanguinicola" and Enterococcus thailandicus actually represent the same species. In contrast, Enterococcus caccae and Enterococcus silesiacus, two other species with nearly identical 16S rRNA gene sequences were confirmed as separate species. |
Impact of HPV assay on observed population prevalence.
Unger ER , Steinau MS , Lin JM , Patel SS , Swan DC . Diagn Mol Pathol 2011 20 (2) 101-4 Type-specific surveillance of human papillomavirus (HPV) has been proposed as an early indicator of vaccine impact. Longitudinal comparison of HPV typing results requires stable assays with high type-specific reproducibility. Assays are evolving and the impact of even minor changes in the assay format may be difficult to anticipate. We initiated a population-based study of HPV with the prototype line blot (PLB) assay. These reagents were replaced by the research use only Linear Array (LA) HPV Genotyping kit. The assays are similar in principle and earlier comparisons found increased sensitivity and detection of more types per sample with LA; however, in samples from women with cervical abnormalities, the overall concordance was good. Slight changes in sensitivity may be more significant in samples from a general population with lower viral loads in the samples. Residual extracts from 3001 self-collected vaginal swabs from women in the general US population originally tested with PLB were retested with LA. With LA, all the samples were hybridized. PLB hybridization was restricted to samples with probable amplicon in gel electrophoresis. For HPV detection, the agreement between the 2 assays was 78.6% (kappa=0.55) with a positive concordance of 52.8%. However, this masks the observation that repeat testing with LA led to the detection of HPV in nearly twice as many samples. Agreement improves if comparison was restricted to the samples hybridized. These results emphasize that assay comparisons should consider the clinical-epidemiologic context of sample collection. Studies designed to examine temporal trends in type-specific prevalence should archive residual material to permit retesting if assays change. |
Role of germination in murine airway CD8 T-cell responses to Aspergillus conidia
Templeton SP , Buskirk AD , Law B , Green BJ , Beezhold DH . PLoS One 2011 6 (4) e18777 Pulmonary exposure to Aspergillus fumigatus has been associated with morbidity and mortality, particularly in immunocompromised individuals. A. fumigatus conidia produce beta-glucan, proteases, and other immunostimulatory factors upon germination. Murine models have shown that the ability of A. fumigatus to germinate at physiological temperature may be an important factor that facilitates invasive disease. We observed a significant increase in IFN-gamma-producing CD8(+) T cells in bronchoalveolar lavage fluid (BALF) of immunocompetent mice that repeatedly aspirated A. fumigatus conidia in contrast to mice challenged with A. versicolor, a species that is not typically associated with invasive, disseminated disease. Analysis of tissue sections indicated the presence of germinating spores in the lungs of mice challenged with A. fumigatus, but not A. versicolor. Airway IFN-gamma(+)CD8(+) T-cells were decreased and lung germination was eliminated in mice that aspirated A. fumigatus conidia that were formaldehyde-fixed or heat-inactivated. Furthermore, A. fumigatus particles exhibited greater persistence in the lungs of recipient mice when compared to non-viable A. fumigatus or A. versicolor, and this correlated with increased maintenance of airway memory-phenotype CD8(+) T cells. Therefore, murine airway CD8(+) T cell-responses to aspiration of Aspergillus conidia may be mediated in part by the ability of conidia to germinate in the host lung tissue. These results provide further evidence of induction of immune responses to fungi based on their ability to invade host tissue. |
T cell chemo-vaccination effects after repeated mucosal SHIV exposures and oral pre-exposure prophylaxis
Kersh EN , Adams DR , Youngpairoj AS , Luo W , Zheng Q , Cong ME , Aung W , Mitchell J , Otten R , Hendry RM , Heneine W , McNicholl J , Garcia-Lerma JG . PLoS One 2011 6 (4) e19295 Pre-exposure prophylaxis (PrEP) with anti-viral drugs is currently in clinical trials for the prevention of HIV infection. Induction of adaptive immune responses to virus exposures during anti-viral drug administration, i.e., a "chemo-vaccination" effect, could contribute to PrEP efficacy. To study possible chemo-vaccination, we monitored humoral and cellular immune responses in nine rhesus macaques undergoing up to 14 weekly, low-dose SHIV(SF162P3) rectal exposures. Six macaques concurrently received PrEP with intermittent, oral Truvada; three were no-PrEP controls. PrEP protected 4 macaques from infection. Two of the four showed evidence of chemo-vaccination, because they developed anti-SHIV CD4(+) and CD8(+) T cells; SHIV-specific antibodies were not detected. Control macaques showed no anti-SHIV immune responses before infection. Chemo-vaccination-induced T cell responses were robust (up to 3,940 SFU/10(6) PBMCs), predominantly central memory cells, short-lived (≤22 weeks), and appeared intermittently and with changing specificities. The two chemo-vaccinated macaques were virus-challenged again after 28 weeks of rest, after T cell responses had waned. One macaque was not protected from infection. The other macaque concurrently received additional PrEP. It remained uninfected and T cell responses were boosted during the additional virus exposures. In summary, we document and characterize PrEP-induced T cell chemo-vaccination. Although not protective after subsiding in one macaque, chemo-vaccination-induced T cells warrant more comprehensive analysis during peak responses for their ability to prevent or to control infections after additional exposures. Our findings highlight the importance of monitoring these responses in clinical PrEP trials and suggest that a combination of vaccines and PrEP potentially might enhance efficacy. |
Influenza virus aerosol exposure and analytical system for ferrets
Gustin KM , Belser JA , Wadford DA , Pearce MB , Katz JM , Tumpey TM , Maines TR . Proc Natl Acad Sci U S A 2011 108 (20) 8432-7 Understanding the transmission ability of newly emerging influenza viruses is central to the development of public health preparedness and prevention strategies. Animals are used to model influenza virus infection and transmission, but the routinely used intranasal inoculation of a liquid virus suspension does not reflect natural infection. We report the development of an inoculation method that delivers an influenza virus aerosol inoculum to ferrets and the characterization of size distribution and viable virus present in aerosols shed from infected ferrets during normal breathing and sneezing. By comparing virus deposition, infectivity, virulence, and transmissibility among animals inoculated intranasally or by aerosols with a human (H3N2) or avian (H5N1) influenza virus, we demonstrate that aerosol inoculations more closely resemble a natural, airborne influenza virus infection and that viable virus is measurable in droplets and droplet nuclei exhaled by infected ferrets. These methods will provide improved risk assessment of emerging influenza viruses that pose a threat to public health. |
Aspergillus terreus accessory conidia are multinucleated, hyperpolarizing structures that display differential dectin staining and can induce heightened inflammatory responses in a pulmonary model of aspergillosis
Deak E , Nelson M , Hernandez-Rodriguez Y , Gade L , Baddley J , Momany M , Steele C , Balajee SA . Virulence 2011 2 (3) 200-7 In addition to phialidic conidia (PC), A. terreus produces accessory conidia (AC) both in vitro and in vivo. AC are distinct from PC in cell surface architecture, with the AC surfaces displaying more beta-glucan, a molecule that can be a trigger for the induction of inflammatory responses. The present study follows beta-glucan cell surface presentation throughout the course of germination of both types of conidia, and analyzes the differential capacity of AC and PC to elicit immune responses. Results show that AC display early, increased dectin-1 labeling on their cell surfaces compared to PC, and this differential dectin-1 labeling is sustained on the cell surface from the time of breaking dormancy through early germ tube emergence. Mouse alveolar macrophages showed a stronger inflammatory cytokine/chemokine response when challenged with AC than with PC in both ex vivo and in vivo experiments, correlating with the greater exposure of beta-glucan exhibited by AC. Further, histopathologic staining of the lungs from mice challenged with AC demonstrated heightened cell recruitment and increased inflammatory response compared to the lungs of mice challenged with PC. Our study also demonstrates that AC are multinucleate structures with the ability to germinate rapidly, polarizing in multiple directions and producing several hyphal extensions. We present evidence that A. terreus AC are phenotypically distinct from PC and can be potent activators of the innate immune mechanism thus possibly playing a role in this organism's pathogenesis. |
Initiation of antiretroviral treatment in women after delivery can induce multiclass drug resistance in breastfeeding HIV-infected infants.
Fogel J , Li Q , Taha TE , Hoover DR , Kumwenda NI , Mofenson LM , Kumwenda JJ , Fowler MG , Thigpen MC , Eshleman SH . Clin Infect Dis 2011 52 (8) 1069-76 BACKGROUND: The World Health Organization currently recommends initiation of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-infected lactating women with CD4+ cell counts <350 cells/microliter or stage 3 or 4 disease. We analyzed antiretroviral drug resistance in HIV-infected infants in the Post Exposure Prophylaxis of Infants trial whose mothers initiated HAART postpartum (with a regimen of nevirapine [NVP], stavudine, and lamivudine). Infants in the trial received single-dose NVP and a week of zidovudine (ZDV) at birth; some infants also received extended daily NVP prophylaxis, with or without extended ZDV prophylaxis. METHODS: We analyzed drug resistance in plasma samples collected from all HIV-infected infants whose mothers started HAART in the first postpartum year. Resistance testing was performed using the first plasma sample collected within 6 months after maternal HAART initiation. Categorical variables were compared by exact or trend tests; continuous variables were compared using rank-sum tests. RESULTS: Multiclass resistance (MCR) was detected in HIV from 11 (29.7%) of 37 infants. Infants were more likely to develop MCR infection if their mothers initiated HAART earlier in the postpartum period (by 14 weeks vs after 14 weeks and up to 6 months vs after 6 months, P = .0009), or if the mother was exclusively breastfeeding at the time of HAART initiation (exclusive breastfeeding vs mixed feeding vs no breastfeeding, P = .003). CONCLUSIONS: postpartum maternal HAART initiation was associated with acquisition of MCR in HIV-infected breastfeeding infants. The risk was higher among infants whose mothers initiated HAART closer to the time of delivery or were still exclusively breastfeeding when they first reported HAART use. |
Physical ergonomic hazards in highway tunnel construction: overview from the Construction Occupational Health Program
Tak S , Buchholz B , Punnett L , Moir S , Paquet V , Fulmer S , Marucci-Wellman H , Wegman D . Appl Ergon 2011 42 (5) 665-71 This report provides an overview of physical ergonomic exposures in highway construction work across trades and major operations. For each operation, the observational method "PATH" (Posture, Activity, Tools and Handling) was used to estimate the percentage of time that workers spent in specific tasks and with exposure to awkward postures and load handling. The observations were carried out on 73 different days, typically for about 4 h per day, covering 120 construction workers in 5 different trades: laborers, carpenters, ironworkers, plasterers, and tilers. Non-neutral trunk postures (forward or sideways flexion or twisting) were frequently observed, representing over 40% of observations for all trades except laborers (28%). Kneeling and squatting were common in all operations, especially tiling and underground utility relocation work. Handling loads was frequent, especially for plasterers and tilers, with a range of load weights but most often under 15 pounds. The results of this study provide quantitative evidence that workers in highway tunnel construction operations are exposed to ergonomic factors known to present significant health hazards. Numerous opportunities exist for the development and implementation of ergonomic interventions to protect the health and safety of construction workers. |
Kinematic performance of a six degree-of-freedom hand model (6DHand) for use in occupational biomechanics
Buczek FL , Sinsel EW , Gloekler DS , Wimer BM , Warren CM , Wu JZ . J Biomech 2011 44 (9) 1805-9 Upper extremity musculoskeletal disorders represent an important health issue across all industry sectors; as such, the need exists to develop models of the hand that provide comprehensive biomechanics during occupational tasks. Previous optical motion capture studies used a single marker on the dorsal aspect of finger joints, allowing calculation of one and two degree-of-freedom (DOF) joint angles; additional algorithms were needed to define joint centers and the palmar surface of fingers. We developed a 6DOF model (6DHand) to obtain unconstrained kinematics of finger segments, modeled as frusta of right circular cones that approximate the palmar surface. To evaluate kinematic performance, twenty subjects gripped a cylindrical handle as a surrogate for a powered hand tool. We hypothesized that accessory motions (metacarpophalangeal pronation/supination; proximal and distal interphalangeal radial/ulnar deviation and pronation/supination; all joint translations) would be small (less than 5 degrees rotations, less than 2mm translations) if segment anatomical reference frames were aligned correctly, and skin movement artifacts were negligible. For the gripping task, 93 of 112 accessory motions were small by our definition, suggesting this 6DOF approach appropriately models joints of the fingers. Metacarpophalangeal supination was larger than expected (approximately 10 degrees ), and may be adjusted through local reference frame optimization procedures previously developed for knee kinematics in gait analysis. Proximal translations at the metacarpophalangeal joints (approximately 10mm) were explained by skin movement across the metacarpals, but would not corrupt inverse dynamics calculated for the phalanges. We assessed performance in this study; a more rigorous validation would likely require medical imaging. |
Schistosomiasis among young children in Usoma, Kenya
Verani JR , Abudho B , Montgomery SP , Mwinzi PN , Shane HL , Butler SE , Karanja DM , Secor WE . Am J Trop Med Hyg 2011 84 (5) 787-91 Although schistosomiasis burden is greatest among school-age children (SAC) (6-15 years of age), infection among preschool-age children (PSAC) (1-5 years), may be underestimated in endemic areas. We conducted a cross-sectional study evaluating Schistosoma mansoni infection among children 1-15 years of age in a highly endemic community in Kenya. Diagnostic tests included stool exam (Kato/Katz technique), serum testing for schistosome-specific antibodies, and urine testing for circulating cathodic antigen (CCA). Overall, 268 SAC and 216 PSAC were enrolled; prevalence increased with age, with 14% of 1 year olds and more than 90% of children > 10 years of age infected. Stool exam was more sensitive among SAC than PSAC, but performance was similar after adjusting for infection intensity (based on CCA). Schistosomiasis poses a threat to PSAC in endemic areas, and stool exam may underestimate the prevalence of infection. Control programs in such areas should consider PSAC in addition to SAC. |
Towards a more coordinated federal response to improving HIV prevention and sexual health among men who have sex with men
Rausch D , Dieffenbach C , Cheever L , Fenton KA . AIDS Behav 2011 15 Suppl 1 S107-11 Nearly 30 years into the HIV/AIDS pandemic, the disease continues to exact a heavy toll in the United States. More than 1.1 million people are currently living with HIV in the US, and each year more than 56,000 new HIV infections occur, with nearly 18,000 people with AIDS dying annually [1]. Men who have sex with men (MSM) continue to be the group most severely impacted by HIV/AIDS, a disparity that has remained unchanged since the beginning of the epidemic, although the demographic characteristics of MSM who are impacted by HIV has changed dramatically [2]. Today, HIV affects MSM of all racial and ethnic backgrounds, with a particularly devastating impact on black and Hispanic/Latino MSM [3], and especially young MSM within these groups [4]. In this paper, we review current strategic efforts being considered or implemented by three United States government agencies (the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration) to accelerate reductions in HIV and improve sexual health among MSM. We also discuss the need for improved collaboration among federal agencies in order to achieve these goals. |
Association of family stressful life-change events and health-related quality of life in fifth-grade children
Coker TR , Elliott MN , Wallander JL , Cuccaro P , Grunbaum JA , Corona R , Saunders AE , Schuster MA . Arch Pediatr Adolesc Med 2011 165 (4) 354-9 OBJECTIVE: To examine the association of recent family-related stressful life-change events (SLEs) with health-related quality of life (HRQOL) in fifth graders. DESIGN: Population-based, cross-sectional survey. SETTING: Three US metropolitan areas; 2004-2006. PARTICIPANTS: A total of 5147 fifth graders and their parents. MAIN EXPOSURES: Nine recent family-related SLEs: a parent's death, another family member's death, a family member's injury/illness, a family member's alcohol/drug problems, loss of a pet, recent change of residence, addition of a new baby or child to the household, parental separation, and parental divorce. MAIN OUTCOME MEASURE: The HRQOL measured using the 23-item Pediatric Quality of Life Inventory. RESULTS: Twenty-four percent of children had no reported recent SLEs; 33% had 1, 25% had 2, 12% had 3, and 6% had 4 or more. Mean HRQOL scores (total, physical, and psychosocial scales) were lower for children with more SLEs. The mean total HRQOL score was 80.4 (95% confidence interval, 79.4-81.3) for children with no recent SLEs and 71.8 (70.2-73.5) for children with 4 or more SLEs (P < .001). In adjusted logistic regression analyses, children with more SLEs had greater odds of impaired HRQOL compared with children without any SLEs. Psychosocial HRQOL fully mediated the relationship between SLEs and physical HRQOL. CONCLUSIONS: The occurrence of multiple family-related SLEs in children is associated with less positive HRQOL. By incorporating the needs of families as part of comprehensive, high-quality care, health care professionals can identify these types of family-level needs and assist families in accessing community resources for support. |
Recurrent wound botulism among injection drug users in California
Yuan J , Inami G , Mohle-Boetani J , Vugia DJ . Clin Infect Dis 2011 52 (7) 862-6 BACKGROUND: Botulism is an acute neurologic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulism is a rare disease and recurrent botulism even more rare. We review cases of recurrent wound botulism (WB) among injection drug users (IDUs) in California from 1993 through 2006 and describe 2 case patients. METHODS: From botulism surveillance data for 1993-2006, we identified patients with >1 episode of clinical WB, defined as acute descending paralysis with a visible wound or recent history of injection drug use. For each patient, ≥1 of their WB episodes was laboratory confirmed. We extracted demographic, clinical, and laboratory information from case and laboratory reports and compared clinical characteristic frequency of initial and second WB episodes. RESULTS: During 1993-2006, 17 IDUs had recurrent WB, 14 with 1 recurrence and 3 with 2 recurrences. Of 25 laboratory-confirmed episodes, 22 were confirmed through serum testing and 3 through wound testing. Patients were 32-61 years old, and 94% were male. All patients reported heroin injections; 88% specified black tar heroin use and 76% reported subcutaneous injection. The most common presentations were having a visible wound, speech difficulty, double vision, respiratory difficulty, and trouble swallowing. There were no significant differences in clinical presentation between initial and second episodes. CONCLUSIONS: As the California epidemic of WB among IDUs continues, WB episodes are recurring. Both clinicians and IDUs should be aware of the potential for WB to recur among IDUs to enable timely diagnosis and early botulinum antitoxin administration and supportive care. |
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