Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system: case report and review of the literature
Haug A , Mahalingam R , Cohrs RJ , Schmid DS , Corboy JR , Gilden D . J Neurol Sci 2010 292 85-8 We describe an immunocompetent 45-year-old woman who had four episodes of neurological disease (meningoencephalitis, multifocal vasculopathy, myelitis and inflammatory brain stem disease) produced by varicella zoster virus (VZV) over an 11-month period, all in the absence of rash. The cerebrospinal fluid (CSF) contained anti-VZV IgG antibody, but not VZV DNA throughout her illness, reaffirming the superiority of detection of anti-VZV IgG in CSF compared to VZV DNA in diagnosing VZV infection of the nervous system. Moreover, 3 of 7 CSF samples examined during the 11 months showed a VZV-induced pleocytosis consisting predominantly of polymorphonuclear cells (PMNs), and 4 of 7 samples also contained increased numbers of red blood cells (RBCs). Because increased PMNs and RBCs in CSF can also occur in patients with central and peripheral nervous system disease produced by cytomegalovirus (CMV), the differential diagnosis of chronic nervous system infection with increased PMNs and RBCs in CSF should include analyses for both VZV and CMV. |
Trends in hypercholesterolemia, treatment and control among United States adults
Ford ES , Li C , Pearson WS , Zhao G , Mokdad AH . Int J Cardiol 2010 140 (2) 226-35 BACKGROUND: Control of hypercholesterolemia is an important clinical and public health objective, yet it is generally poor. The objective of this study was to examine trends in the prevalence of hypercholesterolemia, having a cholesterol check, awareness, treatment, and control among United States adults. METHODS: We examined data for 18053 participants aged > or =20 years of the National Health and Nutrition Examination Surveys from 1999 to 2006. RESULTS: The unadjusted prevalence of hypercholesterolemia ranged from 53.2% to 56.1% and changed little over the study period. Significant increases were evident in the percentage of United States adults who had their concentration of cholesterol checked (from 68.6% to 74.8%), who reported being told that they had high hypercholesterolemia (from 42.0% to 50.4%), who reported using cholesterol-lowering medications (from 39.1% to 54.4%), and who had their hypercholesterolemia controlled (from 47.0 to 64.3%). Among all participants with hypercholesterolemia control of hypercholesterolemia increased from 7.2% to 17.1%. Disparities related to gender and race or ethnicity existed, notably a lower rate of control among women than men and lower rates of having a cholesterol check and reporting being told about hypercholesterolemia among African Americans and Mexican Americans than whites. CONCLUSIONS: Encouraging increases in awareness, treatment, and control of hypercholesterolemia occurred from 1999 through 2006. Nevertheless, control of hypercholesterolemia remains poor. |
Predictive value of albuminuria in American Indian youth with or without type 2 diabetes
Kim NH , Pavkov ME , Knowler WC , Hanson RL , Weil EJ , Curtis JM , Bennett PH , Nelson RG . Pediatrics 2010 125 (4) e844-51 OBJECTIVE: To examine the prognostic significance of elevated albuminuria in youth with type 2 diabetes. PATIENTS AND METHODS: Cross-sectional and prospective studies were conducted on Pima Indian youth aged 5 to 19 years at baseline who were examined between July 1, 1982, and December 31, 2007. Prevalence and sequential changes in the level of microalbuminuria (30 < or = albumin-to-creatinine ratio [ACR] < 300 mg/g) and macroalbuminuria (ACR > or = 300 mg/g) and incidence of macroalbuminuria were computed according to the presence or absence of type 2 diabetes. RESULTS: The prevalence of microalbuminuria and macroalbuminuria was 6.5% and 0.6% in the 3856 nondiabetic youth and 18.5% and 2.9% in the 103 youth with diabetes, respectively. One hundred forty-one of 187 (75.4%) nondiabetic youth, but only 1 of 14 (7.1%) diabetic youth with an elevated ACR (> or =30 mg/g) regressed to an undetectable or normal ACR (<30 mg/g) on subsequent examination. In a subset of 2666 youth with a median follow-up of 8.1 years, 36 nondiabetic and 30 diabetic youth with baseline ACRs of <300 mg/g developed macroalbuminuria. For a given ACR, the incidence of macroalbuminuria was 15.9-fold (95% confidence interval: 11.1-22.6) higher in the diabetic than in the nondiabetic youth. CONCLUSIONS: Elevated albuminuria is infrequent and largely transient in nondiabetic youth, but it is relatively frequent and largely persistent in those with diabetes. Microalbuminuria in youth with type 2 diabetes strongly predicts progression to macroalbuminuria, which supports annual screening for albuminuria. |
Transforming strategies for the prevention of chronic HBV and HCV infections
Ward JW , Hu DJ , Alter MJ , Kanwal F , Taylor C , Block JM , Caballero JB , Chase D , Saly M , Sandt L , Swan T . J Fam Pract 2010 59 S23-8 The article focuses on the prevention of chronic hepatitis B and C virus (HBV and HCV) infections in the U.S. It discusses the global implication of the pandemic chronic viral infections, prevention strategies for HBV infection using the framework of the Centers for Disease Control and Prevention (CDC), and the HCV in quality indicators which include confirmation of HCV viremia, hepatitis A and HBV vaccinations, counseling, and treatment with the Department of Health and Human Services Centers. |
Prognostic factors associated with hepatitis C disease: a case-control study utilizing U.S. multiple-cause-of-death data
Wise M , Finelli L , Sorvillo F . Public Health Rep 2010 125 (3) 414-22 OBJECTIVE: Hepatitis C, an important cause of premature mortality, is the most common chronic bloodborne infection in the United States. The severity of disease is strongly affected by a number of other medical conditions and health behaviors. We sought to estimate the association of several exposures with hepatitis C on death certificates. METHODS: We enrolled 63,189 hepatitis C deaths as cases in a case-control study using multiple-cause-of-death data for the U.S. from 1999 to 2004. Three control groups were assembled from all remaining deaths with no mention of hepatitis C, including a random sample of all deaths, digestive disease deaths, and circulatory disease deaths. RESULTS: Hepatitis B, human immunodeficiency virus (HIV), hemochromatosis, and alcohol use were all strongly associated with hepatitis C, even after controlling for confounding variables. The simultaneous presence of many of these exposures had a synergistic association with hepatitis C being listed as a cause of death. Hepatitis B, HIV, and alcohol use were recorded among 6.4%, 10.5%, and 18.2% of case deaths, respectively. CONCLUSIONS: The strong association of alcohol use, HIV, and hepatitis B with hepatitis C, as well as the frequent occurrence of these conditions, indicates that targeted interventions for mitigating the potential effect of these exposures may present an efficient means of limiting progression of hepatitis C-related liver disease and reducing the population burden of hepatitis C mortality. |
Extensively drug-resistant tuberculosis: "there must be some kind of way out of here"
Cegielski JP . Clin Infect Dis 2010 50 Suppl 3 S195-200 Over the past 7 decades, Mycobacterium tuberculosis has developed resistance to virtually every new drug used to treat tuberculosis, resulting recently in the global emergence of extensively drug-resistant tuberculosis. In an individual, treatment with a single new drug results in acquired drug resistance within weeks to months. On a population basis, the pattern is just as consistent. After a new drug is introduced, drug-resistant cases or case series are reported within months to years, typically leading to focused surveys, and within several years, dramatic outbreaks with extraordinary mortality occur. Invariably, such outbreaks prove to be the tip of the iceberg. Incomplete and delayed diagnoses, drug costs, and drug supplies are frequently implicated. With new drugs and new diagnostics on the horizon, we must develop new ways of incorporating them into public health practice, basing treatment on rapid drug-susceptibility tests, ensuring that effective drugs are always used in combination, and making these drug available to persons who need them. |
Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV
Date AA , Vitoria M , Granich R , Banda M , Fox MY , Gilks C . Bull World Health Organ 2010 88 (4) 253-9 OBJECTIVE: To measure progress in implementing co-trimoxazole prophylaxis (CTXp) (trimethoprim plus sulfamethoxazole) and isoniazid preventive therapy (IPT) policy recommendations, identify barriers to the development of national policies and pinpoint challenges to implementation. METHODS: In 2007 we conducted by e-mail a cross-sectional survey of World Health Organization (WHO) HIV/AIDS programme officers in 69 selected countries having a high burden of infection with HIV or HIV-associated tuberculosis (TB). The specially-designed, self-administered questionnaire contained items covering national policies for CTXp and IPT in people living with HIV, current level of implementation and barriers to developing or implementing these policies. FINDINGS: The 41 (59%) respondent countries, representing all WHO regions, comprised 85% of the global burden of HIV-associated TB and 82% of the global burden of HIV infection. Thirty-eight countries (93%) had an established national policy for CTXp, but only 66% of them (25/38) had achieved nationwide implementation. For IPT, 21 of 41 countries (51%) had a national policy but only 28% of them (6/21) had achieved nationwide implementation. Despite significant progress in the development of CTXp policy, the limited availability of co-trimoxazole for this indication and inadequate systems to manage drug supply impeded nationwide implementation. Inadequate intensified tuberculosis case-finding and concerns regarding isoniazid resistance were challenges to the development and implementation of national IPT policies. CONCLUSION: Despite progress in implementing WHO-recommended CTXp and IPT policies, these interventions remain underused. Urgent steps are required to facilitate the development and implementation of these policies. |
Acute HIV infections among men with genital ulcer disease in South Africa
Paz Bailey G , Sternberg M , Lewis DA , Puren A . J Infect Dis 2010 201 (12) 1811-5 We investigated acute human immunodeficiency virus (HIV) infection among men enrolled in a genital ulcer treatment trial in South Africa. HIV-negative participants were tested at baseline by HIV RNA polymerase chain reaction and followed up after 1 month to measure HIV seroconversion. There were 228 HIV-negative men at baseline; 10 were positive for HIV RNA, and 8 seroconverted to HIV at day 28. The prevalence of acute HIV among HIV-negative men at baseline was 18 (7.9%) of 228 men (95% confidence interval [CI], 4.4-11.4) and 18 (2.9%) of 615 men (95% CI, 1.6-4.3) in the overall study population. These data highlight the importance of genital ulcer patients in HIV transmission. Trial Registration. ClinicalTrials.gov identifier: NCT00164424 . |
Adherence to treatment of latent tuberculosis infection in a clinical population in New York City
Li J , Munsiff SS , Tarantino T , Dorsinville M . Int J Infect Dis 2010 14 (4) e292-7 BACKGROUND: Low adherence to treatment of latent tuberculosis infection (TLTBI) diminishes TB prevention efforts. This study examined the treatment completion rate among those who started TLTBI and factors associated with adherence to TLTBI. METHODS: Patients who started TLTBI in New York City (NYC) Health Department chest clinics during January 2002-August 2004 were studied. TLTBI completion rate were described and compared according to patient demographic and clinical characteristics by regimen using univariate analysis and log-binomial regression. RESULTS: A total of 15 035 patients started and 6788 (45.2%) completed TLTBI. Treatment completers were more likely than non-completers to be >or=35 years old (52.5%, adjusted relative risk (aRR)=1.2, 95% confidence interval (CI)=1.1, 1.2), contacts to pulmonary TB patients (57.4%, aRR=1.5, 95% CI=1.4, 1.7), treated by directly observed preventive therapy (DOPT) (71.4%, aRR=1.3, 95% CI=1.2, 1.3), and to have received the rifamycin-based regimen (60.0%, aRR=1.2, 95% CI=1.1, 1.3). The completion rate with an isoniazid regimen did not differ between HIV-infected and HIV-uninfected persons. Among those who failed to complete, 3748 (47.8%) failed to return for isoniazid and 59 (14.7%) for rifamycin after the first month of medication dispensing. CONCLUSIONS: Shorter regimen and DOPT increased completion rates for LTBI. Though efforts to improve TLTBI completion need to address all groups, greater focus is needed for persons who are contacts and HIV-infected, as they have higher risk of developing TB. |
Identifying gaps in HIV prevention services
Torrone EA , Levandowski BA , Thomas JC , Isler MR , Leone PA . Soc Work Public Health 2010 25 (3) 327-40 Human immunodeficiency virus (HIV) prevention programs and agencies are fighting growing rates of infection with decreasing resources. Identification of gaps in HIV prevention services can help inform prevention funding and program policies. To describe HIV prevention needs in a southern U.S. state, we conducted face-to-face interviews with prevention agencies and persons considered by others in their community to be "influential informants" of the community's HIV prevention services in a sample of counties in North Carolina. Using county as the unit of analysis (n = 10), we investigated differences in gaps by community characteristics, such as disparities in sexually transmitted disease rates. Lack of programs and problems with service program coordination/cooperation were reported frequently by rural counties. The most commonly reported barrier to meeting the needs of persons at risk for HIV was funding, followed by stigma. Findings from this study can inform local and regional planners on how to efficiently target prevention programs, including programs aimed at reducing racial and geographic disparities in sexually transmitted diseases, such as HIV. |
Use of simple pharmacokinetic modeling to characterize exposure of Australians to perfluorooctanoic acid and perfluorooctane sulfonic acid
Thompson J , Lorber M , Toms LM , Kato K , Calafat AM , Mueller JF . Environ Int 2010 36 (4) 390-7 Perflurooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) have been used for a variety of applications including fluoropolymer processing, fire-fighting foams and surface treatments since the 1950s. Both PFOS and PFOA are polyfluoroalkyl chemicals (PFCs), man-made compounds that are persistent in the environment and humans; some PFCs have shown adverse effects in laboratory animals. Here we describe the application of a simple one compartment pharmacokinetic model to estimate total intakes of PFOA and PFOS for the general population of urban areas on the east coast of Australia. Key parameters for this model include the elimination rate constants and the volume of distribution within the body. A volume of distribution was calibrated for PFOA to a value of 170ml/kgbw using data from two communities in the United States where the residents' serum concentrations could be assumed to result primarily from a known and characterized source, drinking water contaminated with PFOA by a single fluoropolymer manufacturing facility. For PFOS, a value of 230ml/kgbw was used, based on adjustment of the PFOA value. Applying measured Australian serum data to the model gave mean+/-standard deviation intake estimates of PFOA of 1.6+/-0.3ng/kgbw/day for males and females >12years of age combined based on samples collected in 2002-2003 and 1.3+/-0.2ng/kg bw/day based on samples collected in 2006-2007. Mean intakes of PFOS were 2.7+/-0.5ng/kgbw/day for males and females >12years of age combined based on samples collected in 2002-2003, and 2.4+/-0.5ng/kgbw/day for the 2006-2007 samples. ANOVA analysis was run for PFOA intake and demonstrated significant differences by age group (p=0.03), sex (p=0.001) and date of collection (p<0.001). Estimated intake rates were highest in those aged >60years, higher in males compared to females, and higher in 2002-2003 compared to 2006-2007. The same results were seen for PFOS intake with significant differences by age group (p<0.001), sex (p=0.001) and date of collection (p=0.016). |
Spatial risk assessments based on vector-borne disease epidemiologic data: importance of scale for West Nile virus disease in Colorado
Winters AM , Eisen RJ , Delorey MJ , Fischer M , Nasci RS , Zielinski-Gutierrez E , Moore CG , Pape WJ , Eisen L . Am J Trop Med Hyg 2010 82 (5) 945-53 We used epidemiologic data for human West Nile virus (WNV) disease in Colorado from 2003 and 2007 to determine 1) the degree to which estimates of vector-borne disease occurrence is influenced by spatial scale of data aggregation (county versus census tract), and 2) the extent of concordance between spatial risk patterns based on case counts versus incidence. Statistical analyses showed that county, compared with census tract, accounted for approximately 50% of the overall variance in WNV disease incidence, and approximately 33% for the subset of cases classified as West Nile neuroinvasive disease. These findings indicate that sub-county scale presentation provides valuable risk information for stakeholders. There was high concordance between spatial patterns of WNV disease incidence and case counts for census tract (83%) but not for county (50%) or zip code (31%). We discuss how these findings impact on practices to develop spatial epidemiologic data for vector-borne diseases and present data to stakeholders. |
A multidisciplinary investigation of a polycythemia vera cancer cluster of unknown origin
Seaman V , Dearwent SM , Gable D , Lewis B , Metcalf S , Orloff K , Tierney B , Zhu J , Logue J , Marchetto D , Ostroff S , Hoffman R , Xu M , Carey D , Erlich P , Gerhard G , Roda P , Iannuzzo J , Lewis R , Mellow J , Mulvihill L , Myles Z , Wu M , Frank A , Gross-Davis CA , Klotz J , Lynch A , Weissfeld J , Weinberg R , Cole H . Int J Environ Res Public Health 2010 7 (3) 1139-1153 Cancer cluster investigations rarely receive significant public health resource allocations due to numerous inherent challenges and the limited success of past efforts. In 2008, a cluster of polycythemia vera, a rare blood cancer with unknown etiology, was identified in northeast Pennsylvania. A multidisciplinary group of federal and state agencies, academic institutions, and local healthcare providers subsequently developed a multifaceted research portfolio designed to better understand the cause of the cluster. This research agenda represents a unique and important opportunity to demonstrate that cancer cluster investigations can produce desirable public health and scientific outcomes when necessary resources are available. copyright 2010 by the authors. |
Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results
Sodha SV , Lynch M , Wannemuehler K , Leeper M , Malavet M , Schaffzin J , Chen T , Langer A , Glenshaw M , Hoefer D , Dumas N , Lind L , Iwamoto M , Ayers T , Nguyen T , Biggerstaff M , Olson C , Sheth A , Braden C . Epidemiol Infect 2010 139 (2) 1-8 A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8.0, 95% confidence interval (CI) 1.1-348.1] and shredded cheddar cheese (mOR 6.2, CI 1.7-33.7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings. |
Japanese encephalitis in travelers from non-endemic countries, 1973-2008
Hills SL , Griggs AC , Fischer M . Am J Trop Med Hyg 2010 82 (5) 930-6 Japanese encephalitis (JE) is a severe disease and a risk for travelers who visit JE-endemic countries. We reviewed all published JE cases in travelers from non-endemic areas from 1973 through 2008, and assessed factors related to risk of infection. There were 55 cases that occurred in citizens of 17 countries. Age range of case-patients was 1-91 years (median = 34 years). Ten (18%) persons died and 24 (44%) had mild to severe sequelae. In a detailed risk assessment of 37 case-patients, 24 (65%) had spent > or = 1 month in JE-endemic areas, and most had factors identified that may have increased infection risk. The estimate of overall JE risk was low, < 1 case/1 million travelers to JE-endemic countries. Nonetheless, for each traveler, a careful assessment of itinerary and activities, a decision on vaccination, and information on mosquito precautions are needed to reduce the risk of this disease. |
Carbon monoxide-related hospitalizations in the U.S.: evaluation of a web-based query system for public health surveillance
Iqbal S , Clower JH , Boehmer TK , Yip FY , Garbe P . Public Health Rep 2010 125 (3) 423-32 OBJECTIVE: Carbon monoxide (CO) poisoning is preventable, yet it remains one of the most common causes of poisoning in the U.S. In the absence of a national data reporting system for CO-poisoning surveillance, the burden of CO-related hospitalizations is unknown. Our objective was to generate the first national estimates of CO-related hospitalizations and to evaluate the use of a Web-based query system for public health surveillance. METHODS: The Healthcare Cost and Utilization Project's (HCUP's) 2005 Nationwide Inpatient Sample (NIS) data were used for CO-related hospitalization estimates. Data for confirmed, probable, and suspected cases were generated using the HCUPnet Web-based query system. We used data from 1993 through 2005 NIS to describe trends in CO-related hospitalizations. We used the Centers for Disease Control and Prevention's surveillance evaluation guidelines to evaluate the system. RESULTS: In 2005, there were 24,891 CO-related hospitalizations nationwide: 16.9% (n=4,216) were confirmed, 1.1% (n=279) were probable, and 81.9% (n=20,396) were suspected CO-poisoning cases. Of the confirmed cases (1.42/100,000 population), the highest hospitalization rates occurred among males, older adults (aged > or = 85 years), and Midwestern residents. CO-related hospitalization rates declined from 1993 through 2000 and plateaued from 2001 through 2005. The simplicity, acceptability, sensitivity, and representativeness of the HCUPnet surveillance system were excellent. However, HCUPnet showed limited flexibility and specificity. CONCLUSIONS: Nationwide, the burden of CO exposure resulting in hospitalization is substantial. HCUPnet is a useful surveillance tool that efficiently characterized CO-related hospitalizations for the first time. Public health practitioners can utilize this data source for state-level surveillance. |
Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area--Puerto Rico, 2007-2008
Gregory CJ , Santiago LM , Arguello DF , Hunsperger E , Tomashek KM . Am J Trop Med Hyg 2010 82 (5) 922-9 Dengue infection can be challenging to diagnose early in the course of infection before severe manifestations develop, but early diagnosis can improve patient outcomes and promote timely public health interventions. We developed age-based predictive models generated from 2 years of data from an enhanced dengue surveillance system in Puerto Rico. These models were internally validated and were able to differentiate dengue infection from other acute febrile illnesses with moderate accuracy. The accuracy of the models was greater than either the current World Health Organization case definition for dengue fever or a proposed modification to this definition, while requiring the collection of fewer data. In young children, thrombocytopenia and the absence of cough were associated with dengue infection; for adults, rash, leucopenia, and the absence of sore throat were associated with dengue infection; in all age groups, retro-orbital pain was associated with dengue infection. |
Clostridium difficile infections among hospitalized children, United States, 1997-2006
Zilberberg MD , Tillotson GS , McDonald C . Emerg Infect Dis 2010 16 (4) 604-9 We evaluated the annual rate (cases/10,000 hospitalizations) of pediatric hospitalizations with Clostridium difficile infection (CDI; International Classification of Diseases, 9th revision, clinical modification code 008.45) in the United States. We performed a time-series analysis of data from the Kids' Inpatient Database within the Health Care Cost and Utilization Project during 1997-2006 and a cross-sectional analysis within the National Hospital Discharge Survey during 2006. The rate of pediatric CDI-related hospitalizations increased from 7.24 to 12.80 from 1997 through 2006; the lowest rate was for children <1 year of age. Although incidence was lowest for newborns (0.5), incidence for children <1 year of age who were not newborns (32.01) was similar to that for children 5-9 years of age (35.27), which in turn was second only to incidence for children 1-4 years of age (44.87). Pediatric CDI-related hospitalizations are increasing. A better understanding of the epidemiology and outcomes of CDI is urgently needed. |
Outbreak of beriberi in the state of Maranhao, Brazil: revisiting the mycotoxin aetiologic hypothesis
Lima HC , Porto EA , Marins JR , Alves RM , Machado RR , Braga KN , de Paiva FB , Carmo GM , Silva e Santelli AC , Sobel J . Trop Doct 2010 40 (2) 95-7 Beriberi is caused by thiamine deficiency. Early 20th century epidemics in Japan were attributed to rice contaminated by citreoviridin mycotoxin. Our investigation of an outbreak of beriberi in Brazil showed an association of beriberi with the consumption of poor quality subsistence farming rice, although, unlike other investigators of this outbreak, we did not identify citreoviridin producing fungi in the implicated rice. |
Future health applications of genomics: priorities for communication, behavioral, and social sciences research.
McBride CM , Bowen D , Brody LC , Condit CM , Croyle RT , Gwinn M , Khoury MJ , Koehly LM , Korf BR , Marteau TM , McLeroy K , Patrick K , Valente TW . Am J Prev Med 2010 38 (5) 556-65 Despite the quickening momentum of genomic discovery, the communication, behavioral, and social sciences research needed for translating this discovery into public health applications has lagged behind. The National Human Genome Research Institute held a 2-day workshop in October 2008 convening an interdisciplinary group of scientists to recommend forward-looking priorities for translational research. This research agenda would be designed to redress the top three risk factors (tobacco use, poor diet, and physical inactivity) that contribute to the four major chronic diseases (heart disease, type 2 diabetes, lung disease, and many cancers) and account for half of all deaths worldwide. Three priority research areas were identified: (1) improving the public's genetic literacy in order to enhance consumer skills; (2) gauging whether genomic information improves risk communication and adoption of healthier behaviors more than current approaches; and (3) exploring whether genomic discovery in concert with emerging technologies can elucidate new behavioral intervention targets. Important crosscutting themes also were identified, including the need to: (1) anticipate directions of genomic discovery; (2) take an agnostic scientific perspective in framing research questions asking whether genomic discovery adds value to other health promotion efforts; and (3) consider multiple levels of influence and systems that contribute to important public health problems. The priorities and themes offer a framework for a variety of stakeholders, including those who develop priorities for research funding, interdisciplinary teams engaged in genomics research, and policymakers grappling with how to use the products born of genomics research to address public health challenges. |
Does patient-delivered partner treatment improve disclosure for treatable sexually transmitted diseases?
Mohammed H , Leichliter JS , Schmidt N , Farley TA , Kissinger P . AIDS Patient Care STDS 2010 24 (3) 183-8 The objective of this research was to determine the factors associated with disclosure of three treatable sexually transmitted diseases (STDs). Data were obtained from two intervention trials to determine the ideal means of partner referral. Men diagnosed with urethritis and women diagnosed with trichomoniasis at public clinics in New Orleans, Louisiana were randomly assigned to partner referral (PR), booklet-enhanced partner referral (BEPR), or patient-delivered partner treatment (PDPT). Participants were asked about sex partners at baseline, then whether they disclosed to them at follow-up. The male trial was conducted from December 2001 to March 2004 and the female trial from December 2001 to August 2004. Data on men and women were analyzed separately. Nine hundred seventy-seven men and 463 women-reporting information on 1991 and 521 sex partners-were respectively enrolled in each trial. Disclosure occurred to 57.8% and 87.3% of their partners, respectively. Most men (68.3%) reported having two or more partners and disclosure was more likely to occur in: those who reported only one sex partner (adjusted odds ratio [aOR] 95% confidence interval [CI]: 1.54 [1.10, 2.16]); those in steady relationships (OR [95% CI]: 1.37 [1.08,1.74]); and those assigned PDPT [OR [95% CI]: 2.71 [1.93,3.82]). Most women reported having only one partner (86.8%) and disclosure was more likely to occur in steady relationships (OR [95% CI]: 2.65 [1.24,5.66]), and when sex was reinitiated with partners during the follow-up period (OR [95% CI]: 3.30 [1.54,7.09]). The provision of PDPT was associated with increased STD disclosure among men but not among women. Both men and women were less likely to disclose to casual partners. Women had high rates of disclosure irrespective of intervention arm. |
A qualitative evaluation of fire safety education programs for older adults
Diekman ST , Stewart TA , Teh SL , Ballesteros MF . Health Promot Pract 2010 11 (2) 216-25 This article presents a qualitative evaluation of six fire safety education programs for older adults delivered by public fire educators. Our main aims were to explore how these programs are implemented and to determine important factors that may lead to program success, from the perspectives of the public fire educators and the older adults. For each program, we interviewed the public fire educator(s), observed the program in action, and conducted focus groups with older adults attending the program. Analysis revealed three factors that were believed to facilitate program success (established relationships with the older adult community, rapport with older adult audiences, and presentation relevance) as well as three challenges (lack of a standardized curriculum and program implementation strategies, attendance difficulties, and physical limitations due to age). More fire safety education should be developed for older adult populations. For successful programs, public fire educators should address the specific needs of their local older adult community. |
Reexamining methods and messaging for hand hygiene in the era of increasing clostridium difficile colonization and infection
Ellingson K , McDonald C . Infect Control Hosp Epidemiol 2010 31 (6) 571-3 There is little question that use of alcohol-based hand rub | (ABHR) as the primary mode of hand hygiene in healthcare | settings, which is strongly encouraged by the Centers for Disease Control and Prevention and the World Health Organization, has increased adherence to recommended hand hygiene practices worldwide. Compared with use of soap and | water, use of ABHR requires less time, irritates hands less, | and is possible at the patient bedside more often.1 | ' | 2 | Although | ABHR has excellent germicidal activity against a broad spectrum of bacteria and viruses, including multidrug-resistant | pathogens such as methicillin-resistant Staphylococcus aureus | (MRSA) and vancomycin-resistant Enterococcus species, ABHR | is not efficacious against spore-forming organisms, such as | Clostridium difficile.3 | The 2009 World Health Organization | guidelines accommodate this discrepancy in ABHR efficacy | by recommending hand washing with soap and water for | visibly soiled hands or "if exposure to potential spore-forming | organisms is strongly suspected or proven, including outbreaks of C. difficile [infection]"4(pl60); for all other situations, | the guidelines recommend use of ABHR as the preferred | means of routine hand hygiene in healthcare facilities. As C. | difficile infection rates increase in the United States, many | healthcare facilities have begun encouraging the routine use | of soap and water for the care of all patients with active C. | difficile-associated diarrhea. However, experts and clinicians | have expressed concern about the patient- and situation-specific nature of the recommendations; they fear that inconsistency in hand hygiene messaging could potentially discourage ABHR use, which could plausibly decrease the | frequency with which healthcare personnel perform hand hygiene when indicated.5,6 |
Inhibitory effect of breast milk on infectivity of live oral rotavirus vaccines
Moon SS , Wang Y , Shane AL , Nguyen T , Ray P , Dennehy P , Baek LJ , Parashar U , Glass RI , Jiang B . Pediatr Infect Dis J 2010 29 (10) 919-23 BACKGROUND: Live oral rotavirus vaccines have been less immunogenic and efficacious among children in poor developing countries compared with middle income and industrialized countries for reasons that are not yet completely understood. We assessed whether the neutralizing activity of breast milk could lower the titer of vaccine virus and explain this difference in vitro. METHODS: Breast milk samples were collected from mothers who were breast-feeding infants 4 to 29 weeks of age (ie, vaccine eligible age) in India (N = 40), Vietnam (N = 77), South Korea (N = 34), and the United States (N = 51). We examined breast milk for rotavirus-specific IgA and neutralizing activity against 3 rotavirus vaccine strains-RV1, RV5 G1, and 116E using enzyme immunoassays. The inhibitory effect of breast milk on RV1 was further examined by a plaque reduction assay. FINDINGS: Breast milk from Indian women had the highest IgA and neutralizing titers against all 3 vaccine strains, while lower but comparable median IgA and neutralizing titers were detected in breast milk from Korean and Vietnamese women, and the lowest titers were seen in American women. Neutralizing activity was greatest against the 2 vaccine strains of human origin, RV1 and 116E. This neutralizing activity in one half of the breast milk specimens from Indian women could reduce the effective titer of RV1 by approximately 2 logs, of 116E by 1.5 logs, and RV5 G1 strain by approximately 1 log more than that of breast milk from American women. INTERPRETATION: The lower immunogenicity and efficacy of rotavirus vaccines in poor developing countries could be explained, in part, by higher titers of IgA and neutralizing activity in breast milk consumed by their infants at the time of immunization that could effectively reduce the potency of the vaccine. Strategies to overcome this negative effect, such as delaying breast-feeding at the time of immunization, should be evaluated. |
Geographic and sociodemographic variation in self-reported seat belt use in the United States
Strine TW , Beck LF , Bolen J , Okoro C , Dhingra S , Balluz L . Accid Anal Prev 2010 42 (4) 1066-71 BACKGROUND: With new data available, we sought to update existing literature on the prevalence of self-reported seat belt use by state, region, and rural/urban status and to estimate the strength of the association between seat belt use and rural/urban status adjusted for type of seat belt law and several other factors. METHODS: We examined data on self-reported use of seat belts from 50 states, the District of Columbia, and three territories using the 2008 Behavioral Risk Factor Surveillance System, a state-based random-digit-dialed telephone survey (n=406,552). Reported seat belt use was assessed by state, U.S. Census regions, and U.S. Department of Agriculture (USDA) rural/urban continuum codes. RESULTS: Overall, 85% of adults in the United States reported they always used seat belts. Regionally, the West had the highest prevalence of persons who reported that they always wear seat belts (89.6%) and the Midwest had the lowest (80.4%). States with primary seat belt laws had the highest prevalence of reported seat belt use, compared with states with secondary or no laws. After adjusting for various sociodemographic characteristics, body mass index, and type of seat belt law, persons in the most densely populated metropolitan areas were significantly more likely to report always wearing seat belts than those in most sparsely populated rural areas (adjusted odds ratio=2.9). CONCLUSION: Our findings reinforce the evidence that primary enforcement seat belt laws are effective for increasing seat belt use, and suggest that upgrading to primary enforcement laws will be an important strategy for reducing crash-related fatalities in rural areas. |
Characteristics of elderly and other vulnerable adult victims of homicide by a caregiver: National Violent Death Reporting System--17 U.S. States, 2003-2007
Karch D , Nunn KC . J Interpers Violence 2010 26 (1) 137-57 Homicides of dependent elderly and nonelderly adults by their caregivers violate trust and have long-term consequences for families. A better understanding of the characteristics of homicide by caregivers may provide insights that can inform prevention efforts. Data collected in the National Violent Death Reporting System (NVDRS) between 2003 and 2007 are used to characterize victims, perpetrators, and caregiver roles, and circumstances that precipitated homicides by a caregiver. A total 68 incidents are categorized into either homicide by neglect (n = 17), intentional injury of the victim only (n = 21), or homicide followed by suicide of the perpetrator (n = 30). Demographics, mechanism of injury, location of injury, and victim-suspect relationship variables are supplemented by narrative accounts of incidents. In general, findings show that adult homicide victims of a caregiver were widowed (42.6%), non-Hispanic (97.1%), White (88.2%), women (63.2%) killed in their homes (92.6%) with a firearm (35.3%) or by intentional neglect (25.0%) by a husband (30.9%) or a son (22.1%). Nearly half were aged 80 years and older (48.5%), 42.6% were aged 50 to 79 years, and 0.9% were aged 20 to 49 years. Many homicide by caregiver incidents are precipitated by physical illness of the victim or caregiver, opportunity for perpetrator financial gain, mental illness of the caregiver, substance use by the caregiver, or an impending crisis in the life of the caregiver not related to illness. Understanding the vulnerabilities of victims, the characteristics of suspects, and the multiple types of motivations is key to developing effective prevention efforts. |
A rapid antimicrobial susceptibility test for Bacillus anthracis
Weigel LM , Sue D , Michel PA , Kitchel B , Pillai SP . Antimicrob Agents Chemother 2010 54 (7) 2793-800 An effective public health response to a deliberate release of Bacillus anthracis will require rapid distribution of antimicrobial agents for post-exposure prophylaxis and treatment. However, conventional antimicrobial susceptibility testing for B. anthracis requires a 16-20 hr incubation period. To reduce this time, we have combined a modified broth microdilution (BMD) susceptibility testing method with real-time quantitative PCR (qPCR). Growth or inhibition of growth of B. anthracis cells incubated in two-fold dilutions of ciprofloxacin (CIP, 0.015-16 mug/ml) or doxycycline (DOX, 0.06-64 mug/ml) was determined by comparing the fluorescence threshold cycle (Ct) generated by target amplification from cells incubated in each drug concentration with the Ct of the no-drug (positive growth) control. This DeltaCt readily differentiated susceptible and non-susceptible strains. Among susceptible strains, the median DeltaCt was ≥7.51 cycles for CIP and ≥7.08 cycles for DOX when drug concentrations were at or above the CLSI breakpoint for susceptibility. For CIP- and DOX-nonsusceptible strains, the DeltaCt was <1.0 cycle at the breakpoint for susceptibility. When evaluated with 14 genetically and geographically diverse strains of B. anthracis, the rapid method provided the same susceptibility results as conventional methods but required less than 6 hr, significantly decreasing the time required for selection and distribution of appropriate medical countermeasures. |
Measurement of pyrethroid, organophosphorus, and carbamate insecticides in human plasma using isotope dilution gas chromatography-high resolution mass spectrometry
Perez JJ , Williams MK , Weerasekera G , Smith K , Whyatt RM , Needham LL , Barr DB . J Chromatogr B Analyt Technol Biomed Life Sci 2010 878 (27) 2554-62 We have developed a gas chromatography-high resolution mass spectrometry method for measuring pyrethroid, organophosphorus, carbamate and fipronil pesticides and the synergist piperonyl butoxide in human plasma. Plasma samples were extracted using solid phase extraction and were then concentrated for injection and analysis using isotope dilution gas chromatography-high resolution mass spectrometry. The limits of detection ranged from 10 to 158pg/mL with relative recoveries at concentrations near the LODs (e.g., 25 or 250pg/mL) ranging from 87% to 156% (9 of the 16 compounds were within +/-15% of 100%). The extraction recoveries ranged from 20% to 98% and the overall method relative standard deviations were typically less than 20% with some exceptions. Analytical characteristics were determined at 25, 250, and 1000pg/mL. |
A multicenter study to determine disk diffusion and broth microdilution criteria for prediction of high- and low-level mupirocin resistance in Staphylococcus aureus
Swenson JM , Wong B , Simor AE , Thomson RB , Ferraro MJ , Hardy DJ , Hindler J , Jorgensen J , Reller LB , Traczewski M , McDougal LK , Patel JB . J Clin Microbiol 2010 48 (7) 2469-75 Mupirocin susceptibility testing of Staphylococcus aureus has become more important as mupirocin is used more widely to suppress or eliminate S. aureus colonization and prevent subsequent healthcare- and community-associated infections. This multi-center study evaluated two susceptibility testing screening methods to detect high-level mupirocin resistance (HLR), broth microdilution (BMD) MIC of ≥ 512 mug/ml and a 6 mm zone diameter for a 200-mug disk diffusion (DD) test. Initial testing indicated that with Clinical and Laboratory Standards Institute methods for BMD and DD, optimal conditions for detection of mupirocin HLR were 24 hours of incubation and reading DD zone diameters with transmitted light. Using the presence or absence of mupA as the gold standard for HLR, the sensitivity and specificity of a single-well 256 mug/ml BMD test were 97 and 99%, and for the 200-mug disk test were 98 and 99%, respectively. Testing with two disks, 200 mug and 5 mug, was evaluated for distinguishing HLR isolates (MIC ≥ 512 mug/ml), low-level resistant (LLR) isolates (MIC 8-256 mug/ml), and susceptible isolates (MIC ≤ 4 mug/ml). Using no zone with both disks as an indication of HLR, and no zone with the 5-mug disk plus any zone with the 200-mug disk as LLR, only 3 of the 340 isolates were misclassified, with 3 susceptible isolates being classified as LLR. Use of standardized MIC or disk tests could enable the detection of emerging high- and low-level mupirocin resistance in S. aureus. |
Phylogenetic analysis of enterohemorrhagic Escherichia coli O157, Germany, 1987-2008
Jenke C , Harmsen D , Weniger T , Rothganger J , Hyytia-Trees E , Bielaszewska M , Karch H , Mellmann A . Emerg Infect Dis 2010 16 (4) 610-6 Multilocus variable number tandem repeat analysis (MLVA) is a subtyping technique for characterizing human pathogenic bacteria such as enterohemorrhagic Escherichia coli (EHEC) O157. We determined the phylogeny of 202 epidemiologically unrelated EHEC O157:H7/H- clinical isolates through 8 MLVA loci obtained in Germany during 1987-2008. Biodiversity in the loci ranged from 0.66 to 0.90. Four of 8 loci showed null alleles and a frequency < or =44.1%. These loci were distributed among 48.5% of all strains. Overall, 141 MLVA profiles were identified. Phylogenetic analysis assigned 67.3% of the strains to 19 MLVA clusters. Specific MLVA profiles with an evolutionary persistence were identified, particularly within sorbitol-fermenting EHEC O157:H-.These pathogens belonged to the same MLVA cluster. Our findings indicate successful persistence of this clone. |
Plasmodium falciparum dihydrofolate reductase and dihyropteroate synthase mutations and the use of trimethoprim-sulfamethoxazole prophylaxis among persons infected with human immunodeficiency virus
Malamba S , Sandison T , Lule J , Reingold A , Walker J , Dorsey G , Mermin J . Am J Trop Med Hyg 2010 82 (5) 766-71 A prospective cohort design was used to measure the association between daily cotrimoxazole-prophylaxis and infection with Plasmodium falciparum containing mutations associated with antifolate resistance among persons infected with human immunodeficiency virus (HIV) in Tororo and Busia District, in eastern Uganda. Of 149 cases of P. falciparum parasitemia diagnosed, 147 (99%) (smears from participants taking prophylaxis = 91 and smears from those not taking cotrimoxazole prophylaxis = 56) were successfully assessed for mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutations associated with antifolate resistance. Prevalences of the dhfr pure triple mutant (74% and 70%; P = 0.71), the dhps pure double mutant (95% and 88%; P = 0.21), and the dhfr/dhps pure quintuple mutant (73% and 64%; P = 0.36), were not significantly different between those taking and those not taking cotrimoxazole-prophylaxis, respectively. The overall prevalence of the pure quintuple mutant in this study was 69%, which is among the highest in Africa. Although resistance rates of P. falciparum to antifolate drugs are high, cotrimoxazole-prophylaxis in HIV-infected persons was not associated with a higher prevalence of mutations associated with antifolate resistance. |
A practical method for the extraction of PCR-quality DNA from environmental soil samples
Fitzpatrick KA , Kersh GJ , Massung RF . Appl Environ Microbiol 2010 76 (13) 4571-3 Methods for the extraction of PCR-quality DNA from environmental soil samples using pairs of commercially available kits were evaluated. Coxiella burnetii DNA was detected in spiked soil samples at <1,000 genome equivalents per gram of soil, and in 12 (16.4%) of 73 environmental soil samples. |
Harmonization of glutamic acid decarboxylase and islet antigen-2 autoantibody assays for National Institute of Diabetes and Digestive and Kidney Diseases Consortia
Bonifacio E , Yu L , Williams AK , Eisenbarth GS , Bingley PJ , Marcovina SM , Adler K , Ziegler AG , Mueller PW , Schatz DA , Krischer JP , Steffes MW , Akolkar B . J Clin Endocrinol Metab 2010 95 (7) 3360-7 BACKGROUND/RATIONALE: Autoantibodies to islet antigen-2 (IA-2A) and glutamic acid decarboxylase (GADA) are markers for diagnosis, screening, and measuring outcomes in National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) consortia studies. A harmonization program was established to increase comparability of results within and among these studies. METHODS: Large volumes of six working calibrators were prepared from pooled sera with GADA 4.8-493 World Health Organization (WHO) units/ml and IA-2A 2-235 WHO units/ml. Harmonized assay protocols for IA-2A and GADA using (35)S-methionine-labelled in vitro transcribed and translated antigens were developed based on methods in use in three NIDDK laboratories. Antibody thresholds were defined using sera from patients with recent onset type 1 diabetes and healthy controls. To evaluate the impact of the harmonized assay protocol on concordance of IA-2A and GADA results, two laboratories retested stored TEDDY study sera using the harmonized assays. RESULTS: The harmonized assays gave comparable but not identical results in the three laboratories. For IA-2A, using a common threshold of 5 DK units/ml, 549 of 550 control and patient samples were concordantly scored as positive or negative, specificity was greater than 99% with sensitivity 64% in all laboratories. For GADA, using thresholds equivalent to the 97th percentile of 974 control samples in each laboratory, 1051 (97.9%) of 1074 samples were concordant. On the retested TEDDY samples, discordance decreased from 4 to 1.8% for IA-2A (n = 604 samples; P = 0.02) and from 15.4 to 2.7% for GADA (n = 515 samples; P < 0.0001). CONCLUSION: Harmonization of GADA and IA-2A is feasible using large volume working calibrators and common protocols and is an effective approach to ensure consistency in autoantibody measurements. |
Concomitant administration of recombinant PsaA and PCV7 reduces Streptococcus pneumoniae serotype 19A colonization in a murine model
Whaley MJ , Sampson JS , Johnson SE , Rajam G , Stinson-Parks A , Holder P , Mauro E , Romero-Steiner S , Carlone GM , Ades EW . Vaccine 2010 28 (18) 3071-5 A murine colonization model was used to determine the effect of co-administering 7-valent polysaccharide-protein conjugate vaccine and pneumococcal surface adhesin A. Mice were challenged intranasally with either PCV7 serotypes, 4 or 14, or a non-PCV7 serotype, 19A. Post-challenge samples were evaluated for IgG antibody levels, opsonophagocytic activity, and nasopharyngeal colonization. No interference was observed between immune responses from the concomitant and individual immunizations. Concomitant immunizations reduced carriage for tested serotypes; largest reduction was observed for 19A. From these mouse studies, co-administering pneumococcal antigens appear to expand coverage and reduce colonization against a non-PCV7 serotype without inhibiting immunogenicity to other serotypes. |
Development and evaluation of a magnetic immunochromatographic test to detect Taenia solium, which causes taeniasis and neurocysticercosis in humans
Handali S , Klarman M , Gaspard AN , Dong XF , Laborde R , Noh J , Lee YM , Rodriguez S , Gonzalez AE , Garcia HH , Gilman RH , Tsang VC , Wilkins PP . Clin Vaccine Immunol 2010 17 (4) 631-7 Taeniasis/cysticercosis caused by Taenia solium is a frequent parasitic infection of the human brain in most of the world. Rapid and simple screening tools to identify taeniasis and cysticercosis cases are needed for control programs, mostly to identify tapeworm carriers which are the source of infection and need to be treated, or as tools for point-of-care case detection or confirmation. These screening assays should be affordable, reliable, rapid, and easy to perform. Immunochromatographic tests meet these criteria. To demonstrate proof of principle, we developed and evaluated two magnetic immunochromatographic tests (MICTs) for detection of human Taenia solium taeniasis antibodies (ES33-MICT) and neurocysticercosis antibodies (T24-MICT). These assays detected stage-specific antibodies by using two recombinant proteins, rES33 for detection of taeniasis antibodies and rT24H for detection of cysticercosis antibodies. The sensitivity and specificity of the ES33-MICT to detect taeniasis infections were 94.5% and 96%, respectively, and those of the T24-MICT to detect cases of human cysticercosis with two or more viable brain cysts were 93.9% and 98.9%, respectively. These data provide proof of principle that the ES33- and T24-MICTs provide rapid and suitable methods to identify individuals with taeniasis and cysticercosis. |
Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States
Levy SE , Giarelli E , Lee LC , Schieve LA , Kirby RS , Cunniff C , Nicholas J , Reaven J , Rice CE . J Dev Behav Pediatr 2010 31 (4) 267-75 BACKGROUND: Autism spectrum disorders (ASDs) often co-occur with other developmental, psychiatric, neurologic, or medical diagnoses. OBJECTIVE: This study examined co-occurring non-ASD diagnoses and symptoms in a population-based cohort of 8 year olds identified with ASD. METHOD: Data on 2,568 children meeting surveillance case definition for ASD were collected by a multi-site surveillance program. Information was systematically abstracted and reviewed from existing health and education source records and systematically entered into a summary record in a secure database. RESULTS: Eighty-one percent of study children were male; 63% white, 23% black, 14% Hispanic, Asian, or not stated. When age of ASD classification was available, 20% were classified before age 3 years, 36% between ages 3 and 5 years, and 44% after age 5 years. The co-occurrence of ≥1 non-ASD developmental diagnoses was 83%, ≥1 psychiatric diagnoses was 10%, ≥1 neurologic diagnoses was 16%, and at least one possibly causative genetic or neurologic diagnosis was 4%. Children with a previous ASD classification and co-occurring psychiatric or neurologic conditions were more likely to be diagnosed or classified at a later age. Each category of co-occurring non-ASD diagnosis was significantly increased in children whose records did not include an ASD diagnosis or educational classification but who met surveillance criteria for ASD. CONCLUSIONS: These data highlight the need for clinicians to keep in mind the high prevalence of associated diagnoses with an ASD diagnosis, and the possibility that in younger children other symptoms or disorders may be masking or obscuring core symptoms of ASD, which would lead to a diagnosis. |
Zinc and iron deficiency and their interrelations in low-income African American and Hispanic children in Atlanta
Cole CR , Grant FK , Swaby-Ellis ED , Smith JL , Jacques A , Northrop-Clewes CA , Caldwell KL , Pfeiffer CM , Ziegler TR . Am J Clin Nutr 2010 91 (4) 1027-34 BACKGROUND: Information about the zinc status of low-income minority children in the United States is lacking. OBJECTIVE: The objective was to determine the prevalence of zinc deficiency and anemia and their interrelation among low-income African American and Hispanic preschool children. DESIGN: This was a cross-sectional study in which a prospective 3-d food diary was completed, and hemoglobin, serum ferritin, zinc, copper, and C-reactive protein concentrations were measured. Children with elevated C-reactive protein concentrations were excluded from analysis. RESULTS: Of 292 children recruited, 280 (mean +/- SD age: 2.5 +/- 1.2 y) qualified for analysis. One hundred forty-six (52%) children were African American and 134 (48%) were Hispanic; 202 (72%) were enrolled in the Women, Infants, and Children nutrition program. A low serum zinc concentration (<10.7 mumol/L) was present in 34 (12%) children, and 37 (13%) were anemic (hemoglobin < 110 g/L). African American (odds ratio: 3.47; 95% CI: 1.51, 7.96) and anemic (odds ratio: 2.92; 95% CI: 1.24, 6.90) children had an increased risk of zinc deficiency. Serum zinc correlated with hemoglobin (r = 0.24, P < 0.001). Children with a height/length less than the fifth percentile had significantly lower mean serum zinc concentrations than those with a height/length greater than the fifth percentile (12.4 +/- 1.8 compared with 13.0 +/- 2.2 micromol/L; P < 0.001). In a multiple logistic regression model, African American race-ethnicity was associated with zinc deficiency (odds ratio: 0.26; P = 0.02). The main sources of iron and zinc in the diets were meat products and cereals. CONCLUSIONS: The prevalence of zinc deficiency and anemia was high in this population of low-income minority children, especially among African Americans. Further investigation of the incidence of zinc deficiency and the ability of anemia to screen for it is warranted. |
Estimation of total usual calcium and vitamin D intakes in the United States
Bailey RL , Dodd KW , Goldman JA , Gahche JJ , Dwyer JT , Moshfegh AJ , Sempos CT , Picciano MF . J Nutr 2010 140 (4) 817-22 Our objective in this study was to estimate calcium intakes from food, water, dietary supplements, and antacids for U.S. citizens aged >or=1 y using NHANES 2003-2006 data and the Dietary Reference Intake panel age groupings. Similar estimates were calculated for vitamin D intake from food and dietary supplements using NHANES 2005-2006. Diet was assessed with 2 24-h recalls; dietary supplement and antacid use were determined by questionnaire. The National Cancer Institute method was used to estimate usual nutrient intake from dietary sources. The mean daily nutrient intake from supplemental sources was added to the adjusted dietary intake estimates to produce total usual nutrient intakes for calcium and vitamin D. A total of 53% of the U.S. population reported using any dietary supplement (2003-2006), 43% used calcium (2003-2006), and 37% used vitamin D (2005-2006). For users, dietary supplements provided the adequate intake (AI) recommendation for calcium intake for approximately 12% of those >or=71 y. Males and females aged 1-3 y had the highest prevalence of meeting the AI from dietary and total calcium intakes. For total vitamin D intake, males and females >or=71, and females 14-18 y had the lowest prevalence of meeting the AI. Dietary supplement use is associated with higher prevalence of groups meeting the AI for calcium and vitamin D. Monitoring usual total nutrient intake is necessary to adequately characterize and evaluate the population's nutritional status and adherence to recommendations for nutrient intake. |
Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients
Podewils LJ , Holtz T , Riekstina V , Skripconoka V , Zarovska E , Kirvelaite G , Kreigere E , Leimane V . Epidemiol Infect 2010 139 (1) 1-8 Despite the adoption of strategies to prevent and treat multidrug-resistant tuberculosis (MDR-TB) over the past decade, Latvia continues to have one of the highest rates of MDR-TB in the world. It is important to identify modifiable factors that may impact on MDR-TB patient outcomes. A study was conducted to elucidate the association between nutritional status and clinical presentation, clinical course, and mortality in 995 adult patients treated for MDR-TB from 2000 to 2004. Twenty percent of patients were underweight, defined as a body mass index <18.5, at the time of diagnosis. These patients were significantly more likely to have clinical evidence of advanced disease, and had a greater risk of experiencing 3 side-effects [adjusted odds ratio 1.5, 95% confidence interval (CI) 1.1-2.1] and death (adjusted hazard ratio 1.9, 95% CI 1.1-3.5) compared to patients who were normal or overweight. Interventions aimed at these high-risk patients, including nutritional supplementation as an adjunct to anti-TB therapy, should be considered and evaluated by TB programmes. |
25-hydroxyvitamin D status of healthy, low-income, minority children in Atlanta, Georgia
Cole CR , Grant FK , Tangpricha V , Swaby-Ellis ED , Smith JL , Jacques A , Chen H , Schleicher RL , Ziegler TR . Pediatrics 2010 125 (4) 633-9 OBJECTIVES: The goals were to determine the prevalence of vitamin D deficiency among minority children in a southern US city, to examine differences in serum 25-hydroxyvitamin D levels between non-Hispanic black and Hispanic children, and to determine dietary sources of vitamin D. METHODS: Low-income, minority children (N = 290; mean age: 2.5 +/- 1.2 years) were recruited during well-child clinic visits. Serum 25-hydroxyvitamin D and calcium levels were measured and dietary information was assessed. RESULTS: The mean 25-hydroxyvitamin D(3) level was 26.2 +/- 7.6 ng/mL, whereas 25-hydroxyvitamin D(2) was not detected. Overall, 22.3% of children had deficient serum 25-hydroxyvitamin D(3) levels (< or =20 ng/mL), 73.6% had less-than-optimal serum 25-hydroxyvitamin D levels (< or =30 ng/mL), and 1.4% had low serum calcium levels (< or =9 mg/dL). A significantly larger proportion of non-Hispanic black children, compared with Hispanic children, had vitamin D deficiency (26% vs 18%; P < .05). Age and season of recruitment were significantly associated with vitamin D deficiency and low serum calcium levels. Older children (> or =3 years) were less likely to have vitamin D deficiency (odds ratio [OR]: 0.89 [95% confidence interval [CI]: 0.81-0.96]; P < .001). Study enrollment during spring and summer reduced the likelihood of vitamin D deficiency by approximately 20% (spring, OR: 0.85 [95% CI: 0.73-0.98]; P = .03; summer, OR: 0.82 [95% CI: 0.73-0.92]; P < .01). Fortified milk provided most dietary vitamin D (62%), with Hispanic children reporting greater intake. CONCLUSIONS: Suboptimal vitamin D status was common among apparently healthy, low-income, minority children. Age and season were significant predictors of vitamin D deficiency. |
Stressors, resources, and well-being among Latino and White warehouse workers in the United States
Hoppe A , Heaney CA , Fujishiro K . Am J Ind Med 2010 53 (3) 252-63 BACKGROUND: Social forces and cultural factors may contribute to Latino and White workers experiencing similar jobs differently. This study examines the psychosocial stressors and resources experienced by Latino and White workers in manual material handling jobs in the US and the effects of these stressors and resources on worker well-being. METHODS: Fifty-nine Latino warehouse workers were matched with White workers by job title, job tenure, and warehouse facility. Matched sample t tests and linear regression analyses models were conducted. RESULTS: Results reveal similar psychosocial stressors and resources for both groups. However, Latino workers reported better well-being. For Latino workers, social resources at work such as management fairness and supervisor support have a stronger relationship with well-being. For White workers wage fairness is the most significant predictor for well-being. CONCLUSIONS: These differential results challenge us to consider how cultural factors, expectations and the prior work history of Latino workers may influence their experience of work and the effect of work on health. |
Vermiculite worker mortality: estimated effects of occupational exposure to Libby amphibole
Larson TC , Antao VC , Bove FJ . J Occup Environ Med 2010 52 (5) 555-60 OBJECTIVE: To examine the relationship between cumulative fiber exposure (CFE) and mortality in a retrospective cohort study of vermiculite workers exposed to Libby amphibole (n = 1862). METHODS: Extended Cox regression was used to estimate the hazards associated with CFE as a time-dependent covariate of multiple-cause mortality. RESULTS: The Cox models for mesothelioma, asbestosis, lung cancer, and non-malignant respiratory disease were significant with rate ratios that increased monotonically with CFE. The model for deaths due to cardiovascular disease was also significant (rate ratio for CFE ≥44.0 f/cc-y vs <1.4 f/cc-y was 1.5; 95% confidence interval = 1.1 to 2.0). CONCLUSIONS: By using a within-cohort comparison, the results demonstrate a clear exposure-response relationship between CFE and mortality from asbestos-related causes. The finding of an association between CFE and cardiovascular mortality suggests persons exposed to Libby amphibole should be monitored for this outcome. |
Evaluation of a preventive program to reduce sensitization at a beryllium metal, oxide, and alloy production plant
Bailey RL , Thomas CA , Deubner DC , Kent MS , Kreiss K , Schuler CR . J Occup Environ Med 2010 52 (5) 505-12 OBJECTIVE: We evaluated a workplace preventive program's effectiveness, which emphasized skin and respiratory protection, workplace cleanliness, and beryllium migration control in lowering beryllium sensitization. METHODS: We compared sensitization prevalence and incidence rates for workers hired before and after the program using available cross sectional and longitudinal surveillance data. RESULTS: Sensitization prevalence was 8.9% for the Pre-Program Group and 2.1% for the Program Group. The sensitization incidence rate was 3.7/1000 person-months for the Pre-Program Group and 1.7/1000 person-months for the Program Group. After making adjustments for potential selection and information bias, sensitization prevalence for the Pre-Program Group was 3.8 times higher (95% CI = 1.5 to 9.3) than the Program Group. The sensitization incidence rate ratio comparing the Pre-Program Group to the Program Group was 1.6 (95% CI = 0.8 to 3.6). CONCLUSIONS: This preventive program reduced the prevalence of but did not eliminate beryllium sensitization. |
A comparison of assessment methods of hand activity and force for use in calculating the ACGIH(R) hand activity level (HAL) TLV(R)
Wurzelbacher S , Burt S , Crombie K , Ramsey J , Luo L , Allee S , Jin Y . J Occup Environ Hyg 2010 7 (7) 407-16 This article compares several methods that were used for determining hand activity level and force in a large prospective ergonomics study. The first goal of this analysis was to determine the degree of correlation between hand activity/ force ratings using different assessment methods. The second goal was to determine if the hand activity/force methods were functionally equivalent for the purpose of calculating the ACGIH(R) hand activity level (HAL) threshold limit value (TLV(R)). A final goal was to investigate reasons for potential differences between methods. More than 700 task analyses were conducted on 484 workers at three study locations. Hand activity was assessed by two methods, including a trained observer on site using a 10-point visual analog scale for hand activity level and by offsite video analysis of the same task to calculate the frequency of exertions and the work/recovery ratio. Hand force was assessed by two on-site methods: ratings of perceived exertion (RPE) using a modified Borg CR-10 scale by a trained observer and RPE by the worker performing the task. The two methods for assessing hand activity level were correlated (Spearman rank = 0.49) and produced main TLV result categories (below Action Limit, Action Limit, TLV) with percent of exact agreement ranging from 71 to 91% and weighted Kappa ranging from 0.61 to 0.75. The two RPE methods for assessing hand force were correlated (Spearman rank ranging from 0.47 to 0.69) and produced TLVs with percent of exact agreement ranging from 64 to 83% and weighted Kappa ranging from 0.52 to 0.62. Differences between methods may be explained by a number of task and subject variables that were significantly associated with higher levels of hand activity and force. In summary, this study found substantial agreement between two methods for assessing hand activity level and moderate agreement between two methods for assessing hand force. |
Digital 3-D headforms with facial features representative of the current US workforce
Zhuang Z , Benson S , Viscusi D . Ergonomics 2010 53 (5) 661-71 Existing headforms are based on anthropometric data collected over 30 years ago. In 2003, the National Institute for Occupational Safety and Health conducted an anthropometric survey of 3997 respirator users, of which 1013 subjects were scanned with a Cyberware 3-D Rapid Digitizer. The objective of this study was to create headforms representative of the current US workforce. Ten facial dimensions relevant to respirator fit were chosen for defining a principal component analysis model, which divides the user population into five face-size categories. Mean facial dimensions were then computed to target the ideal facial dimensions for each size category. Five scans in each category were chosen and averaged to construct a representative headform for each size category. Five digital 3-D headforms were developed: small, medium, large, long/narrow and short/wide. All dimensions are within 3 mm of the computed means for the sample population in each size category. STATEMENT OF RELEVANCE: This manuscript describes a new approach to constructing headforms that takes into account the facial form (size and shape) of the US workforce. These headforms could be incorporated into respirator research, certification standards and design in efforts to reduce the risk of injury or illness caused by inhalation hazards. |
Proficiency testing performance in US laboratories: results reported to the Centers for Medicare & Medicaid Services, 1994 through 2006
Howerton D , Krolak JM , Manasterski A , Handsfield JH . Arch Pathol Lab Med 2010 134 (5) 751-8 CONTEXT: Beginning in 1994, clinical laboratories performing nonwaived testing were required, under the regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA), to enroll and participate in a proficiency testing (PT) program approved by the Centers for Medicare & Medicaid Services. Successful PT performance is a requirement for maintaining CLIA certification to perform testing in certain specialties and subspecialties and for specific analytes. OBJECTIVE: To evaluate the PT performance from 1994 through 2006 of hospital and independent laboratories (HI) compared with all other testing sites (AOT) for selected commonly performed tests and analytes. DESIGN: Proficiency testing data, from 1994 through 2006, were electronically reported to the Centers for Medicare & Medicaid Services by approved PT programs as required by CLIA regulations. Approximately 16 million PT event scores from 36 000 unique testing sites were sorted into 2 groups based on the type of testing facility: HI or AOT. RESULTS: The PT performance scores for 15 of the most commonly performed tests demonstrated a decline in failure rates for both HI and AOT laboratory groups during 1994 through 2006 (analyte/test values reported in this article include alanine aminotransferase, amylase, bilirubin, cholesterol, digoxin, glucose, hemoglobin, leukocyte count, potassium, prothrombin time, theophylline, thyroxine, triglycerides, white blood cell differential, and uric acid). For most analytes, the difference in failure rates between HI and AOT was statistically significant. The AOT group started with higher failure rates, and remained higher for all analytes, during most years when compared with the HI group; although, over time, that difference diminished. The AOT group showed a greater decline in PT failure than the HI group. For all analytes, the AOT group performance improved during this period. CONCLUSIONS: The PT performance improved dramatically for the AOT group from 1994 through 2006 as measured by a decrease in the percentage of laboratories with unsatisfactory performance for 15 selected analytes. The PT performance in the HI group improved modestly for some analytes during this same period, whereas, for other analytes, the group showed no apparent improvement. |
The structure, role, and procedures of the U.S. Advisory Committee on Immunization Practices (ACIP)
Smith JC . Vaccine 2010 28 A68-A75 The National Immunization Technical Advisory Group (NITAG) in the United States is the Advisory Committee on Immunization Practices (ACIP). The ACIP was established in 1964 by the US Surgeon General to assist in the prevention and control of communicable diseases, and includes a chair, an executive secretary, 15 voting members, 8 ex officio members and liaison representatives from 26 health-related professional organizations. Meetings are regularly convened at the Centers for Disease Control and Prevention (CDC) and are open to the public. Stringent measures and rigorous screening are used to avoid both real and apparent conflicts of interest, and no special interest or lobbying groups provide any material support to ACIP or its members. The committee recommends licensed new vaccines to be incorporated into the routine immunization schedule, recommends vaccine formulations, and reviews older vaccines to consider revising its recommendations. |
Estimating duration in partnership studies: issues, methods and examples
Burington B , Hughes JP , Whittington WL , Stoner B , Garnett G , Aral SO , Holmes KK . Sex Transm Infect 2010 86 (2) 84-9 BACKGROUND AND OBJECTIVES: Understanding the time course of sexual partnerships is important for understanding sexual behaviour, transmission risks for sexually transmitted infections (STI) and development of mathematical models of disease transmission. STUDY DESIGN: The authors describe issues and biases relating to censoring, truncation and sampling that arise when estimating partnership duration. Recommendations for study design and analysis methods are presented and illustrated using data from a sexual-behaviour survey that enrolled individuals from an adolescent-health clinic and two STD clinics. Survey participants were queried, for each of (up to) four partnerships in the last 3 months, about the month and year of first sex, the number of days since last sex and whether partnerships were limited to single encounters. Participants were followed every 4 months for up to 1 year. RESULTS: After adjustment for censoring and truncation, the estimated median duration of sexual partnerships declined from 9 months (unadjusted) to 1.6 months (adjusted). Similarly, adjustment for censoring and truncation reduced the bias in relative risks for the effect of age in a Cox model. Other approaches, such as weighted estimation, also reduced bias in the estimated duration distribution. CONCLUSION: Methods are available for estimating partnership duration from censored and truncated samples. Ignoring censoring, truncation and other sampling issues results in biased estimates. |
Determining prevalence and correlates of psychiatric treatment with Andersen's behavioral model of health services use
Dhingra SS , Zack M , Strine T , Pearson WS , Balluz L . Psychiatr Serv 2010 61 (5) 524-8 OBJECTIVE: This study examined the prevalence and correlates of use of health professional services for the treatment of mental or emotional problems by using Andersen's Behavioral Model of Health Services Use. METHODS: In the 2007 Behavioral Risk Factor Surveillance System 169,546 community-dwelling respondents from 35 states, the District of Columbia, and Puerto Rico answered questions about their sociodemographic characteristics; perceived need; nonspecific psychological distress, as measured with the Kessler-6 scale; and use of professional treatment of mental or emotional problems. RESULTS: Evaluated need (psychological distress) was significantly associated with receipt of treatment for mental or emotional problems, as were predisposing factors (age, gender, race or ethnicity, marital status, and education), enabling and impeding factors (income, health insurance, and emotional support), and perceived need (number of mentally and physically unhealthy days and self-rated health). CONCLUSION: Constituents in the public mental health system should seriously consider that health services utilization is socially patterned and not just an individual behavior. |
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