The influence of spiritual framing on African American women's mammography intentions: A randomized trial
Best AL , Spencer SM , Friedman DB , Hall IJ , Billings D . J Health Commun 2016 21 (6) 1-9 Spiritual framing of breast cancer communication may provide a useful strategy for addressing disparate rates of breast cancer mortality among African American women. The efficacy of a spiritually framed breast cancer screening (BCS) message was compared with that of a traditional BCS message. Specifically, 200 African American women were randomly assigned to review either a spiritually framed or traditional BCS message and complete a self-administered survey, including a thought-listing form. Message efficacy was measured by number of thoughts generated (elaboration), ratio of positive to negative thoughts (polarity), and intention to obtain and/or recommend a mammogram. Multiple linear regression and structural equation modeling were used to assess direct and indirect (mediated) associations among variables. Spiritual framing was positively associated with greater elaboration (beta = .265, SE = .36, p < .001) and more positive polarity (beta = .237, SE = .04, p < .001) . Spiritual framing also had a significant indirect effect on mammography intentions through polarity (standardized indirect effect = .057, 95% confidence interval [.024, .106], p < .001). These results indicate that spiritual framing may improve the efficacy of BCS messages among African American women by eliciting more positive thoughts about screening. Interventions targeting African American women might consider the role of spirituality when tailoring messages to encourage regular mammography use. |
Risk factors associated with HIV among men who have sex only with men and men who have sex with both men and women in three urban areas in Mozambique
Sathane I , Horth R , Young P , Inguane C , Nala R , Miranda AE , Lane T , Raymond HF , Cummings B , McFarland W . AIDS Behav 2016 20 (10) 2296-2308 Using respondent-driven sampling (RDS), an integrated biological behavioral survey among men that have sex with men (MSM) enrolled 457 participants in Maputo [63.0 % were MSM who had sex with women (MSMW)], 538 in Beira (36.2 % MSMW) and 330 in Nampula-Nacala (54.8 % MSMW) in 2011. Analysis suggests that MSM who have sex only with men (MSMO) had increased odds of having HIV (aOR 2.7) compared to MSMW. HIV among MSMO associated with age, self-reported STI (aOR 4.2), having a single male anal partner (aOR 3.8) and having transactional sex with a man (aOR 3.5) in the past year. Among MSMW, HIV associated with age, lower education (aOR 32.5), being uncircumcised (aOR 3.1) and having transactional sex with a woman (aOR 6.0) in the past year. Findings confirm that MSMO and MSMW have distinct HIV risks in Mozambique; HIV programs for MSM in Southern Africa should take such differences into consideration. |
Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhea in young children in the Global Enteric Multicenter Study, 2007-2011: case-control study
Baker KK , O'Reilly CE , Levine MM , Kotloff KL , Nataro JP , Ayers TL , Farag TH , Nasrin D , Blackwelder WC , Wu Y , Alonso PL , Breiman RF , Omore R , Faruque AS , Das SK , Ahmed S , Saha D , Sow SO , Sur D , Zaidi AK , Quadri F , Mintz ED . PLoS Med 2016 13 (5) e1002010 BACKGROUND: Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age. METHODS/FINDINGS: The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhica, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1-2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India. CONCLUSIONS: This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved. |
Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya
Muhula S , Memiah P , Mbau L , Oruko H , Baker B , Ikiara G , Mungai M , Ndirangu M , Achwoka D , Ilako F . BMC Public Health 2016 16 (1) 373 BACKGROUND: We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya. METHODS: We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method. RESULTS: Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %-6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV. CONCLUSION: Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC. |
What happens when "germs don't get killed and they attack again and again": perceptions of antimicrobial resistance in the context of diarrheal disease treatment among laypersons and health-care providers in Karachi, Pakistan
Joseph HA , Agboatwalla M , Hurd J , Jacobs-Slifka K , Pitz A , Bowen A . Am J Trop Med Hyg 2016 95 (1) 221-8 In south Asia, where diarrhea is common and antibiotics are accessible without prescription, antimicrobial resistance is an emerging and serious problem. However, beliefs and behaviors related to antimicrobial resistance are poorly understood. We explored laypersons' and health-care providers' (HCP) awareness and perceptions of antimicrobial resistance in the context of treatment of adult diarrheal disease in Karachi, Pakistan. In-depth, open-ended interviews were conducted with 40 laypersons and 45 HCPs in a lower-middle-class urban neighborhood. Interviews conducted in Urdu were audiotaped, transcribed, translated, and coded using applied thematic analysis. Slightly over half of laypersons and two-thirds of HCPs were aware that antimicrobial medication could lose effectiveness, but misperceptions were common. Laypersons and HCPs often believed that "the body becomes immune" or "bacteria attack more strongly" if medications are taken "improperly." Another prevalent theme was that causes and effects of antimicrobial resistance are limited to the individual taking the antimicrobial medication and to the specific diarrheal episode. Participants often attributed antimicrobial resistance to patient behaviors; HCP behavior was rarely discussed. Less than half of the HCPs were aware of treatment guidelines. To combat antimicrobial resistance in urban Pakistan, a health systems strategy and community-supported outreach campaigns on appropriate antimicrobial use are needed. |
Mathematical models of Ebola - consequences of underlying assumptions
Feng Z , Zheng Y , Hernandez-Ceron N , Zhao H , Glasser J , Hill A . Math Biosci 2016 277 89-107 Mathematical models have been used to study Ebola disease transmission dynamics and control for the recent epidemics in West Africa. Many of the models used in these studies are based on the model of Legrand et al. (2007), and most failed to accurately project the outbreak's course (Butler, 2014). Although there could be many reasons for this, including incomplete and unreliable data on Ebola epidemiology and lack of empirical data on how disease-control measures quantitatively affect Ebola transmission, we examine the underlying assumptions of the Legrand model, and provide alternate formulations that are simpler and provide additional information regarding the epidemiology of Ebola during an outbreak. We developed three models with different assumptions about disease stage durations, one of which simplifies to the Legrand model while the others have more realistic distributions. Control and basic reproduction numbers for all three models are derived and shown to provide threshold conditions for outbreak control and prevention. |
New insights into the global burden of noroviruses and opportunities for prevention
Hall AJ , Glass RI , Parashar UD . Expert Rev Vaccines 2016 15 (8) 1-3 Noroviruses are now recognized as the leading cause of acute gastroenteritis across the age spectrum. New global estimates of the norovirus disease burden highlight the specific populations most affected and potential targets for prevention strategies. As traditional infection control and food hygiene measures may be inadequate to fully control norovirus disease, vaccines are an appealing option. Initial trials of candidate vaccines have demonstrated only modest efficacy, but show promise that norovirus prevention through vaccination is possible. Key issues that require further study include duration of immunity, degree of cross-protection, and efficacy in target populations. While initial introduction of norovirus vaccines is likely to occur in developed countries, the greatest public health burden and thus potential impact of such vaccines is in developing countries. | Recognition of the public health impact of noroviruses has increased dramatically in the past two decades through the application of molecular-based diagnostics. In many developed countries, noroviruses are now recognized to be the leading cause of acute gastroenteritis across the age spectrum and the leading cause of foodborne disease, including outbreaks [1]. In the United States, for example, noroviruses are responsible for approximately 20 million episodes of acute gastroenteritis annually, with about 70,000 hospitalizations and up to 800 deaths, mostly in the elderly [2]. Furthermore, following the decline in rotavirus disease after vaccine introduction in 2006, noroviruses have replaced rotavirus as the leading cause of severe gastroenteritis in US children aged <5 years [3]. However, from a global perspective, the greatest public health burden from noroviruses is undoubtedly exacted upon developing countries, where diarrheal diseases remain among the leading causes of death [4]. A recent systematic review concluded that norovirus was associated with 18% of all acute gastroenteritis worldwide [5]. Of 175 studies included in the review, 147 (84%) were published since 2008, among which 94 (64%) were conducted in developing countries. While data specifically on norovirus incidence and disease burden from these countries are more limited and some studies have suggested that detection of noroviruses may not be causally associated with illness in all cases [6,7], this review demonstrates the increased effort in recent years to better understand the public health impact of noroviruses globally so that we may better address it. |
Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitis
Tugume L , Morawski BM , Abassi M , Bahr NC , Kiggundu R , Nabeta HW , Hullsiek KH , Taseera K , Musubire AK , Schutz C , Muzoora C , Williams DA , Rolfes MA , Meintjes G , Rhein J , Meya DB , Boulware DR . HIV Med 2016 18 (1) 13-20 OBJECTIVES: Anaemia represents a common toxicity with amphotericin B-based induction therapy in HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anaemia on survival. METHODS: We used data from Ugandan and South African trial participants to characterize the variation of haemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anaemia severity was classified based on the haemoglobin concentration at cryptococcal meningitis diagnosis, and nadir haemoglobin values during amphotericin induction. Cox proportional hazard models were used to estimate 2- and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir haemoglobin < 8.5 g/dL during amphotericin induction and who survived ≥ 2 weeks post-enrolment. RESULTS: The median haemoglobin concentration at meningitis diagnosis was 11.5 g/dL [interquartile range (IQR) 9.7-13 g/dL; n = 311] with a mean decline of 4.2 g/dL [95% confidence interval (CI) -4.6 to -3.8; P < 0.001; n = 148] from diagnosis to nadir value among participants with baseline haemoglobin ≥ 8.5 g/dL. The median haemoglobin concentration was 8.1 g/dL (IQR 6.5-9.5 g/dL) at 2 weeks, increasing to 9.4 g/dL (IQR 8.2-10.9 g/dL) by 4 weeks and continuing to increase to 12 weeks. Among participants with haemoglobin < 8.5 g/dL at diagnosis, mortality risk was elevated at 2 weeks [hazard ratio (HR) 2.7; 95% CI 1.5-4.9; P < 0.01] and 10 weeks (HR 1.8; 95% CI 1.1-2.2; P = 0.03), relative to those with haemoglobin ≥ 8.5 g/dL. New-onset anaemia occurring with amphotericin therapy did not have a statistically significant association with 10-week mortality (HR 2.0; 95% CI 0.5-9.1; P = 0.4). CONCLUSIONS: Amphotericin induced significant haemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anaemia at baseline had a higher mortality risk at 2 and 10 weeks post-enrolment. |
Geographical variation in prevalence of cryptococcal antigenemia among HIV-infected treatment-naive patients in Nigeria: A multicenter cross-sectional study
Ezeanolue EE , Nwizu C , Greene GS , Amusu O , Chukwuka C , Ndembi N , Smith RM , Chiller T , Pharr J , Kozel TR . J Acquir Immune Defic Syndr 2016 73 (1) 117-21 OBJECTIVE: Worldwide, HIV-associated cryptococcal meningitis affects approximately 1 million persons and causes 600,000 deaths each year mostly in sub-Sharan Africa. Limited data exist on cryptococcal meningitis and antigenemia in Nigeria, and most studies are geographically restricted. We determined the prevalence of cryptococcal antigenemia (CrAg) among HIV-infected treatment-naive individuals in Nigeria. DESIGN: /Methods: This was a retrospective, cross-sectional study across four geographic regions in Nigeria. We performed CrAg testing using a lateral flow immunoassay on archived whole blood samples collected from HIV-infected participants at US PEPFAR-supported sites selected to represent the major geographical and ethnic diversity in Nigeria. Eligible samples were (1) stored in an -80 degrees freezer; (2) collected from consenting patients (>15 years) naive to antiretroviral therapy with CD4+ count less than 200 cells/mm3. RESULTS: A total of 2,752 stored blood samples were retrospectively screened for CrAg. A majority of samples were from participants aged 30 - 44 (57.6%), and 1,570 (57.1%) were from women. The prevalence of CrAg positivity in specimens with CD4 < 200 cells/mm3 was 2.3% (95% CI = 1.8%-3.0%), and varied significantly across the four regions (p < 0.001). At 4.4% (3.2%-5.9%), the South East contained the highest prevalence. CONCLUSION: The significant regional variation in CrAg prevalence found in Nigeria should be taken into consideration as plans are made to integrate routine screening into clinical care for HIV-infected patients. |
Hidden and mobile: A web-based study of migration patterns of men who have sex with men in China
Mi G , Ma B , Kleinman N , Li Z , Fuller S , Bulterys M , Hladik W , Wu Z . Clin Infect Dis 2016 62 (11) 1443-7 BACKGROUND: Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and more likely to migrate due to widespread stigma and discrimination in China. Their mobility complicates estimation of local MSM population sizes and the provision of HIV services, and may also contribute to the spread of HIV. METHODS: Between 1 January 2008 and 31 December 2012, the visits of all individuals to the largest Chinese MSM dating website were recorded. After a predesigned de-identification procedure by the website, we analyzed Internet Protocol addresses for migration patterns. Migrants were defined as individuals who were away from their registered residence for >6 months in the last 12 months. RESULTS: The website contained data on 794 912 MSM eligible for the study, of which 34.5% were migrants. The median age was 26 years (range, 18-61 years), and 85.5% were unmarried. Compared with nonmigrant MSM, migrants were less likely to be married to a woman (8.6% vs 13.5%; P < .001). The 5 provinces with the highest migrant inflow ratios were Guangdong, Shanghai, Beijing, Tianjin, and Zhejiang. Eastern coastal cities were the primary destination of MSM from southwestern China. CONCLUSIONS: Preferential MSM migration may influence MSM population sizes in both originating and destination provinces, particularly for provinces with uneven inflow and outflow. MSM migration from southwestern China, which has the highest HIV prevalence in this population, to coastal cities with lower prevalence may have implications for the spread of the HIV epidemic as well as HIV care services. |
Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey
Gaolathe T , Wirth KE , Holme MP , Makhema J , Moyo S , Chakalisa U , Yankinda EK , Lei Q , Mmalane M , Novitsky V , Okui L , van Widenfelt E , Powis KM , Khan N , Bennett K , Bussmann H , Dryden-Peterson S , Lebelonyane R , El-Halabi S , Mills LA , Marukutira T , Wang R , Tchetgen EJ , DeGruttola V , Essex M , Lockman S . Lancet HIV 2016 3 (5) e221-30 BACKGROUND: HIV programmes face challenges achieving high rates of HIV testing and treatment needed to optimise health and to reduce transmission. We used data from the Botswana Combination Prevention Project study survey to assess Botswana's progress toward achieving UNAIDS targets for 2020: 90% of all people living with HIV knowing their status, 90% of these receiving sustained antiretroviral therapy (ART), and 90% of those having virological suppression (90-90-90). METHODS: A population-based sample of individuals was recruited and interviewed in 30 rural and periurban communities from Oct 30, 2013, to Nov 24, 2015, as part of a large, ongoing community-randomised trial designed to assess the effect of a combination prevention package on HIV incidence. A random sample of about 20% of households in each community was selected. Consenting household residents aged 16-64 years who were Botswana citizens or spouses of citizens responded to a questionnaire and had blood drawn for HIV testing in the absence of documentation of positive HIV status. Viral load testing was done in all HIV-infected participants, irrespective of treatment status. We used modified Poisson generalised estimating equations to obtain prevalence ratios, corresponding Huber robust SEs, and 95% Wald CIs to examine associations between individual sociodemographic factors and a binary outcome indicating achievement of the three individual and combined overall 90-90-90 targets. The study is registered at ClinicalTrials.gov, number NCT01965470. FINDINGS: 81% of enumerated eligible household members took part in the survey (10% refused and 9% were absent). Among 12 610 participants surveyed, 3596 (29%) were infected with HIV, and 2995 (83.3%, 95% CI 81.4-85.2) of these individuals already knew their HIV status. Among those who knew their HIV status, 2617 (87.4%, 95% CI 85.8-89.0) were receiving ART (95% of those eligible by national guidelines, and 73% of all infected people). Of the 2609 individuals receiving ART with a viral load measurement, 2517 (96.5%, 95% CI 96.0-97.0) had viral load of 400 copies per mL or less. Overall, 70.2% (95% CI 67.5-73.0) of HIV-infected people had virological suppression, close to the UNAIDS target of 73%. INTERPRETATION: UNAIDS 90-90-90 targets are achievable even in resource-constrained settings with high HIV burden. FUNDING: US President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention. |
Chikungunya fever cases identified in the Veterans Health Administration System, 2014
Perti T , Lucero-Obusan CA , Schirmer PL , Winters MA , Holodniy M . PLoS Negl Trop Dis 2016 10 (5) e0004630 BACKGROUND: During December 2013, the first locally transmitted chikungunya virus (CHIKV) infections in the Americas were reported in the Caribbean. Although CHIKV infection is rarely fatal, risk for severe disease increases with age and medical comorbidities. Herein we describe characteristics of Veterans Health Administration (VHA) patients with CHIKV infection and, among those with infections diagnosed in Puerto Rico, investigated risk factors for hospitalization. METHODOLOGY: We queried VHA's national electronic medical records to identify patients with CHIKV testing during 2014. Demographics, clinical history, laboratory results, and outcomes were abstracted. We investigated risk factors for hospitalization among patients with laboratory-confirmed CHIKV infection in Puerto Rico. PRINCIPAL FINDINGS: We identified 180 laboratory-confirmed CHIKV infections; 148 (82.2%) were diagnosed in Puerto Rico, and 32 (17.8%) were diagnosed among returning travelers elsewhere in the United States. In Puerto Rico, where more patients were hospitalized (55.4% versus 20.0%) and died (4.1% versus 0%), risk for hospitalization increased with age (relative risk [RR]/each 10-year increase, 1.19; 95% confidence interval [CI], 1.06-1.32) and, adjusted for age, increased among patients with congestive heart failure (RR, 1.58; 95% CI, 1.25-1.99), chronic kidney disease (RR, 1.52; 95% CI, 1.19-1.94), diabetes mellitus (RR, 1.39; 95% CI, 1.06-1.84), or chronic lung disease (RR, 1.37; 95% CI, 1.03-1.82). CONCLUSIONS/SIGNIFICANCE: CHIKV infection is an emerging problem among Veterans residing in or visiting areas with CHIKV transmission. Although overall mortality rates are low, clinicians in affected areas should be aware that older patients and patients with comorbidities may be at increased risk for severe disease. |
Decline in HIV seroprevalence in street youth 2006-2012, St. Petersburg, Russia: Moving toward an AIDS-free generation
Kornilova MS , Batluk JV , Yorick RV , Baughman AL , Hillis SD , Vitek CR . Int J STD AIDS 2016 28 (4) 345-356 A 2006 survey of street youth at pre-mapped street youth locations in St. Petersburg, Russia, found extremely high HIV seroprevalence (37.4%) among 313 street youth aged 15-19 years of age, strongly associated with injection drug use, which was reported by 50.6% of participants. In response, multi-sectoral social support and prevention measures were instituted. In 2012, we conducted a follow-up survey of 15- to 19-year-old street youth using the same study procedures as in 2006. Of 311 participants, 45 (14.5%) reported injection drug use; 31 participants (10.0%, 95% confidence interval, 6.0%-16.2%) were HIV-seropositive. Predictors independently associated with HIV seropositivity included injection drug use (adjusted prevalence ratio 53.1) and transactional sex (adjusted prevalence ratio 1.3). None of the 178 participants aged 15-17 years were HIV-positive. Thirty of 31 (96.8%) HIV-seropositive individuals reported injection drug use. Street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements. |
Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011
Fleming-Dutra KE , Hersh AL , Shapiro DJ , Bartoces M , Enns EA , File TM Jr , Finkelstein JA , Gerber JS , Hyun DY , Linder JA , Lynfield R , Margolis DJ , May LS , Merenstein D , Metlay JP , Newland JG , Piccirillo JF , Roberts RM , Sanchez GV , Suda KJ , Thomas A , Woo TM , Zetts RM , Hicks LA . JAMA 2016 315 (17) 1864-73 IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship. |
Novel exposure biomarkers of N,N-diethyl-m-toluamide (DEET): Data from the 2007-2010 National Health and Nutrition Examination Survey
Calafat AM , Baker SE , Wong LY , Bishop AM , Morales AP , Valentin-Blasini L . Environ Int 2016 92-93 398-404 BACKGROUND: N,N-diethyl-m-toluamide (DEET) is a widely used insect repellent in the United States. OBJECTIVES: To assess exposure to DEET in a representative sample of persons 6years and older in the U.S. general population from the 2007-2010 National Health and Nutrition Examination Survey. METHODS: We analyzed 5348 urine samples by using online solid-phase extraction coupled to isotope dilution-high-performance liquid chromatography-tandem mass spectrometry. We used regression models to examine associations of various demographic parameters with urinary concentrations of DEET biomarkers. RESULTS: We detected DEET in ~3% of samples and at concentration ranges (>0.08mug/L-45.1mug/L) much lower than those of 3-(diethylcarbamoyl)benzoic acid (DCBA) (>0.48mug/L-30,400mug/L) and N,N-diethyl-3-hydroxymethylbenzamide (DHMB) (>0.09mug/L-332mug/L). DCBA was the most frequently detected metabolite (~84%). Regardless of survey cycle and the person's race/ethnicity or income, adjusted geometric mean concentrations of DCBA were higher in May-Sep than in Oct-Apr. Furthermore, non-Hispanic whites in the warm season were more likely than in the colder months [adjusted odds ratio (OR)=10.83; 95% confidence interval (CI), 3.28-35.79] and more likely than non-Hispanic blacks (OR=3.45; 95% CI, 1.51-7.87) to have DCBA concentrations above the 95th percentile. CONCLUSIONS: The general U.S. population, including school-age children, is exposed to DEET. However, reliance on DEET as the sole urinary biomarker would likely underestimate the prevalence of exposure. Instead, oxidative metabolites of DEET are the most adequate exposure biomarkers. Differences by season of the year based on demographic variables including race/ethnicity likely reflect different lifestyle uses of DEET-containing products. |
Improving health in the Arctic region through safe and affordable access to household running water and sewer services: an Arctic Council initiative
Hennessy TW , Bressler JM . Int J Circumpolar Health 2016 75 31149 Important health disparities have been documented among the peoples of the Arctic and subarctic, including those related to limited access to in-home improved drinking water and sanitation services. Although improving water, sanitation and hygiene (WASH) has been a focus of the United Nations for decades, the Arctic region has received little attention in this regard. A growing body of evidence highlights inequalities across the region for the availability of in-home drinking WASH services and for health indicators associated with these services. In this review, we highlight relevant data and describe an initiative through the Arctic Council's Sustainable Development Working Group to characterize the extent of WASH services in Arctic nations, the related health indicators and climate-related vulnerabilities to WASH services. With this as a baseline, efforts to build collaborations across the Arctic will be undertaken to promote innovations that can extend the benefits of water and sanitation services to all residents. |
Comparative genomics reveals Cyclospora cayetanensis possesses coccidia-like metabolism and invasion components but unique surface antigens.
Liu S , Wang L , Zheng H , Xu Z , Roellig DM , Li N , Frace MA , Tang K , Arrowood MJ , Moss DM , Zhang L , Feng Y , Xiao L . BMC Genomics 2016 17 (1) 316 BACKGROUND: Cyclospora cayetanensis is an apicomplexan that causes diarrhea in humans. The investigation of foodborne outbreaks of cyclosporiasis has been hampered by a lack of genetic data and poor understanding of pathogen biology. In this study we sequenced the genome of C. cayetanensis and inferred its metabolism and invasion components based on comparative genomic analysis. RESULTS: The genome organization, metabolic capabilities and potential invasion mechanism of C. cayetanensis are very similar to those of Eimeria tenella. Propanoyl-CoA degradation, GPI anchor biosynthesis, and N-glycosylation are some apparent metabolic differences between C. cayetanensis and E. tenella. Unlike Eimeria spp., there are no active LTR-retrotransposons identified in C. cayetanensis. The similar repertoire of host cell invasion-related proteins possessed by all coccidia suggests that C. cayetanensis has an invasion process similar to the one in T. gondii and E. tenella. However, the significant reduction in the number of identifiable rhoptry protein kinases, phosphatases and serine protease inhibitors indicates that monoxenous coccidia, especially C. cayetanensis, have limited capabilities or use a different system to regulate host cell nuclear activities. C. cayetanensis does not possess any cluster of genes encoding the TA4-type SAG surface antigens seen in E. tenella, and may use a different family of surface antigens in initial host cell interactions. CONCLUSIONS: Our findings indicate that C. cayetanensis possesses coccidia-like metabolism and invasion components but unique surface antigens. Amino acid metabolism and post-translation modifications of proteins are some major differences between C. cayetanensis and other apicomplexans. The whole genome sequence data of C. cayetanensis improve our understanding of the biology and evolution of this major foodborne pathogen and facilitate the development of intervention measures and advanced diagnostic tools. |
Reversion to wildtype of a mutated and nonfunctional coxsackievirus B3CRE(2C).
Smithee S , Tracy S , Chapman NM . Virus Res 2016 220 136-49 The cis-acting replication element (CRE) in the 2C protein coding region [CRE(2C)] of enteroviruses (EV) facilitates the addition of two uridine residues (uridylylation) onto the virus-encoded protein VPg in order for it to serve as the RNA replication primer. We demonstrated that coxsackievirus B3 (CVB3) is replication competent in the absence of a native (uridylylating) CRE(2C) and also demonstrated that lack of a functional CRE(2C) led to generation of 5' terminal genomic deletions in the CVB3 CRE-knock-out (CVB3-CKO) population. We asked whether reversion of the mutated CRE(2C) occurred, thus permitting sustained replication, and when were 5' terminal deletions generated during replication. Virions were isolated from HeLa cells previously electroporated with infectious CVB3-CKO T7 transcribed RNA or from hearts and spleens of mice after transfection with CVB3-CKO RNA. Viral RNA was isolated in order to amplify the CRE(2C) coding region and the genomic 5' terminal sequences. Sequence analysis revealed reversion of the CVB3-CKO sequence to wildtype occurs by 8days post-electroporation of HeLa cells and by 20days post-transfection in mice. However, 5' terminal deletions evolve prior to these times. Reversion of the CRE(2C) mutations to wildtype despite loss of the genomic 5' termini is consistent with the hypothesis that an intact CRE(2C) is inherently vital to EV replication even when it is not enabling efficient positive strand initiation. |
Validation of a standardized extraction method for formalin-fixed paraffin-embedded tissue samples.
Lagheden C , Eklund C , Kleppe SN , Unger ER , Dillner J , Sundstrom K . J Clin Virol 2016 80 36-39 BACKGROUND: Formalin-fixed paraffin-embedded (FFPE) samples can be DNA-extracted and used for human papillomavirus (HPV) genotyping. The xylene-based gold standard for extracting FFPE samples is laborious, suboptimal and involves health hazards for the personnel involved. OBJECTIVES: To compare extraction with the standard xylene method to a xylene-free method used in an HPV LabNet Global Reference Laboratory at the Centers for Disease Control (CDC); based on a commercial method with an extra heating step. STUDY DESIGN: Fifty FFPE samples were randomly selected from a national audit of all cervical cancer cases diagnosed in Sweden during 10 years. For each case-block, a blank-block was sectioned, as a control for contamination. For xylene extraction, the standard WHO Laboratory Manual protocol was used. For the CDC method, the manufacturers' protocol was followed except for an extra heating step, 120 degrees C for 20min. Samples were extracted and tested in parallel with beta-globin real-time PCR, HPV16 real-time PCR and HPV typing using modified general primers (MGP)-PCR and Luminex assays. RESULTS: For a valid result the blank-block had to be betaglobin-negative in all tests and the case-block positive for beta-globin. Overall, detection was improved with the heating method and the amount of HPV-positive samples increased from 70% to 86% (p=0.039). For all samples where HPV type concordance could be evaluated, there was 100% type concordance. CONCLUSIONS: A xylene-free and robust extraction method for HPV-DNA typing in FFPE material is currently in great demand. Our proposed standardized protocol appears to be generally useful. |
Payments For opioids shifted substantially to public and private insurers while consumer spending declined, 1999-2012
Zhou C , Florence CS , Dowell D . Health Aff (Millwood) 2016 35 (5) 824-31 Deaths from opioid pain reliever overdose in the United States quadrupled between 1999 and 2013, concurrent with an increase in the use of the drugs. We used data from the Medical Expenditure Panel Survey to examine trends in opioid pain reliever expenditures, financing by various payers, and use from 1999 to 2012. We found major shifts in expenditures by payer type for these drugs, with private and public insurers paying a much larger share than patients in recent years. Consumer out-of-pocket spending on opioids per 100 morphine milligram equivalents (a standard reference measure of strength for various opioids) declined from $4.40 to $0.90 between 2001 and 2012. Since the implementation of Medicare Part D in 2006, Medicare has been the largest payer for opioid pain relievers, covering about 20-30 percent of the cost. Medicare spends considerably more on these drugs for enrollees younger than age sixty-five than it does for any other age group or than Medicaid or private insurance does for any age group. Further research is needed to evaluate whether payer strategies to address the overuse of opioids could reduce avoidable opioid-related mortality. |
Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: Results from laboratory-based sentinel surveillance in South Africa
Govender NP , Patel J , Magobo RE , Naicker S , Wadula J , Whitelaw A , Coovadia Y , Kularatne R , Govind C , Lockhart SR , Zietsman IL . J Antimicrob Chemother 2016 71 (7) 1994-2004 OBJECTIVES: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals. METHODS: From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory. Demographic and limited clinical data were abstracted from laboratory records. RESULTS: In total, 2172 cases of candidaemia were detected. Among patients with available data, almost two-thirds were critically ill (719/1138, 63%). On multivariable analysis, neonates [adjusted OR (aOR), 2.2; 95% CI, 1.5-3.1; P < 0.001] and patients diagnosed in Gauteng province (aOR, 1.9; 95% CI, 1.3-2.7; P < 0.001) or in the private sector (aOR, 1.9; 95% CI, 1.2-3.2; P = 0.008) were significantly more likely to be infected with Candida parapsilosis than any other Candida species. Of 531 C. parapsilosis isolates, only 199 (37%) were susceptible to fluconazole and voriconazole; 44% (123/282) of fluconazole-resistant isolates were voriconazole cross-resistant. Factors associated with fluconazole non-susceptible C. parapsilosis infection on multivariable analysis included diagnosis in Gauteng province (aOR, 4.2; 95% CI, 2.7-6.7; P < 0.001), an ICU (aOR, 2.3; 95% CI, 1.5-3.6; P < 0.001) or the private sector (aOR, 2.2; 95% CI, 1.4-3.5; P < 0.001). CONCLUSIONS: The dominance of triazole non-susceptible C. parapsilosis limits the choice of antifungal agents for management of candidaemia among critically ill neonates, children and adults in resource-limited South African hospitals. |
Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborative
Mack MR , Rohde JM , Jacobsen D , Barron JR , Ko C , Goonewardene M , Rosenberg DJ , Srinivasan A , Flanders SA . J Hosp Med 2016 11 (8) 576-80 Inappropriate antimicrobial use in hospitalized patients contributes to antimicrobial-resistant infections and complications. We sought to evaluate the impact, barriers, and facilitators of antimicrobial stewardship best practices in a diverse group of hospital medicine programs. This multihospital initiative included 1 community nonteaching hospital, 2 community teaching hospitals, and 2 academic medical centers participating in a collaborative with the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement. We conducted multimodal physician education on best practices for antimicrobial use including: (1) enhanced antimicrobial documentation, (2) improved quality and accessibility of local clinical guidelines, and (3) a 72-hour antimicrobial "timeout." Implementation barriers included variability in physician practice styles, lack of awareness of stewardship importance, and overly broad interventions. Facilitators included engaging hospitalists, collecting real time data and providing performance feedback, and appropriately limiting the scope of interventions. In 2 hospitals, complete antimicrobial documentation in sampled medical records improved significantly (4% to 51% and 8% to 65%, P < 0.001 for each comparison). A total of 726 antimicrobial timeouts occurred at 4 hospitals, and 30% resulted in optimization or discontinuation of antimicrobials. With careful attention to key barriers and facilitators, hospitalists can successfully implement effective antimicrobial stewardship practices. |
Recommendations and offers for adult influenza vaccination, 2011-2012 season, United States
Benedict KM , Kennedy ED , Santibanez TA , Black CL , Ding H , Graitcer SB , Bridges CB . Vaccine 2016 35 (9) 1353-1361 BACKGROUND: Provider recommendations and offers for influenza vaccination improve adult influenza vaccination coverage. Analysis was performed to describe receipt of influenza vaccination recommendations and offers among adults who visited a healthcare provider (HCP) during the 2011-2012 influenza season and describe differences between those receiving and not receiving recommendations and offers for influenza vaccination. Associations between influenza vaccination and receipt of recommendations and offers were examined. METHODS: Respondents to a random digit dial telephone survey who had visited a HCP since July 1, 2011 were asked if they had received a recommendation for influenza vaccination. Those receiving a recommendation were asked if they received an offer for vaccination. Participants were characterized by demographic and access to health care variables. Logistic regression was used to examine the relationships between participant characteristics and recommendation alone, between participant characteristics and recommendation and offer, and between influenza vaccination and recommendation and offer. RESULTS: Of those who reported visiting a HCP, 43.8% reported receiving a recommendation for influenza vaccination. Of those who reported receiving a recommendation, 76.6% reported receiving an offer for influenza vaccination. Persons with high-risk conditions and persons over 65 years were more likely to receive recommendations for influenza vaccination when compared to those without high-risk conditions and 18-49 year olds, respectively. Those reporting receipt of a recommendation and offer for influenza vaccination were 1.76 times more likely and those reporting receipt of a recommendation but no offer were 1.72 times more likely to report being vaccinated for influenza controlling for all patient characteristics. CONCLUSIONS: Less than half of respondents reported receipt of recommendations and offers of influenza vaccination during the 2011-2012 influenza season and disparities exist between groups. All healthcare providers seeing adults should recommend or offer influenza vaccination for all patients at every visit during the influenza season. |
Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines
Aliabadi N , Tate JE , Parashar UD . Clin Microbiol Infect 2016 22 Suppl 5 S128-S135 Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains, and hospitalization in newborn nurseries at time of administration of live, oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination program, and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks and vaccine use is recommended globally. |
The effect of influenza vaccination on birth outcomes in a cohort of pregnant women in Lao PDR, 2014-2015
Olsen SJ , Mirza SA , Vonglokham P , Khanthamaly V , Chitry B , Pholsena V , Chitranonh V , Omer SB , Moen A , Bresee JS , Corwin A , Xeuatvongsa A . Clin Infect Dis 2016 63 (4) 487-94 BACKGROUND: Some studies suggest maternal influenza vaccination can improve birth outcomes. However, there are limited data from tropical settings, particularly from Southeast Asia. We conducted an observational study in Laos to assess the effect of inactivated influenza vaccination in pregnant women on birth outcomes. METHODS: We consented and enrolled a cohort of pregnant woman who delivered babies at three hospitals during Apr 2014-Feb 2015. We collected demographic and clinical information on mother and child. Influenza vaccination status was ascertained by vaccine card. Primary outcomes were the proportion of live births born small for gestational age (SGA) or preterm and mean birth weight. Multivariate models controlled for differences between vaccinated and unvaccinated women and influenza virus circulation. RESULTS: We enrolled 5,103 women (2,172 [43%] were vaccinated). Among the 4,854 who had a live birth, vaccinated women were statistically significantly less likely than unvaccinated women to have an infant born preterm during the period of high influenza virus circulation (RR=0.56, 95% CI 0.45-0.70), and the effect remained after adjusting for covariates (aRR 0.69, 95% CI=0.55-0.87). There was no effect of vaccine on the proportion of infants born SGA or mean birth weight. The population prevented fraction was 18.0%. CONCLUSIONS: In this observational study, we found indirect evidence of influenza vaccine safety during pregnancy, and women who received vaccine had a reduced risk of delivering a preterm live birth during times of high influenza virus circulation. Vaccination may prevent 1 in 5 preterm births that occur during periods of high influenza circulation. |
Improving capture of vaccine history: case study from an evaluation of 10-valent pneumococcal conjugate vaccine introduction in Kenya
Harris AM , Aol G , Ouma D , Bigogo G , Montgomery JM , Whitney CG , Breiman RF , Kim L . Am J Trop Med Hyg 2016 94 (6) 1400-2 With the accelerated introduction of new vaccines in low-income settings, understanding immunization program performance is critical. We sought to improve immunization history acquisition from Ministry of Health vaccination cards during a vaccine impact study of 10-valent pneumococcal conjugate vaccine on pneumococcal carriage among young children in Kenya in 2012 and 2013. We captured immunization history in a low proportion of study participants in 2012 using vaccination cards. To overcome this challenge, we implemented a household-based reminder system in 2013 using community health workers (CHWs), and increased the retrieval of vaccine cards from 62% in 2012 to 89% in 2013 (P < 0.001). The home-based reminder system using CHWs is an example of an approach that improved immunization history data quality in a resource-poor setting. |
Health information technology adoption in the emergency department
Selck FW , Decker SL . Health Serv Res 2016 51 (1) 32-47 OBJECTIVE: To describe the trend in health information technology (IT) systems adoption in hospital emergency departments (EDs) and its effect on ED efficiency and resource use. DATA SOURCES: 2007-2010 National Hospital Ambulatory Medical Care Survey - ED Component. STUDY DESIGN: We assessed changes in the percent of visits to EDs with health IT capability and the estimated effect on waiting time to see a provider, visit length, and resource use. PRINCIPAL FINDINGS: The percent of ED visits that took place in an ED with at least a basic health IT or an advanced IT system increased from 25.2 and 3.1 percent in 2007 to 69.1 and 30.6 percent in 2010, respectively (p < .05). Controlling for ED fixed effects, waiting times were reduced by 6.0 minutes in advanced IT-equipped EDs (p < .05), and the number of tests ordered increased by 9 percent (p < .01). In models using a 1-year lag, advanced systems also showed an increase in the number of medications and images ordered per visit. CONCLUSIONS: Almost a third of visits now occur in EDs with advanced IT capability. While advanced IT adoption may decrease wait times, resource use during ED visits may also increase depending on how long the system has been in place. We were not able to determine if these changes indicated more appropriate care. |
Lessons learned from implementing CDC's STEADI falls prevention algorithm in primary care
Casey CM , Parker EM , Winkler G , Liu X , Lambert GH , Eckstrom E . Gerontologist 2016 57 (4) 787-796 BACKGROUND: Falls lead to a disproportionate burden of death and disability among older adults despite evidence-based recommendations to screen regularly for fall risk and clinical trials demonstrating the effectiveness of multifactorial interventions to reduce falls. The Centers for Disease Control and Prevention developed STEADI (Stopping Elderly Accidents, Deaths, and Injuries) to assist primary care teams to screen for fall risk and reduce risk of falling in older adults. PURPOSE OF THE STUDY: This paper describes a practical application of STEADI in a large academic internal medicine clinic utilizing the Kotter framework, a tool used to guide clinical practice change. DESIGN AND METHODS: We describe key steps and decision points in the implementation of STEADI as they relate to the recommended strategies of the Kotter framework. Strategies include: creating a sense of urgency, building a guiding coalition, forming a strategic vision and initiative, enlisting volunteers, enabling success by removing barriers, generating short-term wins, sustaining change, and instituting change. RESULTS: Fifty-six patients were screened during pilot testing; 360 patients were screened during the first 3 months of implementation. Key to successful implementation was (a) the development of electronic health record (EHR) tools and workflow to guide clinical practice and (b) the proactive leadership of clinical champions within the practice to identify and respond to barriers. IMPLICATIONS: Implementing falls prevention in a clinical setting required support and effort across multiple stakeholders. We highlight challenges, successes, and lessons learned that offer guidance for other clinical practices in their falls prevention efforts. |
Primary care opportunities to prevent unintentional home injuries: A focus on children and older adults
McDonald EM , Mack K , Shields WC , Lee RP , Gielen AC . Am J Lifestyle Med 2016 2016 (2) 96-106 Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all. |
Molecular detection of airborne Coccidioides in Tucson, Arizona.
Chow NA , Griffin DW , Barker BM , Loparev VN , Litvintseva AP . Med Mycol 2016 54 (6) 584-92 Environmental surveillance of the soil-dwelling fungus Coccidioides is essential for the prevention of Valley fever, a disease primarily caused by inhalation of the arthroconidia. Methods for collecting and detecting Coccidioides in soil samples are currently in use by several laboratories; however, a method utilizing current air sampling technologies has not been formally demonstrated for the capture of airborne arthroconidia. In this study, we collected air/dust samples at two sites (Site A and Site B) in the endemic region of Tucson, Arizona, and tested a variety of air samplers and membrane matrices. We then employed a single-tube nested qPCR assay for molecular detection. At both sites, numerous soil samples (n = 10 at Site A and n = 24 at Site B) were collected and Coccidioides was detected in two samples (20%) at Site A and in eight samples (33%) at Site B. Of the 25 air/dust samples collected at both sites using five different air sampling methods, we detected Coccidioides in three samples from site B. All three samples were collected using a high-volume sampler with glass-fiber filters. In this report, we describe these methods and propose the use of these air sampling and molecular detection strategies for environmental surveillance of Coccidioides. |
Reproductive endocrine patterns and volatile urinary compounds of Arctictis binturong: discovering why bearcats smell like popcorn
Greene LK , Wallen TW , Moresco A , Goodwin TE , Drea CM . Naturwissenschaften 2016 103 37 Members of the order Carnivora rely on urinary scent signaling, particularly for communicating about reproductive parameters. Here, we describe reproductive endocrine patterns in relation to urinary olfactory cues in a vulnerable and relatively unknown viverrid-the binturong (Arctictis binturong). Female binturongs are larger than and dominate males, and both sexes engage in glandular and urinary scent marking. Using a large (n = 33), captive population, we collected serum samples to measure circulating sex steroids via enzyme immunoassay and urine samples to assay volatile chemicals via gas chromatography-mass spectrometry. Male binturongs had expectedly greater androgen concentrations than did females but, more unusually, had equal estrogen concentrations, which may be linked to male deference. Males also expressed a significantly richer array of volatile chemical compounds than did females. A subset of these volatile chemicals resisted decay at ambient temperatures, potentially indicating their importance as long-lasting semiochemicals. Among these compounds was 2-acetyl-1-pyrroline (2-AP), which is typically produced at high temperatures by the Maillard reaction and is likely to be responsible for the binturong's characteristic popcorn aroma. 2-AP, the only compound expressed by all of the subjects, was found in greater abundance in males than females and was significantly and positively related to circulating androstenedione concentrations in both sexes. This unusual compound may have a more significant role in mammalian semiochemistry than previously appreciated. Based on these novel data, we suggest that hormonal action and potentially complex chemical reactions mediate communication of the binturong's signature scent and convey information about sex and reproductive state. |
Safety and pharmacokinetics of quick dissolving polymeric vaginal films delivering the antiretroviral IQP-0528 for pre-exposure prophylaxis
Srinivasan P , Zhang J , Martin A , Kelley K , McNicholl JM , Buckheit RW Jr , Smith JM , Ham AS . Antimicrob Agents Chemother 2016 60 (7) 4140-50 For HIV prevention, microbicides or drugs delivered as quick-dissolving films may be more acceptable to women than gels because of their compact size, minimal waste, lack of an applicator, and easier storage and transport. This has the potential to improve adherence to promising products for pre-exposure prophylaxis. Vaginal films containing IQP-0528, a non-nucleoside reverse transcriptase inhibitor, were evaluated for their pharmacokinetics in pigtailed macaques. Polymeric films (22x44x0.1mm-75% of a human dose) containing IQP-0528 (1.5% w/w) with and without poly(lactic-co-glycolic acid) nanoparticle encapsulation were inserted vaginally into pigtailed macaques in a crossover study design (n=6). With unencapsulated drug, the median (range) vaginal fluid concentrations of IQP-0528 were, 160.97 (2.73-2,104), 181.79 (1.86-15,800), and 484.50 (8.26-4,045) mug/mL at 1, 4 and 24 hours post film applications, respectively. Median vaginal tissue IQP-0528 concentrations at 24 hours were 3.10 (0.03-222.58) mug/g. Values were similar proximal, medial and distal to the cervix. The IQP-0528 nanoparticle formulated films delivered similar IQP-0528 levels in vaginal tissue and secretions as the unencapsulated formulation. A single application of either formulation did not disturb the vaginal microflora or the pH (7.24+/-0.84). The high mucosal IQP-0528 levels delivered by both vaginal film formulations were between 1 and 5 logs higher than the in vitro IC90 of 0.146 mug/mL. The excellent coverage and high mucosal levels of IQP-0528, well above the IC90, suggest that the films may be protective, and warrant further evaluation in a vaginal repeat low-dose SHIV transmission study in macaques and clinically in women. |
Lawsonella clevelandensis gen. nov., sp. nov., a new member of the suborder Corynebacterineae isolated from human abscesses
Bell ME , Bernard KA , Harrington SM , Patel NB , Tucker TA , Metcalfe MG , McQuiston JR . Int J Syst Evol Microbiol 2016 66 (8) 2929-2935 Gram-positive, partially acid-fast, non-spore forming, anaerobic, catalase-positive, pleomorphic bacteria were isolated from human abscesses. Strains X1036T, X1698, and NML 120705, were recovered from a spinal abscess, a peritoneal abscess, and a breast abscess respectively. A phylogenetic analysis of the 16S rRNA gene sequences showed that the strains shared 100% similarity and the nearest phylogenetic neighbor is Dietzia timorensis DSM 45568T (95%). Chemotaxonomic characteristics of the strains were consistent with those described for members of the suborder Corynebacterineae. Mycolic acids were detected using HPLC and one-dimensional TLC; whole cell hydrolysates yielded meso-DAP with arabinose and galactose as the predominant sugars; the muramic acid acyl type was acetylated; the major menaquinone was MK-9 (96.3%); polar lipids detected were phosphatidylglycerol, phosphatidylinositol, and an unknown glycophospholipid. Cellular fatty acids were hexadecanoic acid (C16:0), octadecanoic acid (C18:1omega9c), and decanoic acid (C10:0). Tuberculostearic acid was not detected. Based on the results of this polyphasic study, we conclude that these strains represent a novel genus and species within the suborder Corynebacterineae for which we propose the name Lawsonella clevelandensis gen. nov., sp. nov., with the type strain X1036T (=DSM 45743T = CCUG 66657T). |
How should the completeness and quality of curated nanomaterial data be evaluated?
Marchese Robinson RL , Lynch I , Peijnenburg W , Rumble J , Klaessig F , Marquardt C , Rauscher H , Puzyn T , Purian R , Aberg C , Karcher S , Vriens H , Hoet P , Hoover MD , Hendren CO , Harper SL . Nanoscale 2016 8 (19) 9919-43 Nanotechnology is of increasing significance. Curation of nanomaterial data into electronic databases offers opportunities to better understand and predict nanomaterials' behaviour. This supports innovation in, and regulation of, nanotechnology. It is commonly understood that curated data need to be sufficiently complete and of sufficient quality to serve their intended purpose. However, assessing data completeness and quality is non-trivial in general and is arguably especially difficult in the nanoscience area, given its highly multidisciplinary nature. The current article, part of the Nanomaterial Data Curation Initiative series, addresses how to assess the completeness and quality of (curated) nanomaterial data. In order to address this key challenge, a variety of related issues are discussed: the meaning and importance of data completeness and quality, existing approaches to their assessment and the key challenges associated with evaluating the completeness and quality of curated nanomaterial data. Considerations which are specific to the nanoscience area and lessons which can be learned from other relevant scientific disciplines are considered. Hence, the scope of this discussion ranges from physicochemical characterisation requirements for nanomaterials and interference of nanomaterials with nanotoxicology assays to broader issues such as minimum information checklists, toxicology data quality schemes and computational approaches that facilitate evaluation of the completeness and quality of (curated) data. This discussion is informed by a literature review and a survey of key nanomaterial data curation stakeholders. Finally, drawing upon this discussion, recommendations are presented concerning the central question: how should the completeness and quality of curated nanomaterial data be evaluated? |
A humanized monoclonal antibody neutralizes yellow fever virus strain 17D-204 in vitro but does not protect a mouse model from disease
Calvert AE , Dixon KL , Piper J , Bennett SL , Thibodeaux BA , Barrett AD , Roehrig JT , Blair CD . Antiviral Res 2016 131 92-9 The yellow fever virus (YFV) vaccine 17D-204 is considered safe and effective, yet rare severe adverse events (SAEs), some resulting in death, have been documented following vaccination. Individuals exhibiting post-vaccinal SAEs are ideal candidates for antiviral monoclonal antibody (MAb) therapy; the time until appearance of clinical signs post-exposure is usually short and patients are quickly hospitalized. We previously developed a murine-human chimeric monoclonal antibody (cMAb), 2C9-cIgG, reactive with both virulent YFV and 17D-204, and demonstrated its ability to prevent and treat YF disease in both AG129 mouse and hamster models of infection. To counteract possible selection of 17D-204 variants that escape neutralization by treatment with a single MAb (2C9-cIgG), we developed a second cMAb, 864-cIgG, for use in combination with 2C9-cIgG in post-vaccinal therapy. MAb 864-cIgG recognizes/neutralizes only YFV 17D-204 vaccine substrain and binds to domain III (DIII) of the viral envelope protein, which is different from the YFV type-specific binding site of 2C9-cIgG in DII. Although it neutralized 17D-204 in vitro, administration of 864-cIgG had no protective capacity in the interferon receptor-deficient AG129 mouse model of 17D-204 infection. The data presented here show that although DIII-specific 864-cIgG neutralizes virus infectivity in vitro, it does not have the ability to abrogate disease in vivo. Therefore, combination of 864-cIgG with 2C9-cIgG for treatment of YF vaccination SAEs does not appear to provide an improvement on 2C9-cIgG therapy alone. |
Integration of multiplex bead assays for parasitic diseases into a national, population-based serosurvey of women 15-39 years of age in Cambodia
Priest JW , Jenks MH , Moss DM , Mao B , Buth S , Wannemuehler K , Soeung SC , Lucchi NW , Udhayakumar V , Gregory CJ , Huy R , Muth S , Lammie PJ . PLoS Negl Trop Dis 2016 10 (5) e0004699 Collection of surveillance data is essential for monitoring and evaluation of public health programs. Integrated collection of household-based health data, now routinely carried out in many countries through demographic health surveys and multiple indicator surveys, provides critical measures of progress in health delivery. In contrast, biomarker surveys typically focus on single or related measures of malaria infection, HIV status, vaccination coverage, or immunity status for vaccine-preventable diseases (VPD). Here we describe an integrated biomarker survey based on use of a multiplex bead assay (MBA) to simultaneously measure antibody responses to multiple parasitic diseases of public health importance as part of a VPD serological survey in Cambodia. A nationally-representative cluster-based survey was used to collect serum samples from women of child-bearing age. Samples were tested by MBA for immunoglobulin G antibodies recognizing recombinant antigens from Plasmodium falciparum and P. vivax, Wuchereria bancrofti, Toxoplasma gondii, Taenia solium, and Strongyloides stercoralis. Serologic IgG antibody results were useful both for generating national prevalence estimates for the parasitic diseases of interest and for confirming the highly focal distributions of some of these infections. Integrated surveys offer an opportunity to systematically assess the status of multiple public health programs and measure progress toward Millennium Development Goals. |
Assessing immunity to rubella virus: A plea for standardization of IgG (immuno)assays
Bouthry E , Furione M , Huzly D , Ogee-Nwankwo A , Hao L , Adebayo A , Icenogle J , Sarasini A , Revello MG , Grangeot-Keros L , Vauloup-Fellous C . J Clin Microbiol 2016 54 (7) 1720-1725 BACKGROUND: Immunity to rubella virus (RV) is commonly determined by measuring specific immunoglobulin G (RV-IgG). However, RV-IgG results and their interpretation may vary depending on the immunoassay even though most commercial imunoassays (CIAs) have been calibrated against an international standard and results are reported in international units per milliliter (IU/mL). METHODS: A panel of 322 sera collected from pregnant women that pretested negative or equivocal for RV-IgG in a prior test (routine screening) was selected. This panel was tested with two reference tests, immunoblot (IB) and neutralization (Nt), and with 8 CIAs widely used in Europe. RESULTS: IB and Nt gave concordant results on 267/322 (82.9%) sera. Of these, 85 (26.4%) sera were negative and 182 (56.5%) sera were positive for both tests. All 85 IB/Nt-negative samples were classified as negative with all CIAs. Of the 182 IB/Nt-positive samples, 25.3% to 61.5% were classified as equivocal and 6% to 64.8% were classified as positive with the CIAs. Wide variations in IU/ml titers were observed. CONCLUSIONS: In our series, more than half the women considered susceptible to RV based on CIA results, tested positive for RV antibodies by IB/Nt. Our data suggest that: i) sensitivity of CIAs could be increased by considering equivocal results as positive, and ii) the definition of immunity to RV as the 10 IU/mL usual cut-off as well as the use of quantitative results for clinical decisions may warrant reconsideration. A better standardization of CIAs for RV IgG determination is needed. |
Direct stimulation of human fibroblasts by nCeO2 in vitro is attenuated with an amorphous silica coating
Davidson DC , Derk R , He X , Stueckle TA , Cohen J , Pirela SV , Demokritou P , Rojanasakul Y , Wang L . Part Fibre Toxicol 2016 13 (1) 23 BACKGROUND: Nano-scaled cerium oxide (nCeO2) is used in a variety of applications, including use as a fuel additive, catalyst, and polishing agent, yet potential adverse health effects associated with nCeO2 exposure remain incompletely understood. Given the increasing utility and demand for engineered nanomaterials (ENMs) such as nCeO2, "safety-by-design" approaches are currently being sought, meaning that the physicochemical properties (e.g., size and surface chemistry) of the ENMs are altered in an effort to maximize functionality while minimizing potential toxicity. In vivo studies have shown in a rat model that inhaled nCeO2 deposited deep in the lung and induced fibrosis. However, little is known about how the physicochemical properties of nCeO2, or the coating of the particles with a material such as amorphous silica (aSiO2), may affect the bio-activity of these particles. Thus, we hypothesized that the physicochemical properties of nCeO2 may explain its potential to induce fibrogenesis, and that a nano-thin aSiO2 coating on nCeO2 may counteract that effect. RESULTS: Primary normal human lung fibroblasts were treated at occupationally relevant doses with nCeO2 that was either left uncoated or was coated with aSiO2 (amsCeO2). Subsequently, fibroblasts were analyzed for known hallmarks of fibrogenesis, including cell proliferation and collagen production, as well as the formation of fibroblastic nodules. The results of this study are consistent with this hypothesis, as we found that nCeO2 directly induced significant production of collagen I and increased cell proliferation in vitro, while amsCeO2 did not. Furthermore, treatment of fibroblasts with nCeO2, but not amsCeO2, significantly induced the formation of fibroblastic nodules, a clear indicator of fibrogenicity. Such in vitro data is consistent with recent in vivo observations using the same nCeO2 nanoparticles and relevant doses. This effect appeared to be mediated through TGFbeta signaling since chemical inhibition of the TGFbeta receptor abolished these responses. CONCLUSIONS: These results indicate that differences in the physicochemical properties of nCeO2 may alter the fibrogenicity of this material, thus highlighting the potential benefits of "safety-by-design" strategies. In addition, this study provides an efficient in vitro method for testing the fibrogenicity of ENMs that strongly correlates with in vivo findings. |
Role of antibiotics in reducing childhood mortality in resource-poor settings
Kourtis AP , Jamieson DJ , Chasela C , van der Horst C . AIDS 2016 30 (8) 1310-1 A recent article ‘A quiet revolution in the treatment of childhood diarrhea’ in the New York Times[1] highlights childhood diarrhea, a ‘silent’ killer of infants and children in resource-poor settings, second in magnitude only to pneumonia. Diarrhea treatment guidelines in such settings rely on oral rehydration and reserve antibiotics for the presence of blood in the stool. These guidelines were developed more than 30 years ago. Newer evidence points to the higher than previously thought frequency of bacterial causes, even in the absence of visible blood in the stool [1]. Some experts argue that empiric antibiotic treatment of childhood diarrhea in resource-poor settings is a more cost-effective option than microbiologic testing to determine the cause. Others argue that such use of antibiotics will lead to widespread resistance. | Several lines of recent evidence have shown a benefit of administering antibiotics to children in resource-poor settings in which malaria is also prevalent. Use of daily cotrimoxazole prophylaxis in HIV-exposed, uninfected infants in Malawi significantly reduced the risk of infant pneumonia, diarrhea, and malaria, and halved the risk of infant death [2]. Another study in Malawi compared the combination of chloroquine with azithromycin to chloroquine alone as treatment for symptomatic malaria episodes in children [3]; the combination with azithromycin not only treated malaria, but also decreased the incidence of subsequent respiratory infections by 33% and gastrointestinal tract infections by 26%. These data complement those of yet another study in Malawi, which demonstrated a 40% reduction in mortality in children by adding amoxicillin or cefdinir to ready-to-use food for the outpatient treatment of acute severe malnutrition [4], and those of a study of mass treatment for trachoma with azithromycin in Ethiopia [5], which demonstrated a decrease in childhood mortality. |
Lactation and maternal cardio-metabolic health
Perrine CG , Nelson JM , Corbelli J , Scanlon KS . Annu Rev Nutr 2016 36 627-45 Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases. Several large prospective and retrospective studies, mostly from the United States and other industrialized countries, have examined the associations between lactation and cardio-metabolic outcomes. Less evidence exists regarding an association of lactation with maternal postpartum weight status and dyslipidemia, whereas more evidence exists for an association with diabetes, hypertension, and subclinical and clinical cardiovascular disease. Expected final online publication date for the Annual Review of Nutrition Volume 36 is July 17, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
Shiftwork and diurnal salivary cortisol patterns among police officers
Charles LE , Fekedulegn D , Burchfiel CM , Hartley TA , Andrew ME , Violanti JM , Miller DB . J Occup Environ Med 2016 58 (6) 542-9 OBJECTIVE: To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men). METHODS: Information on shiftwork was obtained from the City of Buffalo, NY electronic payroll records. Saliva was collected using Salivettes at seven time points and analyzed for free cortisol concentrations (nmol/L) using a chemiluminescence immunoassay. Mean slopes and areas under the curve were compared across shift schedule using analysis of variance (ANOVA)/analysis of covariance (ANCOVA). RESULTS: Officers working primarily on the night shift had a significantly shallower slope. Mean slope (nmol/L/minutes) of the cortisol curve varied significantly across shifts (day: -0.00332 +/- 0.00017, afternoon: -0.00313 +/- 0.00018, night: -0.00257 +/- 0.0002); adjusted P = 0.023. CONCLUSIONS: Our results suggest that night shiftwork is a workplace factor that may alter the response of the hypothalamic-pituitary-adrenal (HPA) axis to the circadian cues responsible for the pattern of the diurnal cortisol curve. |
Symptoms and immune markers in Plasmodium/dengue virus co-infection compared with mono-infection with either in Peru
Halsey ES , Baldeviano GC , Edgel KA , Vilcarromero S , Sihuincha M , Lescano AG . PLoS Negl Trop Dis 2016 10 (4) e0004646 BACKGROUND: Malaria and dengue are two of the most common vector-borne diseases in the world, but co-infection is rarely described, and immunologic comparisons of co-infection with mono-infection are lacking. METHODOLOGY AND PRINCIPAL FINDINGS: We collected symptom histories and blood specimens from subjects in a febrile illness surveillance study conducted in Iquitos and Puerto Maldonado, Peru, between 2002-2011. Nineteen symptoms and 18 immune markers at presentation were compared among those with co-infection with Plasmodium/dengue virus (DENV), Plasmodium mono-infection, and DENV mono-infection. Seventeen subjects were identified as having Plasmodium/DENV co-infection and were retrospectively matched with 51 DENV mono-infected and 44 Plasmodium mono-infected subjects. Those with Plasmodium mono-infection had higher levels of IL-4, IL-6, IL-10, IL-12, IL-13, IL-17A, IFN-gamma, and MIP1-alpha/CCL3 compared with DENV mono-infection or co-infection; those with Plasmodium mono-infection had more cough than those with DENV mono-infection. Subjects with DENV mono-infection had higher levels of TGF-beta1 and more myalgia than those with Plasmodium mono-infection. No symptom was more common and no immune marker level was higher in the co-infected group, which had similar findings to the DENV mono-infected subjects. CONCLUSIONS/SIGNIFICANCE: Compared with mono-infection with either pathogen, Plasmodium/DENV co-infection was not associated with worse disease and resembled DENV mono-infection in both symptom frequency and immune marker level. |
A public health paradox: the women most vulnerable to malaria are the least protected
Gonzalez R , Sevene E , Jagoe G , Slutsker L , Menendez C . PLoS Med 2016 13 (5) e1002014 Raquel Gonzalez and colleagues highlight an urgent need to evaluate antimalarials that can be safely administered to HIV-infected pregnant women on antiretroviral treatment and cotrimoxazole prophylaxis. |
Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995-2012
Painter JE , Gargano JW , Yoder JS , Collier SA , Hlavsa MC . Epidemiol Infect 2016 144 (8) 1792-802 Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995-2012. The Cochran-Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995-2004, 2005-2008, 2009-2012). The proportion of confirmed cases significantly decreased (P < 0.0001), and a crossover from male to female predominance in case-patients occurred (P < 0.0001). Overall, compared to 1995-2004, rates were higher in 2005-2008 (RR 2.92, 95% CI 2.08-4.09) and 2009-2012 (RR 2.66, 95% CI 1.90-3.73). However, rate changes from 2005-2008 to 2009-2012 varied by age group (P interaction < 0.0001): 0-14 years (RR 0.55, 95% CI 0.42-0.71), 15-44 years (RR 0.99, 95% CI 0.82-1.19), 45-64 years (RR 1.47, 95% CI 1.21-1.79) and 65 years (RR 2.18, 95% CI 1.46-3.25). The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States. |
Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa
Theiss-Nyland K , Lynch M , Lines J . Malar J 2016 15 (1) 255 BACKGROUND: In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. METHODS: For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. RESULTS: Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. CONCLUSIONS: These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels. |
Four aspects of the scope and quality of family planning services in US publicly-funded health centers: Results from a survey of health center administrators
Carter MW , Gavin L , Zapata LB , Bornstein M , Mautone-Smith N , Moskosky SB . Contraception 2016 94 (4) 340-7 OBJECTIVES: To describe aspects of the scope and quality of family planning services provided by US publicly-funded health centers before the release of relevant federal recommendations. STUDY DESIGN: Using nationally-representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols, and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each. RESULTS: Half of the sample received Title X funding, and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past three months. Service provision to males was substantially lower except for STD screening. Sixty-three percent and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all 5 recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients, and being a Planned Parenthood clinic were associated with higher scores on most indices. CONCLUSION: Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types. Implications statement. As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess change as implementation of recent family planning service recommendations continues. |
Descriptive epidemiology of somatising tendency: Findings from the CUPID study
Vargas-Prada S , Coggon D , Ntani G , Walker-Bone K , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Kadir MM , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Sarquis LM , Marziale MH , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Harris EC , Serra C , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Freimann T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A , Vega EJ . PLoS One 2016 11 (4) e0153748 Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait. |
Secondhand smoke exposure and susceptibility to initiating cigarette smoking among never-smoking students in selected African countries: Findings from the Global Youth Tobacco Survey
Lee KA , Palipudi KM , English LM , Ramanandraibe N , Asma S . Prev Med 2016 91S S2-S8 BACKGROUND: Exposure to secondhand smoke (SHS) causes premature death and illness in non-smokers. We examined SHS exposure at home and in public places, as well as susceptibility to initiate cigarette smoking among never cigarette smokers. We used 2006-2011 Global Youth Tobacco Survey (GYTS) data from 29 African countries (56,967 students). METHODS: GYTS is a nationally representative, self-administered school-based survey, conducted among students aged 13-15years.Prevalence ratio, estimates and 95% confidence intervals were computed for SHS exposure in the homes and public places separately. The two-sample t-test was used to assess the difference in susceptibility to smoking by SHS exposure among never-smoking students (alpha=0.05). RESULTS: Among never-smoking students, exposure to SHS at home ranged from 12.7% (Cape Verde) to 44.0% (Senegal). The prevalence ratio (PR) comparing susceptibility to smoking initiation among never smokers exposed to SHS at home to those who were not exposed at home ranged from 1.2 to 2.6. Exposure to SHS in public places ranged from 23.9% (Cape Verde) to 80.4% (Mali). Of the countries being studied, 8 countries showed a significant difference in susceptibility to smoking initiation among never smokers exposed to SHS in public places compared to those not exposed in public places. (PR ranged from 0.5-3.5). CONCLUSION: In many African countries in the study, a substantial proportion of students who never smoked are exposed to SHS at home and in public places. Majority of never smokers who were exposed to SHS at home and in public places had a higher prevalence of susceptibility to initiate smoking than those that were not exposed to SHS at home and in public places. Adoption and enforcement of smoke-free policies in public places and smoke-free rules at home could substantially contribute to reducing SHS exposure in many of these countries. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Drug Safety
- Environmental Health
- Genetics and Genomics
- Health Economics
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Parasitic Diseases
- Reproductive Health
- Social and Behavioral Sciences
- Substance Use and Abuse
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure