Meeting the information needs of lower income cancer survivors: results of a randomized control trial evaluating the American Cancer Society's "I Can Cope"
Martin MY , Evans MB , Kratt P , Pollack LA , Smith JL , Oster R , Dignan M , Prayor-Patterson H , Watson C , Houston P , Andrews S , Liwo A , Tseng TS , Hullett S , Oliver J , Pisu M . J Health Commun 2014 19 (4) 441-59 The American Cancer Society is a leader in the development of cancer survivorship resources. One resource of the American Cancer Society is the I Can Cope program, an educational program for cancer survivors and their families. Evaluations of this program indicate that cancer patients highly rate its objectives. Yet, there are gaps in the understanding of the full impact of the program on diverse cancer survivors. In this study, the authors used a randomized trial to evaluate the program. Participants included 140 low-income survivors (79% Black; 38% breast cancer) from community hospitals who were randomized to 4 sessions of I Can Cope (learning about cancer; understanding cancer treatments; relieving cancer pain; and keeping well in mind and body) or 4 sessions of a wellness intervention (humor, meditation, relaxation, and music therapy). The authors' primary outcome was "met information needs." After controlling for covariates, their analysis indicated that I Can Cope was no more effective than the wellness intervention in addressing survivor information needs relative to the learning objectives. Participants provided high overall ratings for both interventions. Self-efficacy for obtaining advice about cancer, age, education, and income were associated with information needs. Educational programs tailored to levels of self-efficacy and patient demographics may be needed. |
Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009
Dabelea D , Mayer-Davis EJ , Saydah S , Imperatore G , Linder B , Divers J , Bell R , Badaru A , Talton JW , Crume T , Liese AD , Merchant AT , Lawrence JM , Reynolds K , Dolan L , Liu LL , Hamman RF . JAMA 2014 311 (17) 1778-86 IMPORTANCE: Despite concern about an "epidemic," there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups. OBJECTIVE: To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009. DESIGN, SETTING, AND PARTICIPANTS: Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan. MAIN OUTCOMES AND MEASURES: Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years. RESULTS: In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes. CONCLUSIONS AND RELEVANCE: Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases. |
Fatigue is highly associated with poor health-related quality of life, disability and depression in newly-diagnosed patients with inflammatory bowel disease, independent of disease activity
Cohen BL , Zoega H , Shah SA , Leleiko N , Lidofsky S , Bright R , Flowers N , Law M , Moniz H , Merrick M , Sands BE . Aliment Pharmacol Ther 2014 39 (8) 811-22 BACKGROUND: Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC). Data on fatigue in newly diagnosed patients are unavailable. AIM: To report prevalence of fatigue in newly diagnosed CD and UC patients and examine its association with health-related quality of life (HRQOL), depression and disability. METHODS: The Ocean State Crohn's and Colitis Area Registry (OSCCAR) is a statewide cohort of newly diagnosed inflammatory bowel disease patients in Rhode Island. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were administered instruments measuring HRQOL, overall disability and work impairment, and depression. RESULTS: Fatigue was prevalent in 26.4% of 220 subjects. Cohen's d effect sizes for fatigue were large: Short-Form 36 Health Survey mental health component (CD 1.5, UC 1.4) and physical health component (CD 1.4, UC 1.4), EuroQol-5D valuation of current health state (CD 1.2, UC 1.0), Inflammatory Bowel Disease Questionnaire (CD 1.9, UC 1.6) and Patient Health Questionnaire depression scale (CD 1.8, UC 1.7). Fatigued patients reported more work impairment (Score difference: CD 29.5%, UC 23.8%) and activity impairment (score difference: CD 32.3%, UC 25.7%) on the Work Productivity and Activity Impairment Questionnaire. Fatigue's association with all scores remained highly significant despite controlling for disease activity. CONCLUSIONS: Fatigue is strongly associated with poor HRQOL, disability and depression similarly in CD and UC even when controlling for disease activity. Fatigue's association with a wide range of patient-reported outcome measures suggests that monitoring fatigue is a simple way to screen for overall disruption in patient life. |
Human papillomavirus prevalence in oropharyngeal cancer before vaccine introduction, United States
Steinau M , Saraiya M , Goodman MT , Peters ES , Watson M , Cleveland JL , Lynch CF , Wilkinson EJ , Hernandez BY , Copeland G , Saber MS , Hopenhayn C , Huang Y , Cozen W , Lyu C , Unger ER . Emerg Infect Dis 2014 20 (5) 822-8 We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995-2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%-80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables. |
Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers
Fischer DB , William AH , Strauss AC , Unger ER , Jason LA , Marshall Jr GD , Dimitrakoff JD . Fatigue 2014 2 (2) 93-109 BACKGROUND: Chronic fatigue syndrome (CFS) remains an incompletely characterized illness, in part due to controversy regarding its definition, biological basis, and diagnosis. PURPOSE: Biomarkers are objective measures that may lead to improvements in our understanding of CFS by providing a more coherent and consistent approach to study, diagnosis, and treatment of the illness. Such metrics may allow us to distinguish between CFS subtypes - each defined by characteristic biomarkers - currently conflated under the single, heterogeneous condition of CFS. These delineations, in turn, may guide more granular, focused, and targeted treatment strategies based on more precise characterizations of the illness. METHODS: Here, we review potential CFS biomarkers related to neurological and immunological components of the illness. RESULTS, CONCLUSIONS: We discuss how these biomarkers may be used to move the field of CFS forward, emphasizing clinical utility and potential routes of future research. |
Disability in U.S. households, 2000-2010: findings from the National Health Interview Survey
Altman BM , Blackwell DL . Fam Relat 2014 63 (1) 20-38 Understanding the demographic structure of households containing members with disabilities is of key importance in policy planning for populations with disabilities at state and national levels. Yet most, but not all, previous family-level studies of disability have excluded persons living alone or with unrelated persons (e.g., a housemate or an unmarried partner) because they are not considered families. To address this gap, the authors utilize National Health Interview Survey data to produce household-level estimates of disability using a detailed household type variable that includes households omitted from previous reports. Findings indicate that one-person households made up 24.7% of all households with an adult age 18 to 64 with a disability, and 42.9% of all households with an adult age 65 or older with a disability. Including nonfamily households provides a clearer picture of the association between living arrangements and disability in the United States. |
Full-genome analysis of avian influenza A(H5N1) virus from a human, North America, 2013.
Pabbaraju K , Tellier R , Wong S , Li Y , Bastien N , Tang JW , Drews SJ , Jang Y , Davis CT , Fonseca K , Tipples GA . Emerg Infect Dis 2014 20 (5) 887-91 Full-genome analysis was conducted on the first isolate of a highly pathogenic avian influenza A(H5N1) virus from a human in North America. The virus has a hemagglutinin gene of clade 2.3.2.1c and is a reassortant with an H9N2 subtype lineage polymerase basic 2 gene. No mutations conferring resistance to adamantanes or neuraminidase inhibitors were found. |
Prevalence and correlates of willingness to participate in a rectal microbicide trial among men who have sex with men in Bangkok
Thienkrua W , Todd CS , Chaikummao S , Sukwicha W , Yafant S , Tippanont N , Varangrat A , Khlaimanee P , Holtz TH . AIDS Care 2014 26 (11) 1-11 Rectal microbicides (RMs) hold promise as a HIV prevention method to reduce transmission among men who have sex with men (MSM). To assess RM trial feasibility in Bangkok, we measured prevalence and correlates of willingness to participate among Thai MSM observational cohort participants. Between April 2006 and December 2010, 1744 MSM enrolled in the Bangkok MSM Cohort Study; at 12 months, RM trial participation willingness was measured. We evaluated correlates of RM trial participation willingness using logistic regression analysis. Participants completing the 12-month visit (81.4%, n = 1419) had a mean age of 27.3 years (SD = 6.1), and 65.5% and 86.1% reported having a steady partner or anal intercourse (AI) in the past four months, respectively. Most (79.1%, n = 1123) participants reported willingness to participate in an RM trial, which, in multivariable analysis, was independently associated with insertive only (adjusted odds ratio [AOR] = 3.25, 95% CI: 1.82-5.81) or receptive/versatile role AI (AOR = 3.07, 95% CI: 1.88-5.01), and being paid for sex (AOR = 12.15, 95% CI: 1.67-88.21) in the past four months, and believing that people with AIDS look sick (AOR = 1.92, 95% CI: 1.23-2.98). Of hypothetical RM trial features to increase enrollment likelihood, the most (91.1%) compelling was that the study be approved by the Thai ethics committee, followed by the study site offering evening hours (88.9%). Reasons not to participate were not wanting a rectal examination (29.5%) or fluid collected from the penis or anus (24.6%) and not wanting the placebo (23.0%). RM trial participation willingness was high, particularly for those with greater HIV acquisition risk, within this Thai MSM cohort, suggesting feasibility of an RM trial. Addressing potential barriers to trial entry may be useful in educational materials to optimize recruitment. |
Primary and secondary syphilis - United States, 2005-2013
Patton ME , Su JR , Nelson R , Weinstock H . MMWR Morb Mortal Wkly Rep 2014 63 (18) 402-6 In 2013, based on data reported as of April 28, 2014, the rate of reported primary and secondary syphilis in the United States was 5.3 cases per 100,000 population, more than double the lowest-ever rate of 2.1 in 2000. To characterize the recent epidemiology of syphilis in the United States, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for cases of primary and secondary syphilis diagnosed during 2005-2013 with a focus on states that reported the sex of sex partners during 2009-2012 to describe reported syphilis among gay, bisexual, and other men who have sex with men (collectively referred to as MSM). During 2005-2013, primary and secondary syphilis rates increased among men of all ages and races/ethnicities across all regions of the United States. Recent years have shown an accelerated increase in the number of cases, with the largest increases occurring among MSM. Among women, rates increased during 2005-2008 and decreased during 2009-2013, with different trends among different racial/ethnic groups. Racial/ethnic disparities in reported syphilis persisted during 2005-2013, likely reflecting social determinants of health, such as socioeconomic status, that might contribute to the burden of syphilis in a community. These findings underscore the need for continued syphilis prevention measures among MSM. |
Early identification and linkage to care of persons with chronic hepatitis B virus infection - three U.S. Sites, 2012-2014
Beckett GA , Ramirez G , Vanderhoff A , Nichols K , Chute SM , Wyles DL , Schoenbachler BT , Bedell DT , Cabra R , Ward JW . MMWR Morb Mortal Wkly Rep 2014 63 (18) 399-401 In the United States, an estimated 0.8-1.4 million persons are living with chronic hepatitis B virus (HBV) infection. Among these persons, as many as 70% were born in countries of Asia, Africa, or other regions where HBV is moderately or highly endemic (hepatitis B surface antigen [HBsAg] prevalence ≥2%). HBV-associated cirrhosis and liver cancer are major health problems for these populations. Most persons with HBV were infected at birth or during early childhood and are asymptomatic until advanced liver disease develops. To address these concerns, CDC recommends HBsAg testing for all persons born in these areas and linkage to medical care and preventive services for those who are infected. In 2012, CDC awarded funds to nine sites to implement this recommendation. This report describes programs at three sites (New York, New York; Minneapolis-St. Paul, Minnesota; and San Diego, California) that conducted HBV testing, in clinical or community settings, and referred for medical evaluation and care those persons whose HBsAg test results were positive. During October 2012-March 2014, the three sites tested 4,727 persons for HBV infection; 310 (6.6%) were HBsAg-positive. Among the HBsAg-positive persons, 94% were informed of their results, 90% were counseled, 86% were referred for care, and 66% attended their scheduled first medical visit. These projects demonstrate that community-based programs can identify infected persons among populations with a high prevalence of HBV infection and refer HBsAg-positive persons for care. Individualized efforts to assist patients with accessing and receiving health-care services ("patient navigation services") can increase the number of persons who follow up on referrals and receive recommended care. |
Estimating per-act HIV transmission risk: a systematic review
Patel P , Borkowf CB , Brooks JT , Lasry A , Lansky A , Mermin J . AIDS 2014 28 (10) 1509-19 BACKGROUND: Effective HIV prevention programs rely on accurate estimates of the per-act risk of HIV acquisition from sexual and parenteral exposures. We updated the previous risk estimates of HIV acquisition from parenteral, vertical, and sexual exposures, and assessed the modifying effects of factors including condom use, male circumcision, and antiretroviral therapy. METHODS: We conducted literature searches to identify new studies reporting data regarding per-act HIV transmission risk and modifying factors. Of the 7339 abstracts potentially related to per-act HIV transmission risk, 3 meta-analyses provided pooled per-act transmission risk probabilities and 2 studies provided data on modifying factors. Of the 8119 abstracts related to modifying factors, 15 relevant articles, including 3 meta-analyses, were included. We used fixed-effects inverse-variance models on the logarithmic scale to obtain updated estimates of certain transmission risks using data from primary studies, and employed Poisson regression to calculate relative risks with exact 95% confidence intervals for certain modifying factors. RESULTS: Risk of HIV transmission was greatest for blood transfusion, followed by vertical exposure, sexual exposures, and other parenteral exposures. Sexual exposure risks ranged from low for oral sex to 138 infections per 10 000 exposures for receptive anal intercourse. Estimated risks of HIV acquisition from sexual exposure were attenuated by 99.2% with the dual use of condoms and antiretroviral treatment of the HIV-infected partner. CONCLUSION: The risk of HIV acquisition varied widely, and the estimates for receptive anal intercourse increased compared with previous estimates. The risk associated with sexual intercourse was reduced most substantially by the combined use of condoms and antiretroviral treatment of HIV-infected partners. |
Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model - Arizona and Utah, 2012-2014
Mitruka K , Thornton K , Cusick S , Orme C , Moore A , Manch RA , Box T , Carroll C , Holtzman D , Ward JW . MMWR Morb Mortal Wkly Rep 2014 63 (18) 393-8 Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the United States. Of the approximately 3 million persons living with HCV infection in the United States, an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications, such as sofosbuvir and simeprevir, to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. To fully benefit from these new treatments, improvement in linkage to care and treatment is urgently needed.* Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In September 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center in 2003 to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. To assess the effectiveness of these programs in improving primary care provider capacity and increasing the number of patients initiating treatment, process and patient outcome data for each state program were analyzed. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations. |
Hepatitis B virus infection testing and prevalence among Asian and Pacific Islanders
Vijayadeva V , Spradling PR , Moorman AC , Rupp LB , Mei L , Gordon SC , Henkle E , Boscarino JA , Teshale EH , Nakasato C . Am J Manag Care 2014 20 (4) e98-e104 OBJECTIVES: Asian and Pacific Islanders (APIs) constitute less than 6% of the US population, but account for more than half of Americans with chronic hepatitis B virus (HBV) infection. We sought to examine the effect of country of origin on HBV testing and chronic HBV infection prevalence among APIs. METHODS: We analyzed demographic and clinical data collected for adults from Kaiser Permanente Hawaii with 1 or more healthcare encounters during 2006 to 2008, 12 months or more of follow-up before 2009, and no HBV-related diagnosis within 6 months of enrollment. Persons who received a test and a positive test result for HBV surface antigen or HBV DNA were classified "tested" and with "chronic HBV infection," respectively. RESULTS: Of 92,687 eligible APIs, 53,573 (58%) had country-of-origin data available. Among those, 41,263 were US born; 28.3% were tested; and 1.8% of those tested had chronic HBV infection. Of 12,310 foreign-born APIs, 30.5% were tested and 7.4% of those tested had chronic HBV infection. Foreign-born APIs had higher odds of being tested (odds ratio [OR] = 1.15) and testing positive (OR = 4.18) compared with US-born APIs. Persons with 2 or more abnormal tests for alanine aminotransferase (ALT) levels had higher odds of getting tested (OR = 6.12) and of testing positive (OR = 1.86) compared with persons with other ALT levels. CONCLUSIONS: Less than one-third of this managed care API population (29% of 53,573) was tested, yet the prevalence of chronic HBV infection (3.2%) was 12 times higher than that of the general US population. These findings underscore the importance of adherence to HBV testing guidelines to identify persons with infection so they may be linked to care. |
Hepatitis C disease burden and strategies to manage the burden (Guest Editors Mark Thursz, Gregory Dore and John Ward)
Dore GJ , Ward J , Thursz M . J Viral Hepat 2014 21 Suppl 1 1-4 Chronic hepatitis C virus (HCV) infection leads to liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The recent Global Burden of Disease project estimated that in 2010 among 170 million people living with chronic HCV, an estimated 483 100 people died from HCV-related liver failure or HCC. The last two decades has seen progressive improvements in treatment of HCV infection with the most recent therapies offering simple, tolerable, short-duration therapy with extremely high efficacy. The development of public health strategies addressing emerging epidemics requires sound epidemiological data. This study covers epidemiological data collection, detailed expert opinion input and country-specific mathematical modelling of the HCV epidemic and potential impact of improved HCV treatment strategies in 16 countries. The analysis demonstrates that the HCV epidemics vary considerably in terms of age distribution of the infected population across countries. In addition, the burden of advanced liver disease varies widely. This burden is dependent upon factors including chronic HCV prevalence, age distribution (and duration of infection) of those infected, prevalence of cofactors for disease progression (particularly heavy alcohol intake) and uptake and success of therapeutic intervention. Introduction of new therapies with assumed sustained virological response (SVR) rate of >90% will have a modest impact on projected advanced liver disease burden. A combination of enhanced treatment efficacy and improved treatment uptake will have a greater impact on population-level disease burden. However public health advocacy and both public and private sector investment in the HCV response are required to demonstrate significant reduction in HCV disease burden. |
HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies
Lasry A , Sansom SL , Wolitski RJ , Green TA , Borkowf CB , Patel P , Mermin J . AIDS 2014 28 (10) 1521-9 BACKGROUND: The number of strategies to prevent HIV transmission has increased following trials evaluating antiretroviral therapy (ART), preexposure prophylaxis (PrEP) and male circumcision. Serodiscordant couples need guidance on the effects of these strategies alone, and in combination with each other, on HIV transmission. METHODS: We estimated the sexual risk of HIV transmission over 1-year and 10-year periods among male-male and male-female serodiscordant couples. We assumed the following reductions in transmission: 80% from consistent condom use; 54% from circumcision in the negative male partner of a heterosexual couple; 73% from circumcision in the negative partner of a male-male couple; 71% from PrEP in heterosexual couples; 44% from PrEP in male-male couples; and 96% from ART use by the HIV-infected partner. FINDINGS: For couples using any single prevention strategy, a substantial cumulative risk of HIV transmission remained. For a male-female couple using only condoms, estimated risk over 10 years was 11%; for a male-male couple using only condoms, estimated risk was 76%. ART use by the HIV-infected partner was the most effective single strategy in reducing risk; among male-male couples, adding consistent condom use was necessary to keep the 10-year risk below 10%. CONCLUSION: Focusing on 1-year and longer term transmission probabilities gives couples a better understanding of risk than those illustrated by data for a single sexual act. Long-term transmission probabilities to the negative partner in serodiscordant couples can be high, though these can be substantially reduced with the strategic use of preventive methods, especially those that include ART. |
Influenza-associated hospitalizations and deaths, Costa Rica, 2009-2012
Saborio GG , Clara A , Garcia A , Quesada F , Palekar R , Minaya P , Cervantes M , Lopez M , Lara J , Jara J , Blanco N , Bresee J , Widdowson MA , Azziz-Baumgartner E . Emerg Infect Dis 2014 20 (5) 878-81 Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. There were approximately 6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009-2012, supporting continuation of a national influenza vaccine program. |
Antiviral therapy for chronic hepatitis B virus infection and development of hepatocellular carcinoma in a US population
Gordon SC , Lamerato LE , Rupp LB , Li J , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Vijayadeva V , Boscarino JA , Henkle EM , Oja-Tebbe N , Lu M . Clin Gastroenterol Hepatol 2014 12 (5) 885-93 BACKGROUND & AIMS: Antiviral therapy could reduce the risk of hepatocellular carcinoma (HCC) among persons with chronic hepatitis B virus (HBV) infection. We evaluated the relationship between therapy for chronic HBV infection and HCC incidence using data from a longitudinal study of patients at 4 US healthcare centers. METHODS: We analyzed electronic health records of 2671 adult participants in the Chronic Hepatitis Cohort Study who were diagnosed with chronic HBV infection from 1992 through 2011 (49% Asian). Data analyzed were collected for a median of 5.2 years. Propensity-score adjustment was used to reduce bias, and Cox regression was used to estimate the relationship between antiviral treatment and HCC. The primary outcome was time to event of HCC incidence. RESULTS: Of study subjects, 3% developed HCC during follow-up period: 20 cases among the 820 patients with a history of antiviral HBV therapy and 47 cases among the 1851 untreated patients. In propensity-adjusted Cox regression, patients who received antiviral therapy had a lower risk of HCC than those who did not receive antiviral therapy (adjusted hazard ratio, 0.39; 95% confidence interval, 0.27-0.56; P < .001), after adjusting for abnormal level of alanine aminotransferase. In a subgroup analysis, antiviral treatment was associated with a lower risk of HCC after adjusting for serum markers of cirrhosis (adjusted hazard ratio, 0.24; 95% confidence interval, 0.15-0.39; P < .001). In a separate subgroup analysis of patients with available data on HBV DNA viral load, treated patients with viral loads >20,000 IU/mL had a significantly lower risk of HCC than untreated patients with viral loads >20,000 IU/mL. CONCLUSIONS: In a large geographically, clinically, and racially diverse US cohort, antiviral therapy for chronic HBV infection was associated with a reduced risk for HCC. |
Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya
Otieno FO , Ndivo R , Oswago S , Pals S , Chen R , Thomas T , Kunneke E , Mills LA , McLellan-Lemal E . Int J STD AIDS 2014 26 (4) 225-37 BACKGROUND: We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya. METHODS: Participants were enrolled from a convenience sample and underwent aetiologic sexually transmitted infection investigation. Demographic and behavioural information were collected and basic clinical evaluation performed. Multiple regression analysis was done to determine variables associated with having one or more sexually transmitted infections. RESULTS: We screened 846, 18- to 34-year-olds. One-third had at least one sexually transmitted infection with specific prevalence being, syphilis; 1.6%, gonorrhoea; 2.4%, herpes simplex virus type-2; 29.1%, chlamydia; 2.8%, and HIV; 14.8%. Odds of having any sexually transmitted infection were higher among participants who were women, were aged 20-24 or 30-34 years compared to 18-19 years, had secondary or lower education compared to tertiary education, were divorced, widowed or separated compared to singles, reported having unprotected sex compared to those who did not, reported previous sexually transmitted infection treatment, and tested HIV-positive. CONCLUSION: Multiple strategies are needed to address the overall high prevalence of sexually transmitted infections as well as the gender disparity found in this Kenyan population. Structural interventions may be beneficial in addressing educational and socio-economic barriers, and increasing the uptake of health-promoting practices. |
Travel to Brazil: analysis of data from the Boston Area Travel Medicine Network (BATMN) and relevance to travelers attending World Cup and Olympics
Iliaki E , Chen LH , Hamer DH , Macleod WB , Jentes ES , Barnett ED , Wilson ME . J Travel Med 2014 21 (3) 214-7 We describe travelers who were evaluated pre-travel to Brazil from March 2008 through July 2010 in the Boston area. Of 599 Brazil travelers, 71%, 58%, and 50% received vaccines for yellow fever (YF), typhoid, and hepatitis A, respectively. Fewer received influenza and hepatitis B vaccines (14%, 11%). A total of 60% traveled during Brazil's peak influenza season, and one fourth visited during peak dengue transmission. The 2014 World Cup and 2016 Olympics include events throughout Brazil. Travelers should seek pre-travel assessment including YF and malaria risk; travelers should be vaccinated against influenza, be up to date on other routine vaccines, and be prepared to protect themselves against mosquitoes. |
Implications of the fast-evolving scale-up of adult voluntary medical male circumcision for quality of services in South Africa
Rech D , Spyrelis A , Frade S , Perry L , Farrell M , Fertziger R , Toledo C , Castor D , Njeuhmeli E , Loykissoonlal D , Bertrand JT . PLoS One 2014 9 (5) e80577 BACKGROUND: The scale-up of voluntary medical male circumcision (VMMC) services in South Africa has been rapid, in an attempt to achieve the national government target of 4.3 million adult male circumcisions for HIV prevention by 2016. This study assesses the effect of the scale-up on the quality of the VMMC program. METHODS AND FINDINGS: This analysis compares the quality of services at 15 sites operational in 2011 to (1) the same 15 sites in 2012 and (2) to a set of 40 sites representing the expanded program in 2012. Trained clinicians scored each site on 29 items measuring readiness to provide quality services (abbreviated version of the WHO Quality Assessment [QA] Guide) and 29 items to assess quality of surgical care provided (pre-op, surgical technique and post-op) based on the observation of VMMC procedures at each site. Declines in quality far outnumbered improvements. The negative effects in terms of readiness to provide quality services were most evident in expanded sites, whereas the declines in provision of quality services tended to affect both repeat sites and expanded sites equally. Areas of notable concern included the monitoring of adverse events, external supervision, post-operative counselling, and some infection control issues. Scores on quality of surgical technique tended to be among the highest across the 58 items observed, and the South Africa program has clearly institutionalized three "best practices" for surgical efficiency. CONCLUSIONS: These findings demonstrate the challenges of rapidly developing large numbers of new VMMC sites with the necessary equipment, supplies, and protocols. The scale-up in South Africa has diluted human resources, with negative effects for both the original sites and the expanded program. |
Estimation of insecticide persistence, biological activity and mosquito resistance to PermaNet(R) 2 long-lasting insecticidal nets over three to 32 months of use in Ethiopia
Anshebo GY , Graves PM , Smith SC , Wills AB , Damte M , Endeshaw T , Shargie EB , Gebre T , Mosher AW , Patterson AE , Emerson PM . Malar J 2014 13 (1) 80 BACKGROUND: Information is needed on the expected durability of insecticidal nets under operational conditions. The persistence of insecticidal efficacy is important to estimate the median serviceable life of nets under field conditions and to plan for net replacement. METHODS: Deltamethrin residue levels were evaluated by the proxy method of X-ray fluorescence spectrometry on 189 nets used for three to six months from nine sites, 220 nets used for 14-20 months from 11 sites, and 200 nets used for 26-32 months from ten sites in Ethiopia. A random sample of 16.5-20% of nets from each time period (total 112 of 609 nets) were tested by bioassay with susceptible mosquitoes, and nets used for 14-20 months and 26-32 months were also tested with wild caught mosquitoes. RESULTS: Mean insecticide levels estimated by X-ray fluorescence declined by 25.9% from baseline of 66.2 (SD 14.6) mg/m2 at three to six months to 44.1 (SD 21.2) mg/m2 at 14-20 months and by 30.8% to 41.1 (SD 18.9) mg/m2 at 26-32 months. More than 95% of nets retained greater than 10 mg/m2 of deltamethrin and over 79% had at least 25 mg/m2 at all time periods. By bioassay with susceptible Anopheles, mortality averaged 89.0% on 28 nets tested at three to six months, 93.3% on 44 nets at 14-20 months and 94.1% on 40 nets at 26-32 months. With wild caught mosquitoes, mortality averaged 85.4% (range 79.1 to 91.7%) at 14-20 months but had dropped significantly to 47.2% (39.8 to 54.7%) at 26-32 months. CONCLUSIONS: Insecticide residue level, as estimated by X-ray fluorescence, declined by about one third between three and six months and 14-20 months, but remained relatively stable and above minimum requirements thereafter up to 26-32 months. The insecticidal activity of PermaNet(R) 2.0 long-lasting insecticidal nets in the specified study area may be considered effective to susceptible mosquitoes at least for the duration indicated in this study (32 months). However, results indicated that resistance in the wild population is already rendering nets with optimum insecticide concentrations less effective in practice. |
Risk of adverse health outcomes with increasing duration and regularity of opioid therapy
Paulozzi LJ , Zhang K , Jones CM , Mack KA . J Am Board Fam Med 2014 27 (3) 329-38 PURPOSE: The purpose of this study was to examine trends in frequency and daily dosage of opioid use and related adverse health outcomes in a commercially insured population. METHODS: We examined medical claims from the Truven Health MarketScan commercial claims database for 789,457 continuously enrolled patients ages 18 to 64 years to whom opioids were dispensed during the first half of 2008. We tracked them every 6 months until either opioid use was discontinued or the end of 2010. We compared outcomes among all opioid users with those for patients who used opioids with only limited interruptions during the index period, referred to as "daily users." We contrasted the experience of daily users, other users, and nonusers for various outcomes. RESULTS: Of all claimants, 10.7% had at least one opioid prescription during the first 6 months of 2008. Of these, 39.9% continued through a second 6-month period, and 18.0% continued through the end of 2010. Only 9.0% of all users qualified as daily users, but 87.1% of them continued some use of opioids through the end of 2010. Only 43.8% of all users who continued use through 2010 initially qualified as daily users. Among all users who continued use through 2010, days of use and daily dosage increased with duration of use. Among daily users, only dosage increased, rising from 101 to 114 morphine milligram equivalents/day over the 3 years. The prevalence of benzodiazepine use was greater for daily than all users, exceeding 40% among daily users who continued opioid use for 3 years. Drug abuse and overdose rates increased with longer use. Daily users accounted for 25.0%, other users for 43.6%, and nonusers for 31.4% of opioid analgesic overdoses. CONCLUSIONS: Adverse health outcomes can increase with accumulating opioid use and increasing dosage. Existing guidelines developed by specialty societies for managing patients using opioids daily or nearly daily do not address the larger number of patients who use opioids intermittently over periods of years. Practitioners should consider applying such guidelines to patients who use opioids less frequently. |
Perfluorooctanoate exposure and major birth defects
Stein CR , Savitz DA , Elston B , Thorpe PG , Gilboa SM . Reprod Toxicol 2014 47 15-20 Perfluorooctanoate (PFOA) is detectable in umbilical cord blood and amniotic fluid. Some toxicological findings suggest that perfluoroalkyl substances may be teratogenic. Using data from the C8 Health Project, a 2005-2006 survey in a Mid-Ohio Valley community exposed to PFOA through contaminated drinking water, we examined the association between estimated prenatal PFOA concentration and maternally reported birth defects (n=325) among 10,262 live singleton or multiple births from 1990-2006. Logistic regression models accounted for siblings using generalized estimating equations. There was generally no association between estimated PFOA concentration and birth defects, with the possible exception of brain defects, where the odds ratio adjusted for year of conception was 2.6 (95% confidence interval 1.3-5.1) for an increase in estimated PFOA exposure from the 25th to 75th percentile. This estimate, however, was based on 13 cases and may represent a chance finding. Further investigation of this potential association may be warranted. |
Efficacy of chlorine dioxide tablets on inactivation of Cryptosporidium oocysts
Murphy JL , Haas CN , Arrowood MJ , Hlavsa MC , Beach MJ , Hill VR . Environ Sci Technol 2014 48 (10) 5849-56 The ability of chlorine dioxide (ClO2) to achieve 2-log inactivation of Cryptosporidium in drinking water has been documented. No studies have specifically addressed the effects of ClO2 on C. parvum oocyst infectivity in chlorinated recreational water venues (e.g., pools). The aim of this research was to determine the efficacy of ClO2 as an alternative to existing hyperchlorination protocols that are used to achieve a 3-log inactivation of Cryptosporidium in such venues. To obtain a 3-log inactivation of C. parvum Iowa oocysts, contact times of 105 and 128 min for a solution containing 5 mg/L ClO2 with and without the addition of 2.6 mg/L free chlorine, respectively, were required. Contact times of 294 and 857 min for a solution containing 1.4 mg/L ClO2 with and without the addition of 3.6 mg/L free chlorine, respectively, were required. The hyperchlorination control (21 mg/L free chlorine only) required 455 min for a 3-log inactivation. Use of a solution containing 5 mg/L ClO2 and solutions containing 5 or 1.4 mg/L ClO2 with the addition of free chlorine appears to be a promising alternative to hyperchlorination for inactivating Cryptosporidium in chlorinated recreational water venues, but further studies are required to evaluate safety constraints on use. |
Indoor exposure to particulate matter and age at first acute lower respiratory infection in a low-income urban community in Bangladesh
Gurley ES , Salje H , Homaira N , Ram PK , Haque R , Petri WA Jr , Bresee J , Moss WJ , Luby SP , Breysse P , Azziz-Baumgartner E . Am J Epidemiol 2014 179 (8) 967-73 The timing of a child's first acute lower respiratory infection (ALRI) is important, because the younger a child is when he or she experiences ALRI, the greater the risk of death. Indoor exposure to particulate matter less than or equal to 2.5 microm in diameter (PM2.5) has been associated with increased frequency of ALRI, but little is known about how it may affect the timing of a child's first ALRI. In this study, we aimed to estimate the association between a child's age at first ALRI and indoor exposure to PM2.5 in a low-income community in Dhaka, Bangladesh. We followed 257 children from birth through age 2 years to record their age at first ALRI. Between May 2009 and April 2010, we also measured indoor concentrations of PM2.5 in children's homes. We used generalized gamma distribution models to estimate the relative age at first ALRI associated with the mean number of hours in which PM2.5 concentrations exceeded 100 microg/m(3). Each hour in which PM2.5 levels exceeded 100 microg/m(3) was independently associated with a 12% decrease (95% confidence interval: 2, 21; P = 0.021) in age at first ALRI. Interventions to reduce indoor exposure to PM2.5 could increase the ages at which children experience their first ALRI in this urban community. |
Single donor-derived strongyloidiasis in three solid organ transplant recipients: case series and review of the literature
Le M , Ravin K , Hasan A , Clauss H , Muchant DG , Pasko JK , Cipollina G , Abanyie F , Montgomery SP , Loy M , Ahmed M , Mathur M , Chokkalingam Mani B , Mehr J , Kotru A , Varma C , Maksimak M , Schultz M , Obradovic G , Alvarez R , Toyoda Y , Birkenbach M , Brunner E , Nelson J . Am J Transplant 2014 14 (5) 1199-206 Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney-pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed. S. stercoralis larvae were detected in duodenal aspirates, bronchial washings, cerebrospinal fluid, urine and stool specimens. Treatment with ivermectin and albendazole was successful in two of the three patients identified. The Centers for Disease Control and Prevention was contacted and performed an epidemiologic investigation. Donor serology was strongly positive for S. stercoralis antibodies on retrospective testing while all pretransplant recipient serum was negative. There should be a high index of suspicion for parasitic infection in transplant recipients and donors from endemic regions of the world. This case series underscores the need for expanded transplant screening protocols for Strongyloides. Positive serologic or stool tests should prompt early treatment or prophylaxis in donors and recipients as well as timely notification of organ procurement organizations and transplant centers. |
A new approach to mitigate biofilm formation on totally implantable venous access ports
Donlan RM . J Infect Dis 2014 210 (9) 1345-6 Use of intravascular catheters for patient care may be associated with increased risk of central line-associated bloodstream infections. It is estimated that up to 18 000 such infections occurred in intensive care units and up to 23 000 in inpatient wards of acute care hospitals in the United States in 2009 [1]. These device-associated infections result in significant morbidity, mortality, and costs of healthcare delivery in these patient populations. The infections result when microorganisms, introduced from the skin of the patient at the catheter insertion site, from a contaminated hub or needleless connector, or from hematogenous seeding, colonize the catheter and form a biofilm. The process of biofilm formation is initiated when microbial cells attach to the surfaces of the indwelling device. Microbial attachment is a complex process, affected by the chemical and physical characteristics of the substratum, host-produced conditioning films, hydrodynamics, characteristics of the aqueous medium, and properties of the microbial cell surface [2]. | A distinguishing characteristic of biofilms is the presence of an extracellular polymeric substance matrix, also known as the biofilm EPS (extracellular polymeric substance). The biofilm EPS matrix may be composed of polysaccharides, proteins, and extracellular DNA and may perform a number of important functions for the component organisms, including adhesion, aggregation, and protection from the host immune system and antimicrobial agents [3]. Inhibition of biofilm formation is preferred to eradication of an established biofilm because organisms rapidly develop tolerance to antimicrobial agents, a characteristic that worsens as the biofilm ages [4]. Biofilms on central venous catheters are difficult to eradicate, and for certain organisms (eg, Staphylococcus aureus), removal of the device may be the only option. |
Acinetobacter bacteraemia in Thailand: evidence for infections outside the hospital setting
Porter KA , Rhodes J , Dejsirilert S , Henchaichon S , Siludjai D , Thamthitiwat S , Prapasiri P , Jorakate P , Kaewpan A , Peruski LF , Kerdsin A , Prasert K , Yuenprakone S , Maloney SA , Baggett HC . Epidemiol Infect 2014 142 (6) 1317-27 Acinetobacter is a well-recognized nosocomial pathogen. Previous reports of community-associated Acinetobacter infections have lacked clear case definitions and assessment of healthcare-associated (HCA) risk factors. We identified Acinetobacter bacteraemia cases from blood cultures obtained <3 days after hospitalization in rural Thailand and performed medical record reviews to assess HCA risk factors in the previous year and compare clinical and microbiological characteristics between cases with and without HCA risk factors. Of 72 Acinetobacter cases, 32 (44%) had no HCA risk factors. Compared to HCA infections, non-HCA infections were more often caused by Acinetobacter species other than calcoaceticus-baumannii complex species and by antibiotic-susceptible organisms. Despite similar symptoms, the case-fatality proportion was lower in non-HCA than HCA cases (9% vs. 45%, P < 0.01). Clinicians should be aware of Acinetobacter as a potential cause of community-associated infections in Thailand; prospective studies are needed to improve understanding of associated risk factors and disease burden. |
Trends in racial/ethnic disparities in influenza vaccination coverage among adults during the 2007-08 through 2011-12 seasons
Lu PJ , O'Halloran A , Bryan L , Kennedy ED , Ding H , Graitcer SB , Santibanez TA , Meghani A , Singleton JA . Am J Infect Control 2014 42 (7) 763-9 BACKGROUND: Annual influenza vaccination is recommended for all persons aged ≥6 months. The objective of this study was to assess trends in racial/ethnic disparities in influenza vaccination coverage among adults in the United States. METHODS: We analyzed data from the 2007-2012 National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS) using Kaplan-Meier survival analysis to assess influenza vaccination coverage by age, presence of medical conditions, and racial/ethnic groups during the 2007-08 through 2011-12 seasons. RESULTS: During the 2011-12 season, influenza vaccination coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites among most of the adult subgroups, with smaller disparities observed for adults age 18-49 years compared with other age groups. Vaccination coverage for non-Hispanic white, non-Hispanic black, and Hispanic adults increased significantly from the 2007-08 through the 2011-12 season for most of the adult subgroups based on the NHIS (test for trend, P < .05). Coverage gaps between racial/ethnic minorities and non-Hispanic whites persisted at similar levels from the 2007-08 through the 2011-12 seasons, with similar results from the NHIS and BRFSS. CONCLUSIONS: Influenza vaccination coverage among most racial/ethnic groups increased from the 2007-08 through the 2011-12 seasons, but substantial racial and ethnic disparities remained in most age groups. Targeted efforts are needed to improve coverage and reduce these disparities. |
Yellow fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data
Garske T , Van Kerkhove MD , Yactayo S , Ronveaux O , Lewis RF , Staples JE , Perea W , Ferguson NM . PLoS Med 2014 11 (5) e1001638 BACKGROUND: Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. METHODS AND FINDINGS: Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000-380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000-180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%-31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. CONCLUSIONS: With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns. |
Modeling the effect of different vaccine effectiveness estimates on the number of vaccine prevented influenza associated hospitalizations in older adults
Fry AM , Kim IK , Reed C , Thompson M , Chaves SS , Finelli L , Bresee J . Clin Infect Dis 2014 59 (3) 406-9 We compared influenza vaccine-prevented hospitalizations in adults aged >65 years for a range of hypothetical effectiveness estimates. During 2012-13, a vaccine with 10% effectiveness (66% coverage) would have averted approximately 13,000 hospitalizations and a vaccine with 40% effectiveness would have averted approximately 60,000 hospitalizations. Annual vaccination is merited in this vulnerable population. |
Non dermatomal rash and pancytopenia in a 5 year old child
Khandelwal P , Marsh R , Schmid DS , Folster J , Radford KW , Davies SM , Filipovich A . J Clin Virol 2014 60 (2) 81-3 Immune deficiency patients can have unusual presentations to vaccines. | Vaccine strain varicella can cause a non-dermatomal rash. | Hemophagocytic lymphohistiocytosis may be triggered by vaccine strain varicella. |
Influenza seasonality: timing and formulation of vaccines
Cox N . Bull World Health Organ 2014 92 (5) 311-311 In all countries with temperate climates, a clear seasonal peak in influenza activity occurs during the winter months.1 In countries with tropical or subtropical climates, however, influenza seasonality is more variable and influenza activity can be observed year-round – although it often is more intense during the rainy seasons.2 | Effective surveillance is essential for understanding influenza seasonality and for determining the best strategies for influenza control. The extensive influenza surveillance network that was established by the World Health Organization (WHO) during the 1950s has developed into the Global Influenza Surveillance and Response System. The tropical and subtropical Asian countries that participate in this system have recently expanded their influenza surveillance. This expansion has revealed not only that the patterns of influenza virus circulation in southern and south-eastern Asia are complex but also that influenza activity in this area may show no marked seasonality.3 | The results of a recent analysis of influenza surveillance data collected between 2006 and 2011 in Bangladesh, Cambodia, India, Indonesia, the Lao People's Democratic Republic, Malaysia, the Philippines, Singapore, Thailand and Viet Nam are published in this issue of the Bulletin of the World Health Organization.4 Although this analysis revealed year-round circulation of influenza viruses in all 10 study countries, two main patterns of influenza seasonality were also evident.4 In Indonesia, Malaysia and Singapore – i.e. the study countries that lie on or close to the Equator – there was no obvious discrete peak in influenza activity. In the whole or part of each of the seven other – more northern but still at least partially tropical – study countries, influenza activity showed a distinct peak between July and October, in the summer monsoon season. This peak contrasted with the winter peak that typifies influenza seasonality in the more temperate areas of the world.3,5 As a latitude of about 30°N appeared to mark the northern limit of influenza with a summer peak in activity, some study countries – such as India – had influenza with a summer peak in the south but influenza with a winter peak in the north. A similar relationship between latitude and the timing of peak influenza activity has been observed in Brazil and China, which each have land masses that stretch for thousands of kilometres from north to south.6,7 |
Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care
Zimmerman RK , Nowalk MP , Lin CJ , Hannibal K , Moehling KK , Huang HH , Matambanadzo A , Troy J , Allred NJ , Gallik G , Reis EC . Vaccine 2014 32 (29) 3656-63 PURPOSE: To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial. METHODS: Twenty primary care practices treating children (range for n=536-8183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months-18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010-2011 and 2011-2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes. RESULTS: Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P<0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms - 8/10 Intervention (P<0.001) and 7/10 Control sites (P-values 0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23-1.34), having commercial insurance (OR=1.30; 95%CI=1.25-1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16-1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01-1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates. CONCLUSIONS: Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates. CLINICAL TRIAL REGISTRY NAME/NUMBER: From Innovation to Solutions: Childhood Influenza. |
Validation of the ligase detection reaction fluorescent microsphere assay for the detection of Plasmodium falciparum resistance mediating polymorphisms in Uganda
Nankoberanyi S , Mbogo GW , LeClair NP , Conrad MD , Tumwebaze P , Tukwasibwe S , Kamya MR , Tappero J , Nsobya SL , Rosenthal PJ . Malar J 2014 13 (1) 95 BACKGROUND: Malaria remains a major public health problem, and its control has been hampered by drug resistance. For a number of drugs, Plasmodium falciparum single nucleotide polymorphisms (SNPs) are associated with altered drug sensitivity and can be used as markers of drug resistance. Several techniques have been studied to assess resistance markers. The most widely used methodology is restriction fragment length polymorphism (RFLP) analysis. The ligase detection reaction fluorescent microsphere (LDR-FM) assay was recently shown to provide high throughput assessment of P. falciparum SNPs associated with drug resistance. The aim of this study was to validate the reliability and accuracy of the LDR-FM assay in a field setting. METHODS: For 223 samples from a clinical trial in Tororo, Uganda in which P. falciparum was identified by blood smear, DNA was extracted from dried blood spots, genes of interest were amplified by PCR, amplicons were analysed by both RFLP and LDR-FM assays, and results were compared. RESULTS: SNP prevalence (wild type/mixed/mutant) with RFLP analysis was 8/5/87% for pfcrt K76T, 34/37/29% for pfmdr1 N86Y, 64/17/19% for pfmdr1 Y184F, and 42/21/37% for pfmdr1 D1246Y. These prevalences with the LDR-FM assay were 7/5/88%, 31/24/45%, 62/20/18%, and 48/19/33% for the four SNPs, respectively. Combining mixed and mutant outcomes for analysis, agreement between the assays was 97% (K=0.77) for pfcrt K76T, 79% (K=0.55) for pfmdr1 N86Y, 83% (K=0.65) for pfmdr1 Y184F, and 91% (K=0.82) for pfmdr1 D1246Y, with most disagreements due to discrepant readings of mixed genotypes. CONCLUSION: The LDR-FM assay provides a high throughput, relatively inexpensive and accurate assay for the surveillance of P. falciparum SNPs associated with drug resistance in resource-limited countries. |
The equivalence of the ray tracing and modal methods for modeling radio propagation in lossy rectangular tunnels
Zhou C , Waynert J . IEEE Antennas Wirel Propag Lett 2014 13 615-618 Ray tracing and modal methods are widely used for modeling RF propagation in tunnels. In this letter, we show that the two methods are mathematically equivalent and yield the same results. We also compare the theoretical predictions from both methods to field measurements at different frequencies (455, 915, 2450, and 5800 MHz) and find good agreement. |
Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes
De-Regil LM , Pena-Rosas JP , Flores-Ayala R , del Socorro Jefferds ME . Public Health Nutr 2014 17 (3) 634-9 OBJECTIVE: Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. DESIGN: The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. RESULTS: In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. CONCLUSIONS: The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health. |
Toluene diisocyanate (TDI) disposition and co-localization of immune cells in hair follicles
Nayak AP , Hettick JM , Siegel PD , Anderson SE , Long CM , Green BJ , Beezhold DH . Toxicol Sci 2014 140 (2) 327-37 Diisocyanates (dNCOs) are potent chemical allergens utilized in various industries. It has been proposed that skin exposure to dNCOs produces immune sensitization leading to work-related asthma and allergic disease. We examined dNCOs sensitization by using a dermal murine model of toluene diisocyanate (TDI) exposure to characterize the disposition of TDI in the skin, identify the predominant haptenated proteins, and discern the associated antigen uptake by dendritic cells. Ears of BALB/c mice were dosed once with TDI (0.1% or 4% v/v acetone). Ears and draining lymph nodes (DLNs) were excised at selected time points between 1 h and 15 days post-exposure and were processed for histological, immunohistochemical, and proteomic analyses. Monoclonal antibodies specific for TDI-haptenated protein (TDI-hp) and antibodies to various cell markers were utilized with confocal microscopy to determine co-localization patterns. Histopathological changes were observed following exposure in ear tissue of mice dosed with 4% TDI/acetone. Immunohistochemical staining demonstrated TDI-hp localization in the stratum corneum, hair follicles, and sebaceous glands. TDI-hp were co-localized with CD11b+ (integrin alphaM/Mac-1), CD207+ (langerin), and CD103+ (integrin alphaE) cells in the hair follicles and in sebaceous glands. TDI-hp were also identified in the DLN 1 h post-exposure. Cytoskeletal and cuticular keratins along with mouse serum albumin were identified as major haptenated species in the skin. The results of this study demonstrate that the stratum corneum, hair follicles, and associated sebaceous glands in mice are dendritic cell accessible reservoirs for TDI-hp and thus identify a mechanism for immune recognition following epicutaneous exposure to TDI. |
Urinary polycyclic aromatic hydrocarbon (OH-PAH) metabolite concentrations and the effect of GST polymorphisms among US Air Force personnel exposed to jet fuel
Rodrigues EG , Smith K , Maule AL , Sjodin A , Li Z , Romanoff L , Kelsey K , Proctor S , McClean MD . J Occup Environ Med 2014 56 (5) 465-71 OBJECTIVE: To evaluate the association between inhalation exposure to jet propulsion fuel 8 (JP-8) and urinary metabolites among US Air Force (USAF) personnel, and investigate the role of glutathione S-transferase polymorphisms. METHODS: Personal air samples were collected from 37 full-time USAF personnel during 4 consecutive workdays and analyzed for JP-8 constituents and total hydrocarbons. Pre- and postshift urine samples were collected each day and analyzed for polycyclic aromatic hydrocarbon urinary metabolites. RESULTS: Work shift exposure to total hydrocarbons was significantly associated with postshift urinary 1-naphthol (beta = 0.17; P = <0.0001), 2-naphthol (beta = 0.09; P = 0.005), and 2-hydroxyfluorene concentrations (beta = 0.08; P = 0.006), and a significant gene-environment interaction was observed with glutathione S-transferase mu-1. CONCLUSIONS: USAF personnel experience inhalation exposure to JP-8, which is associated with absorption of JP-8 constituents while performing typical job-related tasks, and in our data the glutathione S-transferase mu-1 polymorphism was associated with differential metabolism of naphthalene. |
Measurement of mass-based carbon nanotube penetration through filtering facepiece respirator filtering media
Vo E , Zhuang Z , Birch E , Zhao Q , Horvatin M , Liu Y . Ann Occup Hyg 2014 58 (5) 646-56 Recent studies suggest that a wide range of human health effects could result from exposure to carbon nanotubes (CNTs). A National Institute for Occupational Safety and Health survey of the carbonaceous nanomaterial industry found that 77% of the companies used respiratory protection, such as filtering facepiece respirators (FFRs). Despite CNT studies in some occupational settings being reported, the literature for mass-based penetration of CNTs through FFRs is lacking. The aim of this study was to conduct a quantitative study of single-walled CNT (SWCNT) and multiwalled CNT (MWCNT) penetration through FFRs. A CNT aerosol respirator testing system was used to generate charge-neutralized airborne SWCNTs and MWCNTs for this study. The size distribution was 20-10000nm, with 99% of the particles between 25 and 2840nm. Mass median diameters were 598 and 634nm with geometric standard deviations of 1.34 and 1.48 for SWCNTs and MWCNTs, respectively. Upstream and downstream CNTs were collected simultaneously using closed-face 3.7-cm-diameter filter cassettes. These samples were subsequently analyzed for organic carbon and elemental carbon (EC), with EC as a measure of mass-based CNTs. The mass-based penetration of SWCNTs and MWCNTs through six FFR models at constant flow rates of 30 l min-1 (LPM) was determined. Generally, the penetrations of SWCNTs and MWCNTs at 30 LPM had a similar trend and were highest for the N95 FFRs, followed by N99 and P100 FFRs. The mass-based penetration of MWCNTs through six FFR models at two constant flow rates of 30 and 85 LPM was also determined. The penetration of MWCNTs at 85 LPM was greater compared with the values of MWCNTs at 30 LPM. |
Occupational fatalities among driver/sales workers and truck drivers in the United States, 2003-2008
Chen GX , Amandus HE , Wu N . Am J Ind Med 2014 57 (7) 800-9 BACKGROUND: This study provides a national profile of occupational fatalities among truck drivers and driver-sales workers. METHODS: Data from the 2003-2008 Census of Fatal Occupational Injuries were used. Cases were extracted specifically for occupational subcategories included in the Driver/Sales Workers and Truck Drivers occupational category: Driver/Sales Workers, Heavy and Tractor-Trailer Truck Drivers, and Light Truck or Delivery Services Drivers. RESULTS: In 2003-2008, the group Driver/Sales Workers and Truck Drivers had 5,568 occupational fatalities, representing 17% of all occupational fatalities in the United States. The majority of these fatalities were in the subgroup Heavy and Tractor-Trailer Truck Drivers (85%) and due to transportation incidents (80%). Older and male drivers had higher fatality rates than their counterparts. CONCLUSIONS: Findings suggest a need for targeted interventions to reduce highway fatalities among heavy truck drivers. Better employment data are needed to separate the three occupational subcategories by worker characteristic and employment history for use in research and prevention efforts. |
Interactive effects of cerium oxide and diesel exhaust nanoparticles on inducing pulmonary fibrosis
Ma JY , Young SH , Mercer RR , Barger M , Schwegler-Berry D , Ma JK , Castranova V . Toxicol Appl Pharmacol 2014 278 (2) 135-47 Cerium compounds have been used as a fuel-borne catalyst to lower the generation of diesel exhaust particles (DEPs), but are emitted as cerium oxide nanoparticles (CeO2) along with DEP in the diesel exhaust. The present study investigates the effects of the combined exposure to DEP and CeO2 on the pulmonary system in a rat model. Specific pathogen-free male Sprague-Dawley rats were exposed to CeO2 and/or DEP via a single intratracheal instillation and were sacrificed at various time points post-exposure. This investigation demonstrated that CeO2 induces a sustained inflammatory response, whereas DEP elicits a switch of the pulmonary immune response from Th1 to Th2. Both CeO2 and DEP activated AM and lymphocyte secretion of the proinflammatory cytokines IL-12 and IFN-gamma, respectively. However, only DEP enhanced the anti-inflammatory cytokine IL-10 production in response to ex vivo LPS or Concanavalin A challenge that was not affected by the presence of CeO2, suggesting that DEP suppresses host defense capability by inducing the Th2 immunity. The micrographs of lymph nodes show that the particle clumps in DEP+CeO2 were significantly larger than CeO2 or DEP, exhibiting dense clumps continuous throughout the lymph nodes. Morphometric analysis demonstrates that the localization of collagen in the lung tissue after DEP+CeO2 reflects the combination of DEP-exposure plus CeO2-exposure. At 4weeks post-exposure, the histological features demonstrated that CeO2 induced lung phospholipidosis and fibrosis. DEP induced lung granulomas that were not significantly affected by the presence of CeO2 in the combined exposure. Using CeO2 as diesel fuel catalyst may cause health concerns. |
Temporal changes in prevalence of molecular markers mediating antimalarial drug resistance in a high malaria transmission setting in Uganda.
Mbogo GW , Nankoberanyi S , Tukwasibwe S , Baliraine FN , Nsobya SL , Conrad MD , Arinaitwe E , Kamya M , Tappero J , Staedke SG , Dorsey G , Greenhouse B , Rosenthal PJ . Am J Trop Med Hyg 2014 91 (1) 54-61 Standard therapy for malaria in Uganda changed from chloroquine to chloroquine + sulfadoxine-pyrimethamine in 2000, and artemether-lumefantrine in 2004, although implementation of each change was slow. Plasmodium falciparum genetic polymorphisms are associated with alterations in drug sensitivity. We followed the prevalence of drug resistance-mediating P. falciparum polymorphisms in 982 samples from Tororo, a region of high transmission intensity, collected from three successive treatment trials conducted during 2003-2012, excluding samples with known recent prior treatment. Considering transporter mutations, prevalence of the mutant pfcrt 76T, pfmdr1 86Y, and pfmdr1 1246Y alleles decreased over time. Considering antifolate mutations, the prevalence of pfdhfr 51I, 59R, and 108N, and pfdhps 437G and 540E were consistently high; pfdhfr 164L and pfdhps 581G were uncommon, but most prevalent during 2008-2010. Our data suggest sequential selective pressures as different treatments were implemented, and they highlight the importance of genetic surveillance as treatment policies change over time. |
Neglected parasitic infections in the United States: Chagas disease
Montgomery SP , Starr MC , Cantey PT , Edwards MS , Meymandi SK . Am J Trop Med Hyg 2014 90 (5) 814-8 Chagas disease, which is caused by the protozoan parasite Trypanosoma cruzi, can lead to severe cardiac and gastrointestinal disease. Most persons acquire this infection through contact with vector bugs carrying T. cruzi in endemic areas of Latin America. Infection can also be acquired by congenital, transfusion, transplantation, and foodborne transmission. Although an estimated 300,000 persons with Chagas disease live in the United States, little is known about the burden of chagasic heart disease. It is not known how often congenital or vector-borne transmission of T. cruzi occurs in the United States, although it is known that infected mothers and infected vector bugs are found in this country. Better diagnostic tests and treatment drugs are needed to improve patient care, and research is needed to define transmission risks and develop strategies to prevent new infections and reduce the burden of disease. |
Neglected parasitic infections in the United States: cysticercosis
Cantey PT , Coyle CM , Sorvillo FJ , Wilkins PP , Starr MC , Nash TE . Am J Trop Med Hyg 2014 90 (5) 805-9 Cysticercosis is a potentially fatal and preventable neglected parasitic infection caused by the larval form of Taenia solium. Patients with symptomatic disease usually have signs and symptoms of neurocysticercosis, which commonly manifest as seizures or increased intracranial pressure. Although there are many persons living in the United States who emigrated from highly disease-endemic countries and there are foci of autochthonous transmission of the parasite in the United States, little is known about burden and epidemiology of the disease in this country. In addition, despite advances in the diagnosis and management of neurocysticercosis, there remain many unanswered questions. Improving our understanding and management of neurocysticercosis in the United States will require improved surveillance or focused prospective studies in appropriate areas and allocation of resources towards answering some of the key questions discussed in this report. |
Neglected parasitic infections in the United States: toxocariasis
Woodhall DM , Eberhard ML , Parise ME . Am J Trop Med Hyg 2014 90 (5) 810-3 Toxocariasis is a preventable parasitic disease that is caused by the dog and cat roundworms Toxocara cani and T. cati, respectively. Humans become infected when they accidently ingest infectious Toxocara eggs commonly found in contaminated soil; children are most often affected. Clinical manifestations of Toxocara infection in humans include ocular toxocariasis and visceral toxocariasis. Although infection with Toxocara can cause devastating disease, the burden of toxocariasis in the United States population remains unknown. In addition, risk factors for acquiring infection need to be better defined, and research needs to be conducted to better understand the pathophysiology and clinical course of toxocariasis. Development of diagnostic tests would enable clinicians to detect active infection, and determination of optimal drug regiments would ensure patients were appropriately treated. Addressing these public health gaps is necessary to understand and address the impact of toxocariasis in the United States. |
Neglected parasitic infections in the United States: toxoplasmosis
Jones JL , Parise ME , Fiore AE . Am J Trop Med Hyg 2014 90 (5) 794-9 Toxoplasma gondii is a leading cause of severe foodborne illness in the United States. Population-based studies have found T. gondii infection to be more prevalent in racial/ethnic minority and socioeconomically disadvantaged groups. Soil contaminated with cat feces, undercooked meat, and congenital transmission are the principal sources of infection. Toxoplasmosis-associated illnesses include congenital neurologic and ocular disease; acquired illness in immunocompetent persons, most notably ocular disease; and encephalitis or disseminated disease in immunosuppressed persons. The association of T. gondii infection with risk for mental illness is intriguing and requires further research. Reduction of T. gondii in meat, improvements in hygiene and food preparation practices, and reduction of environmental contamination can prevent toxoplasmosis, but more research is needed on how to implement these measures. In addition, screening and treatment may help prevent toxoplasmosis or reduce the severity of disease in some settings. |
Neglected parasitic infections in the United States: trichomoniasis
Secor WE , Meites E , Starr MC , Workowski KA . Am J Trop Med Hyg 2014 90 (5) 800-4 Trichomonas vaginalis is one of the most common human parasitic infections in the United States, as well as the most prevalent non-viral sexually transmitted infection. However, it has long received much less consideration than other parasitic and sexually transmitted diseases. Much of this inattention can be attributed to a poor understanding of the public health impact of trichomoniasis. Increasing recognition of the sequelae of infection, including increased risk of infection with human immunodeficiency virus and adverse outcomes of pregnancy, has led to increased interest in T. vaginalis. Recent innovations include development of diagnostic tests that could improve detection of the parasite. A number of important questions, such as the epidemiology among men and women, the true public health burden of symptomatic and asymptomatic T. vaginalis infections, and whether current treatments will be adequate to reduce the substantial health disparities and costs associated with trichomoniasis, need consideration to remedy neglect of this important disease. |
A description of malaria sentinel surveillance: a case study in Oromia Regional State, Ethiopia
Yukich JO , Butts J , Miles M , Berhane Y , Nahusenay H , Malone JL , Dissanayake G , Reithinger R , Keating J . Malar J 2014 13 (1) 88 BACKGROUND: In the context of the massive scale up of malaria interventions, there is increasing recognition that the current capacity of routine malaria surveillance conducted in most African countries through integrated health management information systems is inadequate. The timeliness of reporting to higher levels of the health system through health management information systems is often too slow for rapid action on focal infectious diseases such as malaria. The purpose of this paper is to: 1) describe the implementation of a malaria sentinel surveillance system in Ethiopia to help fill this gap; 2) describe data use for epidemic detection and response as well as programmatic decision making; and 3) discuss lessons learned in the context of creating and running this system. CASE DESCRIPTION: As part of a comprehensive strategy to monitor malaria trends in Oromia Regional State, Ethiopia, a system of ten malaria sentinel sites was established to collect data on key malaria morbidity and mortality indicators. To ensure the sentinel surveillance system provides timely, actionable data, the sentinel facilities send aggregate data weekly through short message service (SMS) to a central database server. Bland-Altman plots and Poisson regression models were used to investigate concordance of malaria indicator reports and malaria trends over time, respectively. DISCUSSION: This paper describes three implementation challenges that impacted system performance in terms of: 1) ensuring a timely and accurate data reporting process; 2) capturing complete and accurate patient-level data; and 3) expanding the usefulness and generalizability of the system's data to monitor progress towards the national malaria control goals of reducing malaria deaths and eventual elimination of transmission. CONCLUSIONS: The use of SMS for reporting surveillance data was identified as a promising practice for accurately tracking malaria trends in Oromia. The rapid spread of this technology across Africa offers promising opportunities to collect and disseminate surveillance data in a timely way. High quality malaria surveillance in Ethiopia remains a resource intensive activity and extending the generalizability of sentinel surveillance findings to other contexts remains a major limitation of these strategies. |
Vital signs: disability and physical activity - United States, 2009-2012
Carroll DD , Courtney-Long EA , Stevens AC , Sloan ML , Lullo C , Visser SN , Fox MH , Armour BS , Campbell VA , Brown DR , Dorn JM . MMWR Morb Mortal Wkly Rep 2014 63 (18) 407-13 BACKGROUND: Adults with disabilities are less active and have higher rates of chronic disease than the general population. Given the health benefits of physical activity, understanding physical activity, its relationship with chronic disease, and health professional recommendations for physical activity among young to middle-age adults with disabilities could help increase the effectiveness of health promotion efforts. METHODS: Data from the 2009-2012 National Health Interview Survey (NHIS) were used to estimate the prevalence of, and association between, aerobic physical activity (inactive, insufficiently active, or active) and chronic diseases (heart disease, stroke, diabetes, and cancer) among adults aged 18-64 years by disability status and type (hearing, vision, cognitive, and mobility). The prevalence of, and association between, receiving a health professional recommendation for physical activity and level of aerobic physical activity was assessed using 2010 data. RESULTS: Overall, 11.6% of U.S. adults aged 18-64 years reported a disability, with estimates for disability type ranging from 1.7% (vision) to 5.8% (mobility). Compared with adults without disabilities, inactivity was more prevalent among adults with any disability (47.1% versus 26.1%) and for adults with each type of disability. Inactive adults with disabilities were 50% more likely to report one or more chronic diseases than those who were physically active. Approximately 44% of adults with disabilities received a recommendation from a health professional for physical activity in the past 12 months. CONCLUSIONS: Almost half of adults with disabilities are physically inactive and are more likely to have a chronic disease. Among adults with disabilities who visited a health professional in the past 12 months, the majority (56%) did not receive a recommendation for physical activity. IMPLICATIONS FOR PUBLIC HEALTH: These data highlight the need for increased physical activity among persons with disabilities, which might require support across societal sectors, including government and health care. |
Combining information from two data sources with misreporting and incompleteness to assess hospice-use among cancer patients: a multiple imputation approach
He Y , Landrum MB , Zaslavsky AM . Stat Med 2014 33 (21) 3710-24 Combining information from multiple data sources can enhance estimates of health-related measures by using one source to supply information that is lacking in another, assuming the former has accurate and complete data. However, there is little research conducted on combining methods when each source might be imperfect, for example, subject to measurement errors and/or missing data. In a multisite study of hospice-use by late-stage cancer patients, this variable was available from patients' abstracted medical records, which may be considerably underreported because of incomplete acquisition of these records. Therefore, data for Medicare-eligible patients were supplemented with their Medicare claims that contained information on hospice-use, which may also be subject to underreporting yet to a lesser degree. In addition, both sources suffered from missing data because of unit nonresponse from medical record abstraction and sample undercoverage for Medicare claims. We treat the true hospice-use status from these patients as a latent variable and propose to multiply impute it using information from both data sources, borrowing the strength from each. We characterize the complete-data model as a product of an 'outcome' model for the probability of hospice-use and a 'reporting' model for the probability of underreporting from both sources, adjusting for other covariates. Assuming the reports of hospice-use from both sources are missing at random and the underreporting are conditionally independent, we develop a Bayesian multiple imputation algorithm and conduct multiple imputation analyses of patient hospice-use in demographic and clinical subgroups. The proposed approach yields more sensible results than alternative methods in our example. Our model is also related to dual system estimation in population censuses and dual exposure assessment in epidemiology. |
Comparison of models for analyzing two-group, cross-sectional data with a Gaussian outcome subject to a detection limit
Wiegand RE , Rose CE , Karon JM . Stat Methods Med Res 2014 25 (6) 2733-2749 A potential difficulty in the analysis of biomarker data occurs when data are subject to a detection limit. This detection limit is often defined as the point at which the true values cannot be measured reliably. Multiple, regression-type models designed to analyze such data exist. Studies have compared the bias among such models, but few have compared their statistical power. This simulation study provides a comparison of approaches for analyzing two-group, cross-sectional data with a Gaussian-distributed outcome by exploring statistical power and effect size confidence interval coverage of four models able to be implemented in standard software. We found using a Tobit model fit by maximum likelihood provides the best power and coverage. An example using human immunodeficiency virus type 1 ribonucleic acid data is used to illustrate the inferential differences in these models. |
Exposure to secondhand smoke and attitudes toward smoke-free workplaces among employed U.S. adults: findings from the National Adult Tobacco Survey
King BA , Homa DM , Dube SR , Babb SD . Nicotine Tob Res 2014 16 (10) 1307-18 INTRODUCTION: This study assessed the prevalence and correlates of secondhand smoke (SHS) exposure and attitudes toward smoke-free workplaces among employed U.S. adults. METHODS: Data came from the 2009-2010 National Adult Tobacco Survey, a landline and cellular telephone survey of adults aged ≥18 years in the 50U.S. states and District of Columbia. National and state estimates of past 7-day workplace SHS exposure and attitudes toward indoor and outdoor smoke-free workplaces were assessed among employed adults. National estimates were calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, U.S. region, and smoking status. RESULTS: Among employed adults who did not smoke cigarettes, 20.4% reported past 7-day SHS exposure at their workplace (state range: 12.4% [Maine] to 30.8% [Nevada]). Nationally, prevalence of exposure was higher among males, those aged 18-44 years, non-Hispanic Blacks, Hispanics, and non-Hispanic American Indians/Alaska natives compared to non-Hispanic Whites, those with less education and income, those in the western United States, and those with no smoke-free workplace policy. Among all employed adults, 83.8% and 23.2% believed smoking should never be allowed in indoor and outdoor areas of workplaces, respectively. CONCLUSIONS: One-fifth of employed U.S. adult nonsmokers are exposed to SHS in the workplace and disparities in exposure exist across states and subpopulations. Most employed adults believe indoor areas of workplaces should be smoke free and nearly one-quarter believe outdoor areas should be smoke free. Efforts to protect employees from SHS exposure and to educate the public about the dangers of SHS and benefits of smoke-free workplaces could be beneficial. |
Association between current asthma and secondhand smoke exposure in vehicles among adults living in four US states
Nguyen KH , King BA , Dube SR . Tob Control 2014 24 (4) 376-81 OBJECTIVE: Many states have implemented laws prohibiting tobacco smoking in indoor public places. However, private settings remain a major source of secondhand smoke (SHS) exposure for many people. We assessed the association between current asthma and SHS exposure in vehicles among adult never-smokers in Indiana, Kentucky, Louisiana and Mississippi. METHODS: Data came from the 2011 Behavioral Risk Factor Surveillance System, a state-based telephone survey of US adults aged ≥18 years. Analyses were restricted to states (n=4) that administered an optional SHS module. Prevalence of self-reported asthma and past 7-day SHS exposure in vehicles was calculated by demographics, voluntary smoke-free vehicle rules and SHS exposure in homes, public places and workplaces. Logistic regression was used to assess the adjusted association between asthma and SHS exposure in vehicles. RESULTS: Among 17 863 never-smoking adults, 7.4% reported having current asthma, whereas 12.3% reported past 7-day SHS exposure in vehicles. Among adults with asthma, SHS exposure in vehicles was lower among those with voluntary smoke-free rules compared with those without voluntary smoke-free rules (9.5% vs 56.7%, p<0.0001). Following adjustment, adults exposed to SHS in a vehicle had a higher odds of having current asthma compared with unexposed adults (OR=2.01, 95% CI 1.18 to 3.40). CONCLUSIONS: Never-smoking adults recently exposed to SHS in a vehicle had higher odds of having current asthma compared with unexposed adults. Efforts are warranted to warn about the dangers of SHS and to encourage voluntary smoke-free rules in vehicles, especially among adults with asthma. |
Feline fecal virome reveals novel and prevalent enteric viruses.
Ng TF , Mesquita JR , Nascimento MS , Kondov NO , Wong W , Reuter G , Knowles NJ , Vega E , Esona MD , Deng X , Vinje J , Delwart E . Vet Microbiol 2014 171 102-11 Humans keep more than 80 million cats worldwide, ensuring frequent exposure to their viruses. Despite such interactions the enteric virome of cats remains poorly understood. We analyzed a fecal sample from a single healthy cat from Portugal using viral metagenomics and detected five eukaryotic viral genomes. These viruses included a novel picornavirus (proposed genus "Sakobuvirus") and bocavirus (feline bocavirus 2), a variant of feline astrovirus 2 and sequence fragments of a highly divergent feline rotavirus and picobirnavirus. Feline sakobuvirus A represents the prototype species of a proposed new genus in the Picornaviridae family, distantly related to human salivirus and kobuvirus. Feline astroviruses (mamastrovirus 2) are the closest known relatives of the classic human astroviruses (mamastrovirus 1), suggestive of past cross-species transmission. Presence of these viruses by PCR among Portuguese cats was detected in 13% (rotavirus), 7% (astrovirus), 6% (bocavirus), 4% (sakobuvirus), and 4% (picobirnavirus) of 55 feline fecal samples. Co-infections were frequent with 40% (4/10) of infected cats shedding more than one of these five viruses. Our study provides an initial description of the feline fecal virome indicating a high level of asymptomatic infections. Availability of the genome sequences of these viruses will facilitate future tropism and feline disease association studies. |
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- Disease Reservoirs and Vectors
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