Silver diamine fluoride (SDF) may be better than fluoride varnish and no treatment in arresting and preventing cavitated carious lesions
Beltran-Aguilar ED . J Evid Based Dent Pract 2010 10 (2) 122-4 PURPOSE/QUESTION: The authors conducted a systematic review of clinical studies on the effectiveness of silver diamine fluoride to arrest and prevent dental caries at the cavitated level. SOURCE OF FUNDING: NIH Grant (DOI:10.1177/0022034508329406) TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 2: Limited-quality patient-oriented evidence STRENGTH OF THE RECOMMENDATION GRADE: Grade B: Limited-quality patient-oriented evidence. |
Trends in prevalence of obesity and overweight among children enrolled in the New York State WIC program, 2002-2007
Sekhobo JP , Edmunds LS , Reynolds DK , Dalenius K , Sharma A . Public Health Rep 2010 125 (2) 218-24 OBJECTIVES: We examined recent overweight and obesity trends in a multiethnic population of low-income preschool children. METHODS: We defined overweight as sex-specific body mass index (BMI)-forage > or = 85th and < 95th percentile and obesity as sex-specific BMI-for-age > or = 95th percentile, and calculated them using demographic data and randomly selected height and weight measurements that were recorded while 2- to < 5-year-old children were enrolled in the New York State (NYS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during 2002-2007. RESULTS: Obesity prevalence peaked at 16.7% in 2003, declined from 2003 through 2005, and stabilized at 14.7% through 2007. Among both boys and girls, the downward trend in annual prevalence of obesity was evident only among Hispanic children (22.8% boys and 20.9% girls in 2002 vs. 19.3% boys and 17.5% girls in 2007) and non-Hispanic black children (15.6% boys and 14.2% girls in 2002 vs. 13.6% boys and 12.4% girls in 2007). In contrast, the annual prevalence estimate for overweight showed an increasing trend from 2002 through 2007. CONCLUSIONS: These results showed a slight decline in prevalence of childhood obesity and a continuing rise in prevalence of childhood overweight among children enrolled in the NYS WIC program during 2002-2007. Future research should investigate the extent to which the slight decline in childhood obesity prevalence may be attributable to population-based and high-risk obesity prevention efforts in NYS. |
The predicted effects of chronic obesity in middle age on medicare costs and mortality
Cai L , Lubitz J , Flegal KM , Pamuk ER . Med Care 2010 48 (6) 510-7 BACKGROUND: The prevalence of adult obesity has increased in recent decades. It is important to predict the long-term effect of body weight, and changes in body weight, in middle age on longevity and Medicare costs in older ages. METHODS: The relationships between individuals' characteristics in middle age and subsequent Medicare costs and mortality were estimated from the linkage of the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study to Medicare administrative records (1991-2000) and mortality information (1971-2000). We predicted longevity and lifetime Medicare costs via simulation for 45-year-old persons by body weight in 1973 and changes in body weight between 1973 and 1983. RESULTS: Obese 45-year-olds had a smaller chance of surviving to age 65 and, if they did, incurred significantly higher average lifetime Medicare costs than normal-weight 45-year-olds ($163,000 compared with $117,000). Those who remained obese between ages 45 and 55 in 1973 to 1983 incurred significantly higher lifetime Medicare costs than those who maintained normal weight. Other weight change categories did not differ significantly from those who maintained normal weight in terms of life expectancy at age 65, but overweight and obese people who lost weight had less chance of surviving to age 65 and the lowest estimated life expectancies thereafter. CONCLUSIONS: Chronic obesity in middle age increases lifetime Medicare costs relative to those who remained normal weight. As the survival of obese persons improves, it is possible that Medicare costs may rise substantially in the future to meet the health care needs of today's obese middle-aged population. Thus, active engagement by both the private and public sectors to prevent and to reduce obesity are critically needed. |
Moving toward chlamydia control in the United States
Hogben M , Habel MA . J Womens Health (Larchmt) 2010 19 (6) 1055-7 National legislative efforts to reform the process of healthcare currently include greater attention to public health care measures with evidence of effectiveness. In infectious disease public health, perhaps the principal key to effectiveness is population-level infection control; this in turn requires that interventions have “prevention impact.”1 Prevention impact is defined as the product of the intervention efficacy in a targeted population or subpopulation, the contribution of that population to overall morbidity, and the coverage achieved by the intervention in the population. We would add (1) that efficacy should be reasonably measured as the net efficacy achieved by a mix of interventions and (2) that prevention impact can be measured along a continuum of service. |
The public's response to the 2009 H1N1 influenza pandemic
Steelfisher GK , Blendon RJ , Bekheit MM , Lubell K . N Engl J Med 2010 362 (22) e65 In April 2009, a novel influenza A (H1N1) virus emerged in the United States with the key characteristics of a pandemic virus, and within weeks it had spread to every region in the country.1 Ultimately, the rate of death was lower than was initially predicted, but the numbers of H1N1 cases, hospitalizations, and deaths were nonetheless substantial,2 and the experience offers some lessons that may help us to prepare for future influenza outbreaks. | Given the crucial role that the public plays in containing or spreading illness and in seeking related medical care, we have examined the public's response to the 2009 H1N1 pandemic and relevant public health recommendations through a comprehensive review of available data from national public opinion polls conducted by telephone between April 2009 and January 2010 (see Polls on Public Response to H1N1). Our sources include 20 polls, 8 of which were conducted by the Harvard School of Public Health (HSPH) through cooperative agreements with the Centers for Disease Control and Prevention (CDC), the National Preparedness Leadership Initiative, and the National Public Health Information Coalition. We examined the extent to which people adopted specific behaviors during three periods: the early months of the pandemic, when no vaccine was available; at the time of the initial, delayed release of vaccine to high-priority groups; and after the vaccine was widely available. We also examined the reasons why many Americans did not get vaccinated and reviewed the public's view of the government's response to the pandemic. In instances in which multiple polling questions were relevant, we present a range of findings. |
Diaphragm for STI and HIV prevention: is it a safe method for women at high risk?
Njoroge B , Gallo MF , Sharma A , Bukusi EA , Nguti R , Bell AJ , Jamieson DJ , Williams D , Eschenbach DA . Sex Transm Dis 2010 37 (6) 382-5 Female sex workers (n = 140) were enrolled in a 6-month acceptability trial of the diaphragm. We randomized a subset (n = 40) to receive colposcopies after 1 month of diaphragm use or after 1 month of observation before commencing diaphragm use. Adverse events were mild in nature. Frequency of colposcopic findings did not differ between women randomized to immediate versus delayed diaphragm use (P = 0.25). |
Tuberculosis control: lessons for outbreak preparedness in correctional facilities
Parvez FM , Lobato MN , Greifinger RB . J Correct Health Care 2010 16 (3) 239-42 Correctional facilities typically house large numbers of persons in close and crowded conditions for long periods. Clusters of communicable diseases ranging from simple viral upper respiratory infections to more serious threats, such as tuberculosis (TB), infections with methicillin-resistant Staphylococcus aureus, and influenza, often emerge in these surroundings. The recent H1N1 influenza pandemic highlights the importance of outbreak prevention and containment preparedness, particularly in congregate settings. In this commentary, the authors propose that the TB control model can provide valuable lessons for infection control practitioners to prepare for, identify, investigate, and control outbreaks of communicable diseases to prevent transmission in correctional facilities and to the surrounding community. |
Improving the lives of vulnerable children: implications of Horizons research among orphans and other children affected by AIDS
Schenk KD , Michaelis A , Sapiano TN , Brown L , Weiss E . Public Health Rep 2010 125 (2) 325-36 From 1997 through 2007, the Horizons program conducted research to inform the care and support of children who had been orphaned and rendered vulnerable by acquired immunodeficiency syndrome in sub-Saharan Africa. Horizons conducted studies in Kenya, Malawi, Rwanda, South Africa, Uganda, Zambia, and Zimbabwe. Research included both diagnostic studies exploring the circumstances of families and communities affected by human immunodeficiency virus (HIV) and evaluations of pioneering intervention strategies. Interventions found to be supportive of families included succession planning for families with an HIV-positive parent, training and supporting youth as caregivers, and youth mentorship for child-headed households. Horizons researchers developed tools to assess the psychosocial well-being of children affected by HIV and outlined key ethical guidelines for conducting research among children. The design, implementation, and evaluation of community-based interventions for orphans and vulnerable children continue to be a key gap in the evidence base. |
Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogota, Colombia
Parra DC , Gomez LF , Sarmiento OL , Buchner D , Brownson R , Schimd T , Gomez V , Lobelo F . Soc Sci Med 2010 70 (7) 1070-6 This study examines associations between neighborhood environment attributes and health related quality of life (HRQOL) and self-rated health (SRH) among older adults (60 years and over) in Bogota, Colombia. Perceived and objective neighborhood environmental characteristics were assessed in a cross sectional multilevel design with 1966 older adults within 50 neighborhoods. Outcome variables included HRQOL (physical and mental dimensions) and SRH measured with the Spanish version of the Short Form 8 (SF-8). Independent variables included perceived and objective neighborhood characteristics as well as self-reported levels of walking. Hierarchical linear and logistic regression models were used for the analysis. Among perceived neighborhood characteristics, safety from traffic was positively associated with both HRQOL dimensions and SRH. Having safe parks was positively associated with the mental dimension of HRQOL and with SRH. Street noise was negatively associated with both HRQOL dimensions. Regarding objective neighborhood characteristics, residing in areas with more than eight percent of land covered by public parks was positively associated with SRH. Objective and perceived neighborhood characteristics could provide insight into potential interventions among older adults from rapidly urbanizing settings in Latin America. |
Presence of Coxiella burnetii DNA in the environment of the United States (2006-2008)
Kersh GJ , Wolfe TM , Fitzpatrick KA , Candee AJ , Oliver LD , Patterson NE , Self JS , Priestley RA , Loftis AD , Massung RF . Appl Environ Microbiol 2010 76 (13) 4469-75 Coxiella burnetii is an obligate intracellular bacterium that causes the zoonotic disease Q fever. Because C. burnetii is highly infectious, can survive under a variety of environmental conditions, and has been weaponized in the past, it is classified as a select agent and is considered a potential bioweapon. The agent is known to be present in domestic livestock and in wild animal populations, but the background levels of C. burnetii in the environment have not been reported. To better understand the amount of C. burnetii present in the environment of the U.S., greater than 1,600 environmental samples were collected from 6 geographically diverse U.S. states in the years 2006-2008. DNA was purified from these samples, and the presence of C. burnetii DNA was evaluated by quantitative PCR of the IS1111 repetitive element. Overall, 23.8% of the samples were positive for C. burnetii DNA. The prevalence in the different states ranged from 6 to 44 percent. C. burnetii DNA was detected in locations with livestock and also in locations with primarily human activity (post offices, stores, schools, etc.). This study demonstrates that C. burnetii is fairly common in the environment in the U.S., and any analysis of C. burnetii after a suspected intentional release should be interpreted in light of these background levels. It also suggests that human exposure to C. burnetii may be more common than what is suggested by the number of reported cases of Q fever. |
Elevated cadmium exposure may be associated with periodontal bone loss
Dye BA , Dillon CF . J Evid Based Dent Pract 2010 10 (2) 109-11 PURPOSE/QUESTION: Is environmental cadmium associated with periodontal disease? SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Cross-sectional study LEVEL OF EVIDENCE: Level 3: Other evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable. |
The good, the bad, and the volatile: can we have both healthy pools and healthy people?
LaKind JS , Richardson SD , Blount BC . Environ Sci Technol 2010 44 (9) 3205-10 Swimming is a healthful activity that comes with increased risk of exposure to pathogenic microorganisms and disinfection agents/byproducts. |
Keep on swimming!
Otto 3rd C , Hlavsa M . J Environ Health 2010 72 (9) 25-7 This month’s column updates the medley of healthy swimming initiatives by | the Centers for Disease Control and | Prevention (CDC). Let’s dive right into | • Recreational Water Illness (RWI) Prevention Week 2010, | • the New Pool Inspection Data Study and | • the Model Aquatic Health Code (MAHC). | RWI Prevention Week 2010 | RWI Prevention Week will be celebrated May | 24–30, 2010, in many jurisdictions across the | United States and at CDC. This week highlights | the public’s signifi cant role in practicing healthy | swimming behaviors and showcases one of the | many important environmental health (EH) | programs in our partner state and local agencies. | Support materials, including a publicity tool kit, | are available on the Healthy Swimming Web | site at www.cdc.gov/healthywater/swimming/ | index.html. |
Differential performance of SF-36 items in healthy adults with and without functional limitations
Horner-Johnson W , Krahn GL , Suzuki R , Peterson JJ , Roid G , Hall T . Arch Phys Med Rehabil 2010 91 (4) 570-5 OBJECTIVE: To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations. DESIGN: Survey responses were analyzed by using partial correlations. SETTING: General community. PARTICIPANTS: Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: SF-36. RESULTS: Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions. CONCLUSIONS: Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36. |
Dealing with the evidence dilemma in genomics and personalized medicine.
Khoury MJ . Clin Pharmacol Ther 2010 87 (6) 635-8 In this commentary, I discuss how the promise of genomics and personalized medicine (GPM) is currently not matched by the evidence that supports its use in clinical practice. The mismatch between expectations and reality can be addressed by placing greater emphasis on multidisciplinary translation research and by stakeholder-driven collaboration that uses such research to address various and occasionally competing factors affecting the integration of genomic discoveries into clinical practice. |
Men who have sex with men in the United States: demographic and behavioral characteristics and prevalence of HIV and HSV-2 infection: results from National Health and Nutrition Examination Survey 2001-2006
Xu F , Sternberg MR , Markowitz LE . Sex Transm Dis 2010 37 (6) 399-405 OBJECTIVES: To describe demographic and behavioral characteristics and the prevalence of HIV and herpes simplex virus type 2 (HSV-2) infections in men who had sex with men identified through a nationally representative, population-based survey. METHODS: As part of National Health and Nutrition Examination Surveys in 2001-2006, men 18 to 59 years of age were interviewed about sexual behavior using audio computer assisted self-interview and were tested for antibodies to HIV and HSV-2. RESULTS: Of the 4319 men interviewed, 5.2% reported having ever had sex with men (MSM). MSM were more likely than non-MSM (those reporting female partners only) to have first sex at <15 years (31.9% vs. 17.3%), have ≥10 lifetime sex partners (73.6% vs. 40.8%), and have ever used cocaine (46.1% vs. 26.6%) (all P < 0.004). Among MSM, the prevalence of HIV and HSV-2 was 9.1% and 18.4%, respectively. Only 44.5% of MSM reported their sexual orientation as homosexual or gay. Comparing with bisexual and heterosexual MSM, homosexual MSM reported the highest number of lifetime male partners and had the highest HIV prevalence (16.5%). CONCLUSIONS: In this population-based sample of men in the United States, self-reported same-sex behavior and homosexual orientation are strong markers for high risk of HIV infection. |
The elephant never forgets; piloting a chlamydia and gonorrhea retesting reminder postcard in an STD clinic setting
Paneth-Pollak R , Klingler EJ , Blank S , Schillinger JA . Sex Transm Dis 2010 37 (6) 365-8 We examined the number and proportion of persons retesting and reinfected with Chlamydia and/or gonorrhea 3 to 4 months after initial infection in one New York City sexually transmitted disease clinic using a reminder postcard compared to clinics not using this reminder. Retesting increased, however, the proportion reinfected was lower during the intervention. |
The Influence of the VERB campaign on children's physical activity in 2002 to 2006
Huhman ME , Potter LD , Nolin MJ , Piesse A , Judkins DR , Banspach SW , Wong FL . Am J Public Health 2010 100 (4) 638-45 OBJECTIVES: We evaluated physical activity outcomes for children exposed to VERB, a campaign to encourage physical activity in children, across campaign years 2002 to 2006. METHODS: We examined the associations between exposure to VERB and (1) physical activity sessions (free time and organized) and (2) psychosocial outcomes (outcome expectations, self-efficacy, and social influences) for 3 nationally representative cohorts of children. Outcomes among adolescents aged 13 to 17 years (cohort 1, baseline) and children aged 9 to 13 years from cohorts 2 and 3 were analyzed for dose-response effects. Propensity scoring was used to control for confounding influences. RESULTS: Awareness of VERB remained high across campaign years. In 2006, reports of children aged 10 to 13 years being active on the day before the survey increased significantly as exposure to the campaign increased. Psychosocial outcomes showed dose-response associations. Effects lessened as children aged out of the campaign target age range (cohort 1, baseline), but dose-response associations persisted in 2006 for outcome expectations and free-time physical activity. CONCLUSIONS: VERB positively influenced children's physical activity outcomes. Campaign effects persisted as children grew into their adolescent years. |
Audience reactions and receptivity to HIV prevention message concepts for people living with HIV
Uhrig JD , Bann CM , Wasserman J , Guenther-Grey C , Eroglu D . AIDS Educ Prev 2010 22 (2) 110-25 This study measured audience reactions and receptivity to five draft HIV prevention messages developed for people living with HIV (PLWH) to inform future HIV message choice and audience targeting decisions. Our premise was that message concepts that receive wide audience appeal constitute a strong starting point for designing future HIV prevention messages, program activities, and health communication and marketing campaigns for PLWH. The majority of participants indicated agreement with evaluative statements that expressed favorable attitudes toward all five of the message concepts we evaluated. Participants gave the lowest approval to the message promoting sero-sorting. Sociodemographic characteristics played less of a role in predicting differences in message perceptions than attitudes, beliefs and sexual behavior. The general appeal for these messages is encouraging given that messages were expressed in plain text without the support of other creative elements that are commonly used in message execution. These results confirm the utility of systematic efforts to generate and screen message concepts prior to large-scale testing. |
Methodological innovations in data gathering: newborn screening linkage with live births records, Michigan, 1/2007-3/2008
Korzeniewski SJ , Grigorescu V , Copeland G , Gu G , Thoburn KK , Rogers JD , Young WI . Matern Child Health J 2010 14 (3) 360-4 OBJECTIVE: To match Michigan birth and newborn screening records to identify and follow-up potentially unscreened infants, assess data quality, and demonstrate the utility of Link Plus linkage software for matching MCH related administrative datasets. METHODS: Birth and newborn screening records maintained by the Michigan Department of Community Health from January 2007 through March 2008 were used in this study. Link Plus, a freely-available probabilistic record linkage software program developed at the Centers for Disease Control and Prevention, was used to match records. Linkage performance was assessed by the linkage success rate (percentage of valid matches). Follow-up of un-matched records was conducted by the Michigan Newborn Screening Follow-up Program. RESULTS: Nearly all (99.2%) of the 142,178 birth records included in this study were successfully matched to newborn screening records. Following a transition to a web-based electronic birth certificate system and inclusion of a newborn screening card identification number on the birth record in 2008, the linkage success rate increased to 99.6% based on analysis of approximately 18,000 records. Of approximately 600 un-matched records, nearly half had received a newborn screen. Approximately 8% of un-matched records were due to parental refusal of newborn screening. Nine children received an initial screen as a result of this study; one was confirmed as having sickle cell trait. CONCLUSIONS: We have demonstrated that a freely available record linkage software, Link Plus, can be used to successfully match records of MCH databases thereby providing an opportunity for further research and quality assurance investigations. |
A Public Health Grid (PHGrid): architecture and value proposition for 21st century public health
Savel T , Hall K , Lee B , McMullin V , Miles M , Stinn J , White P , Washington D , Boyd T , Lenert L . Int J Med Inform 2010 79 (7) 523-9 PURPOSE:This manuscript describes the value of and proposal for a high-level architectural framework for a Public Health Grid (PHGrid), which the authors feel has the capability to afford the public health community a robust technology infrastructure for secure and timely data, information, and knowledge exchange, not only within the public health domain, but between public health and the overall health care system. METHODS: The CDC facilitated multiple Proof-of-Concept (PoC) projects, leveraging an open-source-based software development methodology, to test four hypotheses with regard to this high-level framework. The outcomes of the four PoCs in combination with the use of the Federal Enterprise Architecture Framework (FEAF) and the newly emerging Federal Segment Architecture Methodology (FSAM) was used to develop and refine a high-level architectural framework for a Public Health Grid infrastructure. RESULTS: The authors were successful in documenting a robust high-level architectural framework for a PHGrid. The documentation generated provided a level of granularity needed to validate the proposal, and included examples of both information standards and services to be implemented. Both the results of the PoCs as well as feedback from selected public health partners were used to develop the granular documentation. CONCLUSIONS: A robust high-level cohesive architectural framework for a Public Health Grid (PHGrid) has been successfully articulated, with its feasibility demonstrated via multiple PoCs. In order to successfully implement this framework for a Public Health Grid, the authors recommend moving forward with a three-pronged approach focusing on interoperability and standards, streamlining the PHGrid infrastructure, and developing robust and high-impact public health services. |
Managing traumatic brain injury secondary to explosions
Burgess P , Sullivent EE , Sasser SM , Wald MM , Ossmann E , Kapil V . J Emerg Trauma Shock 2010 3 (2) 164-172 Explosions and bombings are the most common deliberate cause of disasters with large numbers of casualties. Despite this fact, disaster medical response training has traditionally focused on the management of injuries following natural disasters and terrorist attacks with biological, chemical, and nuclear agents. The following article is a clinical primer for physicians regarding traumatic brain injury (TBI) caused by explosions and bombings. The history, physics, and treatment of TBI are outlined. |
Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance
Looker AC , Dawson-Hughes B , Tosteson AN , Johansson H , Kanis JA , Melton 3rd LJ . Osteoporos Int 2010 22 (2) 541-9 This analysis of National Health and Nutrition Examination Survey III data found a significant risk of incident hip fracture in adults aged 65 years and older who are candidates for treatment to lower fracture risk, according to the new National Osteoporosis Foundation Clinician's Guide. INTRODUCTION: The relationship between treatment eligibility by the new National Osteoporosis Foundation (NOF) Guide to the Prevention and Treatment of Osteoporosis and the risk of subsequent hip fracture is unknown. METHODS: The study sample consisted of 3,208 men and women ages 65 years and older who were examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), a nationally representative survey. Risk factors used to define treatment eligibility at baseline were measured in NHANES III or were simulated using World Health Organization study cohorts. Incident hip fractures were ascertained using linked mortality and Medicare records that were obtained for NHANES III participants through December 31, 2000. Cox proportional hazards models were used to estimate the relative risk (RR) of hip fracture by treatment eligibility status. RESULTS: The RR for subsequent hip fracture was 4.9 (95% CI 3.30, 7.94) in treatment-eligible vs treatment-ineligible persons. The increased risk for treatment-eligible persons remained statistically significant when examined by sex or age: RR(men) = 5.5 (2.6, 11.4) and RR(women) = 4.3 (2.2, 8.4); RR(65-79 y) = 4.8 (2.6, 8.7) and RR(80+ y) = 4.6 (2.1, 10.1). CONCLUSIONS: Treatment-eligible persons were about five times more likely to experience a subsequent hip fracture than the non-eligible persons. The new NOF guidelines appear to predict future hip fracture risk equally in men as in women, and fracture risk prediction did not appear to diminish with age. |
Declining hip fracture rates in the United States
Stevens JA , Rudd RA . Age Ageing 2010 39 (4) 500-3 Unintentional falls are a common occurrence among older adults, affecting ~30% of persons aged 65 years and older annually [1]. One of the most serious fall outcomes is hip fracture, an injury that often results in long-term functional impairment, nursing home admission and increased mortality [2]. More than 90% of hip fractures are caused by falls [3], usually by falling onto the hip [4]. In 2006 there were ~293,000 hospital admissions for hip fracture [5]. Osteoporosis, a metabolic disease characterised by low bone mineral density (BMD) and bone structure deterioration, greatly increases the chances that a person who falls will sustain a hip fracture [6]. The National Osteoporosis Foundation estimates that more than 10 million people over age 50 in the United States have osteoporosis and another 34 million have low BMD and are at risk for the disease [7]. | Extending an earlier and less comprehensive analysis [8], this study used hospital discharge data to analyse the national trends in hip fracture rates from 1990 to 2006 for people aged 65 years and older by both sex and 10-year age groups. |
A recursive version of Grubbs' test for detecting multiple outliers in environmental and chemical data
Jain RB . Clin Biochem 2010 43 (12) 1030-3 OBJECTIVE: To compare the performance of Grubbs' outlier detection procedure with recursive Extreme Studentized Deviate (ESD) outlier detection procedure. DESIGN AND METHODS: Using simulated data, the powers of Grubbs' and ESD procedures were evaluated. RESULTS: Except when the sample contained exactly one outlier, the power of ESD procedure was higher than that of Grubbs' procedure. CONCLUSION: The ESD recursive procedure is the procedure of choice to detect multiple outliers in environmental and chemical data. |
Significant impact of sequence variations in the nucleoprotein on CD8 T cell-mediated cross-protection against influenza A virus infections
Zhong W , Liu F , Dong L , Lu X , Hancock K , Reinherz EL , Katz JM , Sambhara S . PLoS One 2010 5 (5) e10583 BACKGROUND: Memory CD8 T cells to influenza A viruses are widely detectable in healthy human subjects and broadly cross-reactive for serologically distinct influenza A virus subtypes. However, it is not clear to what extent such pre-existing cellular immunity can provide cross-subtype protection against novel emerging influenza A viruses. METHODOLOGY/PRINCIPAL FINDINGS: We show in the mouse model that naturally occurring sequence variations of the conserved nucleoprotein of the virus significantly impact cross-protection against lethal disease in vivo. When priming and challenge viruses shared identical sequences of the immunodominant, protective NP(366)/D(b) epitope, strong cross-subtype protection was observed. However, when they did not share complete sequence identity in this epitope, cross-protection was considerably reduced. Contributions of virus-specific antibodies appeared to be minimal under these circumstances. Detailed analysis revealed that the magnitude of the memory CD8 T cell response triggered by the NP(366)/D(b) variants was significantly lower than those triggered by the homologous NP(366)/D(b) ligand. It appears that strict specificity of a dominant public TCR to the original NP(366)/D(b) ligand may limit the expansion of cross-reactive memory CD8 T cells to the NP(366)/D(b) variants. CONCLUSIONS/SIGNIFICANCE: Pre-existing CD8 T cell immunity may provide substantial cross-protection against heterosubtypic influenza A viruses, provided that the priming and the subsequent challenge viruses share the identical sequences of the immunodominant, protective CTL epitopes. |
Utility of high-performance liquid chromatography analysis of mycolic acids and partial 16S rRNA gene sequencing for routine identification of Mycobacterium spp. in a national reference laboratory
Toney NC , Toney SR , Butler WR . Diagn Microbiol Infect Dis 2010 67 (2) 143-52 High-performance liquid chromatography analysis of mycolic acids and partial gene sequencing for the first 500-bp 5' end of the 16S rRNA gene were used singularly and in combination to evaluate the final identification of species. Examination of 200 cultures revealed 100 strains of slowly growing mycobacteria (SGM), 91 strains of rapidly growing mycobacteria (RGM), and 9 strains of other genera. SGM were discriminated in complexes with both methods for 56 strains, composed primarily of the Mycobacterium spp.: Mycobacterium avium, Mycobacterium terrae, and Mycobacterium simiae-Mycobacterium lentiflavum. For RGM, 73 strains were associated with complexes designated as Mycobacterium abscessus-Mycobacterium chelonae, Mycobacterium fortuitum-Mycobacterium peregrinum, and Mycobacterium mucogenicum-Mycobacterium phocaicum. Consistent identification of all the isolates differentiated to single species within the Mycobacterium genus was not possible with either test method. Sequencing results often distinguished complexes containing fewer species, and combining the results from each method increased the confidence of identifying the correct species. |
Low-frequency HIV-1 drug resistance mutations can be clinically significant but must be interpreted with caution
Johnson JA , Geretti AM . J Antimicrob Chemother 2010 65 (7) 1322-6 With drug-resistant HIV-1 present in at least 10%-20% of new infections in Western countries and in >60% of patients failing antiretroviral therapy (ART), monitoring HIV-1 drug resistance is becoming increasingly important for assessing its impact on therapeutic measures of virus control and for guiding treatment. The sensitivity limitations of conventional bulk genotyping often lead to an underestimation of the total burden of drug resistance in a patient, as resistant variants escape detection when present at low frequency within the viral quasispecies. Using sensitive resistance testing methods, a few investigators have linked low-frequency mutations to poor treatment outcomes, while other studies have shown no correlation. Understanding the technical limitations of sensitive testing methods and the relevance of the amount of a particular resistance mutation in the context of different ART regimens will help to define the clinical benefit of low-frequency resistance testing. Paramount to interpreting the clinical utility of sensitive testing is evaluating resistance mutations selectively, at biologically significant frequencies, and using methods that have been broadly validated on clinical specimens. |
Parechovirus typing in clinical specimens by nested or semi-nested PCR coupled with sequencing
Nix WA , Maher K , Pallansch MA , Oberste MS . J Clin Virol 2010 48 (3) 202-7 BACKGROUND: The Parechovirus genus (Picornaviridae) contains two known species, Human parechovirus (HPeV) and Ljungan virus (LV). HPeVs cause a wide spectrum of disease, including meningitis, gastroenteritis, encephalitis, respiratory illness, and neonatal sepsis-like disease. LVs are associated with diabetes and myocarditis in bank voles and have been proposed to cause disease in humans. The ability to rapidly and accurately type parechoviruses is critical to understanding their role in human disease. OBJECTIVES: For parechovirus molecular typing, we sought to develop reverse transcription, nested polymerase chain reaction (RT-PCR) assays to amplify the sequence encoding the VP1 capsid protein from all known members of the Parechovirus genus. STUDY DESIGN: The assays consist of a two-step RT-PCR with primers flanking VP1 (PCR1), followed by semi-nested PCR2A and PCR2B reactions that produce overlapping amplicons, encompassing the complete VP1 gene, as well as a nested PCR2C that amplifies a shorter internal VP1 amplicon. RESULTS: All primer sets are 100% sensitive and 100% specific for the 77 parechovirus culture isolates tested. The semi-nested and nested PCR primer sets are 94% sensitive and 100% specific for detection of parechovirus in original specimens. Viral genotype can be deduced from analysis of amplicon sequences. Parechoviruses of the same type share ≥77% complete VP1 nucleotide sequence identity or ≥87% amino acid identity, while those of different types share ≤73% nucleotide identity and ≤81% amino acid identity. CONCLUSIONS: The PCR primers described here amplify VP1 sequences from all known parechoviruses, providing a sensitive, reliable system for molecular typing directly from original clinical specimens. |
Trends in incidence rates of congenital hypothyroidism related to select demographic factors: data from the United States, California, Massachusetts, New York, and Texas
Hinton CF , Harris KB , Borgfeld L , Drummond-Borg M , Eaton R , Lorey F , Therrell BL , Wallace J , Pass KA . Pediatrics 2010 125 Suppl 2 S37-47 Primary congenital hypothyroidism (CH) is a common and preventable cause of intellectual disability. The incidence rate of CH has been reported to be increasing in the United States, but the factors behind the observed rate increase are not known. We summarize here the data presented at a workshop on CH, at which factors potentially related to the CH-incidence-rate increase (namely, race, ethnicity, sex, and birth outcomes) were evaluated. Data sources for the analyses included a national data set of newborn-screening results and state-specific data from newborn-screening programs in California, Massachusetts, New York, and Texas. The incidence rate of CH increased in the United States by 3% per year; however, an increase did not occur in all states, at a constant rate, or even at the same rate. Analysis of US data (1991-2000) showed a CH-incidence-rate increase only among white newborns. More recently, in California (2000-2007), the rate was constant in non-Hispanic newborns, but it increased among Hispanic newborns. In the national data, the CH-incidence rate increased similarly among boys and girls, whereas in Texas (1992-2006), the rate among boys increased significantly more than among girls and varied according to race and ethnicity. In Massachusetts (1995-2007), low birth weight newborns or newborns who had a delayed rise in thyrotropin concentration accounted for the majority of the recent rate increase. Race, ethnicity, sex, and pregnancy outcomes have affected the observed increasing incidence rate of CH, although there have been some inconsistencies and regional differences. The association with preterm birth or low birth weight could reflect the misclassification of some cases of transient hypothyroxinemia as true CH. Future studies of risk factors should focus on correct initial identification and reporting of demographic characteristics and pregnancy outcomes for cases of CH. In addition, long-term follow-up data of presumed cases of CH should be ascertained to differentiate true cases of CH from cases of transient hypothyroidism. |
Perinatal risk for common mental disorders and suicidal ideation among women in Paraguay
Ishida K , Stupp P , Serbanescu F , Tullo E . Int J Gynaecol Obstet 2010 110 (3) 235-40 OBJECTIVE: To examine the association between mental health problems among pregnant women and those in the postpartum period using a nationally representative sample of 6538 women aged 15-49years from the National Survey of Demography and Sexual and Reproductive Health in Paraguay. METHODS: The predicted probabilities (PP) of common mental disorders (CMD) and suicidal ideation were assessed using the Self-Reporting Questionnaire (SRQ-20) and logistic regression models. RESULTS: No evidence was found of an increased risk for mental health problems associated with being pregnant or in the postpartum period alone. The risk for CMD during pregnancy and the postpartum period and for suicidal ideation during pregnancy was significantly greater when the pregnancy was unintended. In addition, unintentionally pregnant women who had neither been in a union nor had a child were at a significantly higher risk for CMD and suicidal ideation compared with non-pregnant and non-postpartum women (PP: 0.54 versus 0.21 for CMD risk and 0.15 versus 0.02 for suicidal ideation). However, there were no significant differences by marital status among postpartum women. CONCLUSION: The significant effects of pregnancy intention and marital status highlight the importance of psychosocial, rather than physiological, contexts in which women experience pregnancy and childbirth. |
Prevalence of congenital hypothyroidism--current trends and future directions: workshop summary
Olney RS , Grosse SD , Vogt RF Jr . Pediatrics 2010 125 Suppl 2 S31-6 In response to published newborn-screening data that have shown an increase in the incidence (birth prevalence) rate of primary congenital hypothyroidism (CH) in the United States, a workshop was held in Atlanta, Georgia, on February 27 and 28, 2008, to examine this issue. Topics of the meeting included pathophysiology, medical management, and follow-up of CH; transient hypothyroidism (etiology, clinical implications, management, and changes in prevalence); risk factors for CH; laboratory approaches to newborn screening for CH; state-specific evaluations of trends in incidence rates of CH; and concluding discussions on future directions to resolve outstanding issues. Through presentations and discussion, gaps in knowledge were identified, such as the lack of consistent definitions for CH and transient hypothyroidism and the effects of preventable risk factors on incidence rates of CH. One outcome of the meeting was a series of accompanying articles that examined (1) trends in the incidence rates of CH in individual states and nationally, (2) effects of newborn-screening practices on CH-incidence rates, (3) the contribution of transient hypothyroidism to CH-incidence rates, and (4) future research directions. In this summary, we briefly touch on the topics of these articles and examine highlights of other presentations from the workshop that illuminated the secular trends in reported CH-incidence rates in the United States. |
Future research directions to identify causes of the increasing incidence rate of congenital hypothyroidism in the United States
Shapira SK , Lloyd-Puryear MA , Boyle C . Pediatrics 2010 125 Suppl 2 S64-8 A workshop to evaluate the reported increasing trend in the incidence rate of primary congenital hypothyroidism (CH) identified by newborn screening was held February 27 and 28, 2008, in Atlanta, Georgia, and was sponsored by the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Newborn Screening and Genetics Resource Center. Through a series of presentations and discussions, this group of experts considered a variety of factors that could be contributing to the perceived increasing trend of the CH-incidence rate, the gaps in knowledge that need to be overcome to identify the causes of the observed trend, and possible future research activities that might resolve the uncertainties surrounding the increasing incidence rate of CH in the United States. On the basis of these discussions, workshop participants concluded that the initial focus of future efforts should be to determine if the increasing CH-incidence rate persists once there is standardization of the diagnostic criteria for the classification of CH versus transient hypothyroidism. In discussions, workshop participants suggested that if the increasing incidence rate of CH could not be explained by definitional issues, then future research could focus on the identification and evaluation of risk factors for CH that might be changing among the US population and, thus, contributing to the observed increasing incidence rate of CH. |
Investigation of sex differences in hip structure in peripubertal children
Sayers A , Marcus M , Rubin C , McGeehin MA , Tobias JH . J Clin Endocrinol Metab 2010 95 (8) 3876-83 CONTEXT: There is evidence that sex differences in hip structure are increased during puberty, possibly as a consequence of associated changes in body composition. OBJECTIVES: The objective of the study was to explore relationships between sex, puberty, hip structure, and body composition. DESIGN/SETTING: The design was a longitudinal birth cohort study: The Avon Longitudinal Study of Parents and Children. Participants: Participants included 3914 boys and girls (mean age 13.8 yr). OUTCOME MEASURES: Measures included dual-energy x-ray absorptiometry-derived femoral neck width (FNW), cortical thickness (CT), bending strength [cross-sectional moment of inertia (CSMI)], section modulus, buckling ratio (BR), and femoral neck and total hip bone mineral density. RESULTS: FNW, CT, and CSMI were higher in boys, whereas BR was lower in girls (P < 0.001). Differences in hip structure were studied according to puberty (self-completion Tanner stage questionnaires). FNW, CT, and CSMI were higher in Tanner stage IV/V vs. I/II, particularly in boys (P < 0.001, puberty-sex interaction). BR was lower in Tanner stage IV/V, particularly in girls (P = 0.008, puberty-sex interaction). Adjusting for height, fat mass, and lean mass resulted in differential attenuation in the sexes, such that CT attenuated by about 80% and about 40% in boys and girls, respectively (P = 0.004, puberty-sex interaction for adjusted CT, Tanner stages I/II vs. IV/V). The difference in BR showed little attenuation after adjustment. CONCLUSION: During puberty, hip-bending strength increases, particularly in boys, due to their greater FNW, reflecting changes in height, fat mass, and lean mass. In contrast, BR falls during puberty, particularly in girls, reflecting their smaller FNW relative to CT, involving mechanisms partly independent of height and body composition. |
Characterization of the correlation between ages at entry into breast and pubic hair development
Christensen KY , Maisonet M , Rubin C , Flanders WD , Drews-Botsch C , Dominguez C , McGeehin MA , Marcus M . Ann Epidemiol 2010 20 (5) 405-8 PURPOSE: The timing of breast and pubic hair development in girls are related, but the degree of correlation has not been well characterized. Periodic observations also are complicated by interval censoring. METHODS: Data used were from the Avon Longitudinal Study of Parents and Children. Mean age at entry into breast and pubic hair development was determined by the use of parametric survival analysis. The bivariate normal cumulative distribution function was evaluated over the region containing the paired event times; the likelihood was maximized with respect to the correlation coefficient rho. RESULTS: Among 3938 participants, estimated mean ages at entry into Tanner stage 2 for breast and pubic hair development were 10.19 and 10.95, respectively. The likelihood was maximized at rho = 0.503 to 0.506. This value remained relatively constant among subgroups, although some heterogeneity was observed by maternal and child body mass index and birth order. CONCLUSIONS: The timing of breast and of pubic hair development is moderately correlated and remain so when it is stratified by characteristics associated with puberty. |
Fruit and vegetable intakes are associated with lower risk of breast fibroadenomas in Chinese women
Nelson ZC , Ray RM , Wu C , Stalsberg H , Porter P , Lampe JW , Shannon J , Horner N , Li W , Wang W , Hu Y , Gao D , Thomas DB . J Nutr 2010 140 (7) 1294-301 Fibroadenomas are common benign breast conditions among women and account for approximately 50% of breast biopsies performed. Dietary factors are known to influence benign breast conditions in the aggregate, but little is known of their association specifically with fibroadenoma. Our objective in this study was to evaluate the association between dietary and other factors and fibroadenoma risk. A case-control study, nested in a randomized trial of breast self-examination (BSE) in Chinese textile workers in Shanghai, China, was conducted between 1989 and 2000. The study sample included 327 affected women and 1070 controls. Women were administered a FFQ and a questionnaire that elicited reproductive and gynecological history and other information. Odds ratios, as estimates of relative risks, were calculated using multivariate conditional logistic regression. Significant decreasing trends in risk of fibroadenoma were observed with intake of fruits and vegetables and with number of live births, and a reduced risk was also associated with natural menopause, oral contraceptive use, and moderate exercise (walking and gardening). Increased risk of fibroadenoma was associated with heavy physical activity in one's 20s, breast cancer in a first-degree relative, and a history of prior benign breast lumps; and significant increasing trends in risk were observed with numbers of BSE per year and years of education. In conclusion, a diet rich in fruits and vegetables and the use of oral contraceptives may reduce risk of fibroadenoma. |
Development of a retrospective job exposure matrix for PCB-exposed workers in capacitor manufacturing
Hopf NB , Waters MA , Ruder AM , Prince MM . J Occup Health 2010 52 (4) 199-208 BACKGROUND: Polychlorinated biphenyls (PCBs) are considered probable human carcinogens by the International Agency for Research on Cancer and one congener, PCB 126, has been rated as a known human carcinogen. A period-specific job exposure matrix (JEM) was developed for former PCB-exposed capacitor manufacturing workers (n=12,605) (1938-1977). METHODS: A detailed exposure assessment for this plant was based on a number of exposure determinants (proximity, degree of contact with PCBs, temperature, ventilation, process control, job mobility). The intensity and frequency of PCB exposures by job for both inhalation and dermal exposures, and additional chemical exposures were reviewed. The JEM was developed in nine steps: (1) all unique jobs (n=1,684) were assessed using (2) defined PCB exposure determinants; (3) the exposure determinants were used to develop exposure profiles; (4) similar exposure profiles were combined into categories having similar PCB exposures; (5) qualitative intensity (high-medium-low-baseline) and frequency (continuous-intermittent) ratings were developed, and (6) used to qualitatively rate inhalation and dermal exposure separately for each category; (7) quantitative intensity ratings based on available air concentrations were developed for inhalation and dermal exposures based on equal importance of both routes of exposure; (8) adjustments were made for overall exposure, and (9) for each category the product of intensity and frequency was calculated, and exposure in the earlier era was weighted. RESULTS: A period-specific JEM modified for two eras of stable PCB exposure conditions. CONCLUSIONS: These exposure estimates, derived from a systematic and rigorous use of the exposure determinant data, lead to cumulative PCB exposure-response relationships in the epidemiological cancer mortality and incidence studies of this cohort. |
Translating evidence into policy: lessons learned from the case of lowering the legal blood alcohol limit for drivers
Mercer SL , Sleet DA , Elder RW , Cole KH , Shults RA , Nichols JL . Ann Epidemiol 2010 20 (6) 412-20 This case study examines the translation of evidence on the effectiveness of laws to reduce the blood alcohol concentration (BAC) of drivers into policy. It was reconstructed through discussions among individuals involved in the processes as well as a review of documentation and feedback on oral presentations. The Centers for Disease Control and Prevention collaborated extensively with federal and non-federal partners and stakeholders in conducting a rigorous systematic review, using the processes of the Guide to Community Preventive Services to evaluate the body of empirical evidence on 0.08% BAC laws. The timely dissemination of the findings and related policy recommendations-made by the independent Task Force on Community Preventive Services-to Congress very likely contributed to the inclusion of strong incentives to States to adopt 0.08 BAC laws by October 2003. Subsequent dissemination to partners and stakeholders informed decision-making about support for state legislative and policy action. This case study suggests the value of: clearly outlining the relationships between health problems, interventions and outcomes; systematically assessing and synthesizing the evidence; using a credible group and rigorous process to assess the evidence; having an impartial body make specific policy recommendations on the basis of the evidence; being ready to capitalize in briefly opening policy windows; engaging key partners and stakeholders throughout the production and dissemination of the evidence and recommendations; undertaking personalized, targeted and compelling dissemination of the evidence and recommendations; involving multiple stakeholders in encouraging uptake and adherence of policy recommendations; and addressing sustainability. These lessons learned may help others working to translate evidence into policy. |
Toward a more collaborative federal response to chronic kidney disease
Narva AS , Briggs M , Jordan R , Pavkov ME , Burrows NR , Williams DE . Adv Chronic Kidney Dis 2010 17 (3) 282-8 Chronic kidney disease (CKD) is a significant public health problem in the United States. However, data from the United States Renal Data System and other sources suggest that care for people with CKD does not meet recommended standards. The Federal government has developed the infrastructure to promote population-based interventions which have reduced the burden of other chronic illnesses. An effective, coordinated response by Federal health agencies to the public health challenge of CKD could have a significant effect on the morbidity, mortality, and costs associated with CKD. In recent years, initiatives undertaken by three Federal agencies have made important advances in coordinating efforts. The Centers for Disease Control and Prevention has begun to develop public health infrastructure for monitoring the burden of CKD. The Centers for Medicare and Medicaid Services has, through the successful Fistula First Breakthrough Initiative (FFBI) and inclusion of CKD in the scope of work of Quality Improvement Organizations, promoted earlier diagnosis and treatment of CKD. The National Institute of Diabetes and Digestive and Kidney Diseases, through its National Kidney Disease Education Program, has reinvigorated and expanded the Kidney Interagency Coordinating Committee so that it is a robust vehicle to share information about activities, identify and disseminate promising practices and tools, and foster cross-agency collaboration. Collaboration among Federal health agencies has the potential to enhance efforts to reduce the burden of CKD. |
A definition that includes first and second generation immigrants returning to their countries of origin to visit friends and relatives still makes sense to me
Arguin PM . J Travel Med 2010 17 (3) 147-149 This issue of the Journal of Travel Medicine contains two articles drafted by an expert committee of the International Society of Travel Medicine (ISTM) charged with examining what it means to be a traveler who visits friends and relatives (VFR).1,2 They have arrived at the decision that a new definition is needed. Previous definitions of VFR travelers usually included variations on the theme that the travelers involved were recent immigrants who were returning to their country of origin to visit friends and relatives. These authors propose that a VFR should be anyone traveling for the purpose of visiting a friend or a relative (regardless of the traveler's immigrant status or ethnicity) and that there is “an epidemiological risk gradient” between their current location and the travel destination. | The authors first assert that there is no universally accepted definition in the medical literature and that one is needed. That is not entirely true. The Centers for Disease Control (CDC)'s “Health Information for International Travel 2010” (the Yellow Book) defines a VFR as “an immigrant, ethnically and racially distinct from the majority population of the country of residence (a higher‐income country), who returns to his or her homeland (lower‐income country) to visit friends or relatives. Included in the VFR category are family members such as the spouse or children, who were born in the country of residence.”3 The International Travel and Health Book of the World Health Organization (WHO) also defines VFRs as immigrants traveling to their place of origin.4 The principal textbook for the field of travel medicine also includes ethnicity in definition and acknowledges that subsequent generations who maintain cultural identity with their country of origin who travel to visit friends and relatives should also be considered VFRs.5 |
Classroom academic and social context: relationships among emergent literacy, behavioural functioning and teacher curriculum goals in kindergarten
Massetti GM , Bracken SS . Early Child Dev Care 2010 180 (3) 359-375 The teaching beliefs and classroom practices of 54 kindergarten teachers were assessed using a Q-sort measure. Cluster analysis of the Q-sort responses revealed four instructional approaches that differed in their focus on literacy skills, social development and self-esteem. In addition, measures of emergent literacy skills, classroom behaviour and peer relationships were obtained for 162 low-income children attending these kindergarten classrooms. Children in classrooms emphasising emergent literacy skills demonstrated greater mastery of such skills than did children in classrooms emphasising social development. Moreover, literacy skill-focused teachers also reported fewer disruptive behaviour and peer problems among these children. These findings highlight the importance of integrating an emphasis on emergent literacy development into kindergarten curricula for promoting literacy development among low-income children, and also suggest that children's rates of problem behaviour may vary under different curricular approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract). |
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