Sleep duration and history of stroke among adults from the USA
Fang J , Wheaton AG , Ayala C . J Sleep Res 2014 23 (5) 531-7 Although short sleep duration is related to chronic conditions, such as hypertension, diabetes and obesity, the association with stroke is less well known. Using 2006-2011 National Health Interview Surveys, we assessed the association between self-reported duration of sleep and prevalence of stroke stratifying by age and sex. Of the 154 599 participants aged 18 years or older, 29.2%, 61.8% and 9.0% reported they sleep ≤6, 7-8 and ≥9 h per day, respectively. Corresponding age-standardized prevalence of stroke were 2.78%, 1.99% and 5.21% (P < 0.001). Logistic regression models showed a higher prevalence of stroke among those who slept ≤6 or ≥9 h a day compared with those who slept 7-8 h, after adjusting for sociodemographic, behavioural and health characteristics. Further stratifying by age and sex showed that the association of duration of sleep and stroke differed among different age or sex groups. Among young adults (18-44 years), a higher prevalence of stroke was found among women with short sleep. Higher prevalence of stroke was found among middle-aged men and women reporting short or long sleep duration. Among older adults (≥65 years), higher prevalence of stroke was found only among those who slept ≥9 h. In this national sample of adults, the association between duration of sleep and stroke varied by sex and age. Although there was an association of short sleep duration with stroke, we also observed the association of long sleep duration with stroke, especially among those aged 65 years or older. |
Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men
Peterson JL , Bakeman R , Sullivan P , Millett GG , Rosenberg E , Salazar L , Di Clemente RJ , Cooper H , Kelley CF , Mulligan MJ , Frew P , Rio CD . J Acquir Immune Defic Syndr 2014 66 (5) 538-43 OBJECTIVES: To examine associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white MSM. METHODS: The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet ads and were tested for HIV. We assessed respondents' demographics, whether they had engage in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency. RESULTS: Compared to white MSM, black MSM were less likely to report UAI in the past 6 months (OR = 0.59, CI = 0.44-0.80), more likely to be HIV-positive (OR = 5.05, CI = 3.52-7.25) and, among-those HIV-positive-more likely to report not being aware of their HIV infection (OR = 2.58, CI = 1.18-5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio [pOR] = 1.48, CI = 1.10-1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in sample. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -.27, p < .001, for both). CONCLUSION: Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM. |
Effectiveness of neuraminidase inhibitors for severe influenza
Fry AM . Lancet Respir Med 2014 2 (5) 346-8 The neuraminidase inhibitors (NAIs) were licensed for use for the treatment of uncomplicated influenza on the basis of results from phase 3 placebo-controlled, randomised clinical trials and are the only influenza-specific treatment option recommended for use.1 However, the greatest potential clinical and public health benefits of NAI treatment are associated with more severe influenza-associated illness and outcomes, including admission to hospital and death. Thus, in the absence of placebo-controlled clinical trials in patients admitted to hospital with influenza, results from observational studies have been used to inform clinical and public health practice. | In this issue of The Lancet Respiratory Medicine, Stella Muthuri and colleagues2 report the results of a study that adds to the evidence provided by observational studies assessing the effects of NAI treatment on mortality in patients admitted to hospital with influenza. The investigators compiled individual-level data on patients admitted to hospital with confirmed or suspected pandemic influenza A H1N1pdm09 virus infection from 78 observational studies in 38 countries worldwide done during the 2009–10 pandemic. Using a systematic and transparent approach, they addressed several potential biases that can occur in observational studies when treatment is not randomly assigned and demonstrate the complexities involved with these analyses. |
Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data
Muthuri SG , Venkatesan S , Myles PR , Leonardi-Bee J , Al Khuwaitir TS , Al Mamun A , Anovadiya AP , Azziz-Baumgartner E , Baez C , Bassetti M , Beovic B , Bertisch B , Bonmarin I , Booy R , Borja-Aburto VH , Burgmann H , Cao B , Carratala J , Denholm JT , Dominguez SR , Duarte PA , Dubnov-Raz G , Echavarria M , Fanella S , Gao Z , Gerardin P , Giannella M , Gubbels S , Herberg J , Iglesias AL , Hoger PH , Hu X , Islam QT , Jimenez MF , Kandeel A , Keijzers G , Khalili H , Knight M , Kudo K , Kusznierz G , Kuzman I , Kwan AM , Amine IL , Langenegger E , Lankarani KB , Leo YS , Linko R , Liu P , Madanat F , Mayo-Montero E , McGeer A , Memish Z , Metan G , Mickiene A , Mikic D , Mohn KG , Moradi A , Nymadawa P , Oliva ME , Ozkan M , Parekh D , Paul M , Polack FP , Rath BA , Rodriguez AH , Sarrouf EB , Seale AC , Sertogullarindan B , Siqueira MM , Skret-Magierlo J , Stephan F , Talarek E , Tang JW , To KK , Torres A , Torun SH , Tran D , Uyeki TM , Van Zwol A , Vaudry W , Vidmar T , Yokota RT , Zarogoulidis P , Nguyen-Van-Tam JS . Lancet Respir Med 2014 2 (5) 395-404 BACKGROUND: Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. METHODS: We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. FINDINGS: We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0.81; 95% CI 0.70-0.93; p=0.0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0.48; 95% CI 0.41-0.56; p<0.0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0.50; 95% CI 0.37-0.67; p<0.0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1.23] [95% CI 1.18-1.28]; p<0.0001 for the increasing HR with each day's delay). INTERPRETATION: We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection. FUNDING: F Hoffmann-La Roche. |
Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa
Ershova JV , Podewils LJ , Bronner E , Stockwell HG , Dlamini S , Mametja LD . S Afr Med J 2014 104 (5) 362-368 BACKGROUND: Standardised tuberculosis (TB) treatment through directly observed therapy (DOT) is available in South Africa, but the level of adherence to standardised TB treatment and its impact on treatment outcomes is unknown. OBJECTIVES: To describe adherence to standardised TB treatment and provision of DOT, and analyse its impact on treatment outcome. METHODS: We utilised data collected for an evaluation of the South African national TB surveillance system. A treatment regimen was considered appropriate if based on national treatment guidelines. Multivariate log-binomial regression was used to evaluate the association between treatment regimens, including DOT provision, and treatment outcome. RESULTS: Of 1 339 TB cases in the parent evaluation, 598 (44.7%) were excluded from analysis owing to missing outcome or treatment information. The majority (697, 94.1%) of the remaining 741 patients received an appropriate TB regimen. Almost all patients (717, 96.8%) received DOT, 443 (59.8%) throughout the treatment course and 274 (37.0%) during the intensive (256, 34.6%) or continuation (18, 2.4%) phase. Independent predictors of poor outcome were partial DOT (adjusted risk ratio (aRR) 3.1, 95% confidence interval (CI) 2.2 - 4.3) and previous treatment default (aRR 2.3, 95% CI 1.1 - 4.8). CONCLUSION: Patients who received incomplete DOT or had a history of defaulting from TB treatment had an increased risk of poor outcomes. |
First confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities - May 2014
Bialek SR , Allen D , Alvarado-Ramy F , Arthur R , Balajee A , Bell D , Best S , Blackmore C , Breakwell L , Cannons A , Brown C , Cetron M , Chea N , Chommanard C , Cohen N , Conover C , Crespo A , Creviston J , Curns AT , Dahl R , Dearth S , DeMaria A , Echols F , Erdman DD , Feikin D , Frias M , Gerber SI , Gulati R , Hale C , Haynes LM , Heberlein-Larson L , Holton K , Ijaz K , Kapoor M , Kohl K , Kuhar DT , Kumar AM , Kundich M , Lippold S , Liu L , Lovchik JC , Madoff L , Martell S , Matthews S , Moore J , Murray LR , Onofrey S , Pallansch MA , Pesik N , Pham H , Pillai S , Pontones P , Poser S , Pringle K , Pritchard S , Rasmussen S , Richards S , Sandoval M , Schneider E , Schuchat A , Sheedy K , Sherin K , Swerdlow DL , Tappero JW , Vernon MO , Watkins S , Watson J . MMWR Morb Mortal Wkly Rep 2014 63 (19) 431-6 Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014. |
Hepatitis C virus-related knowledge and willingness to receive treatment among patients on methadone maintenance
Zeremski M , Dimova RB , Zavala R , Kritz S , Lin M , Smith BD , Zibbell JE , Talal AH . J Addict Med 2014 8 (4) 249-57 OBJECTIVES: Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. METHODS: A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. RESULTS: Respondents' mean age was 53 +/- 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 +/- 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus-seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher-HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. CONCLUSIONS: The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge. |
Identifying syphilis risk networks through venue attendance in San Francisco
Stephens SC , Fann CK , Strona FV , Wolf W , Cohen SE , Philip SS , Bernstein KT . Sex Transm Dis 2014 41 (5) 333-7 BACKGROUND: Prioritizing interventions for patients with syphilis who are part of large or interconnected sexual networks may be high yield for partner services, and identifying venues named by patients with syphilis who report high numbers of partners may help identify such networks. In this analysis, we explore differences between interviewed patients with early syphilis regarding where they met sex partners. METHODS: With a cross-sectional design, we examined the distribution of total reported sex partners from male index patients with early syphilis interviewed through the San Francisco Department of Public Health partner services program and the self-reported venues named as places they met sex partners. Based on the median number of total partners among male cases of syphilis who named each venue, we categorized venues into 3 levels of partner frequency: high (>15 partners reported), medium (6-15 partners reported), and low (<6 partners reported). Interviewed patients with early syphilis were then classified into these venue categories, and sociodemographic and risk behaviors from electronic medical records and interviews were compared using chi tests. RESULTS: In 2011, 433 male patients with early syphilis named 32 venues. One hundred forty-three (32.3%) patients were categorized as high, 226 (51.0%) as medium, and 74 (16.7%) as low partner frequency venue users. Patients with early syphilis who reported meeting partners at high partner frequency venues were generally older, more likely to be white, have a previous syphilis infection, use methamphetamines in the previous year, and be HIV infected (all P < 0.05) compared with those who reported meeting partners at medium-frequency and low-frequency venues. CONCLUSIONS: Venues where partners are met may be an appropriate proxy for network membership. Targeting additional resources, outreach, and services to clients who attend high-frequency venues may have a positive impact on syphilis prevention efforts. |
Infection control for norovirus
Barclay L , Park GW , Vega E , Hall A , Parashar U , Vinje J , Lopman B . Clin Microbiol Infect 2014 20 (8) 731-40 Norovirus infections are notoriously difficult to prevent and control due to their low infectious dose, high shedding titer, and environmental stability. The virus can spread through multiple transmission routes of which person-to-person and foodborne are the most important. Recent advances in molecular diagnostics, have helped to establish norovirus as the most common cause of sporadic gastroenteritis and most common cause of outbreaks of acute gastroenteritis across all ages. In this paper, we review the epidemiology and virology of noroviruses as well as prevention and control guidelines with a focus on the principles of disinfection and decontamination; Outbreak management relies on sound infection control principles including hand hygiene, limiting exposure to infectious individuals, and thorough environmental decontamination. Ideally, all infection control recommendations would rely on empirical evidence, but a number of challenges, including the inability to culture norovirus in the laboratory and the challenges of outbreak management in complex environments, has made it difficult to garner clear evidence of efficacy in certain areas of infection control. New experimental data on cultivable surrogates for human norovirus on the environmental survivability and relative resistance to commonly used disinfectants, are providing new insights in further refining disinfection practices. Finally, clinical trials are underway to evaluate the efficacy of vaccines which may shift the current infection control principles to more targeted interventions. This article is protected by copyright. All rights reserved. |
Intermittent tuberculosis treatment for patients with isoniazid intolerance or drug resistance
Reves R , Heilig CM , Tapy JM , Bozeman L , Kyle RP , Hamilton CD , Bock N , Narita M , Wing D , Hershfield E , Goldberg SV . Int J Tuberc Lung Dis 2014 18 (5) 571-580 SETTING: Twenty tuberculosis (TB) clinics in the United States and Canada. OBJECTIVE: To evaluate the efficacy and safety of a 6- month intermittent regimen of rifampin (RMP), pyrazinamide (PZA) and ethambutol (EMB) in human immunodeficiency virus (HIV) negative patients with culture-confirmed pulmonary or extra-pulmonary tuberculosis and either isoniazid (INH) resistance or INH intolerance. DESIGN: Patients were enrolled in a single-arm clinical trial to receive intermittent dosing after at least 14 initial daily doses of RMP+PZA+EMB. Treatment was continued twice (BIW) or thrice weekly (TIW) per physician/patient preference for a total of 6 months, with 2 years of follow-up for relapse after treatment. RESULTS: From 1999 to 2004, 98 patients were enrolled, 78 with reported INH resistance and 20 with INH intolerance. BIW dosing was used in 77 and TIW in 21. Study treatment was completed in 73 (74%). Reasons for discontinuation were hepatic adverse events (n = 12), other adverse effects (n = 3) and other reasons (n = 10). Failure (n = 1) and relapse (n = 2) occurred in 3 (3.5%, 95%CI 1.2-9.8) of 86 patients eligible for efficacy analysis, all occurring in patients with cavitary, acid-fast bacilli smear-positive pulmonary TB. CONCLUSIONS: Intermittent RMP+PZA+EMB appears to be effective in HIV-negative patients, but the regimen is poorly tolerated, possibly due to the prolonged use of PZA. Alternative regimens of lower toxicity are needed. |
Oral vaccination and protection of striped skunks (Mephitis mephitis) against rabies using ONRAB
Brown LJ , Rosatte RC , Fehlner-Gardiner C , Ellison JA , Jackson FR , Bachmann P , Taylor JS , Franka R , Donovan D . Vaccine 2014 32 (29) 3675-9 Skunks are one of the most important rabies vector species in North America due to their wide geographic distribution, high susceptibility to the rabies virus, and tendency to inhabit areas around human dwellings and domestic animals. Oral vaccination is a cost-effective, socially acceptable technique often used to control rabies in terrestrial wildlife; however, control of rabies in skunks has proven especially challenging due to the lack of a vaccine effective by the oral route in this species. In this study, we examined the antibody response of captive striped skunks (Mephitis mephitis) to ONRAB(R) and tested the protection afforded by the vaccine against rabies virus. Thirty-one skunks were each offered one ONRAB(R) vaccine bait, 25 skunks were administered ONRAB(R) via direct instillation into the oral cavity (DIOC) and ten controls received no vaccine. A blood sample was collected from controls and vaccinates 6 weeks prior to treatment, and then 5 and 7 weeks post-vaccination (PV). A competitive ELISA was used to detect rabies antibody (RAb). Pre-vaccination sera for all skunks, and sera for all controls throughout the serology study, were negative for RAb. Fifty-eight percent (18/31) of skunks in the bait group and 100% (25/25) of skunks that received ONRAB(R) DIOC had detectable RAb by 7 week PV. All 10 controls succumbed to experimental rabies infection. In the group of skunks administered ONRAB(R) DIOC, 100% (23/23) survived challenge 247 days PV. Survival of skunks presented ONRAB(R) baits was 81% (25/31). In the bait group, all 18 skunks that had detectable RAb by 7 week PV survived challenge. Seven additional skunks without detectable RAb prior to week 7 PV also survived. Lack of any remarkable pathology in study animals, together with positive serology and challenge results, supports that ONRAB(R) is a safe and effective oral rabies vaccine for use in skunks. |
Pool chemical-associated health events in public and residential settings - United States, 2003-2012, and Minnesota, 2013
Hlavsa MC , Robinson TJ , Collier SA , Beach MJ . MMWR Morb Mortal Wkly Rep 2014 63 (19) 427-30 Pool chemicals are added to treated recreational water venues (e.g., pools, hot tubs/spas, and interactive fountains) primarily to protect public health by inactivating pathogens and maximizing the effectiveness of disinfection by controlling pH. However, pool chemicals also can cause injuries when handled or stored improperly. To estimate the number of emergency department (ED) visits for injuries associated with pool chemicals in the United States per year during 2003-2012, CDC analyzed data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). This report summarizes the results of that analysis. In 2012 alone, an estimated 4,876 persons (95% confidence interval [CI] = 2,821-6,930) visited an ED for injuries associated with pool chemicals. Almost half of the patients were aged <18 years. This report also describes a pool chemical-associated health event that occurred in Minnesota in 2013, which sent seven children and one adult to an ED. An investigation by the Minnesota Department of Health (MDH) determined the cause to be poor monitoring of or response to pool chemistry. Pool chemical-associated health events are preventable. CDC's Model Aquatic Health Code (MAHC) (1) is a resource that state and local agencies can use to optimize prevention of injuries and illnesses associated with public treated recreational water venues, including pool chemical-associated health events. |
Fish consumption and blood mercury levels: Golding et al. respond
Golding J , Steer CD , Lowery T , Jones R , Hibbeln JR . Environ Health Perspect 2014 122 (5) A120-1 Obviously our article (Golding et al. 2013) must have been less than clear in leading Groth to assume findings that we had not claimed. For example, he states both that “there was no strong correlation between fish consumption and blood mercury levels” and that we “observed no association between fish intake and blood mercury.” Neither statement is true. We did show that the R2 for total blood mercury associated with seafood consumption was 8.75%, implying a correlation coefficient of about 0.3. The relationship between fish intake and blood mercury was highly significant (p < 0.0001). | The point that we were making in the article was that seafood did contribute to the total blood mercury levels, but that many other dietary items did so as well. The other studies quoted by Groth did not investigate other sources of mercury. However, two studies in the United Kingdom have shown that seafood provides only 25–33% of dietary mercury (Ysart et al. 1999, 2000); although we did not distinguish between types of fish, these authors assayed the mercury content of 500 different samples of seafood, typical of a normal UK diet. | In conclusion we do not disagree with Groth that excessive consumption of fish with high mercury content should be avoided, but would emphasize the overall beneficial effects of fish in general. |
Health assessment of gasoline and fuel oxygenate vapors: reproductive toxicity assessment
Gray TM , Steup D , Roberts LG , O'Callaghan JP , Hoffman G , Schreiner CA , Clark CR . Regul Toxicol Pharmacol 2014 70 S48-57 Vapor condensates of baseline gasoline (BGVC), or gasoline-blended with methyl tertiary butyl ether (G/MTBE), ethyl t-butyl ether (G/ETBE), t-amyl methyl ether (G/TAME), diisopropyl ether (G/DIPE), ethanol (G/EtOH), or t-butyl alcohol (G/TBA) were evaluated for reproductive toxicity in rats at target concentrations of 2000, 10,000, or 20,000mg/m3, 6h/day, 7days/week. BGVC and G/MTBE were assessed over two generations, the others for one generation. BGVC and G/MTBE F1 offspring were evaluated for neuropathology and changes in regional brain glial fibrillary acidic protein content. No neurotoxicity was observed. Male kidney weight was increased consistent with light hydrocarbon nephropathy. In adult rats, decreased body weight gain and increased liver weight were seen. Spleen weight decreased in adults and pups exposed to G/TBA. No pathological changes to reproductive organs occurred in any study. Decreased food consumption was seen in G/TAME lactating females. Transient decreases in G/TAME offspring weights were observed during lactation. Except for a minor increase in time to mating in G/TBA which did not affect other reproductive parameters, there were no adverse reproductive findings. The NOAEL for reproductive and offspring parameters was 20,000mg/m3 for all vapor condensates except for lower offspring NOAELs of 10,000mg/m3 for G/TBA and 2000mg/m3 for G/TAME. |
Acrolein and asthma attack prevalence in a representative sample of the United States adult population 2000 - 2009
Decastro BR . PLoS One 2014 9 (5) e96926 BACKGROUND: Acrolein is an air toxic and highly potent respiratory irritant. There is little epidemiology available, but US EPA estimates that outdoor acrolein is responsible for about 75 percent of non-cancer respiratory health effects attributable to air toxics in the United States, based on the Agency's 2005 NATA (National-Scale Air Toxics Assessment) and acrolein's comparatively potent inhalation reference concentration of 0.02 microg/m3. OBJECTIVES: Assess the association between estimated outdoor acrolein exposure and asthma attack reported by a representative cross-sectional sample of the adult United States population. METHODS: NATA 2005 chronic outdoor acrolein exposure estimates at the census tract were linked with residences oif adults (≥18 years old) in the NHIS (National Health Interview Survey) 2000 - 2009 (n = 271,348 subjects). A sample-weighted logistic regression model characterized the association between the prevalence of reporting at least one asthma attack in the 12 months prior to survey interview and quintiles of exposure to outdoor acrolein, controlling for potential confounders. RESULTS: In the highest quintile of outdoor acrolein exposure (0.05 - 0.46 microg/m3), there was a marginally significant increase in the asthma attack pOR (prevalence-odds ratio [95% CI] = 1.08 [0.98ratio1.19]) relative to the lowest quintile. The highest quintile was also associated with a marginally significant increase in prevalence-odds (1.13 [0.98ratio1.29]) in a model limited to never smokers (n = 153,820). CONCLUSIONS: Chronic exposure to outdoor acrolein of 0.05 - 0.46 microg/m3 appears to increase the prevalence-odds of having at least one asthma attack in the previous year by 8 percent in a representative cross-sectional sample of the adult United States population. |
State and regional comparisons of the use of complementary health approaches: National Health Interview Survey, 2012
Clarke T , Jones L , Peregoy J , Stussman B , Nahin R . J Altern Complement Med 2014 20 (5) A143 Purpose: Based on previous health behavior studies, we expected variation in use of individual complementary health approaches by geographic location. This analysis presents geographic comparisons of use of complementary health approaches among U.S. adults ≥18 years, using data from the 2012 National Health Interview Survey (NHIS). | Methods: Data from the Adult Complementary and Alternative Medicine supplement of the 2012 NHIS were examined to compare prevalence estimates of complementary health approaches among 9 geographic regions and the top 10 most populous states in the U.S. Differences between regional/state percentages and national averages were evaluated using two-sided significance tests at the 0.05 level. All analyses were conducted using SUDAAN to account for the complex NHIS sample design. | Results: Non-vitamin, non-mineral dietary supplements (NVNMDS) (17.9%), chiropractic and osteopathic manipulation (8.5%), and yoga (8.4%) were the top three approaches used in the U.S. The prevalence of adults who used any of the most popular approaches was consistently higher in the Mountain region and consistently lower in the South Atlantic region when compared to the national average. Adults in Michigan (24.6%) and Ohio (23.3%) were more likely to use NVNMDS. Fewer adults in Florida (6.2%) and Texas (5.9%) saw a practitioner for chiropractic or osteopathic manipulation. A greater proportion of adults in California (11.0%) and Illinois (11.0%) used yoga. Other complementary health approaches commonly used by adults in 2012 included massage (6.8%) and meditation (6.3%). | Conclusion: Prevalence of use of complementary health approaches was consistently higher in the Mountain region compared to the national average. States with the lowest prevalence were in the southern regions. |
Why adults use complementary health approaches: an analysis of nationally representative data
Clarke T , Stussman B , Barnes P , Jones L , Nahin R . J Altern Complement Med 2014 20 (5) A143-4 Purpose: The use of complementary health approaches such as mind-body therapies and natural products is popular among Americans. We investigated the specific reasons that complementary health approaches are used and individuals' perceived outcomes of utilizing a particular approach. | Methods: Using data from the 2012 National Health Interview Survey Complementary and Alternative Medicine Supplement we examined the reasons for use and reported outcomes of popular complementary health approaches among their individual users aged 18 and over. We report percentages and standard errors for each sub-group in this nationally representative cross-sectional study. | Results: Popular therapies used included, but were not limited to non-vitamin non-mineral dietary supplement (NVNMDS) use, chiropractic or osteopathic manipulation, yoga, massage therapy and meditation. Eighty-three percent of persons who used NVNMDs did so for general wellness or disease prevention while 42% used them to treat a specific condition. Sixty-six percent of persons who used chiropractic and osteopathic manipulation did so to treat a specific health condition, and 67% said it improved their overall health and made them feel better. Individuals using massage therapy reported a number of benefits including reduced stress (76%) and better sleep (54%). More than 80% of individuals using yoga or mindfulness meditation used these approaches for general wellness or disease prevention and said these approaches improved their overall health and made them feel better. Complementary health approaches were also perceived to be beneficial to social wellbeing, improving relationships and attendance at work/school. | Conclusion: The reasons Americans use complementary health approaches differ greatly by the approach, with some, such as NVNMDS used primarily for wellness or disease prevention, and others like chiropractic and osteopathic manipulation, used primarily to treat specific health conditions. The perceived outcomes associated with each therapy also varied considerably by approach. |
The influence of social determinants on sexual risk among out-of-school African American female adolescents
Browne FA , Wechsberg WM , White VM , Middlesteadt Ellerson R , Raiford JL , Carry MG , Herbst JH . Vulnerable Child Youth Stud 2014 9 (2) 139-150 Formative research was conducted to understand the social determinants of HIV risk among African American female adolescents as part of a systematic adaptation of an evidence-based behavioral HIV prevention intervention, the Women's CoOp. Semi-structured in-depth interviews were conducted between November 2008 and April 2009 with 20 African American female adolescents aged 16-18 who reported engaging in sex, using alcohol or other drugs, and dropping out of school. All interviews were audio recorded, transcribed, and coded for key themes and emergent content patterns. The findings indicate that while female adolescents are knowledgeable about HIV and other sexually transmitted infections (STIs), myriad social factors relate to their level of risk. Interpersonal relationships, primarily with older boyfriends and friends, played a pivotal role in their decision-making regarding sex risk behavior, substance use, and educational attainment. A lack of viable employment opportunities, exacerbated by the lack of a high school education, resulted in some young women trading sex to make money. In addition, violence, victimization, and gang involvement are pervasive in their communities. Out-of-school African American female adolescents face a plethora of issues that are directly and indirectly related to their sex risk behaviors and consequently their HIV/STI risk. To reach a vulnerable population disproportionately affected by HIV and other STIs, these factors must be addressed in prevention interventions, when feasible. The findings were incorporated into the intervention adaptation that is currently being tested in a randomized controlled trial. |
Training meals on wheels volunteers as health literacy coaches for older adults
Rubin DL , Freimuth VS , Johnson SD , Kaley T , Parmer J . Health Promot Pract 2014 15 (3) 448-54 Homebound older adults constitute a "hardly reached" population with respect to health communication. Older adults also typically suffer from health literacy challenges, which put them at increased risk of adverse health outcomes. Suboptimal interactions with providers are one such challenge. Interventions to improve interactive health literacy focus on training consumers/patients in question preparation and asking. Meals on Wheels volunteers are uniquely suited to coach their clients in such interaction strategies. Seventy-three Meals on Wheels volunteers participated in workshops to train as health literacy coaches. The 3- to 4-hour workshops included units on communicating with older adults, on the nature of health literacy, and on the process of interactive health literacy coaching. Participants viewed and discussed videos that modeled the targeted communication behaviors for older adult patients interacting with physicians. They role-played the coaching process. After 9 months, coaches participated in a "booster" session that included videos of ideal coaching practices. Evaluation questionnaires revealed that participants had favorable reactions to the workshops with respect to utility and interest. They especially appreciated learning communication skills and seeing realistic videos. A measure of knowledge about the workshop material revealed a significant increment at posttest. Fidelity of coaching practices with respect to workshop curriculum was confirmed. This training in interactive health literacy for community-based lay volunteers constitutes one way to implement the National Action Plan to Improve Health Literacy for one "hardly reached" population. An online tool kit containing all workshop materials is available. |
Community survey of rabies knowledge and exposure to bats in homes - Sumter County, South Carolina, USA
Lankau EW , Cox SW , Ferguson SC , Blanton JD , Tack DM , Petersen BW , Rupprecht CE . Zoonoses Public Health 2014 62 (3) 190-8 Subsequent to a human rabies death in Sumter County, South Carolina, we assessed the frequency of exposures to bats in homes and citizens' rabies knowledge. A self-administered survey was mailed to 6033 randomly selected Sumter County addresses. The survey inquired about household exposures to bats and respondents' rabies knowledge. Surveys were returned by mail for descriptive analysis. Of 597 respondents, 3.5% (21/597) reported having bats living in (2.8% or 17/597) or entering their homes (2.5% or 15/597) during 2010-2012. Respondents generally understood that mammals transmit rabies virus through bites, but were less aware of the severity of rabies illness and modern post-exposure vaccine administration. Respondents were unsure about how to exclude bats from homes and ranked highly both healthcare and non-healthcare entities as preferred resources for obtaining assistance with bat-related concerns. We found potential for human exposures to bats in Sumter County households and gaps in citizen knowledge of rabies and bat exclusion. Public health officials should engage non-healthcare partners in assistance disseminating rabies educational materials and for providing appropriate referral for persons potentially exposed to bats. |
Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update
Dubberke ER , Carling P , Carrico R , Donskey CJ , Loo VG , McDonald LC , Maragakis LL , Sandora TJ , Weber DJ , Yokoe DS , Gerding DN . Infect Control Hosp Epidemiol 2014 35 (6) 628-45 PURPOSE: Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates "Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates. |
Strategies to prevent surgical site infections in acute care hospitals: 2014 update
Anderson DJ , Podgorny K , Berrios-Torres SI , Bratzler DW , Dellinger EP , Greene L , Nyquist AC , Saiman L , Yokoe DS , Maragakis LL , Kaye KS . Infect Control Hosp Epidemiol 2014 35 (6) 605-27 Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates "Strategies to Prevent Surgical Site Infections in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates. |
Long-term renal and neurologic outcomes among survivors of diethylene glycol poisoning
Conklin L , Sejvar JJ , Kieszak S , Sabogal R , Sanchez C , Flanders D , Tulloch F , Victoria G , Rodriguez G , Sosa N , McGeehin MA , Schier JG . JAMA Intern Med 2014 174 (6) 912-7 IMPORTANCE: At least 13 medication-associated diethylene glycol (DEG) mass poisonings have occurred since 1937. To our knowledge, this is the first longitudinal study characterizing long-term health outcomes among survivors beyond the acute poisoning period. OBJECTIVE: To characterize renal and neurologic outcomes among survivors of a 2006 DEG mass-poisoning event in Panama for 2 years after exposure. DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal study used descriptive statistics and mixed-effects repeated-measures analysis to evaluate DEG-poisoned survivors at 4 consecutive 6-month intervals (0, 6, 12, and 18 months). Case patients included outbreak survivors with a history of (1) ingestion of DEG-contaminated medication, (2) hospitalization for DEG poisoning, and (3) an unexplained serum creatinine level of 1.5 mg/dL or higher (to convert to micromoles per liter, multiply by 88.4) during acute illness or unexplained exacerbation of preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES: Demographics, mortality, dialysis dependence, renal function, neurologic signs and symptoms, and nerve conduction studies. RESULTS: Of the 32 patients enrolled, 5 (15.6%) died and 1 was lost to follow-up, leaving 26 patients at 18 months. Three (9.4%) missed 1 or more evaluations. The median age was 62 years (range, 15-88 years), and 59.4% were female. Three (9.4%) patients had preexisting renal failure. Enrollment evaluations occurred at a median of 108 days (range, 65-154 days) after acute illness. The median serum creatinine level for the 22 patients who were not dialysis dependent at time 0 was 5.9 mg/dL (range, 1.8-17.1 mg/dL) during acute illness and 1.8 mg/dL (range, 0.9-5.9 mg/dL) at time 0. Among non-dialysis-dependent patients, there were no significant differences in the log of serum creatinine or estimated glomerular filtration rate over time. The number of patients with subjective generalized weakness declined significantly over time (P < .001). A similar finding was observed for any sensory loss (P = .05). The most common deficits at enrollment were bilateral lower extremity numbness in 13 patients (40.6%) and peripheral facial nerve motor deficits in 7 (21.9%). All patients with neurologic deficits at enrollment demonstrated improvement in motor function over time. Among 28 patients (90.3%) with abnormal nerve conduction study findings at enrollment, 10 (35.7%) had motor axonal involvement, the most common primary abnormality. CONCLUSIONS AND RELEVANCE: Neurologic findings of survivors tended to improve over time. Renal function generally improved among non-dialysis-dependent patients between acute illness and the first evaluation with little variability thereafter. No evidence of delayed-onset neurologic or renal disease was observed. |
Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11)
Mereckiene J , Cotter S , Nicoll A , Lopalco P , Noori T , Weber J , D'Ancona F , Levy-Bruhl D , Dematte L , Giambi C , Valentiner-Branth P , Stankiewicz I , Appelgren E , OFlanagan D . Euro Surveill 2014 19 (16) 20780 Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low. |
Effectiveness and impact of rotavirus vaccines in the United States - 2006-2012
Rha B , Tate JE , Payne DC , Cortese MM , Lopman BA , Curns AT , Parashar UD . Expert Rev Vaccines 2014 13 (3) 365-376 Prior to the introduction of rotavirus vaccines in 2006, rotavirus was the leading cause of severe gastroenteritis among US children <5 years of age. In the first 7 years of vaccine use, both recommended rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) have been shown to be highly effective in preventing outcomes of severe disease in US children in a variety of settings. In addition, substantial decreases in severe diarrheal disease in US children, exceeding the level expected based on vaccine coverage, as well as the extension of benefits to older age groups ineligible for vaccination have demonstrated both the direct and indirect impacts of vaccination in the USA. |
Influenza seasonality and vaccination timing in tropical and subtropical areas of southern and south-eastern Asia
Saha S , Chadha M , Al Mamun A , Rahman M , Sturm-Ramirez K , Chittaganpitch M , Pattamadilok S , Olsen SJ , Dwi Sampurno O , Setiawaty V , Nur Andriana Pangesti K , Samaan G , Archkhawongs S , Vongphrachanh P , Phonekeo D , Corwin A , Sok T , Buchy P , Chea N , Kitsutani P , Le Quynh M , Vu Dinh T , Lin R , Low C , Chong Chee K , Ismail N , Apandi Yusof M , Tandoc Iii A , Roque Jr V , Mishra A , Moen AC , Widdowson M-C , Partridge J , Lal RB . Bull World Health Organ 2014 92 (5) 318-330 OBJECTIVE: To characterize influenza seasonality and identify the best time of the year for vaccination against influenza in tropical and subtropical countries of southern and south-eastern Asia that lie north of the equator. METHODS: Weekly influenza surveillance data for 2006 to 2011 were obtained from Bangladesh, Cambodia, India, Indonesia, the Lao People's Democratic Republic, Malaysia, the Philippines, Singapore, Thailand and Viet Nam. Weekly rates of influenza activity were based on the percentage of all nasopharyngeal samples collected during the year that tested positive for influenza virus or viral nucleic acid on any given week. Monthly positivity rates were then calculated to define annual peaks of influenza activity in each country and across countries. FINDINGS: Influenza activity peaked between June/July and October in seven countries, three of which showed a second peak in December to February. Countries closer to the equator had year-round circulation without discrete peaks. Viral types and subtypes varied from year to year but not across countries in a given year. The cumulative proportion of specimens that tested positive from June to November was > 60% in Bangladesh, Cambodia, India, the Lao People's Democratic Republic, the Philippines, Thailand and Viet Nam. Thus, these tropical and subtropical countries exhibited earlier influenza activity peaks than temperate climate countries north of the equator. CONCLUSION: Most southern and south-eastern Asian countries lying north of the equator should consider vaccinating against influenza from April to June; countries near the equator without a distinct peak in influenza activity can base vaccination timing on local factors. |
Signal detection of adverse events with imperfect confirmation rates in vaccine safety studies using self-controlled case series design
Xu S , Newcomer S , Nelson J , Qian L , McClure D , Pan Y , Zeng C , Glanz J . Biom J 2014 56 (3) 513-525 The Vaccine Safety Datalink project captures electronic health record data including vaccinations and medically attended adverse events on 8.8 million enrollees annually from participating managed care organizations in the United States. While the automated vaccination data are generally of high quality, a presumptive adverse event based on diagnosis codes in automated health care data may not be true (misclassification). Consequently, analyses using automated health care data can generate false positive results, where an association between the vaccine and outcome is incorrectly identified, as well as false negative findings, where a true association or signal is missed. We developed novel conditional Poisson regression models and fixed effects models that accommodate misclassification of adverse event outcome for self-controlled case series design. We conducted simulation studies to evaluate their performance in signal detection in vaccine safety hypotheses generating (screening) studies. We also reanalyzed four previously identified signals in a recent vaccine safety study using the newly proposed models. Our simulation studies demonstrated that (i) outcome misclassification resulted in both false positive and false negative signals in screening studies; (ii) the newly proposed models reduced both the rates of false positive and false negative signals. In reanalyses of four previously identified signals using the novel statistical models, the incidence rate ratio estimates and statistical significances were similar to those using conventional models and including only medical record review confirmed cases. |
Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤ 29 years - United States, 1999-2010
Gilchrist J , Parker EM . MMWR Morb Mortal Wkly Rep 2014 63 (19) 421-6 In the United States, almost 4,000 persons die from drowning each year. Drowning is responsible for more deaths among children aged 1-4 years than any other cause except congenital anomalies. For persons aged ≤29 years, drowning is one of the top three causes of unintentional injury death (2). Previous research has identified racial/ethnic disparities in drowning rates. To describe these differences by age of decedent and drowning setting, CDC analyzed 12 years of combined mortality data from 1999-2010 for those aged ≤29 years. Among non-Hispanics, the overall drowning rate for American Indians/Alaska Natives (AI/AN) was twice the rate for whites, and the rate for blacks was 1.4 times the rate for whites. Disparities were greatest in swimming pools, with swimming pool drowning rates among blacks aged 5-19 years 5.5 times higher than those among whites in the same age group. This disparity was greatest at ages 11-12 years; at these ages, blacks drown in swimming pools at 10 times the rate of whites. Drowning prevention strategies include using barriers (e.g., fencing) and life jackets, actively supervising or lifeguarding, teaching basic swimming skills and performing bystander cardiopulmonary resuscitation (CPR). The practicality and effectiveness of these strategies varies by setting; however, basic swimming skills can be beneficial across all settings. |
Second worldwide proficiency study on variable number of tandem repeats typing of Mycobacterium tuberculosis complex
De Beer JL , Kodmon C , Van Ingen J , Jamieson FB , Bidovec-Stojkovic U , Brown T , Cirillo DM , Cruz L , Miranda A , Dou HY , Fauville-Dufaux M , Fitzgibbon MM , Garcia De Viedma D , Groenheit R , Haanpera-Heikkinen M , Indra A , Kam KM , Kramer R , Jiang GL , Niemann S , Obrovac M , Rasmussen EM , Refregier G , Realpe T , Samper S , Sharma MK , Sougakoff W , Stakenas P , Stavrum R , Trenkler J , Wada T , Siame KK , Tafaj S , Cowan L , Sng LH , Seagar AL , Basu I , Rastogi N , Ferro BE , De Matos F , Kipnis A , Van Soolingen D , Supply P . Int J Tuberc Lung Dis 2014 18 (5) 594-600+i BACKGROUND: The quality of variable number of tandem repeats (VNTR) typing of Mycobacterium tuberculosis was first investigated in 2009 in 37 laboratories worldwide. The results revealed an inter- and intra-laboratory reproducibility of respectively 60% and 72%. These data spurred an improvement in laboratory-specific assays and global standardisation of VNTR typing. OBJECTIVE: To measure the effects of the technical improvements and increased standardisation, a test panel consisting of 30 M. tuberculosis complex DNA samples was distributed for VNTR typing in 41 participating laboratories from 36 countries. RESULTS: The inter- and intra-laboratory reproducibility increased overall to respectively 78% and 88%. The 33 laboratories that participated in both the first and second proficiency studies improved their inter- and intra-laboratory reproducibility from 62% and 72% to respectively 79% and 88%. The largest improvement in reproducibility was detected in 10 laboratories that use an in-house polymerase chain reaction technique and perform amplicon sizing using gel electrophoresis. Detailed error analysis revealed a reduction in the number of systematic errors, sample exchange events and non-amplifiable loci. CONCLUSION: This second worldwide proficiency study indicates a substantial increase in the reproducibility of VNTR typing of M. tuberculosis. This will contribute to a more meaningful interpretation of molecular epidemiological and phylogenetic studies on the M. tuberculosis complex. |
Assessment of Etest as an alternative to agar dilution for antimicrobial susceptibility testing of Neisseria gonorrhoeae
Liu H , Taylor TH Jr , Pettus K , Trees D . J Clin Microbiol 2014 52 (5) 1435-40 We studied whether the Etest can be used as an alternative to agar dilution to determine antimicrobial susceptibilities of ceftriaxone, cefixime, and cefpodoxime in Neisseria gonorrhoeae surveillance. One hundred fifteen clinical and laboratory isolates of N. gonorrhoeae were tested following the Clinical Laboratory Improvement Amendments (CLIA)-approved CLSI standard agar dilution method and, separately, by the Etest according to the manufacturer's recommendations. The MICs were determined and compared. Ten laboratory-generated mutants were used to simulate substantially nonsusceptible specimens. The Etest and agar dilution methods were well correlated. Statistical tests produced regression R(2) values of 88%, 82%, and 85% and Pearson correlation coefficients of 92%, 91%, and 92% for ceftriaxone, cefixime, and cefpodoxime, respectively. When paired comparisons were made, the two tests were 88.7%, 80%, and 87% within 1 log2 dilution from each other for ceftriaxone, cefixime, and cefpodoxime, respectively. The within-2-log2 agreements were 99.1%, 98.3%, and 94.8% for ceftriaxone, cefixime, and cefpodoxime, respectively. Notwithstanding the good correlations and the within-2-log2 general agreement, the Etest results produced slightly lower MICs than the agar dilution results. In conclusion, we found that the Etest can be effectively used as an alternative to agar dilution testing to determine the susceptibility of N. gonorrhoeae to ceftriaxone, cefixime, and cefpodoxime, although we recommend further research into extremely resistant isolates. For isolates within the typical range of clinical MICs, reexamination of the Etest interpretation of susceptible and nonsusceptible categories would likely allow for successful transition from agar dilution to the Etest. |
Comment on comparison of powder dustiness methods
Evans DE , Turkevich LA , Roettgers CT , Deye GJ . Ann Occup Hyg 2014 58 (4) 524-8 We have read with interest the recent work by the University of Wuppertal group (Bach et al., 2013) on dustiness determination using the University of North Carolina (UNC) Dustiness Testing Device (Boundy et al., 2006). We have referred to the UNC device as the ‘Venturi’ device (Evans et al., 2013), as that describes the underlying dispersal mechanism; we continue with this terminology. The Wuppertal paper is presented in two parts. In Part 1, the dustiness of nine industrial powders was measured with the Venturi device, and results compared with their earlier measurements (Bach and Schmidt, 2008) using macroscopic techniques: EN 1505 standardized continuous drop (CEN 2006, 2013) and the commercial Heubach rotating drum and commercial Palas single drop. In Part 2, dustiness values for 11 pharmaceutical powders were determined solely with the Venturi device. We would like to comment on these Wuppertal results, especially in light of our previous and extensive use of the Venturi device for fine and nanoscale powders (Evans et al., 2013). | Unfortunately, insufficient detail is provided on the provenance of the Wuppertal powders (Bach and Schmidt, 2008; Bach et al., 2013), to allow an inter-laboratory comparison with identical materials. (By contrast, our measurements (Evans et al., 2013) for Holland lactose of Dtot = 5.2 (0.4)% and Dresp = 0.9 (0.1)% are fully consistent with those of the UNC group (Boundy et al., 2006), with Dtot = 5.1 (0.9)% and Dresp = 1.3 (0.5)% for the same material.) In the technique comparison, Part 1, of the Wuppertal study, only three Venturi measurements were made for each powder, and no ranges or statistics were reported. In the pharmaceutical, Part 2, of their study, five Venturi measurements were made for each powder, and standard deviations were reported, permitting some analysis of possible error. Finally, we observed an empirical correlation between respirable and total dustiness, as measured with the Venturi device, to hold for a wide range of powders (Evans et al., 2013). It is informative to test that empirical correlation with these additional Wuppertal results. |
Rates of adverse events associated with male circumcision in US medical settings, 2001 to 2010
El Bcheraoui C , Zhang X , Cooper CS , Rose CE , Kilmarx PH , Chen RT . JAMA Pediatr 2014 168 (7) 625-34 IMPORTANCE: Approximately 1.4 million male circumcisions (MCs) are performed annually in US medical settings. However, population-based estimates of MC-associated adverse events (AEs) are lacking. OBJECTIVES: To estimate the incidence rate of MC-associated AEs and to assess whether AE rates differed by age at circumcision. DESIGN: We selected 41 possible MC AEs based on a literature review and on medical billing codes. We estimated a likely risk window for the incidence calculation for each MC AE based on pathogenesis. We used 2001 to 2010 data from SDI Health, a large administrative claims data set, to conduct a retrospective cohort study. SETTING AND PARTICIPANTS: SDI Health provided administrative claims data from inpatient and outpatient US medical settings. MAIN OUTCOMES AND MEASURES: For each AE, we calculated the incidence per million MCs. We compared the incidence risk ratio and the incidence rate difference for circumcised vs uncircumcised newborn males and for males circumcised at younger than 1 year, age 1 to 9 years, or 10 years or older. An AE was considered probably related to MC if the incidence risk ratio significantly exceeded 1 at P < .05 or occurred only in circumcised males. RESULTS: Records were available for 1 400 920 circumcised males, 93.3% as newborns. Of 41 possible MC AEs, 16 (39.0%) were probable. The incidence of total MC AEs was slightly less than 0.5%. Rates of potentially serious MC AEs ranged from 0.76 (95% CI, 0.10-5.43) per million MCs for stricture of male genital organs to 703.23 (95% CI, 659.22-750.18) per million MCs for repair of incomplete circumcision. Compared with boys circumcised at younger than 1 year, the incidences of probable AEs were approximately 20-fold and 10-fold greater for males circumcised at age 1 to 9 years and at 10 years or older, respectively. CONCLUSIONS AND RELEVANCE: Male circumcision had a low incidence of AEs overall, especially if the procedure was performed during the first year of life, but rose 10-fold to 20-fold when performed after infancy. |
Popular modalities among children who use complementary health approaches
Jones L , Clarke T , Stussman B , Barnes P , Peregoy J , Nahin R . J Altern Complement Med 2014 20 (5) A144 Purpose: We examined changes between 2007 and 2012 in the use of selected modalities among children who used complementary health approaches. | Methods: Using the Child Complementary and Alternative Medicine supplements of the 2007 and 2012 National Health Interview Survey (NHIS), we calculated the percentage of children aged 4–17 years who used selected complementary health approach modalities among all children in that age range who used any complementary health approach. Point and standard error estimates were calculated using SUDAAN, accounting for the complex sample design of the NHIS. Percentages were age-adjusted to the projected 2000 U.S. standard population in order to make comparisons over time. Estimates were compared between years using two-tailed significance tests at the 0.05 level. | Results: The use of non-vitamin, non-mineral dietary supplements (NVNMDS) was the most common approach among children using any complementary health approach in both 2007 (33%) and 2012 (45%); however, the relative popularity of individual NVNMDS such as Echinacea, fish oils and melatonin changed substantially between years. In 2012, among those children who used any complementary health approach, 30% practiced yoga, tai chi or qi gong; this was a 50% increase from 2007. Conversely, use of acupuncture, progressive relaxation and special diets declined among children using complementary health approaches in 2007 and 2012. | Conclusion: We noted increased use of some individual approaches and decreased use of others. Children who used complementary health approaches in 2012 were more likely to take NVNMDS and participate in yoga, tai chi and qi gong compared to similar-aged children in 2007. |
Health and well-being of children adopted from foster care
Zill N , Bramlett MD . Child Youth Serv Rev 2014 40 29-40 Data from the National Survey of Children's Health, 2011-12 were used to compare children in foster care with children adopted from foster care with respect to health, health care and well-being. Children living with both biological parents and children living with never-married biological mothers were included as comparison groups. The findings suggest that adoption confers socioeconomic advantages for children, relative to children who remain in foster care. However, these advantages do not tend to translate into better developmental, academic, or other well-being outcomes. The evidence suggests that children in foster care who are adopted tend to cost the public less than children who remain in foster care or are reunited with their biological families. |
Changing dietary supplement use among U.S. adults: 2000-2012
Jones L , Clarke T , Stussman B , Barnes P , Peregoy J , Nahin R . J Altern Complement Med 2014 20 (5) A144 Purpose: Non-vitamin, non-mineral dietary supplements (NVNMDS) such as fish oils, melatonin and Echinacea are used by many Americans for improving health and wellbeing. Previous studies indicate a steady increase in overall use of NVNMDS over time, but none have documented changes in individual NVNMDS use. | Methods: We used data from the 2000, 2002, 2007 and 2012 National Health Interview Survey (NHIS), which are collected from representative samples of U.S. adults aged 18 and over. Point and standard error estimates of overall and selected NVNMDS use were calculated using SUDAAN, accounting for the complex sample design of the NHIS. For each year, the denominator was the estimated number of adults in the U.S. Data were age-adjusted to the projected 2000 U.S. standard. Estimates of NVNMDS use were compared between years using two-tailed significance tests at the 0.05 level. | Results: In 2000, 14% of adults aged 18 years and over used NVNMDS. Overall use has remained stable with an increase of over3 percentage points between 2000 and 2012, but little change was seen when comparing 2007 to 2012. However, during this same time period, there have been significant changes in the specific NVNMDS used. In 2002, Echinacea, ginseng and ginkgo biloba were the most common supplements used by adults. In 2007 and 2012, the use of these three supplements decreased, and they were no longer among the top 5 NVNMDS used in 2012. In 2007 and 2012 fish oil was the most common NVNMDS used among adults (4.8% and 7.8%, respectively). Between 2007 and 2012 the use of melatonin doubled, while probiotic/prebiotic use quadrupled. Conversely, there was a decrease in glucosamine/chondroitin use between 2007 and 2012. | Conclusion: While the overall use of NVNMDS has remained relatively stable over time, large increases and decreases in the use of individual NVNMDS have been noted. |
Prevalence of carpal tunnel syndrome among employees at a poultry processing plant
Musolin K , Ramsey JG , Wassell JT , Hard DL . Appl Ergon 2014 45 (6) 1377-83 OBJECTIVE: To determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups. METHODS: Performed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios. RESULTS: Three hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)]. CONCLUSIONS: Increasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors. |
Neglected parasitic infections in the United States: needs and opportunities
Parise ME , Hotez PJ , Slutsker L . Am J Trop Med Hyg 2014 90 (5) 783-5 Parasitic infections are a major global health burden. The impact of debilitating diseases caused by parasites is greatest among those who struggle to meet their daily basic needs and access basic health care services in low-income countries. However, persons who have or are at risk for parasitic infections are present in every income and social strata, and residents of the United States and other developed nations are not unaffected. For some persons living in the United States, these parasitic infections are acquired in their own immediate environment; for example, exposure to feces from domestic dogs or cats puts children at risk for toxocariasis and toxoplasmosis. For others, chronic parasitic infections acquired years ago in other areas of the world can manifest with severe illness later in life, such as neurocysticercosis leading to adult–onset epilepsy or Chagas disease leading to severe cardiomyopathy requiring heart transplant. We know much less than we should about the health and economic burden and impact of parasitic diseases in developed countries, including the United States (Table 1).1 |
Lifetime cumulative exposure to waterpipe smoking is associated with coronary artery disease
Sibai AM , Tohme RA , Almedawar MM , Itani T , Yassine SI , Nohra EA , Isma'eel HA . Atherosclerosis 2014 234 (2) 454-460 OBJECTIVE: Globally, waterpipe (WP) smoking is becoming a more prevalent form of tobacco consumption. Whilst research so far has demonstrated a significant link between WP use and a number of health outcomes, little is known of its association with heart disease. We examine in this study the association of WP smoking with angiographically confirmed coronary artery disease (CAD). METHODS: A total of 1210 patients, aged 40 years and over and free from smoking-associated illnesses or history of cardiovascular procedures, admitted for coronary angiography at four major hospitals in Lebanon, were included. The extent of CAD was summarized in two ways, firstly as diseased (≥50% and ≥70% occlusion in at least one main coronary artery) versus non-diseased (entirely normal coronaries), and secondly, as CAD cumulative score based on Duke CAD Prognostic Index. A score of WP-years, capturing intensity and lifetime duration of exposure, was estimated for each individual. RESULTS: Lifetime exposure exceeding 40 WP-years was associated with a threefold significant increase in the odds of having severe stenosis (≥70%) compared to non-smokers (OR = 2.94, 95% CI 1.04-8.33) as well as with the CAD Index (beta = 7.835, p-value = 0.027), net of the effect of socio-demographic characteristics, health behaviors and co-morbidity. A dose-response relationship between WP-years and percent stenosis was also established. WP smoking status (never, past and current) did not associate with CAD. CONCLUSIONS: Cumulative exposure to WP smoking is significantly associated with severe CAD. There is a need to monitor WP use among cardiac patients and include this information in their medical charts in the same manner cigarettes smoking is documented. This is likely to increase awareness of the hazards of WP smoking and prompt physicians to target WP tobacco control by providing advice to their patients on WP smoking cessation. |
Content Index (Achived Edition)
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