Sedentary behaviour and cardiovascular disease: a review of prospective studies
Ford ES , Caspersen CJ . Int J Epidemiol 2012 41 (5) 1338-53 BACKGROUND: Current estimates from objective accelerometer data suggest that American adults are sedentary for approximately 7.7 h/day. Historically, sedentary behaviour was conceptualized as one end of the physical activity spectrum but is increasingly being viewed as a behaviour distinct from physical activity. METHODS: Prospective studies examining the associations between screen time (watching television, watching videos and using a computer) and sitting time and fatal and non-fatal cardiovascular disease (CVD) were identified. These prospective studies relied on self-reported sedentary behaviour. RESULTS: The majority of prospective studies of screen time and sitting time has shown that greater sedentary time is associated with an increased risk of fatal and non-fatal CVD. Compared with the lowest levels of sedentary time, risk estimates ranged up to 1.68 for the highest level of sitting time and 2.25 for the highest level of screen time after adjustment for a series of covariates, including measures of physical activity. For six studies of screen time and CVD, the summary hazard ratio per 2-h increase was 1.17 (95% CI: 1.13-1.20). For two studies of sitting time, the summary hazard ratio per 2-h increase was 1.05 (95% CI: 1.01-1.09). CONCLUSIONS: Future prospective studies using more objective measures of sedentary behaviour might prove helpful in quantifying better the risk between sedentary behaviour and CVD morbidity and mortality. This budding science may better shape future guideline development as well as clinical and public health interventions to reduce the amount of sedentary behaviour in modern societies. |
Adult current smoking: differences in definitions and prevalence estimates-NHIS and NSDUH, 2008
Ryan H , Trosclair A , Gfroerer J . J Environ Public Health 2012 2012 918368 OBJECTIVES: To compare prevalence estimates and assess issues related to the measurement of adult cigarette smoking in the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH). METHODS: 2008 data on current cigarette smoking and current daily cigarette smoking among adults ≥18 years were compared. The standard NHIS current smoking definition, which screens for lifetime smoking ≥100 cigarettes, was used. For NSDUH, both the standard current smoking definition, which does not screen, and a modified definition applying the NHIS current smoking definition (i.e., with screen) were used. RESULTS:. NSDUH consistently yielded higher current cigarette smoking estimates than NHIS and lower daily smoking estimates. However, with use of the modified NSDUH current smoking definition, a notable number of subpopulation estimates became comparable between surveys. Younger adults and racial/ethnic minorities were most impacted by the lifetime smoking screen, with Hispanics being the most sensitive to differences in smoking variable definitions among all subgroups. CONCLUSIONS: Differences in current cigarette smoking definitions appear to have a greater impact on smoking estimates in some sub-populations than others. Survey mode differences may also limit intersurvey comparisons and trend analyses. Investigators are cautioned to use data most appropriate for their specific research questions. |
Decreasing prevalence of obesity among young children in Massachusetts from 2004 to 2008
Wen X , Gillman MW , Rifas-Shiman SL , Sherry B , Kleinman K , Taveras EM . Pediatrics 2012 129 (5) 823-31 OBJECTIVE: To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases. METHODS: We analyzed data from 108,762 well-child visits (36,827 children) at a multisite pediatric practice in eastern Massachusetts during 1999-2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months. By using multivariable logistic regression, we estimated gender-specific obesity trends in 2 separate periods, 1999-2003 and 2004-2008, adjusting for age group, race/ethnicity, health insurance, and practice site. RESULTS: From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004-2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid. CONCLUSIONS: Among children aged <6 years at this multisite pediatric practice, obesity prevalence decreased during 2004-2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity. |
Recognition and diagnosis of Cryptococcus gattii infections in the United States
Iverson SA , Chiller T , Beekmann S , Polgreen PM , Harris J . Emerg Infect Dis 2012 18 (6) 1012-5 TO THE EDITOR: An outbreak of Cryptococcus gattii cryptococcosis has been ongoing in the US Pacific Northwest (PNW) since 1999. In contrast to C. neoformans infections, which typically cause meningitis in HIV-infected persons, outbreak-associated C. gattii infections occur primarily in persons without HIV and often cause pneumonia. Sporadic, nonoutbreak-associated C. gattii infections often cause meningitis and have been reported outside the PNW. The prevalence of both types of C. gattii infection in the United States is unknown because diagnostic practices and awareness vary among physicians. |
Trichomonas vaginalis antimicrobial drug resistance in 6 US cities, STD Surveillance Network, 2009-2010
Kirkcaldy RD , Augostini P , Asbel LE , Bernstein KT , Kerani RP , Mettenbrink CJ , Pathela P , Schwebke JR , Secor WE , Workowski KA , Davis D , Braxton J , Weinstock HS . Emerg Infect Dis 2012 18 (6) 939-43 Nitroimidazoles (metronidazole and tinidazole) are the only recommended drugs for treating Trichomonas vaginalis infection, and previous samples that assessed resistance of such isolates have been limited in geographic scope. We assessed the prevalence of in vitro aerobic metronidazole and tinidazole resistance among T. vaginalis isolates from multiple geographic sites in the United States. Swab specimens were obtained from women who underwent routine pelvic examinations at sexually transmitted disease clinics in 6 US cities. Cultured T. vaginalis isolates were tested for nitroimidazole resistance (aerobic minimum lethal concentration [MLC] >50 microg/mL). Of 538 T. vaginalis isolates, 23 (4.3%) exhibited low-level in vitro metronidazole resistance (minimum lethal concentrations 50-100 microg/mL). No isolates exhibited moderate- to high-level metronidazole resistance or tinidazole resistance. Results highlight the possibility that reliance on a single class of antimicrobial drugs for treating T. vaginalis infections may heighten vulnerability to emergence of resistance. Thus, novel treatment options are needed. |
Molecular epidemiology of geographically dispersed Vibrio cholerae, Kenya, January 2009-May 2010
Mohamed AA , Oundo J , Kariuki SM , Boga HI , Sharif SK , Akhwale W , Omolo J , Amwayi AS , Mutonga D , Kareko D , Njeru M , Li S , Breiman RF , Stine OC . Emerg Infect Dis 2012 18 (6) 925-31 Numerous outbreaks of cholera have occurred in Kenya since 1971. To more fully understand the epidemiology of cholera in Kenya, we analyzed the genetic relationships among 170 Vibrio cholerae O1 isolates at 5 loci containing variable tandem repeats. The isolates were collected during January 2009-May 2010 from various geographic areas throughout the country. The isolates grouped genetically into 5 clonal complexes, each comprising a series of genotypes that differed by an allelic change at a single locus. No obvious correlation between the geographic locations of the isolates and their genotypes was observed. Nevertheless, geographic differentiation of the clonal complexes occurred. Our analyses showed that multiple genetic lineages of V. cholerae were simultaneously infecting persons in Kenya. This finding is consistent with the simultaneous emergence of multiple distinct genetic lineages of V. cholerae from endemic environmental reservoirs rather than recent introduction and spread by travelers. |
The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States
Bresee JS , Marcus R , Venezia RA , Keene WE , Morse D , Thanassi M , Brunett P , Bulens S , Beard RS , Dauphin LA , Slutsker L , Bopp C , Eberhard M , Hall A , Vinje J , Monroe SS , Glass RI . J Infect Dis 2012 205 (9) 1374-81 BACKGROUND: Acute gastroenteritis (AGE) remains a common cause of clinic visits and hospitalizations in the United States, but the etiology is rarely determined. METHODS: We performed a prospective, multicenter emergency department-based study of adults with AGE. Subjects were interviewed on presentation and 3-4 weeks later. Serum samples, rectal swab specimens, and/or whole stool specimens were collected at presentation, and serum was collected 3-4 weeks later. Fecal specimens were tested for a comprehensive panel of viral, bacterial, and parasitic pathogens; serum was tested for calicivirus antibodies. RESULTS: Pathogens were detected in 25% of 364 subjects, including 49% who provided a whole stool specimen. The most commonly detected pathogens were norovirus (26%), rotavirus (18%), and Salmonella species (5.3%). Pathogens were detected significantly more often from whole stool samples versus a rectal swab specimen alone. Nine percent of subjects who provided whole stool samples had >1 pathogen identified. CONCLUSIONS: Viruses, especially noroviruses, play a major role as agents of severe diarrhea in adults. Further studies to confirm the unexpectedly high prevalence of rotaviruses and to explore the causes of illness among patients from whom a pathogen cannot be determined are needed. Studies of enteric pathogens should require the collection of whole stool samples. |
Etymologia: prion
Schonberger LB , Schonberger RB . Emerg Infect Dis 2012 18 (6) 1030b-1031 TO THE EDITOR: The January 2012 Etymologia section might confuse readers because it incorrectly reports that "prion" describes a noninfectious agent. In fact, prion -pronounced pree'-on- is a term coined in 1982 by Nobel laureate Stanley Prusiner to describe the novel infectious agent responsible for scrapie, a transmissble neurodegenerative disorder of sheep and goats. He proposed his new term to underscore that the agents are "small proteinaceous infectious particles" resistant to procedures that attack nucleic acids. In his seminal article, he summarized experimental data indicating that the molecular properties of this infectious agent differed from those of other infectious agents, including viruses, viroids, and plasmids; he proposed the word prion to replace other terms then in circulation, such as "unconventional virus" or "unusual slow virus-like agent." |
Iatrogenic Creutzfeldt-Jakob disease, final assessment
Brown P , Brandel JP , Sato T , Nakamura Y , Mackenzie J , Will RG , Ladogana A , Pocchiari M , Leschek EW , Schonberger LB . Emerg Infect Dis 2012 18 (6) 901-7 The era of iatrogenic Creutzfeldt-Jakob disease (CJD) has nearly closed; only occasional cases with exceptionally long incubation periods are still appearing. The principal sources of these outbreaks are contaminated growth hormone (226 cases) and dura mater grafts (228 cases) derived from human cadavers with undiagnosed CJD infections; a small number of additional cases are caused by neurosurgical instrument contamination, corneal grafts, gonadotrophic hormone, and secondary infection with variant CJD transmitted by transfusion of blood products. No new sources of disease have been identified, and current practices, which combine improved recognition of potentially infected persons with new disinfection methods for fragile surgical instruments and biological products, should continue to minimize the risk for iatrogenic disease until a blood screening test for the detection of preclinical infection is validated for human use. |
The 2009 pandemic influenza virus: where did it come from, where is it now, and where is it going?
York I , Donis RO . Curr Top Microbiol Immunol 2012 370 241-57 Around 2008 or 2009, an influenza A virus that had been circulating undetected in swine entered human population. Unlike most swine influenza infections of humans, this virus established sustained human-to-human transmission, leading to a global pandemic. The virus responsible, 2009 pandemic H1N1 (H1N1pdm), is the result of multiple reassortment events that brought together genomic segments from classical H1N1 swine influenza virus, human seasonal H3N2 influenza virus, North American avian influenza virus, and Eurasian avian-origin swine influenza viruses. Genetically, H1N1pdm possesses a number of unusual features, although the genomic characteristics that permitted sustained human-to-human transmission are yet unclear. Human infection with H1N1pdm has generally resulted in low mortality, although certain subgroups (including pregnant women, people with some chronic medical conditions, morbidly obese individuals, and immunosuppressed people) have significantly higher risk of severe disease. As H1N1pdm has spread throughout the human population it continued to evolve. It has also reentered the swine population as a circulating pathogen, and has been transiently identified in other species such as turkeys, cats, and domestic ferrets. Most genetic changes in H1N1pdm to date have not been clearly linked to changes in antigenicity, disease severity, antiviral drug resistance, or transmission efficiency. However, the rapid evolution rate characteristic of influenza viruses suggests that changes in antigenicity are inevitable in future years. Experience with this first pandemic of twenty-first century reemphasizes the importance of influenza surveillance in animals as well as humans, and offers lessons to develop and enhance our ability to identify potentially pandemic influenza viruses in the future. |
Avian influenza A (H5N1) virus antibodies in poultry cullers, South Korea, 2003-2004
Kwon D , Lee JY , Choi W , Choi JH , Chung YS , Lee NJ , Cheong HM , Katz JM , Oh HB , Cho H , Kang C . Emerg Infect Dis 2012 18 (6) 986-8 Transmission of influenza (H5N1) virus from birds to humans is a serious public health threat. In South Korea, serologic investigation among 2,512 poultry workers exposed during December 2003-March 2004 to poultry with confirmed or suspected influenza (H5N1) virus infection found antibodies in 9. Frequency of bird-to-human transmission was low. |
Predicting the effect of climate change on African trypanosomiasis: integrating epidemiology with parasite and vector biology
Moore S , Shrestha S , Tomlinson KW , Vuong H . J R Soc Interface 2012 9 (70) 817-30 Climate warming over the next century is expected to have a large impact on the interactions between pathogens and their animal and human hosts. Vector-borne diseases are particularly sensitive to warming because temperature changes can alter vector development rates, shift their geographical distribution and alter transmission dynamics. For this reason, African trypanosomiasis (sleeping sickness), a vector-borne disease of humans and animals, was recently identified as one of the 12 infectious diseases likely to spread owing to climate change. We combine a variety of direct effects of temperature on vector ecology, vector biology and vector-parasite interactions via a disease transmission model and extrapolate the potential compounding effects of projected warming on the epidemiology of African trypanosomiasis. The model predicts that epidemics can occur when mean temperatures are between 20.7 degrees C and 26.1 degrees C. Our model does not predict a large-range expansion, but rather a large shift of up to 60 per cent in the geographical extent of the range. The model also predicts that 46-77 million additional people may be at risk of exposure by 2090. Future research could expand our analysis to include other environmental factors that influence tsetse populations and disease transmission such as humidity, as well as changes to human, livestock and wildlife distributions. The modelling approach presented here provides a framework for using the climate-sensitive aspects of vector and pathogen biology to predict changes in disease prevalence and risk owing to climate change. |
Use of tuberculosis genotyping for postoutbreak monitoring.
Miramontes R , Winston CA , Haddad MB , Moonan PK . J Public Health Manag Pract 2012 18 (4) 375-8 CONTEXT: Review of routinely collected tuberculosis genotyping results following a known outbreak is a potential mechanism to examine the effectiveness of outbreak control measures. OBJECTIVE: To assess differences in characteristics between outbreak and postoutbreak tuberculosis cases. DESIGN: Retrospective. SETTING: United States. PARTICIPANTS: All tuberculosis cases identified as a result of >5-person outbreaks investigated by the Centers for Disease Control and Prevention during 2003 to 2007 (original outbreak cases), and subsequent culture-positive tuberculosis cases with matching Mycobacterium tuberculosis genotypes reported in the same county during 2004 to 2008 (postoutbreak cases). MAIN OUTCOME MEASURE: Proportion of demographic, social, and clinical characteristics of tuberculosis outbreak cases compared to postoutbreak cases. SECONDARY: Proportion of demographic, social, and clinical characteristics of epidemiologically linked versus nonlinked cases. RESULTS: Six outbreaks with 111 outbreak cases and 110 postoutbreak cases were identified. Differences between outbreak and postoutbreak cases were gender (69% vs 85% male; P < .01), birth origin (3% vs 11% foreign-born; P = .02), disease severity (48% vs 62% sputum smear-positive; P = .04), homelessness (38% vs 51%; P = .05), and injection drug use (4% vs 11%; P = .04). For 5 of the 6 outbreaks, the status of epidemiologic relationships among postoutbreak cases was available (n = 89). The postoutbreak cases with a known epidemiologic link to the original outbreak were in younger persons (aged 39 vs 47 years; P < .01), and a larger proportion reported injection drug use (18% vs 4%; P = .04) or noninjection drug use (44% vs 18%; P < .01) than those without a reported link. CONCLUSIONS: Health jurisdictions can utilize genotyping data to monitor and define the characteristics of postoutbreak cases related to the original outbreak. |
Estimated cumulative incidence of West Nile virus infection in US adults, 1999-2010
Petersen LR , Carson PJ , Biggerstaff BJ , Custer B , Borchardt SM , Busch MP . Epidemiol Infect 2012 141 (3) 1-5 SUMMARY: West Nile virus (WNV) was first recognized in the USA in 1999. We estimated the cumulative incidence of WNV infection in the USA from 1999 to 2010 using recently derived age- and sex-stratified ratios of infections to WNV neuroinvasive disease (WNND) and the number of WNND cases reported to national surveillance. We estimate that over 3 million persons have been infected with WNV in the USA, with the highest incidence rates in the central plains states. These 3 million infections would have resulted in about 780,000 illnesses. A substantial number of WNV infections and illnesses have occurred during the virus' first decade in the USA. |
Using the Internet to trace contacts of a fatal meningococcemia case-New York City, 2010
Gounder P , Del Rosso P , Adelson S , Rivera C , Middleton K , Weiss D . J Public Health Manag Pract 2012 18 (4) 379-381 In August 2010, the New York City Department of Health and Mental Hygiene (DOHMH) conducted an investigation to identify and provide antibiotic prophylaxis to close contacts of a patient who had died of invasive meningococcal disease. Traditional contact tracing, which relies on interviews with the patient's close associates, identified 3 persons meeting prophylaxis criteria. In addition, DOHMH learned of an Internet site used by the patient to arrange anonymous sexual encounters. By working with the Internet site administrator through a liaison, DOHMH sent notification to 15 additional persons potentially at risk for meningococcal disease; of those, at least 1 met prophylaxis criteria. The Internet has been used previously for partner notification by sexually transmitted disease control programs. This case report illustrates how the Internet can aid contact investigations for other communicable diseases, especially when identifying potential contacts is urgent, patients have died, or contacts are unknown to the patient's associates. |
Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition
Stone ND , Lewis DR , Johnson TM 2nd , Hartney T , Chandler D , Byrd-Sellers J , McGowan JE Jr , Tenover FC , Jernigan JA , Gaynes RP . Infect Control Hosp Epidemiol 2012 33 (6) 551-7 OBJECTIVE: To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents. DESIGN: Multicenter, prospective cohort followed over 6 months. SETTING: Three Veterans Affairs (VA) LTCFs. Participants. All current and new residents except those with short stay (<2 weeks). METHODS: MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1-28.6]; [Formula: see text]). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers. CONCLUSIONS: MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions. |
Marital conflict and fifth-graders' risk for injury
Schwebel DC , Roth DL , Elliott MN , Chien AT , Mrug S , Shipp E , Dittus P , Zlomke K , Schuster MA . Accid Anal Prev 2012 47 30-5 BACKGROUND: Injuries are the leading cause of morbidity and mortality for American children. Marital conflict has been associated with a range of negative health outcomes, but little is known about how marital conflict may influence risk of injury among children. We hypothesized marital conflict would be related to increased youth injury risk after controlling for relevant demographic and parenting covariates. METHODS: A community sample of 3218 fifth-graders recruited from three US locales was utilized. Ordinal logistic regression models were used to predict the frequency of unintentional injuries from marital conflict while adjusting for demographics, parenting factors (nurturance, communication, involvement with youth), and family cohesion. RESULTS: Higher levels of marital conflict were associated with higher rates of injury that required professional medical attention (OR=1.20, 95% CI 1.06, 1.35 per standard deviation). The same association held after inclusion of all covariates in a multivariate ordinal logistic regression model. CONCLUSIONS: Parental marital conflict is associated with higher rates of injuries requiring professional medical attention in preadolescent children. |
Examining disclosure of physical and sexual victimization by method in samples of women involved in the criminal justice system
Kubiak SP , Nnawulezi N , Karim N , Sullivan CM , Beeble ML . J Offender Rehabil 2012 51 (3) 161-175 Definitions vary on what constitutes sexual and/or physical abuse, and scholars have debated on which methods might yield the most accurate response rates for capturing this sensitive information. Although some studies suggest respondents prefer methods that provide anonymity, previous studies have not utilized high-risk or stigmatized populations. In this article, the authors report on serendipitous findings when using two methods to assess the past year incidence of sexual and physical violence among women involved in the criminal justice system. Women who participated in an anonymous survey reported higher physical and sexual victimization than did the women who were interviewed, even though the questions were identical. Implications of the findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). |
Health risks of Oregon eighth-grade participants in the "choking game": results from a population-based survey
Ramowski SK , Nystrom RJ , Rosenberg KD , Gilchrist J , Chaumeton NR . Pediatrics 2012 129 (5) 846-51 OBJECTIVE: To examine the risk behaviors associated with participation in the "choking game" by eighth-graders in Oregon. METHODS: We obtained data from the 2009 Oregon Healthy Teens survey, a cross-sectional weighted survey of 5348 eighth-graders that questioned lifetime prevalence and frequency of choking game participation. The survey also included questions about physical and mental health, gambling, sexual activity, nutrition, physical activity/body image, exposure to violence, and substance use. RESULTS: Lifetime prevalence of choking game participation was 6.1% for Oregon eighth-graders, with no differences between males and females. Of the eighth-grade choking game participants, 64% had engaged in the activity more than once and 26.6% >5 times. Among males, black youth were more likely to participate than white youth. Among both females and males, Pacific Islander youth were much more likely to participate than white youth. Multivariate logistic regression revealed that sexual activity and substance use were significantly associated with choking game participation for both males and females. CONCLUSIONS: At >6%, the prevalence of choking game participation among Oregon youth is consistent with previous findings. However, we found that most of those who participate will put themselves at risk more than once. Participants also have other associated health risk behaviors. The comprehensive adolescent well visit, as recommended by the American Academy of Pediatrics, is a good opportunity for providers to conduct a health behavior risk assessment and, if appropriate, discuss the dangers of engaging in this activity. |
Dating Matters: the next generation of teen dating violence prevention
Tharp AT . Prev Sci 2012 13 (4) 398-401 This Special Section was introduced with the assertion that most programs, to date, have been ineffective in preventing intimate partner violence (IPV) and teen dating violence (TDV) because they do not take into account recent work about the development and nature of IPV/TDV (Capaldi and Langhinrichsen-Rohling 2012). Each contribution highlighted dimensions of relationship functioning that can be used to inform the development of prevention programs. The findings in this issue underscore the importance of considering the independent and interactive effects of risk factors occurring at each level of the social ecology, such as alcohol use (Reyes et al. 2012) and violence in the home (Ehrensaft and Cohen 2012), as well as the importance of developing prevention strategies for high-risk groups (Langhinrichsen-Rohling and Turner 2012) that target both boys and girls (Chiodo et al. 2012; O’Leary and Slep 2012) and are strategically administered at key times in adolescent development to stop the initiation or persistence of violence across time and relationships (O’Leary and Slep 2012; Shortt et al. 2012). As national estimates of the frequency of physical dating violence victimization have remained unchanged over the past decade (Centers for Disease Control and Prevention (CDC) 2011), the translation of these findings into effective prevention programs has the potential to transform the field of partner violence prevention. Although some programs (e.g., Building Lasting Love, Langhinrichsen-Rohling and Turner 2012) that reflect these findings have been developed and evaluated, a transformation of the field would require the refinement of many programs currently in practice and the development of new prevention approaches. As an example of a new comprehensive approach that reflects some of the critical findings in this Special Section, the Division of Violence Prevention at CDC is embarking on a new initiative: Dating Matters™: Strategies to Promote Healthy Teen Relationships. This commentary describes the programmatic strategies involved in Dating Matters™, when and with whom these strategies will be implemented, and additional characteristics that have been incorporated to enhance the public health impact of the initiative. |
Use, location, and timeliness of clinical microbiology testing in Georgia for select infectious diseases
Brzozowski AK , Silk BJ , Berkelman RL , Loveys DA , Caliendo AM . J Public Health Manag Pract 2012 18 (4) E4-E10 OBJECTIVE: Although clinical microbiology testing facilitates both public health surveillance of infectious diseases and patient care, research on testing patterns is scant. We surveyed hospital laboratories in Georgia to assess their diagnostic testing practices. METHODS: Using e-mail, all directors of hospital laboratories in Georgia were invited to participate. The survey focused on timing and location of diagnostic testing in 2006 for 6 reportable diseases: giardiasis, legionellosis, meningococcal disease, pertussis, Rocky Mountain spotted fever, and West Nile virus disease. RESULTS: Of 141 laboratories, 62 (44%) responded to the survey. Hospitals varied widely in their use of diagnostic testing in 2006, with 95.1% testing for meningococcal disease, but only 66.1% and 63.3% testing for legionellosis and West Nile virus disease, respectively. Most laboratories (91%) performed gram stain/culture to diagnose meningococcal disease in-house and 23% performed ova and parasite panels for giardiasis were conducted in-house. Fewer than 11% of laboratories performed in-house testing for the remaining diseases. Laboratories affiliated with small hospitals (≤100 beds) were more likely to send specimens for outside testing compared with laboratories associated with large hospitals (>250 beds). Median turnaround time for ova and parasite panel testing for giardiasis was significantly shorter for in-house testing (1.0 days) than within-system (2.25 days) or outside laboratory (3.0 days) testing (P = .0003). No laboratories reported in-house testing for meningococcal disease, pertussis, or Rocky Mountain spotted fever using polymerase chain reaction. CONCLUSION: Many hospitals did not order diagnostic tests for important infectious diseases during 2006, even for relatively common diseases. In addition, hospital laboratories were unlikely to perform diagnostic testing in-house; sending specimens to an outside laboratory may result in substantial delays in receiving results. These unsettling findings have adverse implications for both patient care and public health surveillance; they indicate an immediate need to study nationally the use and timeliness of clinical microbiologic testing. |
Mitochondrial superoxide mediates doxorubicin-induced keratinocyte apoptosis through oxidative modification of ERK and Bcl-2 ubiquitination
Luanpitpong S , Chanvorachote P , Nimmannit U , Leonard SS , Stehlik C , Wang L , Rojanasakul Y . Biochem Pharmacol 2012 83 (12) 1643-54 Massive apoptosis of keratinocytes has been implicated in the pathogenesis of chemotherapy-induced skin toxicities, but the underlying mechanisms of action are not well understood. The present study investigated the apoptotic effect of doxorubicin (DOX) on HaCaT keratinocytes and determined the underlying mechanisms. Treatment of the cells with DOX induced reactive oxygen species (ROS) generation and a concomitant increase in apoptotic cell death through the mitochondrial death pathway independent of p53. Electron spin resonance and flow cytometry studies showed that superoxide is the primary oxidative species induced by DOX and responsible for the death inducing effect. Ectopic expression of mitochondrial superoxide scavenging enzyme (MnSOD) or treatment with MnSOD mimetic (MnTBAP) inhibited DOX-induced superoxide generation and apoptosis. The mechanism by which superoxide mediates the apoptotic effect of DOX was shown to involve downregulation of Bcl-2 through ubiquitin-proteasomal degradation. Superoxide induces dephosphorylation of Bcl-2 through MAP kinase ERK1/2 inactivation, which promotes ubiquitination of Bcl-2. We also provide evidence for the oxidative modification of ERK1/2 through cysteine sulfenic acid formation. These findings indicate a novel pathway for redox regulation of apoptosis regulatory proteins, which could be important in the understanding of chemotherapy-induced toxicities and development of preventive treatment strategies which are currently lacking. |
Pulmonary and cardiovascular responses of rats to inhalation of a commercial antimicrobial spray containing titanium dioxide nanoparticles
McKinney W , Jackson M , Sager TM , Reynolds JS , Chen BT , Afshari A , Krajnak K , Waugh S , Johnson C , Mercer RR , Frazer DG , Thomas TA , Castranova V . Inhal Toxicol 2012 24 (7) 447-57 Our laboratory has previously demonstrated that application of an antimicrobial spray product containing titanium dioxide (TiO(2)) generates an aerosol of titanium dioxide in the breathing zone of the applicator. The present report describes the design of an automated spray system and the characterization of the aerosol delivered to a whole body inhalation chamber. This system produced stable airborne levels of TiO(2) particles with a median count size diameter of 110 nm. Rats were exposed to 314 mg/m(3) min (low dose), 826 mg/m(3) min (medium dose), and 3638 mg/m(3) min (high dose) of TiO(2) under the following conditions: 2.62 mg/m(3) for 2 h, 1.72 mg/m(3) 4 h/day for 2 days, and 3.79 mg/m(3) 4 h/day for 4 days, respectively. Pulmonary (breathing rate, specific airway resistance, inflammation, and lung damage) and cardiovascular (the responsiveness of the tail artery to constrictor or dilatory agents) endpoints were monitored 24 h post-exposure. No significant pulmonary or cardiovascular changes were noted at low and middle dose levels. However, the high dose caused significant increases in breathing rate, pulmonary inflammation, and lung cell injury. Results suggest that occasional consumer use of this antimicrobial spray product should not be a hazard. However, extended exposure of workers routinely applying this product to surfaces should be avoided. During application, care should be taken to minimize exposure by working under well ventilated conditions and by employing respiratory protection as needed. It would be prudent to avoid exposure to children or those with pre-existing respiratory disease. |
Pulmonary toxicity, distribution, and clearance of intratracheally instilled silicon nanowires in rats
Roberts JR , Mercer RR , Chapman RS , Cohen GM , Bangsaruntip S , Schwegler-Berry D , Scabilloni JF , Castranova V , Antonini JM , Leonard SS . J Nanomater 2012 2012 Article ID 398302 Silicon nanowires (Si NWs) are being manufactured for use as sensors and transistors for circuit applications. The goal was to assess pulmonary toxicity and fate of Si NW using an in vivo experimental model. Male Sprague-Dawley rats were intratracheally instilled with 10, 25, 50, 100, or 250 mcg of Si NW (~20-30 nm diameter; ~215 mcm length). Lung damage and the pulmonary distribution and clearance of Si NW were assessed at 1, 3, 7, 28, and 91 days after-treatment. Si NW treatment resulted in dose-dependent increases in lung injury and inflammation that resolved over time. At day 91 after treatment with the highest doses, lung collagen was increased. Approximately 70% of deposited Si NW was cleared by 28 days with most of the Si NW localized exclusively in macrophages. In conclusion, Si NW induced transient lung toxicity which may be associated with an early rapid particle clearance; however, persistence of Si NW over time related to dose or wire length may lead to increased collagen deposition in the lung. |
Adsorption of surfactant lipids by single-walled carbon nanotubes in mouse lung upon pharyngeal aspiration
Kapralov AA , Feng WH , Amoscato AA , Yanamala N , Balasubramanian K , Winnica DE , Kisin ER , Kotchey GP , Gou P , Sparvero LJ , Ray P , Mallampalli RK , Klein-Seetharaman J , Fadeel B , Star A , Shvedova AA , Kagan VE . ACS Nano 2012 6 (5) 4147-56 The pulmonary route represents one of the most important portals of entry for nanoparticles into the body. However, the in vivo interactions of nanoparticles with biomolecules of the lung have not been sufficiently studied. Here, using an established mouse model of pharyngeal aspiration of single-walled carbon nanotubes (SWCNTs), we recovered SWCNTs from the bronchoalveolar lavage fluid (BALf), purified them from possible contamination with lung cells, and examined the composition of phospholipids adsorbed on SWCNTs by liquid chromatography mass spectrometry (LC-MS) analysis. We found that SWCNTs selectively adsorbed two types of the most abundant surfactant phospholipids: phosphatidylcholines (PC) and phosphatidylglycerols (PG). Molecular speciation of these phospholipids was also consistent with pulmonary surfactant. Quantitation of adsorbed lipids by LC-MS along with the structural assessments of phospholipid binding by atomic force microscopy and molecular modeling indicated that the phospholipids ( approximately 108 molecules per SWCNT) formed an uninterrupted "coating" whereby the hydrophobic alkyl chains of the phospholipids were adsorbed onto the SWCNT with the polar head groups pointed away from the SWCNT into the aqueous phase. In addition, the presence of surfactant proteins A, B, and D on SWCNTs was determined by LC-MS. Finally, we demonstrated that the presence of this surfactant coating markedly enhanced the in vitro uptake of SWCNTs by macrophages. Taken together, this is the first demonstration of the in vivo adsorption of the surfactant lipids and proteins on SWCNTs in a physiologically relevant animal model. |
Major, non-chromosomal, birth defects and maternal physical activity: a systematic review
Flak AL , Yun Tark J , Tinker SC , Correa A , Cogswell ME . Birth Defects Res A Clin Mol Teratol 2012 94 (7) 521-31 BACKGROUND: We reviewed the published literature to assess the association between maternal periconceptional physical activity and the risk for major, non-chromosomal, birth defects and whether this varies by pre-pregnancy obesity. METHODS: We conducted a systematic literature search of MEDLINE, EMBASE, and CINAHL databases. Data were abstracted from all articles that met our inclusion criteria and included information on physical activity intensity (mild, moderate, and vigorous) and modality (i.e., standing, lifting, other). We assessed occupational and recreational physical activity separately. The quality of included articles was assessed using the Newcastle-Ottawa Scale. RESULTS: Of 3316 screened articles, 11 were included in this review. Of the four studies that assessed prolonged standing, two reported a positive association with risk for some birth defects; null associations were observed in the other two studies. Associations between heavy lifting or other occupational physical activity exposures and risk for birth defects were inconsistent. A protective association between leisure-time physical activity (i.e., active sports, swimming) and some birth defects (e.g., neural tube defects), was suggested by the results of two studies. Only one study reported assessment of possible effect modification by maternal body mass index (BMI). DISCUSSION: Our review suggests that there may be some associations between occupational and leisure-time physical activities and some, major non-chromosomal, birth defects, but relatively limited published research exists on these associations. Further research in this area should include differentiation of birth defects phenotypes, valid assessments of all domains of physical activity, including household and transportation activity, and account for the potential influence of pre-pregnancy BMI. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Machine safety: new & updated consensus standards
Harris JR , Current RS . Prof Saf 2012 57 (5) 50-57 SH&E professionals should be aware of recent changes to the ANSI B11.0 and B11.19 standards, and should be aware of select international standards and their differences from B11 standards. ANSI B11.0 was created to include elements of general machine safety and risk assessment information formerly found in a technical report. The standard includes guidelines for the risk assessment process as well as sample risk assessment matrices and references. ANSI B11.19 covers machine guarding performance requirements. Topics which have been added or updated to this standard include: protective safety stops; emergency stops; perimeter guarding; muting; bypass; hold-to-run control; guard interlocking switches; and presence-sensing device initiation. |
Evaluation of the performance of the n95-companion: effects of filter penetration and comparison with other aerosol instruments
Rengasamy S , Eimer BC , Shaffer RE . J Occup Environ Hyg 2012 9 (7) 417-26 Fit factor is the ratio of the particle concentration outside (C(out)) to the inside (C(in)) of the respirator and assumes that filter penetration is negligible. For Class-95 respirators, concerns were raised that filter penetration could bias fit test measurements. The TSI N95-Companion was designed to overcome this limitation by measuring only 40-60 nm size particles. Recent research has shown that particles in this size range are the most penetrating for respirators containing electrostic filter media. The goal of this study was to better understand the performance of the N95-Companion by assessing the impact of filter penetration and by comparing C(out)/C(in) ratios measured by other aerosol instruments (nano-Differential Mobility Analyzer/Ultrafine Condensation Particle Counter (nano-DMA/UCPC) and the TSI PortaCount Plus) using N95 filtering facepiece respirators sealed to a manikin and with intentionally created leaks. Results confirmed that 40-60 nm-diameter size room air particles were most penetrating for the respirators tested. A nonlinear relationship was found between the N95-Companion-measured C(out)/C(in) ratios and the other instruments at the sealed condition and at the small leak sizes because the N95-Companion measures only charged particles that are preferentially captured by the electrostic filter media, while the other instrument configurations also measure uncharged particles, which are captured less efficiently. The C(out)/C(in) ratios from the N95-Companion for experiments conducted under sealed condition suggest that filter penetration of negatively charged 40-60 nm size particles was less than 0.05%. Thus, the N95-Companion measured C(out)/C(in) ratios are due primarily to particle penetration through leakage, not through filter media, while the C(out)/C(in) ratios for the PortaCount, nano-DMA/UCPC, and UCPC result from a combination of face seal leakage and filter penetration. |
Fungal and atopic sensitization are low among farmers in the Agricultural Health Study
Endres SM , Green BJ , Henneberger PK , Germolec DR , Bledsoe TA , Beezhold DH , London SJ , Alavanja MC , Beane Freeman LE , Hoppin JA . J Allergy Clin Immunol 2012 130 (1) 267-70 e1 Prevalence of fungal sensitization and atopy was lower among farmers than the US population. Fungal sensitization was related to growing specific agricultural commodities. |
Public health: a best buy for America
Rein AS , Ogden LL . J Public Health Manag Pract 2012 18 (4) 299-302 Public health has considerable capacity to reduce the drag of health spending on our nation by preventing the leading causes of disease, death, and disability with cost-efficient, population-based interventions and innovative, boundary-spanning approaches that link clinical care and community prevention. Public health is uniquely able to identify the burdens of disease and analyze the best strategies for addressing them. A 3-pronged strategy can help assure the value needed from our public health investments. First, we must center our efforts on prevention. Second, we must optimize our public health investments to achieve the greatest value for our investment. Third, public health must collaborate with traditional and new partners on initiatives and in funding. How we finance public health is critical to maximizing public health's benefits and requires thoughtful analysis of how federal funding affects state and local health agencies' programming and how allocation drives choices and design, among other topics, as discussed in this special issue of the journal. |
How federalism shapes public health financing, policy, and program options
Ogden LL . J Public Health Manag Pract 2012 18 (4) 317-22 In the United States, fiscal and functional federalism strongly shape public health policy and programs. Federalism has implications for public health practice: it molds financing and disbursement options, including funding formulas, which affect allocations and program goals, and shapes how funding decisions are operationalized in a political context. This article explores how American federalism, both fiscal and functional, structures public health funding, policy, and program options, investigating the effects of intergovernmental transfers on public health finance and programs. |
Does obesity modify the association of supplemental folic acid with folate status among nonpregnant women of childbearing age in the United States?
Tinker SC , Hamner HC , Berry RJ , Bailey LB , Pfeiffer CM . Birth Defects Res A Clin Mol Teratol 2012 94 (10) 749-55 BACKGROUND: Obesity is associated with an increased risk of having a pregnancy affected by a neural tube defect (NTD). It is not clear whether the amount of folic acid required by obese women to protect against NTDs is the same as that for nonobese women. METHODS: We analyzed data from the National Health and Nutrition Examination Survey, representative of the noninstitutionalized civilian U.S. population, to assess whether body mass index (BMI; normal weight, overweight, and obese categories) modified the association between supplemental folic acid intake and folate status. We estimated the geometric mean concentration among nonpregnant women of childbearing age (15-44 years) during the postfortification period of: serum folate (2003-2008); red blood cell (RBC) folate (2007-2008); and plasma total homocysteine (tHcy; 2003-2006), adjusted for age, race and ethnicity, and total dietary folate expressed as dietary folate equivalents for strata of supplement use and BMI. RESULTS: BMI was inversely associated with serum folate among women who did not use supplements containing folic acid; no differences between women in different BMI categories were observed among supplement users. Regardless of supplement use, obese women had the highest RBC folate concentrations. There were no differences in tHcy by BMI, regardless of supplement use. CONCLUSIONS: These results do not support a straightforward modification of the relationship between supplemental folic acid intake and folate status by BMI. In this population, BMI may affect the body distribution of folate, as reflected by lower serum and higher RBC folate levels in obese women who do not use supplements. (Birth Defects Research (Part A) 2012. (c) 2012 Wiley Periodicals, Inc.) |
Molecular characterization of Cryptosporidium spp. in grazing beef cattle in Japan
Murakoshi F , Xiao L , Matsubara R , Sato R , Kato Y , Sasaki T , Fukuda Y , Tada C , Nakai Y . Vet Parasitol 2012 187 123-8 Cattle are major hosts of Cryptosporidium spp. Cryptosporidiosis in neonatal calves is associated with retarded growth, weight loss and calf mortality, and zoonotic infections in humans. In many areas, cow-calf grazing system is an important beef cattle rearing method with distinct advantages in terms of cost and the labor required. However, few epidemiologic studies of Cryptosporidium spp. have been conducted in this system, especially using molecular diagnostic tools. To understand the transmission of Cryptosporidium spp. in a grazing system, we followed cryptosporidiosis on a grazing farm in Osaki City, Miyagi Prefecture, in northwest Japan for one year. Fecal samples were collected from Japanese Black and Japanese Shorthorn cattle and examined by PCR-RFLP and sequence analyses. Of 113 fecal samples collected in October 2010, 23 (20%) were positive for Cryptosporidium, including 15 samples (13%) having C. bovis, 6 (5%) having C. ryanae, and 2 (2%) having mixed infections of both species. Additionally, C. bovis or C. ryanae was detected on all other sampling dates involving smaller numbers of animals. The infection rate of C. bovis was significantly different among age groups, and calve-to-calve infection might be the major route of cryptosporidiosis transmission in beef cattle. Interestingly, one animal had C. bovis infection or re-infection for one year. Our results suggest that C. bovis and C. ryanae are distributed in Japan, but might have low level of detection in grazing beef cattle. |
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