Years of potential life lost caused by prostate cancer deaths in the United States-projection from 2004 through 2050
Li C , Ekwueme DU . Cancer Epidemiol 2010 34 (4) 368-72 BACKGROUND: The purpose of this study is to estimate and project the number of years of potential life lost (YPLL) among males who die of prostate cancer in the United States from 2004 through 2050 and compare the projections by race/ethnicity and age, accounting for demographic changes and population growth. METHODS: We applied the life expectancy method to estimate YPLL caused by deaths of prostate cancer and all cancers in men by using 1999-2004 national mortality data, 2008 census population demographic projections, and 2004 U.S. life tables. We performed sensitivity analyses by varying death rate and population projections, and examined increase in YPLL from population growth, changes in demographics, and death rates. RESULTS: The number of YPLL caused by prostate cancer deaths was projected to increase by 226.1%, from 291,853 in 2004 to 951,753 in 2050. Hispanics were projected to have the fastest growth in YPLL (977.1% from 2004 to 2050) caused by prostate cancer, followed by non-Hispanic blacks (543.1%), and non-Hispanic others (269.7%). People aged 75 or older was projected to account for 62.0% of YPLL from prostate cancer in 2050 compared with 50.8% in 2004. Of the projected increase in YPLL caused by prostate cancer deaths by 2050, 9.8% were due to changes in demographic composition, 26.8% because of mortality change, and 63.4% because of population growth. CONCLUSIONS: YPLL due to prostate cancer deaths are projected to increase dramatically, and become a greater burden in the future. The projections highlight the importance of comprehensive cancer control and research on cancers including prostate cancer and racial/ethnic-specific estimates. |
Late presentation for human immunodeficiency virus care in the United States and Canada
Althoff KN , Gange SJ , Klein MB , Brooks JT , Hogg RS , Bosch RJ , Horberg MA , Saag MS , Kitahata MM , Justice AC , Gebo KA , Eron JJ , Rourke SB , Gill MJ , Rodriguez B , Sterling TR , Calzavara LM , Deeks SG , Martin JN , Rachlis AR , Napravnik S , Jacobson LP , Kirk GD , Collier AC , Benson CA , Silverberg MJ , Kushel M , Goedert JJ , McKaig RG , Van Rompaey SE , Zhang J , Moore RD . Clin Infect Dis 2010 50 (11) 1512-20 BACKGROUND: Initiatives to improve early detection and access to human immunodeficiency virus (HIV) services have increased over time. We assessed the immune status of patients at initial presentation for HIV care from 1997 to 2007 in 13 US and Canadian clinical cohorts. METHODS: We analyzed data from 44,491 HIV-infected patients enrolled in the North American-AIDS Cohort Collaboration on Research and Design. We identified first presentation for HIV care as the time of first CD4(+) T lymphocyte (CD4) count and excluded patients who prior to this date had HIV RNA measurements, evidence of antiretroviral exposure, or a history of AIDS-defining illness. Trends in mean CD4 count (measured as cells/mm(3)) and 95% confidence intervals were determined using linear regression adjusted for age, sex, race/ethnicity, HIV transmission risk, and cohort. RESULTS: Median age at first presentation for HIV care increased over time (range, 40-43 years; [Formula: see text]), whereas the percentage of patients with injection drug use HIV transmission risk decreased (from 26% to 14%; [Formula: see text]) and heterosexual transmission risk increased (from 16% to 23%; [Formula: see text]). Median CD4 count at presentation increased from 256 cells/mm(3) (interquartile range, 96-455 cells/mm(3)) to 317 cells/mm(3) (interquartile range, 135-517 cells/mm(3)) from 1997 to 2007 ([Formula: see text]). The percentage of patients with a CD4 count > or = 350 cells/mm(3) at first presentation also increased from 1997 to 2007 (from 38% to 46%; [Formula: see text]). The estimated adjusted mean CD4 count increased at a rate of 6 cells/mm(3) per year (95% confidence interval, 5-7 cells/mm(3) per year). CONCLUSION: CD4 count at first presentation for HIV care has increased annually over the past 11 years but has remained <350 cells/mm(3), which suggests the urgent need for earlier HIV diagnosis and treatment. |
Outbreak of adenovirus type 4 infection in a long-term care facility for the elderly
Kandel R , Srinivasan A , D'Agata EM , Lu X , Erdman D , Jhung M . Infect Control Hosp Epidemiol 2010 31 (7) 755-7 An outbreak of acute respiratory disease due to human adenovirus and a resulting increase in mortality occurred in a long-term care facility for the elderly. By use of viral culture and polymerase chain reaction, not a rapid antigen test, the virus was detected. Human adenovirus infection can occur in elderly individuals, but detection by rapid antigen testing may be limited. |
Potential threat of drug-resistant and vaccine-escape HBV mutants to public health
Teo CG , Locarnini SA . Antivir Ther 2010 15 445-9 Immune pressure exerted on HBV by anti-HBV antibodies and long-term therapy with drugs that mutagenize the viral P gene can select for mutations in its S gene, leading to vaccine escape and evasion from serological detection. Although transmissibility of these mutants is poor and their evolution towards heightened virulence appears slow, the situation could change as vaccination coverage increases, and treatment of patients with chronic hepatitis B and those coinfected by HIV and HBV becomes widespread. Enhanced surveillance programmes to track changes in the genotype and phenotype of the mutants are needed. |
Hyperendemic H. pylori and tapeworm infections in a U.S.-Mexico border population
Cardenas VM , Mena KD , Ortiz M , Karri S , Variyam E , Behravesh CB , Snowden KF , Flisser A , Bristol JR , Mayberry LF , Ortega YR , Fukuda Y , Campos A , Graham DY . Public Health Rep 2010 125 (3) 441-7 OBJECTIVE: A higher incidence of infectious disease has been documented in U.S. regions bordering Mexico compared with non-border areas. We assessed the prevalence of important gastrointestinal infections in Ciudad Juarez, Mexico, and El Paso, Texas, the largest binational community along the U.S.-Mexico border. METHODS: Fecal specimens from a sample of the asymptomatic population representing all ages were tested for Helicobacter pylori (H. pylori), Cryptosporidium spp., Giardia spp., and other intestinal parasitic pathogens using flotation, immunoassays, and/or polymerase chain reaction. We also measured indicators of microbiological contamination of drinking water, hands of food preparers, and kitchen surfaces. RESULTS: Overall, of the 386 participants, H. pylori was present in 38.2%, Taenia spp. in 3.3%, Giardia spp. in 2.7%, Cryptosporidium spp. in 1.9%, Entamoeba dispar in 1.3%, and Ascaris lumbricoides and Necator americanus in 0.3% of the study subjects; Cyclospora spp. and Entamoeba histolytica were not found. H. pylori infection was associated with handwashing (prevalence ratio [PR] = 1.3, 95% confidence interval [CI] 1.0, 1.8). Taenia spp. was found more often on the U.S. side (PR=8.6, 95% CI 2.3, 30.8). We did not find an association between these infections and the occurrence of total coliforms or fecal coliforms on kitchen surfaces. In addition, Escherichia coli was not found in any drinking water sample. CONCLUSION: The study results indicated that H. pylori and Taenia spp. infections may be highly prevalent along the U.S.-Mexico border. Additional research is necessary to adequately characterize the prevalence, as well as determine whether interventions that reduce these infections are warranted. |
2009 pandemic influenza A (H1N1): pathology and pathogenesis of 100 fatal cases in the United States
Shieh WJ , Blau DM , Denison AM , Deleon-Carnes M , Adem P , Bhatnagar J , Sumner J , Liu L , Patel M , Batten B , Greer P , Jones T , Smith C , Bartlett J , Montague J , White E , Rollin D , Gao R , Seales C , Jost H , Metcalfe M , Goldsmith CS , Humphrey C , Schmitz A , Drew C , Paddock C , Uyeki TM , Zaki SR . Am J Pathol 2010 177 (1) 166-75 In the spring of 2009, a novel influenza A (H1N1) virus emerged in North America and spread worldwide to cause the first influenza pandemic since 1968. During the first 4 months, over 500 deaths in the United States had been associated with confirmed 2009 pandemic influenza A (H1N1) [2009 H1N1] virus infection. Pathological evaluation of respiratory specimens from initial influenza-associated deaths suggested marked differences in viral tropism and tissue damage compared with seasonal influenza and prompted further investigation. Available autopsy tissue samples were obtained from 100 US deaths with laboratory-confirmed 2009 H1N1 virus infection. Demographic and clinical data of these case-patients were collected, and the tissues were evaluated by multiple laboratory methods, including histopathological evaluation, special stains, molecular and immunohistochemical assays, viral culture, and electron microscopy. The most prominent histopathological feature observed was diffuse alveolar damage in the lung in all case-patients examined. Alveolar lining cells, including type I and type II pneumocytes, were the primary infected cells. Bacterial co-infections were identified in >25% of the case-patients. Viral pneumonia and immunolocalization of viral antigen in association with diffuse alveolar damage are prominent features of infection with 2009 pandemic influenza A (H1N1) virus. Underlying medical conditions and bacterial co-infections contributed to the fatal outcome of this infection. More studies are needed to understand the multifactorial pathogenesis of this infection. |
Challenges faced by the global polio eradication initiative
Wassilak S , Orenstein W . Expert Rev Vaccines 2010 9 (5) 447-9 After the World Health Assembly resolved in 1988 to eradicate wild poliovirus (WPV) transmission globally by 2000, dramatic progress in reducing polio cases and increasing the number of countries that interrupted indigenous WPV transmission was made by 2000 Citation[1]. In 2010, 10 years past the target date and with US$7 billion of external funds expended since the beginning of the effort, some individuals question the feasibility of reaching the goal Citation[2,3]. This editorial will provide an overview of the polio eradication strategies, progress to date, challenges and efforts to overcome those challenges that, although substantial, are surmountable. |
Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection
Bautista E , Chotpitayasunondh T , Gao Z , Harper SA , Shaw M , Uyeki TM , Zaki SR , Hayden FG , Hui DS , Kettner JD , Kumar A , Lim M , Shindo N , Penn C , Nicholson KG . N Engl J Med 2010 362 (18) 1708-19 During the spring of 2009, a novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico.1,2 After initially spreading among persons in the United States and Canada,3,4 the virus spread globally, resulting in the first influenza pandemic since 1968 with circulation outside the usual influenza season in the Northern Hemisphere (see the Supplementary Appendix, available with the full text of this article at NEJM.org). As of March 2010, almost all countries had reported cases, and more than 17,700 deaths among laboratory-confirmed cases had been reported to the World Health Organization (WHO).5 The number of laboratory-confirmed cases significantly underestimates the pandemic's impact. In the United States, an estimated 59 million illnesses, 265,000 hospitalizations, and 12,000 deaths had been caused by the 2009 H1N1 virus as of mid-February 2010.6 This article reviews virologic, epidemiologic, and clinical data on 2009 H1N1 virus infections and summarizes key issues for clinicians worldwide. |
Assessing bed net use and non-use after long-lasting insecticidal net distribution: a simple framework to guide programmatic strategies
Vanden Eng JL , Thwing J , Wolkon A , Kulkarni MA , Manya A , Erskine M , Hightower A , Slutsker L . Malar J 2010 9 (1) 133 BACKGROUND: Insecticide-treated nets (ITNs) are becoming increasingly available to vulnerable populations at risk for malaria. Their appropriate and consistent use is essential to preventing malaria, but ITN use often lags behind ITN ownership. In order to increase ITN use, it is necessary to devise strategies that accurately identify, differentiate, and target the reasons and types of non-use. METHODS: A simple method based on the end-user as the denominator was employed to classify each individual into one of four ITN use categories: 1) living in households not owning an ITN; 2) living in households owning, but not hanging an ITN; 3) living in households owning and hanging an ITN, but who are not sleeping under one; and 4) sleeping under an ITN. This framework was applied to survey data designed to evaluate long-lasting insecticidal nets (LLINs) distributions following integrated campaigns in five countries: Togo, Sierra Leone, Madagascar, Kenya and Niger. RESULTS: The percentage of children <5 years of age sleeping under an ITN ranged from 51.5% in Kenya to 81.1% in Madagascar. Among the three categories of non-use, children living in households without an ITN make up largest group (range: 9.4%-30.0%), despite the efforts of the integrated child health campaigns. The percentage of children who live in households that own but do not hang an ITN ranged from 5.1% to 16.1%. The percentage of children living in households where an ITN was suspended, but who were not sleeping under it ranged from 4.3% to 16.4%. Use by all household members in Sierra Leone (39.9%) and Madagascar (60.4%) indicate that integrated campaigns reach beyond their desired target populations. CONCLUSIONS: The framework outlined in this paper provides a helpful tool to examine the deficiencies in ITN use. Monitoring and evaluation strategies designed to assess ITN ownership and use can easily incorporate this approach using existing data collection instruments that measure the standard indicators. |
Beyond beta: lessons learned from implementation of the Department of Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative
Garcia-Williams AG , Miller LJ , Burkitt KH , Cuerdon T , Jain R , Fine MJ , Jernigan JA , Sinkowitz-Cochran RL . Infect Control Hosp Epidemiol 2010 31 (7) 763-5 To describe the key strategies and potential pitfalls involved with implementing the Department of Veterans Affairs (VA) Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention Initiative in a qualitative evaluation, we conducted in-depth interviews with MRSA Prevention Coordinators at 17 VA beta sites at 2 time points during program implementation. |
Current and historically used pesticides in residential soil from 11 homes in Atlanta, Georgia, USA
Riederer AM , Smith KD , Barr DB , Hayden SW , Hunter Jr RE , Ryan PB . Arch Environ Contam Toxicol 2010 58 (4) 908-17 We used a multiresidue, gas chromatography/mass spectrometry-based method to measure seven pyrethroid, five organophosphorus (OP), and six organochlorine pesticides in soil collected from 11 Atlanta homes in 2006. Our objective was to collect preliminary data for a larger study of pesticide exposures among Atlanta children. The pyrethroid insecticides (cis- and trans-permethrin, bioallethrin) were the most commonly detected analytes, giving evidence of widespread outdoor use among our study homes. Our pyrethroid insecticide detection frequencies were higher than those reported in a recent study of Ohio and North Carolina homes; however, our maximum values were approximately half of those reported. We detected the target OP pesticides in only a few samples, but we found two restricted-use OP pesticides--methyl parathion and terbufos--and thus possible evidence of illegal residential use or environmental persistence in soil. We also detected dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethane (DDE) in samples from six homes. Although our small sample size limits comparison to other studies, our results provide evidence that residential soil is a potential source of human exposure to both current and historically used pesticides. |
Recent population changes in HbA(1c) and fasting insulin concentrations among US adults with preserved glucose homeostasis
Cheng YJ , Kahn HS , Gregg EW , Imperatore G , Geiss LS . Diabetologia 2010 53 (9) 1890-3 AIMS/HYPOTHESIS: Although diagnosed type 2 diabetes has increased in the past decade, little is known about accompanying changes in fasting plasma glucose (FPG), HbA(1c) and fasting serum insulin (FI) levels in the non-diabetic population. METHODS: Using population estimates from National Health and Nutrition Examination Surveys, we compared distribution of FPG, HbA(1c) and FI in non-diabetic US persons who were ≥20 years old in 1999 to 2006 with that in persons of the same age in 1988 to 1994. RESULTS: Age-, sex- and race-adjusted mean FPG levels between the two study periods did not change, but mean HbA(1c) and FI levels increased (0.10% and 4.8 pmol/l, respectively; p < 0.001 for both). The increased HbA(1c) level was driven largely by an upward shift in the lower end of the HbA(1c) distribution. In contrast, the increased FI level was driven primarily by an upward shift in the middle and higher end of FI distribution, especially among persons aged 20 to 44 years. After adjustments for BMI or waist circumference, the increase in the mean HbA(1c) level was attenuated (0.06%; p < 0.001), whereas the mean FPG level decreased by 0.1 mmol/l (p < 0.001) and the mean FI level no longer demonstrated significant change. CONCLUSIONS/INTERPRETATION: Despite little change in the distribution of FPG levels, HbA(1c) and FI levels increased in the non-diabetic population in the past decade. The increase in FI levels suggests that levels of insulin resistance were greater among US adults, especially young adults, than in the previous decade. |
Viral respiratory infections in hospitalized and community control children in Alaska
Singleton RJ , Bulkow LR , Miernyk K , DeByle C , Pruitt L , Hummel KB , Bruden D , Englund JA , Anderson LJ , Lucher L , Holman RC , Hennessy TW . J Med Virol 2010 82 (7) 1282-90 Respiratory syncytial virus (RSV) in Alaska Native children from the Yukon Kuskokwim (YK) Delta is associated with a hospitalization rate five times higher than that reported for the general US child population. The role of other viral respiratory pathogens has not been studied in this population. YK Delta children <3 years of age hospitalized with respiratory infections and same aged community control children were prospectively enrolled between October 2005 and September 2007. Polymerase chain reaction detection of viruses was performed on nasopharyngeal samples. Characteristics of hospitalized and asymptomatic control children were analyzed. From October 2005 to September 2007, 440 hospitalized and 425 control children were analyzed. Respiratory viruses were detected in 90% (395) of hospitalized children: 194 (44%) rhinovirus, 131 (30%) adenovirus, 102 (23%) RSV, 77 (18%) para influenza viruses (PIV), 66 (15%) human metapneumovirus (hMPV), 23 (5%) influenza, and 25 (6%) coronavirus. Fifty-two percent (221) of control children had a virus detected, most commonly rhinovirus (33%), and adenovirus (16%). RSV, PIV, hMPV, and influenza were significantly more common in hospitalized cases than control children, but rhinovirus, adenovirus, and coronavirus were not. RSV and hMPV were associated with higher severity of illness. In this study, RSV remains the most important virus associated with respiratory hospitalization, although hMPV and PIV were also common. RSV and hMPV were associated with more severe illness. Rhinovirus and adenovirus were detected in two-thirds of hospitalized children, but their frequent detection in control children made their role in respiratory hospitalization uncertain. |
Prevalence, nature, and correlates of sleep problems among children with fragile X syndrome based on a large scale parent survey
Kronk R , Bishop EE , Raspa M , Bickel JO , Mandel DA , Bailey Jr DB . Sleep 2010 33 (5) 679-87 STUDY OBJECTIVES: This study reports on current child sleep difficulties reported by parents of children with Fragile X syndrome (FXS). We address prevalence and type of sleep problems (e.g., difficulty falling asleep, frequent awakenings); type and effectiveness of medical and behavioral treatments (e.g., medication, surgery, environmental changes); and explore specific child and family characteristics (e.g., child age, child gender, co-occurring conditions) as possible predictors of child sleep difficulties. DESIGN/PARTICIPANTS: This study is part of a larger survey addressing needs of families with children with FXS. This article focuses on the families who responded to the survey sleep questions, had one or more children with the full mutation FXS, and who reside in the United States. The mean age for male and female children in this group was 15 years and 16 years respectively (N=1295). RESULTS: Parents reported that 32% of the children with FXS currently experience sleep difficulties; 84% of those children are reported to have > or =2 current sleep problems. Problems falling asleep and frequent night awakenings were the most frequently reported difficulties; 47% of males and 40% of females received > or =1 medication to help with sleep. Children with more problematic health or behavioral characteristics had a higher likelihood of having current sleep problems. CONCLUSIONS: Our survey provides the most representative sample to date of sleep problems in children with FXS or any other neurodevelopmental disability. This large scale survey establishes a foundation for the prevalence of sleep disorders in children with FXS. |
Household-based sero-epidemiologic survey after a yellow fever epidemic, Sudan, 2005
Farnon EC , Gould LH , Griffith KS , Osman MS , Kholy AE , Brair ME , Panella AJ , Kosoy O , Laven JJ , Godsey MS , Perea W , Hayes EB . Am J Trop Med Hyg 2010 82 (6) 1146-52 From September through early December 2005, an outbreak of yellow fever (YF) occurred in South Kordofan, Sudan, resulting in a mass YF vaccination campaign. In late December 2005, we conducted a serosurvey to assess YF vaccine coverage and to better define the epidemiology of the outbreak in an index village. Of 552 persons enrolled, 95% reported recent YF vaccination, and 25% reported febrile illness during the outbreak period: 13% reported YF-like illness, 4% reported severe YF-like illness, and 12% reported chikungunya-like illness. Of 87 persons who provided blood samples, all had positive YF serologic results, including three who had never been vaccinated. There was also serologic evidence of recent or prior chikungunya virus, dengue virus, West Nile virus, and Sindbis virus infections. These results indicate that YF virus and chikungunya virus contributed to the outbreak. The high prevalence of YF antibody among vaccinees indicates that vaccination was effectively implemented in this remotely located population. |
The impact of transient hypothyroidism on the increasing rate of congenital hypothyroidism in the United States
Parks JS , Lin M , Grosse SD , Hinton CF , Drummond-Borg M , Borgfeld L , Sullivan KM . Pediatrics 2010 125 Suppl 2 S54-63 The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodine-containing disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and (123)I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with long-term follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia. |
Is self-rated health associated with blood immune markers in healthy individuals?
Nakata A , Takahashi M , Otsuka Y , Swanson NG . Int J Behav Med 2010 17 (3) 234-42 BACKGROUND: Although self-rated health (SRH) has been established as a robust predictor of morbidity and mortality, the immunological mechanisms underpinning this relationship are poorly understood. PURPOSE: This study examined the association of SRH with humoral and cellular immune markers in healthy individuals who reported no physical illnesses. METHOD: A total of 116 healthy Japanese white-collar employees (79 women and 37 men) at a pharmaceutical company, aged 23-62 (mean 32) years, underwent a blood draw for the measurement of circulating immune (T, B, and natural killer) cells, inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha), and plasma immunoglobulin G (IgG) and completed a health survey including SRH. The question regarding SRH ranged from "very good" (coded 1) to "very poor" (coded 5). Hierarchical multiple regression analysis was carried out to calculate the relationship between SRH and immune markers. RESULTS: In this sample, poor SRH was positively correlated with B (CD19(+)) cell numbers (beta = 0.260, p < 0.05) and IgG levels (beta = 0.335, p < 0.01) even after adjusting for depressive symptoms, age, education, marital status, smoking, alcohol consumption, physical activity, body mass index, sex, and sex x SRH interaction. The interaction between SRH and sex on the immune markers was not significant. CONCLUSION: Although the connection between SRH and immune markers was not strong in this context, the results suggest that poor SRH may be associated with reduced humoral immune system capacity to respond to new/latent challenges. The results provide some support for the immunological basis of SRH in healthier individuals. |
Changing sociodemographic and clinical characteristics of tuberculosis among HIV-infected patients, New York City, 1992-2005
Harris TG , Li J , Hanna DB , Munsiff SS . Clin Infect Dis 2010 50 (11) 1524-31 BACKGROUND: Although highly active antiretroviral therapy (HAART) has decreased human immunodeficiency virus (HIV)-related morbidity, tuberculosis remains an important disease among HIV-infected individuals. METHODS: By use of surveillance data, sociodemographic and clinical changes among HIV-infected and HIV-uninfected tuberculosis patients in New York City were evaluated using the Cochran-Armitage trend test and multivariate logistic regression across 3 periods: 1992-1995 (pre-HAART), 1996-2000 (early HAART), and 2001-2005 (late HAART). RESULTS: Among tuberculosis patients with known HIV status, 4345 (60%) of 7224 were HIV-infected in pre-HAART, 1943 (33%) of 5933 in early HAART, and 851 (22%) of 3815 in late HAART ([Formula: see text] for trend). During the study period, the age of HIV-infected tuberculosis patients increased, and greater proportions were female, non-Hispanic black, Asian, and foreign born; the proportion that was non-Hispanic white decreased. The proportion that was culture-negative for Mycobacterium tuberculosis increased (from 7% pre-HAART to 21% late HAART; [Formula: see text] for trend; early HAART vs pre-HAART adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.38-2.04), and the proportion with extrapulmonary disease also increased (from 32% to 46%; [Formula: see text] for trend). The proportion with multidrug-resistant tuberculosis decreased (from 16% to 4%; [Formula: see text] for trend), especially from pre-HAART to early HAART (aOR, 0.31; 95% CI, 0.25-0.40). The proportion who died before tuberculosis treatment decreased (from 12% to 7%), and the proportion who died during tuberculosis treatment also decreased (from 29% to 11%) (both, [Formula: see text] for trend). Over time, HIV-infected tuberculosis patients had AIDS longer before the diagnosis of tuberculosis ([Formula: see text] for trend). Similar trends for culture, site of disease, and drug resistance were seen for HIV-uninfected tuberculosis patients. CONCLUSIONS: The sociodemographic and clinical characteristics changed substantially among HIV-infected tuberculosis patients in New York City. Awareness of these changes may speed diagnosis of tuberculosis. Future studies should evaluate HAART's effect on tuberculosis presentation among HIV-infected patients. |
Coevolution and HBV drug resistance
Khudyakov Y . Antivir Ther 2010 15 505-15 A high rate of mutation sets a strong foundation for the development of resistance to antiviral drugs. However, the ubiquitous presence of drug resistance mutations in the HBV population does not explain variations in the rate and specific types of drug resistance among patients. These variations can be explained by consideration of coevolution among individual sites in the HBV genome, viral variants and subpopulations, as well as coevolution between the entire intrahost HBV population and the host. The concept of coevolution offers a more complete framework for understanding drug resistance. |
Prevalence and protective value of serosorting and strategic positioning among black and Latino men who have sex with men
Marks G , Millett GA , Bingham T , Lauby J , Murrill CS , Stueve A . Sex Transm Dis 2010 37 (5) 325-7 Self-reported HIV-negative black and Latino MSM who engaged in serosorting or strategic positioning were less likely to have unrecognized HIV infection than men who engaged in unprotected anal intercourse without using these risk-reduction strategies. |
Stroke awareness: surveillance, educational campaigns, and public health practice
Payne GH , Fang J , Fogle CC , Oser CS , Wigand DA , Theisen V , Farris RP . J Public Health Manag Pract 2010 16 (4) 345-358 Stroke is a leading cause of death and disability in the United States. However, there is limited public knowledge about stroke signs and symptoms and the importance of seeking immediate medical care. Educational efforts such as stroke awareness campaigns are one way of informing the public about stroke symptoms and the need for early medical treatment following their onset. In this article, we present recent surveillance data concerning public awareness of stroke symptoms; summarize findings from 12 studies of the effectiveness of stroke awareness campaigns; and describe the efforts by three states to develop, implement, and evaluate heart disease and stroke programs, and the lessons to be learned from their experiences. |
Transmission of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) to tissue-allograft recipients: a report of two cases
Cartwright EJ , Prabhu RM , Zinderman CE , Schobert WE , Jensen B , Noble-Wang J , Church K , Welsh C , Kuehnert M , Burke TL , Srinivasan A . J Bone Joint Surg Am 2010 92-A (6) 1501-1506 According to the American Association of Tissue Banks,over 1.5 million allografts are distributed annually inthe United States1. Recent incidents involving the dis-tribution of human tissues from donors not properly screenedfor infectious diseases have highlighted concerns for diseasetransmission through transplanted tissues2-4. Although rarelyreported, allograft-associated infections have been associatedwith a variety of organisms and tissue types4. In all of thepreviously published reports, organisms were transmittedfrom the donor, because of either an unrecognized infection orcontamination during tissue recovery. However, in the fall of2006, we investigated the cases of two patients who had allograft-associated surgical site infections caused byElizabethkingiameningoseptica(formerlyChryseobacterium meningosepticum),detected by orthopaedic surgeons, that may have been theresult of environmental contamination at one firm duringprocessing of tissues from different donors.Elizabethkingia meningosepticais a waterborne, gram-negative rod widely distributed in nature that rarely infectshumans. It has been reported as a cause of neonatal meningitis,pneumonia in patients on ventilator support, peritonitis in apatient receiving peritoneal dialysis, and community-acquirednecrotizing fasciitis5-9. The species is usually resistant to multipleantibiotics, including extended-spectrum beta-lactam agents,aminoglycosides, and vancomycin |
Infectivity and vaccination efficacy studies in animal models of HBV S and pol gene mutants
Kamili S . Antivir Ther 2010 15 477-85 Infectious HBV wild-type and mutant clones were produced in vitro with three mutations in pol (rtV173L plus rtL180M plus rtM204V) or with a single mutation in the S gene (sG145R) and inoculated in treatment-naive chimpanzees. Intravenous inoculation of these mutants in chimpanzees resulted in HBV infection; the pol mutations remained stable, whereas the sG145R mutation reverted to wild type during viraemia. Additional hepatitis B vaccine efficacy studies conducted in chimpanzees showed lack of sterilizing immunity against the pol mutant. Whether such mutants can transmit to and infect vaccinated humans requires further investigation. |
Health risks in travelers to South Africa: the GeoSentinel experience and implications for the 2010 FIFA World Cup
Mendelson M , Davis XM , Jensenius M , Keystone JS , von Sonnenburg F , Hale DC , Burchard GD , Field V , Vincent P , Freedman DO , The GeoSentinel Surveillance Network . Am J Trop Med Hyg 2010 82 (6) 991-995 Using the GeoSentinel database, an analysis of ill patients returning from throughout sub-Saharan Africa over a 13-year period was performed. Systemic febrile illness, dermatologic, and acute diarrheal illness were the most common syndromic groupings, whereas spotted fever group rickettsiosis was the most common individual diagnosis for travelers to South Africa. In contrast to the rest of sub-Saharan Africa, only six cases of malaria were documented in South Africa travelers. Vaccine-preventable diseases, typhoid, hepatitis A, and potential rabies exposures were uncommon in South Africa travelers. Pre-travel advice for the travelers to the 2010 World Cup should be individualized according to these findings. |
Receptor specificity of influenza A H3N2 viruses isolated in mammalian cells and embryonated chicken eggs
Stevens J , Chen LM , Carney PJ , Garten R , Foust A , Le J , Pokorny BA , Manojkumar R , Silverman J , Devis R , Rhea K , Xu X , Bucher DJ , Paulson J , Cox NJ , Klimov A , Donis RO . J Virol 2010 84 (16) 8287-99 Isolation of human subtype H3N2 influenza viruses in embryonated chicken eggs yields viruses with amino acid substitutions in the hemagglutinin (HA) that often affect binding to sialic acid receptors. We used a glycan array approach to analyze the repertoire of sialylated glycans recognized by viruses from the same clinical specimen isolated in eggs or cell cultures. The binding profiles of whole virions to 85 sialoglycans on the microarray allowed the categorization of cell isolates into 2 groups. Group 1 cell isolates displayed binding to a restricted set of alpha2-6 and alpha2-3 sialoglycans whereas Group 2 cell isolates revealed broader receptor specificity relative to their egg counterparts. Egg isolates from Group 1 showed similar binding specificity as cell isolates, whereas Group 2 egg isolates showed a significantly reduced binding to alpha2-6 and alpha2-3-type receptors but retained substantial binding to specific O- and N-linked alpha2-3 glycans, including alpha2-3GalNAc and fucosylated alpha2-3 glycans (including sialyl Lewis x), both of which may be important receptors for H3N2 virus replication in eggs. These results revealed an unexpected diversity in receptor binding specificities among recent H3N2 viruses; with distinct patterns of amino acid substitution in the HA upon isolation and/or propagation in eggs. These findings also suggest that clinical specimens containing viruses with Group 1-like receptor binding profiles would be less prone to undergoing receptor binding or antigenic changes upon isolation in eggs. Screening cell isolates for appropriate receptor binding properties might help focus efforts to isolate the most suitable viruses in eggs for production of antigenically well-matched influenza vaccines. |
Reduced reactive oxygen species-generating capacity contributes to the enhanced cell growth of arsenic-transformed epithelial cells
Chang Q , Pan J , Wang X , Zhang Z , Chen F , Shi X . Cancer Res 2010 70 (12) 5127-35 Reactive oxygen species (ROS) have been implicated in the activation of protein kinases, DNA damage responses, and cell apoptosis. The details of how ROS regulate these intracellular biochemical and genetic processes remain to be fully understood. By establishing transformed bronchial epithelial cells through chronic low-dose arsenic treatment, we showed that the capacity of ROS generation induced by arsenic is substantially reduced in the transformed cells relative to the nontransformed cells. Such a reduction in ROS generation endows cells with premalignant features, including rapid growth, resistance to arsenic toxicity, and increased colony formation of the transformed cells. To validate these observations, the capability of ROS generation was restored in the transformed cells by treatment with inhibitors or siRNAs to silence the function of superoxide dismutase (SOD) or catalase and cell growth was determined following these treatments. Enhancement in ROS generation suppressed cell growth and colony formation of the transformed cells significantly. Despite the fact that the transformed cells showed a decreased expression of NF-kappaB signaling proteins IKKbeta and IKKgamma, the proteolytic processing p105 and p100 and NF-kappaB DNA binding activity were elevated in these cells. Increasing ROS generation by silencing SOD and catalase reduced the DNA binding activity of NF-kappaB in the transformed cells. Taken together, the transformed cells induced by arsenic exhibited a decrease in ROS generation, which is responsible for the enhanced cell growth and colony formation of the transformed cells, most likely through a sustained alternative activation of the NF-kappaB transcription factor. Cancer Res; 70(12); 5127-35. (c)2010 AACR. |
Sequence diversity of genes encoding botulinum neurotoxin type F
Raphael BH , Choudoir MJ , Luquez C , Fernandez R , Maslanka SE . Appl Environ Microbiol 2010 76 (14) 4805-12 Botulism due to type F botulinum neurotoxin (BoNT/F) is rare (< 1% of cases) and only a limited number of clostridial strains producing this toxin type have been isolated. As a result, analysis of the diversity of genes encoding BoNT/F has been challenging. In this study, the entire bont/F nucleotide sequences were determined from 33 type F botulinum toxin producing clostridia isolated from environmental sources and botulism outbreak investigations. We examined proteolytic and non-proteolytic Clostridium botulinum type F strains, bivalent strains including Bf and Af, and C. baratii type F strains. Phylogenetic analysis revealed that the bont/F genes examined formed 7 subtypes (F1-F7) and the nucleotide sequence identity of these subtypes differed by up to 25%. The genes from proteolytic (Group I) C. botulinum strains formed subtypes F1 through F5 while the genes from non-proteolytic (Group II) C. botulinum strains formed subtype F6. Subtype F7 was composed exclusively of bont/F genes from C. baratii strains. The region of the bont/F5 gene encoding the neurotoxin light chain was found to be highly divergent compared to the other subtypes. Although the bont/F5 nucleotide sequence was found to be identical in strains harboring this gene, the gene located directly upstream (ntnh/F) demonstrated sequence variation among representative strains of this subtype. These results demonstrate that extensive nucleotide diversity exists among genes encoding type F neurotoxins from strains with different phylogenetic backgrounds and from various geographical sources. |
Mass spectrometric analysis of multiple pertussis toxins and toxoids
Williamson YM , Moura H , Schieltz D , Rees J , Woolfitt AR , Pirkle JL , Sampson JS , Tondella ML , Ades E , Carlone G , Barr JR . J Biomed Biotechnol 2010 2010 942365 Bordetella pertussis (Bp) is the causative agent of pertussis, a vaccine preventable disease occurring primarily in children. In recent years, there has been increased reporting of pertussis. Current pertussis vaccines are acellular and consist of Bp proteins including the major virulence factor pertussis toxin (Ptx), a 5-subunit exotoxin. Variation in Ptx subunit amino acid (AA) sequence could possibly affect the immune response. A blind comparative mass spectrometric (MS) analysis of commercially available Ptx as well as the chemically modified toxoid (Ptxd) from licensed vaccines was performed to assess peptide sequence and AA coverage variability as well as relative amounts of Ptx subunits. Qualitatively, there are similarities among the various sources based on AA percent coverages and MS/MS fragmentation profiles. Additionally, based on a label-free mass spectrometry-based quantification method there is differential relative abundance of the subunits among the sources. |
Effect of laboratory practices on the incidence rate of congenital hypothyroidism
Hertzberg V , Mei J , Therrell BL . Pediatrics 2010 125 Suppl 2 S48-53 OBJECTIVE: Newborn screening (NBS) laboratories in the United States expanded their programs to include primary congenital hypothyroidism (CH) in the 1970s. An increase in the national CH-incidence rate since 1987 has been reported. Our goal was to analyze national data reported by state NBS programs and laboratories from 1991 to 2000 to determine the extent to which changing laboratory methods might have contributed to the reported rise in CH-incidence rate. METHODS: We used generalized estimating equations to analyze the association between the rate of confirmed cases of CH per 100000 live births and the initial screening method (thyroxine [T4] or thyrotropin [TSH] assay), the T4- and TSH-assay methods, the screening-test cutoff value used to report abnormal T4- or thyrotropin-assay results, and the performance of a second screen on >or=80% of newborns in the state. We then evaluated the association of CH rate with year after adjusting for any screening methodology or parameter that was significant in the univariate analysis. RESULTS: During 1991-2000, laboratories that used a TSH assay for initial screening reported a 24% higher incidence rate of CH than those that used a T4 assay. The assay type also affected the incidence rate. Screening for T4 by enzyme immunometric assay (EIA) or fluoroimmunoassay (FIA) methods resulted in 38% and 24% higher incidence rates of CH, respectively, compared with the radioimmunoassay (RIA) method, whereas screening for TSH by the FIA method resulted in a 20% higher incidence rate of CH than did screening with radiochemical methods. During the decade studied, many laboratories changed their T4-assay method from RIA to either FIA or EIA; this particular change seemed to have the greatest impact on the CH-incidence rate. CONCLUSIONS: Although the use of different laboratory methods and screening practices by NBS laboratories affected the incidence rate of CH, after adjusting for screening methodologies and parameters, an increasing incidence rate still persisted during the decade studied. Thus, there seem to be additional unknown factors that contributed to the reported increase in incidence rate. |
Physiological effects of boot weight and design on men and women firefighters
Turner NL , Chiou S , Zwiener J , Weaver D , Spahr J . J Occup Environ Hyg 2010 7 (8) 477-82 The purpose of this study was to determine the effects of two leather (L1, L2) and two rubber (R1, R2) boots on firefighters' metabolic and respiratory variables during simulated firefighting tasks. Twenty-five men and 25 women, while wearing full turnout clothing, a 10.5-kg backpack, gloves, helmet, and one of four randomly assigned pairs of firefighter boots, walked for 6 min at 3 mph (4.8 km/hr) on a level treadmill while carrying a 9.5-kg hose and climbed a stair ergometer for 6 min at 45 steps per min without the hose. [Abstract truncated.] |
Health hazards, injury problems, and workplace conditions of carpet-weaving children in three districts of Punjab, Pakistan
Awan S , Nasrullah M , Cummings KJ . Int J Occup Environ Health 2010 16 (2) 113-119 Carpet weaving among children is common in rural Pakistan, but little information is available on the health effects of this work. A total of 628 carpet-weaving children and 292 non-working children from 10 rural villages were evaluated with questionnaires and physical exams. Fifty-five home-based and 30 shed-based worksites in these villages were assessed. Girls comprised the majority of working (73%) and non-working (69%) children; the mean age for both boys and girls was 10 years. The mean number of hours worked daily was 7.2 for males and 6.8 for females. Dust exposure in homes was generally higher than in sheds. Working children had significantly greater odds of joint pain (OR = 2.8), dry cough (OR = 2.5), cuts/bruises (OR = 22.1), Phalen's sign (OR = 17.2), and neck/shoulder abnormalities (OR = 14.2). Symptoms and signs of acute and repetitive injury and respiratory symptoms were more common among carpet-weaving children than their non-working peers. |
Impact of state mandatory insurance coverage on the use of diabetes preventive care
Li R , Zhang P , Barker L , Hartsfield D . BMC Health Serv Res 2010 10 (1) 133 BACKGROUND: 46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG). METHODS: We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend) were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively. RESULTS: All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P=0.04) and a 5.8 (P=0.03) percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not significantly associated with receiving annual diabetic eye (0.05 percentage points decrease, P=0.92) or foot exams (2.3 percentage points increase, P=0.45). CONCLUSIONS: Effects of state mandates varied by preventive care type, with state mandates being associated with a small increase in SMBG. We found no evidence that state mandates were effective in increasing receipt of annual eye or foot exams. The small or non-significant effects might be attributed to small numbers of insured people not having the benefits prior to the mandates' passage. If state mandates' purpose is to provide improved benefits to many persons, policy makers should consider determining the number of people who might benefit prior to passing the mandate. |
Physiologic reference ranges for captive black-tailed prairie dogs (Cynomys ludovicianus)
Keckler MS , Gallardo-Romero NF , Langham GL , Damon IK , Karem KL , Carroll DS . J Am Assoc Lab Anim Sci 2010 49 (3) 274-281 The black-tailed prairie dog (Cynomys ludovicianus) is a member of the order Rodentia and the family Sciuridae. Ecologically, prairie dogs are a keystone species in prairie ecology. This species is used as an animal model for human gallbladder disease and diseases caused by infection with Clostridium difficile, Yersinia pestis, Francisella tularensis, and most recently, Orthopoxvirus. Despite increasing numbers of prairie dogs used in research and kept as pets, few data are available on their baseline physiology in animal facility housing conditions. To establish baseline physiologic reference ranges, we designed a study using 18 wild-caught black-tailed prairie dogs. Telemetry data were analyzed to establish circadian rhythms for activity and temperature. In addition, hematologic and serum chemistry analyses were performed. Baseline measurements were used to establish the mean for each animal, which then were compiled and analyzed to determine the reference ranges. Here we present physiologic data on serum chemistry and hematology profiles, as well as weight, core body temperature, and daily activity patterns for black-tailed prairie dogs. These results reflect the use of multiple measurements from species- and age-matched prairie dogs and likely will be useful to ecologists, scientists interested in using this animal model in research, and veterinarians caring for pet prairie dogs. |
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