Safe, affordable,convenient: Environmental features of malls and other public spaces used by older adults for walking
King DK , Allen P , Jones DL , Marquez DX , Brown DR , Rosenberg D , Janicek S , Allen L , Belza B . J Phys Act Health 2016 13 (3) 289-95 BACKGROUND: Midlife and older adults use shopping malls for walking, but little research has examined mall characteristics that contribute to their walkability. METHODS: We used modified versions of the Centers for Disease Control and Prevention (CDC)-Healthy Aging Research Network (HAN) Environmental Audit and the System for Observing Play and Recreation in Communities (SOPARC) tool to systematically observe 443 walkers in 10 shopping malls. We also observed 87 walkers in 6 community-based nonmall/nongym venues where older adults routinely walked for physical activity. RESULTS: All venues had public transit stops and accessible parking. All malls and 67% of nonmalls had wayfinding aids, and most venues (81%) had an established circuitous walking route and clean, well-maintained public restrooms (94%). All venues had level floor surfaces, and one-half had benches along the walking route. Venues varied in hours of access, programming, tripping hazards, traffic control near entrances, and lighting. CONCLUSIONS: Despite diversity in location, size, and purpose, the mall and nonmall venues audited shared numerous environmental features known to promote walking in older adults and few barriers to walking. Future research should consider programmatic features and outreach strategies to expand the use of malls and other suitable public spaces for walking. |
The Philadelphia Glaucoma Detection and Treatment Project: Detection rates and initial management
Waisbourd M , Pruzan NL , Johnson D , Ugorets A , Crews JE , Saaddine JB , Henderer JD , Hark LA , Katz LJ . Ophthalmology 2016 123 (8) 1667-1674 PURPOSE: To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. DESIGN: Retrospective analysis. PARTICIPANTS: A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. METHODS: Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. MAIN OUTCOME MEASURES: Detection rates of glaucoma-related diagnoses and types of treatments administered. RESULTS: Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. CONCLUSIONS: Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations. |
Quality of patient-provider communication among cancer survivors: findings from a nationally representative sample
Chawla N , Blanch-Hartigan D , Virgo KS , Ekwueme DU , Han X , Forsythe L , Rodriguez J , McNeel TS , Yabroff KR . J Oncol Pract 2016 12 (12) e964-e973 PURPOSE: Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer. METHODS: Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from "did not discuss" to "discussed in detail," a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses. RESULTS: At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married. CONCLUSION: Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions. |
Geographic Accessibility of Pulmonologists for Adults With COPD: United States, 2013
Croft JB , Lu H , Zhang X , Holt JB . Chest 2016 150 (3) 544-53 BACKGROUND: Geographic clusters in prevalence and hospitalizations for chronic obstructive pulmonary disease (COPD) have been identified at national, state, and county levels. The study objective is to identify county-level geographic accessibility to pulmonologists for adults with COPD. METHODS: Service locations of 12,392 practicing pulmonologists and 248,160 primary care physicians were identified from the 2013 National Provider Identifier Registry and weighted by census block-level populations within a series of circular distance buffer zones. Model-based county-level population counts of US adults aged >18 years with COPD were estimated from the 2013 Behavioral Risk Factor Surveillance System. The percentages of all estimated adults with potential access to at least one provider type and the county-level ratio of adults with COPD per pulmonologist were estimated for selected distances. RESULTS: The majority of US adults (100% in urbanized areas, 99.5% in urban clusters, and 91.7% in rural areas) had geographic access to a primary care physician within a 10-mile buffer distance; almost all (>99.9%) had access to a primary care physician within 50 miles. At least one pulmonologist within 10 miles was available for 97.5% of US adults living in urbanized areas, but only for 38.3% in urban clusters and 34.5% in rural areas. When distance increased to 50 miles, at least one pulmonologist was available for 100% in urbanized areas, 93.2% in urban clusters, and 95.2% in rural areas. County-level ratios of adults with COPD per pulmonologist varied greatly across the US with residents in many counties in the Midwest having no pulmonologist within 50 miles. CONCLUSIONS: County-level geographic variations in pulmonologist access for adults with COPD suggest that those adults with limited access will have to depend upon care from primary care physicians. |
The changing epidemiology and etiology of hepatocellular carcinoma from 1969 through 2013 in Alaska Native peoples
Connelly M , Bruce MG , Bulkow L , Snowball M , McMahon BJ . Liver Int 2016 36 (12) 1829-1835 BACKGROUND AND AIMS: Alaska Native peoples have an increased rate of hepatocellular carcinoma compared to the United States population. Viral hepatitis is a risk factor for malignancy and the leading cause of hepatocellular carcinoma in Alaska. With the introduction of hepatitis B immunization in 1982, as well as the emergence of hepatitis C virus in this population, the epidemiology and etiology of hepatocellular carcinoma in Alaska have changed. METHODS: Using the Alaska Native Tumor Registry, all cases of viral and non-viral hepatocellular carcinoma occurring from 1969 through 2013 were identified and reviewed. Incidence rates per 100,000 population were calculated for hepatocellular carcinoma overall and by etiologic category. RESULTS: 152 cases of hepatocellular carcinoma were identified in 148 Alaska Native persons. Overall tumor rate was 3.82 per 100,000 and did not change significantly over the study period. Hepatitis B associated cases decreased significantly over the study period (p=0.048) and were eliminated in persons under the age of 20. Hepatitis C associated cases increased significantly (P<0.001). Undetermined hepatocellular carcinoma rates also decreased. (p=0.034) CONCLUSIONS: Overall hepatocellular carcinoma rates in Alaska Native peoples remained stable over the study period, but the epidemiology and etiology are changing. Two decades after routine hepatitis B immunization, the hepatocellular carcinoma age distribution has shifted to cases presenting later in life. This is consistent with an aging hepatitis B infected population with no new infected young persons coming into the population, as well as the emergence of hepatitis C in adults. This article is protected by copyright. All rights reserved. |
Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity
Joseph DA , Meester RG , Zauber AG , Manninen DL , Winges L , Dong FB , Peaker B , van Ballegooijen M . Cancer 2016 122 (16) 2479-86 BACKGROUND: In 2014, a national campaign was launched to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018; it is unknown whether there is sufficient colonoscopy capacity to reach this goal. This study estimated the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy and determined whether there was sufficient colonoscopy capacity to meet the need. METHODS: The Microsimulation Screening Analysis-Colon model was used to simulate CRC screening test use in the United States (2014-2040); the implementation of a national screening program in 2014 with FIT or colonoscopy with 80% participation was assumed. The 2012 Survey of Endoscopic Capacity (SECAP) estimated the number of colonoscopies that were performed and the number that could be performed. RESULTS: If a national screening program started in 2014, by 2024, approximately 47 million FIT procedures and 5.1 million colonoscopies would be needed annually to screen the eligible population with a program using FIT as the primary screening test; approximately 11 to 13 million colonoscopies would be needed annually to screen the eligible population with a colonoscopy-only screening program. According to the SECAP survey, an estimated 15 million colonoscopies were performed in 2012, and an additional 10.5 million colonoscopies could be performed. CONCLUSIONS: The estimated colonoscopy capacity is sufficient to screen 80% of the eligible US population with FIT, colonoscopy, or a mix of tests. Future analyses should take into account the geographic distribution of colonoscopy capacity. Cancer 2016. (c) 2016 American Cancer Society. |
Comorbidities of asthma in U.S. children
Mirabelli MC , Hsu J , Gower WA . Respir Med 2016 116 34-40 Background Few epidemiologic population-based data are available to describe the wide range of health conditions that affect children with asthma. We conducted this study to identify common comorbidities of asthma during childhood and compare the prevalences of selected comorbidities among children with and without asthma. Methods We analyzed weighted data from the 2012 National Health Interview Survey child sample, a sample of 10,954 U.S. children aged 3-17 years. Information about each child's health, including history of asthma and other health conditions, was provided by an adult proxy respondent. We conducted binomial regression to compare the prevalences of 41 selected health conditions among children with and without current asthma. Results An estimated 10.4% of children aged 3-17 years (n = 1202) were identified as having current asthma. Nearly all conditions considered were more common among children with than without asthma. Compared to children without asthma, children with asthma had higher prevalences of hay fever or respiratory allergies (prevalence difference [PD]: 30.5%; 95% CI: 26.6, 34.4), eczema or skin allergies (PD: 14.1%; 95% CI: 10.7, 17.5), sinusitis (PD: 11.3%; 95% CI: 8.4, 14.1), food or digestive allergies (PD: 10.4%; 95% CI: 7.7, 13.1), and difficulty with emotions, concentration, behavior, or getting along (PD: 7.9%; 95% CI: 4.7, 11.1). Conclusions These results highlight the burden of comorbidities among children with asthma. Improved understanding of the impact of comorbidities among children with asthma may help develop best practices for the assessment, treatment, and control of coexisting health conditions. |
Cost-effectiveness analysis of hepatocellular carcinoma screening by combinations of ultrasound and alpha-fetoprotein among Alaska Native people, 1983-2012
Gounder PP , Bulkow LR , Meltzer MI , Bruce MG , Hennessy TW , Snowball M , Spradling PR , Adhikari BB , McMahon BJ . Int J Circumpolar Health 2016 75 31115 BACKGROUND: The American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (US) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged ≥40 years and Asian females aged ≥50 years. OBJECTIVE: To analyse the cost-effectiveness of 2 HCC screening methods in the Alaska Native (AN) health system: US-alone, or screening by alpha-fetoprotein (AFP) initially and switching to US for subsequent screenings if AFP >10 ng/mL (AFP-->US). DESIGN: A spreadsheet-based model was developed for accounting the costs of 2 hypothetical HCC screening methods. We used epidemiologic data from a cohort of 839 AN persons with CHB who were offered HCC screening by AFP/US semi-annually during 1983-2012. We assumed that compared with AFP-->US, US-alone identifies 33% more tumours at an early stage (defined as a single tumour ≤5 cm or ≤3 tumours ≤3 cm in diameter). Years of life gained (YLG) attributed to screening was estimated by comparing additional years of survival among persons with early- compared with late-stage tumours. Screening costs were calculated using Medicare reimbursement rates in 2012. Future screening costs and YLG were projected over a 30-year time horizon using a 3% discount rate. RESULTS: The total cost of screening for the cohort by AFP-->US would have been approximately $357,000 ($36,000/early-stage tumour detected) compared to $814,000 ($59,000/early-stage tumour detected) by US-alone. The AFP-->US method would have yielded an additional 27.8 YLG ($13,000/YLG) compared with 38.9 YLG ($21,000/YLG) for US-alone. Screening by US-alone would incur an additional $114,000 per extra early-tumour detected compared with AFP-->US and $41,000 per extra YLG. CONCLUSIONS: Although US-alone HCC screening might have yielded more YLG than AFP-->US, the reduced costs of the AFP-->US method could expand access to HCC screening in resource constrained settings. |
Defining arthritis for public health surveillance: Methods and estimates in four US population health surveys
Murphy LB , Cisternas MG , Greenlund KG , Giles W , Hannan C , Helmick CG . Arthritis Care Res (Hoboken) 2016 69 (3) 356-367 OBJECTIVE: To determine variability of arthritis prevalence in 4 US population health surveys. METHODS: We estimated annualized arthritis prevalence in 2011/12, among adults ≥ 20 years, using 2 definition methods, both based on self-report: 1) doctor/health care provider diagnosed arthritis in the Behavioral Risk Factor Surveillance Survey (BRFSS), National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), and Medical Expenditure Panel Survey (MEPS); and 2) three ICD-9-CM based arthritis definitions in MEPS (National Arthritis Data Workgroup Arthritis and Rheumatic Conditions [NADW-AORC], Clinical Classification System [CCS], and Centers for Disease Control and Prevention [CDC]). RESULTS: Diagnosed arthritis prevalence percentages were within 3 percentage points (BRFSS= 26.2% [99% CI=26.0 - 26.4], MEPS= 26.1 [99% CI=25.0-27.2], NHIS=23.5 [99% CI = 22.9-24.1], NHANES=23.0% [99% CI=19.2-26.8]) and ICD-9-CM within 5 (CCS=25.8%; 99% CI=24.6-27.1; CDC=28.3%; 99% CI=27.0-29.6; and NADW=30.7%; 95% CI=29.4-32.1). Range in estimated number (in millions) affected with diagnosed arthritis was 7.8 (BRFSS=58.5 [99% CI=58.1-59.1]; MEPS=59.3 [99% CI=55.6-63.1]; NHANES=51.5 [99% CI=37.2-65.5], and NHIS=52.6 [99% CI=50.9-54.4]) and ICD-9-CM definitions was 11.1 (CCS=58.7 [99% CI=54.5-62.9]; CDC=64.3 [99% CI=59.9-68.6], and NADW=69.9 [99% CI=65.2-74.5]). Most (57% to 70%) reporting diagnosed arthritis also reported ICD-9-CM arthritis; respondents reporting diagnosed arthritis were older than those meeting ICD-9-CM definitions. Proxy response status affected arthritis prevalence differently across surveys. CONCLUSION: Public health practitioners and decision makers are frequently charged with choosing a single number to represent arthritis prevalence in the US population. We encourage them to consider the surveys' purpose, design, measurement methods, and statistical precision when choosing an estimate. |
Origin and spread of HIV-1 in persons who inject drugs in Bulgaria.
Alexiev I , Shankar A , Dimitrova R , Gancheva A , Kostadinova A , Teoharov P , Golkocheva E , Nikolova M , Muhtarova M , Elenkov I , Stoycheva M , Nikolova D , Varleva T , Switzer WM . Infect Genet Evol 2016 46 269-278 Increased HIV transmission in persons who inject drugs (PWIDs) has led to subepidemics and outbreaks in several countries in Europe, including Bulgaria. In this study in Bulgaria, we investigate the origin and spatiotemporal evolutionary history of HIV-1 infections in PWIDs and the distribution of antiretroviral resistance mutations and hepatitis co-infections in these populations. We analyzed HIV-1 polymerase sequences available from 117 of 359 PWIDs diagnosed with HIV/AIDS from 1999 to 2011. Of these, 50 (42.7%) were classified as CRF02_AG, 41 (35.0%) CRF01_AE, 12 (10.3%) URFs, ten (8.5%) subtype B, two (1.7%) subtype F1 and two (1.7%) CRF14_BG. Most recent common ancestor dating suggests that CRF01_AE was likely first introduced from Southeast Asia into persons reporting heterosexual infection in Bulgaria in 1992 and spread subsequently to PWIDs in the capital city of Sofia around 2003. Conversely, CRF02_AG in Bulgaria was likely first introduced into PWID from Germany in 2000 and later entered heterosexual populations around 2009. The overall prevalence of resistance mutations was 6.8% (8/117), of which 5.1% (5/117) was observed in patients on antiretroviral therapy and 1.7% (2/117) was from transmitted drug resistance mutations in drug-naive individuals. 189/204 (92.6%) PWIDs were also co-infected with hepatitis C (HCV) and 31/183 (16.9%) were co-infected with hepatitis B (HBV). Our study provides valuable molecular epidemiological information on the introduction and distribution of the main HIV-1 subtypes, resistance mutations and hepatitis co-infections among PWIDs with HIV-1 in Bulgaria which can be used to target prevention efforts. |
Taxonomy of the order Mononegavirales: update 2016
Afonso CL , Amarasinghe GK , Banyai K , Bao Y , Basler CF , Bavari S , Bejerman N , Blasdell KR , Briand FX , Briese T , Bukreyev A , Calisher CH , Chandran K , Cheng J , Clawson AN , Collins PL , Dietzgen RG , Dolnik O , Domier LL , Durrwald R , Dye JM , Easton AJ , Ebihara H , Farkas SL , Freitas-Astua J , Formenty P , Fouchier RA , Fu Y , Ghedin E , Goodin MM , Hewson R , Horie M , Hyndman TH , Jiang D , Kitajima EW , Kobinger GP , Kondo H , Kurath G , Lamb RA , Lenardon S , Leroy EM , Li CX , Lin XD , Liu L , Longdon B , Marton S , Maisner A , Muhlberger E , Netesov SV , Nowotny N , Patterson JL , Payne SL , Paweska JT , Randall RE , Rima BK , Rota P , Rubbenstroth D , Schwemmle M , Shi M , Smither SJ , Stenglein MD , Stone DM , Takada A , Terregino C , Tesh RB , Tian JH , Tomonaga K , Tordo N , Towner JS , Vasilakis N , Verbeek M , Volchkov VE , Wahl-Jensen V , Walsh JA , Walker PJ , Wang D , Wang LF , Wetzel T , Whitfield AE , Xie JT , Yuen KY , Zhang YZ , Kuhn JH . Arch Virol 2016 161 (8) 2351-60 In 2016, the order Mononegavirales was emended through the addition of two new families (Mymonaviridae and Sunviridae), the elevation of the paramyxoviral subfamily Pneumovirinae to family status (Pneumoviridae), the addition of five free-floating genera (Anphevirus, Arlivirus, Chengtivirus, Crustavirus, and Wastrivirus), and several other changes at the genus and species levels. This article presents the updated taxonomy of the order Mononegavirales as now accepted by the International Committee on Taxonomy of Viruses (ICTV). |
Low bone mineral density and risk of incident fracture in HIV-infected adults
Battalora L , Buchacz K , Armon C , Overton ET , Hammer J , Patel P , Chmiel JS , Wood K , Bush TJ , Spear JR , Brooks JT , Young B . Antivir Ther 2016 21 (1) 45-54 BACKGROUND: Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. METHODS: Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to <-1.0 (osteopenia) or ≤-2.5 (osteoporosis). We analysed the association of low BMD with risk of subsequent incident fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. RESULTS: Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. CONCLUSIONS: In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population. |
Meta-analysis of the performance of a combined treponemal and non-treponemal rapid diagnostic test for syphilis and yaws
Marks M , Yin YP , Chen XS , Castro A , Causer L , Guy R , Wangnapi R , Mitja O , Aziz A , Castro R , da Luz Martins Pereira F , Taleo F , Guinard J , Belec L , Tun Y , Bottomley C , Ballard RC , Mabey DC . Clin Infect Dis 2016 63 (5) 627-633 BACKGROUND: The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100,000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform Syphilis Screen and Confirm test includes both a treponemal (T1) and non-treponemal (T2) component and may improve the accuracy of diagnosis. METHODS: We conducted a meta-analysis of published and unpublished evaluations of the DPP Rapid Diagnostic Test (RDT) for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity and overall agreement of the test compared to reference laboratory tests. RESULTS: Nine evaluations including a total of 7,267 tests were included. Sensitivity was higher in patients with higher titre RPR (≥1:16) for both the T1 (98.2% vs 90.1%, p<0.0001) and the T2 component (98.2% vs 80.6%, p<0.0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4-86.1%). Agreement was highest for high titre active infection and lowest for past infection CONCLUSIONS: The RDT has good sensitivity and specificity of the treponemal and non-treponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titres. |
Nasopharyngeal pneumococcal serotypes before and after mass azithromycin distributions for trachoma
Keenan JD , Sahlu I , McGee L , Cevallos V , Vidal JE , Chochua S , Hawkins P , Gebre T , Tadesse Z , Emerson PM , Gaynor BD , Lietman TM , Klugman KP . J Pediatric Infect Dis Soc 2016 5 (2) 222-6 Twenty-four Ethiopian communities were randomized to receive either (1) quarterly mass azithromycin distributions for trachoma for 1 year or (2) delayed treatment. Nasopharyngeal swabs collected from separate cross-sectional population-based samples of children were processed for Streptococcus pneumoniae Mass azithromycin did not significantly alter the pneumococcal serotype distribution, and hence it would not be expected to alter vaccine coverage. |
Notes from the field: outbreak of Serogroup B meningococcal disease at a university - California, 2016
Biswas HH , Han GS , Wendorf K , Winter K , Zipprich J , Perti T , Martinez L , Arellano A , Kyle JL , Zhang P , Harriman K . MMWR Morb Mortal Wkly Rep 2016 65 (20) 520-1 On January 31, 2016, the Santa Clara County Public Health Department (SCCPHD) was notified of a suspected case of meningococcal disease in a university undergraduate student. By February 2, two additional suspected cases had been reported in undergraduate students living on the same campus. The index patient (patient A) required intensive care, whereas patients B and C had milder illness; there were no deaths. All three patients were part of overlapping social networks and had attended the same events during the week before the onset of patient A's symptoms, but whether they had direct contact with one another could not be verified. Serogroup B Neisseria meningitidis was identified in cerebrospinal fluid and blood from patient A and in blood from patient B. Serogroup B has been responsible for all U.S. college outbreaks of meningococcal disease since 2011 (1). Laboratory results for patient C were inconclusive. |
Prevalence of renal impairment and associated conditions among HCV-infected persons in the Chronic Hepatitis Cohort Study (CHeCS)
Moorman AC , Tong X , Spradling PR , Rupp LB , Gordon SC , Lu M , Teshale EH , Boscarino JA , Trinacty CM , Schmidt MA , Xu F , Holmberg SD . Dig Dis Sci 2016 61 (7) 2087-93 BACKGROUND: Guidelines for the treatment of HCV-infected persons were updated in August 2015 with new recommendations for patients with renal impairment. Treatment is imperative for patients with severe, renal-associated extrahepatic manifestations of HCV infection. AIMS: We sought to describe the prevalence of these conditions among current HCV-infected patients in a population-based prospective, observational cohort study at four large US health systems. METHODS: Data from cohort patients with chronic HCV infection during 2012 were analyzed for the period from 2006 to 2013. We determined the prevalence of mild to moderately impaired renal function defined as having the most recent estimated glomerular filtration rate [eGFR] ≤ 80 ml/min/1.73 m2, with severe impairment defined as eGFR < 30 ml/min/1.73 m2, based on the treatment guidelines. Prevalence of extrahepatic conditions was ascertained using ICD9-codes. RESULTS: Among 5772 persons, the prevalence of eGFR ≤ 80 was 33 % and eGFR < 30 was 2 %, including among patients with hepatic fibrosis. Diagnosed extrahepatic renal manifestations were rare: vasculitis- 0.2 %, nephrotic syndrome- 0.3 %, and cryoglobulinemia- 0.9 %. CONCLUSIONS: While the prevalence of severe renal impairment and diagnosed extrahepatic manifestations was low, mild-to-moderate renal impairment was common in HCV patients, including those with advanced liver fibrosis for whom the need for treatment is urgent. |
Programmatic management of drug-resistant tuberculosis: An updated research agenda
Mitnick CD , Rodriguez CA , Hatton ML , Brigden G , Cobelens F , Grobusch MP , Horsburgh R , Lange C , Lienhardt C , Oren E , Podewils LJ , Seaworth B , van den Hof S , Daley CL , Gebhard AC , Wares F . PLoS One 2016 11 (5) e0155968 INTRODUCTION: There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey. METHODS: Publications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts. A survey was distributed through snowball sampling to identify research priorities. Respondent priority rankings were scored and summarized by mean. Sensitivity analyses explored weighting and handling of missing rankings. RESULTS: Thirty normative documents and publications were reviewed for stated research needs; these were collapsed into 56 research questions across 5 categories. Of more than 500 survey recipients, 133 ranked priorities within at least one category. Priorities within categories included new diagnostics and their effect on improving treatment outcomes, improved diagnosis of paucibacillary and extra pulmonary TB, and development of shorter, effective regimens. Interruption of nosocomial transmission and treatment for latent TB infection in contacts of known MDR-TB patients were also top priorities in their respective categories. Results were internally consistent and robust. DISCUSSION: Priorities retained from the 2008 research agenda include shorter MDR-TB regimens and averting transmission. Limitations of recent advances were implied in the continued quest for: shorter regimens containing new drugs, rapid diagnostics that improve treatment outcomes, and improved methods of estimating burden without representative data. CONCLUSION: There is continuity around the priorities for research in PMDT. Coordinated efforts to address questions regarding shorter treatment regimens, knowledge of disease burden without representative data, and treatment for LTBI in contacts of known DR-TB patients are essential to stem the epidemic of TB, including DR-TB. |
Ebola virus disease in pregnancy: clinical, histopathologic and immunohistochemical findings
Muehlenbachs A , de la Rosa Vazquez O , Bausch DG , Schafer IJ , Paddock CD , Nyakio JP , Lame P , Bergeron E , McCollum AM , Goldsmith CS , Bollweg BC , Prieto MA , Lushima RS , Ilunga BK , Nichol ST , Shieh WJ , Stroher U , Rollin PE , Zaki SR . J Infect Dis 2016 215 (1) 64-69 Here we describe clinicopathologic features of EVD in pregnancy. One woman infected with Sudan virus in Gulu, Uganda in 2000 had a stillbirth and survived, and another woman with Bundibugyo virus had a livebirth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemistry, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malaria pigment-laden macrophages. These data suggest trophoblast infection may be a mechanism of transplacental ebolavirus transmission. |
Elevated pertussis reporting in response to 2011-2012 outbreak, New York City, New York, USA
Arciuolo RJ , Rosen JB , Zucker JR . Emerg Infect Dis 2016 22 (6) 1117-9 Pertussis is a highly communicable, acute bacterial respiratory infection caused by Bordetella pertussis. In the United States, the incidence of pertussis declined dramatically after pertussis-containing vaccine was introduced in the 1940s (1,2). However, a resurgence of disease results in widespread outbreaks of pertussis nationally (3). | Beginning in August 2011, an outbreak of pertussis occurred in New York City (NYC), New York, USA. Reported pertussis incidence by month peaked in December 2011 (1.03 cases/100,000 persons) and remained above the baseline average monthly incidence of 0.11 cases/100,000 persons until February 2013. We hypothesized that provider awareness and altered practices after the start of the outbreak contributed to the sustained elevation in reported pertussis incidence. | To test this hypothesis, we surveyed NYC providers to assess their awareness of the outbreak, their consideration of pertussis in symptomatic patients, and the type and frequency of diagnostic testing ordered. The survey (available on request) was designed in FeedbackServer 5 (University of Massachusetts, Worcester, MA, USA; https://w3.umassmed.edu/fs/FeedbackServer/help/feedbackserver.htm) and consisted of 20 questions that required ≈5 minutes to complete by using a Web link. We distributed the survey in January 2013 to providers through 3 health department email lists: the NYC Health Alert Network, the Citywide Immunization Registry, and the Primary Care Information Project. The lists included ≈30,000 email addresses that were not mutually exclusive and that included nonmedical providers. |
Evaluation of case definitions to detect respiratory syncytial virus infection in hospitalized children below 5 years in rural Western Kenya, 2009-2013
Nyawanda BO , Mott JA , Njuguna HN , Mayieka L , Khagayi S , Onkoba R , Makokha C , Otieno NA , Bigogo GM , Katz MA , Feikin DR , Verani JR . BMC Infect Dis 2016 16 (1) 218 BACKGROUND: In order to better understand respiratory syncytial virus (RSV) epidemiology and burden in tropical Africa, optimal case definitions for detection of RSV cases need to be identified. METHODS: We used data collected between September 2009 - August 2013 from children aged <5 years hospitalized with acute respiratory Illness at Siaya County Referral Hospital. We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of individual signs, symptoms and standard respiratory disease case definitions (severe acute respiratory illness [SARI]; hospitalized influenza-like illness [hILI]; integrated management of childhood illness [IMCI] pneumonia) to detect laboratory-confirmed RSV infection. We also evaluated an alternative case definition of cough or difficulty breathing plus hypoxia, in-drawing, or wheeze. RESULTS: Among 4714 children hospitalized with ARI, 3810 (81 %) were tested for RSV; and 470 (12 %) were positive. Among individual signs and symptoms, cough alone had the highest sensitivity to detect laboratory-confirmed RSV [96 %, 95 % CI (95-98)]. Hypoxia, wheezing, stridor, nasal flaring and chest wall in-drawing had sensitivities ranging from 8 to 31 %, but had specificities >75 %. Of the standard respiratory case definitions, SARI had the highest sensitivity [83 %, 95 % CI (79-86)] whereas IMCI severe pneumonia had the highest specificity [91 %, 95 % CI (90-92)]. The alternative case definition (cough or difficulty breathing plus hypoxia, in-drawing, or wheeze) had a sensitivity of [55 %, 95 % CI (50-59)] and a specificity of [60 %, 95 % CI (59-62)]. The PPV for all case definitions and individual signs/symptoms ranged from 11 to 20 % while the negative predictive values were >87 %. When we stratified by age <1 year and 1- < 5 years, difficulty breathing, severe pneumonia and the alternative case definition were more sensitive in children aged <1 year [70 % vs. 54 %, p < 0.01], [19 % vs. 11 %, p = 0.01] and [66 % vs. 43 %, p < 0.01] respectively, while non-severe pneumonia was more sensitive [14 % vs. 26 %, p < 0.01] among children aged 1- < 5 years. CONCLUSION: The sensitivity and specificity of different commonly used case definitions for detecting laboratory-confirmed RSV cases varied widely, while the positive predictive value was consistently low. Optimal choice of case definition will depend upon study context and research objectives. |
Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014
Scott MK , Chommanard C , Lu X , Appelgate D , Grenz L , Schneider E , Gerber SI , Erdman DD , Thomas A . Emerg Infect Dis 2016 22 (6) 1044-51 Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013-July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection. |
Improved global capacity for influenza surveillance
Polansky LS , Outin-Blenman S , Moen AC . Emerg Infect Dis 2016 22 (6) 993-1001 During 2004-2009, the Centers for Disease Control and Prevention (CDC) partnered with 39 national governments to strengthen global influenza surveillance. Using World Health Organization data and program evaluation indicators collected by CDC in 2013, we retrospectively evaluated progress made 4-9 years after the start of influenza surveillance capacity strengthening in the countries. Our results showed substantial increases in laboratory and sentinel surveillance capacities, which are essential for knowing which influenza strains circulate globally, detecting emergence of novel influenza, identifying viruses for vaccine selection, and determining the epidemiology of respiratory illness. Twenty-eight of 35 countries responding to a 2013 questionnaire indicated that they have leveraged routine influenza surveillance platforms to detect other pathogens. This additional surveillance illustrates increased health-system strengthening. Furthermore, 34 countries reported an increased ability to use data in decision making; data-driven decisions are critical for improving local prevention and control of influenza around the world. |
Adapting the Get Yourself Tested Campaign to reach black and Latino sexual-minority youth
Garbers S , Friedman A , Martinez O , Scheinmann R , Bermudez D , Silva M , Silverman J , Chiasson MA . Health Promot Pract 2016 17 (5) 739-50 BACKGROUND: Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population. METHOD: This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design. RESULTS: During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth. |
The burden of cryptosporidium diarrheal disease among children < 24 months of age in moderate/high mortality regions of Sub-Saharan Africa and South Asia, utilizing data from the Global Enteric Multicenter Study (GEMS)
Sow SO , Muhsen K , Nasrin D , Blackwelder WC , Wu Y , Farag TH , Panchalingam S , Sur D , Zaidi AK , Faruque AS , Saha D , Adegbola R , Alonso PL , Breiman RF , Bassat Q , Tamboura B , Sanogo D , Onwuchekwa U , Manna B , Ramamurthy T , Kanungo S , Ahmed S , Qureshi S , Quadri F , Hossain A , Das SK , Antonio M , Hossain MJ , Mandomando I , Nhampossa T , Acacio S , Omore R , Oundo JO , Ochieng JB , Mintz ED , O'Reilly CE , Berkeley LY , Livio S , Tennant SM , Sommerfelt H , Nataro JP , Ziv-Baran T , Robins-Browne RM , Mishcherkin V , Zhang J , Liu J , Houpt ER , Kotloff KL , Levine MM . PLoS Negl Trop Dis 2016 10 (5) e0004729 BACKGROUND: The importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized. METHODS: Data from the Global Enteric Multicenter Study (GEMS), a 3-year, 7-site, case-control study of moderate-to-severe diarrhea (MSD) and GEMS-1A (1-year study of MSD and less-severe diarrhea [LSD]) were analyzed. Stools from 12,110 MSD and 3,174 LSD cases among children aged <60 months and from 21,527 randomly-selected controls matched by age, sex and community were immunoassay-tested for Cryptosporidium. Species of a subset of Cryptosporidium-positive specimens were identified by PCR; GP60 sequencing identified anthroponotic C. parvum. Combined annual Cryptosporidium-attributable diarrhea incidences among children aged <24 months for African and Asian GEMS sites were extrapolated to sub-Saharan Africa and South Asian regions to estimate region-wide MSD and LSD burdens. Attributable and excess mortality due to Cryptosporidium diarrhea were estimated. FINDINGS: Cryptosporidium was significantly associated with MSD and LSD below age 24 months. Among Cryptosporidium-positive MSD cases, C. hominis was detected in 77.8% (95% CI, 73.0%-81.9%) and C. parvum in 9.9% (95% CI, 7.1%-13.6%); 92% of C. parvum tested were anthroponotic genotypes. Annual Cryptosporidium-attributable MSD incidence was 3.48 (95% CI, 2.27-4.67) and 3.18 (95% CI, 1.85-4.52) per 100 child-years in African and Asian infants, respectively, and 1.41 (95% CI, 0.73-2.08) and 1.36 (95% CI, 0.66-2.05) per 100 child-years in toddlers. Corresponding Cryptosporidium-attributable LSD incidences per 100 child-years were 2.52 (95% CI, 0.33-5.01) and 4.88 (95% CI, 0.82-8.92) in infants and 4.04 (95% CI, 0.56-7.51) and 4.71 (95% CI, 0.24-9.18) in toddlers. We estimate 2.9 and 4.7 million Cryptosporidium-attributable cases annually in children aged <24 months in the sub-Saharan Africa and India/Pakistan/Bangladesh/Nepal/Afghanistan regions, respectively, and ~202,000 Cryptosporidium-attributable deaths (regions combined). ~59,000 excess deaths occurred among Cryptosporidium-attributable diarrhea cases over expected if cases had been Cryptosporidium-negative. CONCLUSIONS: The enormous African/Asian Cryptosporidium disease burden warrants investments to develop vaccines, diagnostics and therapies. |
Comparison of severe acute respiratory illness (sari) and clinical pneumonia case definitions for the detection of influenza virus infections among hospitalized patients, western Kenya, 2009-2013
Makokha C , Mott J , Njuguna HN , Khagayi S , Verani JR , Nyawanda B , Otieno N , Katz MA . Influenza Other Respir Viruses 2016 10 (4) 333-9 Although the severe acute respiratory illness (SARI) case definition is increasingly used for inpatient influenza surveillance, pneumonia is a more familiar term to clinicians and policymakers. We evaluated WHO case definitions for severe acute respiratory illness (SARI) and pneumonia (Integrated Management of Childhood Illnesses (IMCI) for children aged <5 years and Integrated Management of Adolescent and Adult Illnesses (IMAI) for patients aged ≥13 years) for detecting laboratory-confirmed influenza among hospitalized ARI patients. Sensitivities were 84% for SARI and 69% for IMCI pneumonia in children aged <5 years and 60% for SARI and 57% for IMAI pneumonia in patients aged ≥13 years. Clinical pneumonia case definitions may be a useful complement to SARI for inpatient influenza surveillance. |
Disease burden of group B streptococcus among infants in sub-Saharan Africa: A systematic literature review and meta-analysis
Sinha A , Russell LB , Tomczyk S , Verani JR , Schrag SJ , Berkley JA , Mohammed M , Sigauque B , Kim SY . Pediatr Infect Dis J 2016 35 (9) 933-42 BACKGROUND: Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence, and GBS serotype distribution. METHODS: MEDLINE, MEDLINE in process, and Cochrane Library were searched for studies published 1990 - 2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS (EOGBS) disease incidence, late-onset GBS (LOGBS) disease incidence, and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals. RESULTS: We identified 17 studies of colonization, nine of disease incidence, and six of serotype distribution meeting inclusion criteria. 21.8% (95% CI 18.3, 25.5) of expectant women were colonized with GBS. The incidence of EOGBS disease was 1.3 per 1000 births (95% CI 0.81, 1.9), that of LOGBS disease 0.73 per 1000 births (95% CI 0.48, 1.0). The most common disease-causing serotype was 3, followed by 1a. Serotypes 1b, 2 and 5 were next most common in frequency. CONCLUSION: Despite methodologic factors leading to under-estimation, GBS disease incidence appears high in sub-Saharan Africa. A small number of GBS serotypes cause almost all disease. GBS disease burden in sub-Saharan Africa suggests that safe, effective, and affordable GBS disease prevention is needed. |
The US National Tuberculosis Surveillance System: A descriptive assessment of the completeness and consistency of data reported from 2008 to 2012
Yelk Woodruff RS , Pratt RH , Armstrong LR . JMIR Public Health Surveill 2015 1 (2) e15 BACKGROUND: In 2009, the Tuberculosis (TB) Information Management System transitioned into the National TB Surveillance System to allow use of 4 different types of electronic reporting schemes: state-built, commercial, and 2 schemes developed by the Centers for Disease Control and Prevention. Simultaneously, the reporting form was revised to include additional data fields. OBJECTIVE: Describe data completeness for the years 2008-2012 and determine the impact of surveillance changes. METHODS: Data were categorized into subgroups and assessed for completeness (eg, the percentage of patients dead at diagnosis who had a date of death reported) and consistency (eg, the percentage of patients alive at diagnosis who erroneously had a date of death reported). Reporting jurisdictions were grouped to examine differences by reporting scheme. RESULTS: Each year less than 1% of reported cases had missing information for country of origin, race, or ethnicity. Patients reported as dead at diagnosis had death date (a new data field) missing for 3.6% in 2009 and 4.4% in 2012. From 2010 to 2012, 313 cases (1%) reported as alive at diagnosis had a death date and all of these were reported through state-built or commercial systems. The completeness of reporting for guardian country of birth for pediatric patients (a new data field) ranged from 84% in 2009 to 88.2% in 2011. CONCLUSIONS: Despite major changes, completeness has remained high for most data elements in TB surveillance. However, some data fields introduced in 2009 remain incomplete; continued training is needed to improve national TB surveillance data. |
Quantifying the epidemiological impact of vector control on dengue
Reiner RC Jr , Achee N , Barrera R , Burkot TR , Chadee DD , Devine GJ , Endy T , Gubler D , Hombach J , Kleinschmidt I , Lenhart A , Lindsay SW , Longini I , Mondy M , Morrison AC , Perkins TA , Vazquez-Prokopec G , Reiter P , Ritchie SA , Smith DL , Strickman D , Scott TW . PLoS Negl Trop Dis 2016 10 (5) e0004588 Dengue virus (DENV) is a self-limiting illness in tropical and subtropical regions around the globe caused by four closely related, but distinct, virus serotypes (DENV-1, -2, -3, and -4) that are transmitted among humans by mosquitoes, primarily Aedes aegypti [1]. Approximately 4 billion people living in more than 128 countries are at risk of infection [2]. Each year there are an estimated 400 million new infections, of which about 100 million manifest as apparent illness [3]. The outcome of human infections ranges from asymptomatic to mild illness to severe, life-threatening disease [4]. DENV not only causes more human morbidity and mortality than any other arthropod-borne virus but it is also a growing public health threat. There has been a dramatic 4-fold increase in dengue cases between 1990–2013 and dengue continues to expand in geographic range [2,3,5,6]. | Presently, vector control is the primary means for preventing dengue [7]. Several vaccine constructs are in clinical trials and initial results are encouraging [8]; recently licensure was granted for the Sanofi Pasteur vaccine in Mexico, Brazil, and the Philippines [9]. A few well-documented successes indicate that, when rigorously applied, vector control can reduce dengue. The advent of DDT in 1947 led to a hemisphere-wide program in the 1950s and 1960s across Central and South America that dramatically reduced Ae. aegypti populations, resulting in impressive reductions in yellow fever and dengue [10]. During the 1970s–1980s [11] and the 1980s–1990s [12], respectively, Singapore and Cuba successfully used vector control and larval source reduction to reduce the force of DENV infection (i.e., per capita risk of human infection [13]) and, thus, disease. Recent trials of indoor residual spraying [14] and indoor space spraying [15] appeared to reduce human DENV infections. Regrettably, these control achievements were rare and ultimately transient. Dengue reinvaded Latin America after the Ae. aegypti eradication campaign ended, rebounded in Singapore and Cuba after 20 and 16 years of successful control, respectively, and is increasingly being reported in Africa due to improved surveillance [16]. |
Endemic orthopoxvirus circulating in procyonids in Mexico
Gallardo-Romero NF , Arechiga-Ceballos N , Emerson GL , Martinez-Martinez FO , Doty JB , Nakazawa YJ , Rendon-Franco E , Munoz-Garcia CI , Villanueva-Garcia C , Ramirez-Cid C , Gama-Campillo LM , Gual-Sill F , Aguilar-Setien A , Carroll DS . J Wildl Dis 2016 52 (3) 609-15 Limited serosurveillance studies suggested that orthopoxviruses (OPXV) are widespread in the US (e.g., Raccoonpox virus, Skunkpox virus, Volepox virus) and Brazil (Vaccinia virus); however, their animal reservoir(s) remain unconfirmed. Mexican mammal diversity includes several species related to those in which evidence for OPXV infections has been found (Oryzomys, Peromyscus, Microtus, and Procyonidae). The presence of these groups of mammals in Mexico and the evidence of their possible involvement in the maintenance of OXPV in nature suggest the same or similar OPXV are circulating in Mexico. We tested 201 sera from 129 procyonids via modified enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) to estimate OPXV antibody prevalence in these animals. We detected a prevalence of 16.67% in Nasua narica (white-nosed coati), 35% in Procyon lotor (raccoon), and 30.4% in Bassariscus astutus (ring-tailed cat) when tested by either ELISA or WB. Western blot results presented protein bands consistent with the size of some OXPV immunodominant bands (14, 18, 32, 36, and 62 kDa). These results support the hypothesis that OPXV circulate in at least three genera of Procyonidae in Central and Southeast Mexico. |
Determining mosquito distribution from egg data: the role of the citizen scientist
Cohnstaedt LW , Ladner J , Campbell LR , Busch N , Barrera R . Am Biol Teach 2016 78 (4) 317-322 Nationwide science classes, from elementary through secondary, are placing a larger emphasis on inquiry and authentic experiences. The opportunity for community members (students, teachers, or interested individuals) to collect real data and contribute to a research project is the definition of citizen science. Recent disease outbreaks of mosquito-transmitted pathogens (West Nile, eastern equine encephalitis, dengue, chikungunya, and Zika) demonstrate the need to educate children and adults about the public health risks posed by mosquitoes. This lesson plan has students determine mosquito species and subsequent disease risk around their house and in their community by collecting mosquito eggs and rearing a portion of them to adults. The students identify adult mosquitoes and associated health risks. Furthermore, students and teachers have the option to participate in a national mosquito-species-distribution study by submitting mosquito eggs and adults to the U.S. Department of Agriculture. The data generated by participant submissions will be available to all mosquito submitters, making each student and school part of a larger project. This lesson plan has three objectives beyond the citizen science experience: (1) clarify the individual's role in protecting individuals, communities, and pets from illness; (2) raise awareness of pathogens transmitted by mosquitoes; and (3) participate in a national program to gather mosquito distribution data. The lesson and the associated supplementary material (available at http://www.citizenscience.us) can be used for middle to high school classes, as well as Advanced Placement classes, because the materials and presentations can be easily modified to classroom needs. |
Thyroid antagonists and thyroid indicators in U.S. pregnant women in the Vanguard Study of the National Children's Study
Mortensen ME , Birch R , Wong LY , Valentin-Blasini L , Boyle EB , Caldwell KL , Merrill LS , Moye J Jr , Blount BC . Environ Res 2016 149 179-188 The sodium iodide-symporter (NIS) mediates uptake of iodide into thyroid follicular cells. This key step in thyroid hormone synthesis is inhibited by perchlorate, thiocyanate (SCN) and nitrate (NO3) anions. When these exposures occur during pregnancy the resulting decreases in thyroid hormones may adversely affect neurodevelopment of the human fetus. Our objectives were to describe and examine the relationship of these anions to the serum thyroid indicators, thyroid stimulating hormone (TSH) and free thyroxine (FT4), in third trimester women from the initial Vanguard Study of the National Children's Study (NCS); and to compare urine perchlorate results with those in pregnant women from the National Health and Nutritional Examination Survey (NHANES). Urinary perchlorate, SCN, NO3, and iodine, serum TSH, FT4, and cotinine were measured and a food frequency questionnaire (FFQ) was administered to pregnant women enrolled in the initial Vanguard Study. We used multiple regression models of FT4 and TSH that included perchlorate equivalent concentration (PEC, which estimates combined inhibitory effects of the anions perchlorate, SCN, and NO3 on the NIS). We used multiple regression to model predictors of each urinary anion, using FFQ results, drinking water source, season of year, smoking status, and demographic characteristics. Descriptive statistics were calculated for pregnant women in NHANES 2001-2012. The geometric mean (GM) for urinary perchlorate was 4.04microg/L, for TSH 1.46mIU/L, and the arithmetic mean for FT4 1.11ng/dL in 359 NCS women. In 330 women with completed FFQs, consumption of leafy greens, winter season, and Hispanic ethnicity were significant predictors of higher urinary perchlorate, which differed significantly by study site and primary drinking water source, and bottled water was associated with higher urinary perchlorate compared to filtered tap water. Leafy greens consumption was associated with higher urinary NO3 and higher urinary SCN. There was no association between urinary perchlorate or PEC and TSH or FT4, even for women with urinary iodine <100microg/L. GM urinary perchlorate concentrations in the full sample (n=494) of third trimester NCS women (4.03microg/L) were similar to pregnant women in NHANES (3.58microg/L). |
Immediate closures and violations identified during routine inspections of public aquatic facilities - Network for Aquatic Facility Inspection Surveillance, five states, 2013
Hlavsa MC , Gerth TR , Collier SA , Dunbar EL , Rao G , Epperson G , Bramlett B , Ludwig DF , Gomez D , Stansbury MM , Miller F , Warren J , Nichol J , Bowman H , Huynh BA , Loewe KM , Vincent B , Tarrier AL , Shay T , Wright R , Brown AC , Kunz JM , Fullerton KE , Cope JR , Beach MJ . MMWR Surveill Summ 2016 65 (5) 1-26 PROBLEM/CONDITION: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS: During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION: Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION: Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections. |
Impact of the 2012 extreme drought conditions on private well owners in the United States, a qualitative analysis
Murti M , Yard E , Kramer R , Haselow D , Mettler M , McElvany R , Martin C . BMC Public Health 2016 16 (1) 430 BACKGROUND: Extreme hot and dry weather during summer 2012 resulted in some of the most devastating drought conditions in the last half-century in the United States (U.S.). While public drinking water systems have contingency plans and access to alternative resources to maintain supply for their customers during drought, little is known about the impacts of drought on private well owners, who are responsible for maintaining their own water supply. The purpose of this investigation was to explore the public health impacts of the 2012 drought on private well owners' water quality and quantity, identify their needs for planning and preparing for drought, and to explore their knowledge, attitudes, and well maintenance behaviors during drought. METHODS: In the spring of 2013, we conducted six focus group discussions with private well owners in Arkansas, Indiana, and Oklahoma. RESULTS: There were a total of 41 participants, two-thirds of whom were men aged 55 years or older. While participants agreed that 2012 was the worst drought in memory, few experienced direct impacts on their water quantity or quality. However, all groups had heard of areas or individuals whose wells had run dry. Participants conserved water by reducing their indoor and outdoor consumption, but they had few suggestions on additional ways to conserve, and they raised concerns about limiting water use too much. Participants wanted information on how to test their well and any water quality issues in their area. CONCLUSIONS: This investigation identified information needs regarding drought preparedness and well management for well owners. |
Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey
Grey JA , Bernstein KT , Sullivan PS , Purcell DW , Chesson HW , Gift TL , Rosenberg ES . JMIR Public Health Surveill 2016 2 (1) e14 BACKGROUND: In the United States, male-to-male sexual transmission accounts for the greatest number of new human immunodeficiency virus (HIV) diagnoses and a substantial number of sexually transmitted infections (STI) annually. However, the prevalence and annual incidence of HIV and other STIs among men who have sex with men (MSM) cannot be estimated in local contexts because demographic data on sexual behavior, particularly same-sex behavior, are not routinely collected by large-scale surveys that allow analysis at state, county, or finer levels, such as the US decennial census or the American Community Survey (ACS). Therefore, techniques for indirectly estimating population sizes of MSM are necessary to supply denominators for rates at various geographic levels. OBJECTIVE: Our objectives were to indirectly estimate MSM population sizes at the county level to incorporate recent data estimates and to aggregate county-level estimates to states and core-based statistical areas (CBSAs). METHODS: We used data from the ACS to calculate a weight for each county in the United States based on its relative proportion of households that were headed by a male who lived with a male partner, compared with the overall proportion among counties at the same level of urbanicity (ie, large central metropolitan county, large fringe metropolitan county, medium/small metropolitan county, or nonmetropolitan county). We then used this weight to adjust the urbanicity-stratified percentage of adult men who had sex with a man in the past year, according to estimates derived from the National Health and Nutrition Examination Survey (NHANES), for each county. We multiplied the weighted percentages by the number of adult men in each county to estimate its number of MSM, summing county-level estimates to create state- and CBSA-level estimates. Finally, we scaled our estimated MSM population sizes to a meta-analytic estimate of the percentage of US MSM in the past 5 years (3.9%). RESULTS: We found that the percentage of MSM among adult men ranged from 1.5% (Wyoming) to 6.0% (Rhode Island) among states. Over one-quarter of MSM in the United States resided in 1 of 13 counties. Among counties with over 300,000 residents, the five highest county-level percentages of MSM were San Francisco County, California at 18.5% (66,586/359,566); New York County, New York at 13.8% (87,556/635,847); Denver County, Colorado at 10.5% (25,465/243,002); Multnomah County, Oregon at 9.9% (28,949/292,450); and Suffolk County, Massachusetts at 9.1% (26,338/289,634). Although California (n=792,750) and Los Angeles County (n=251,521) had the largest MSM populations of states and counties, respectively, the New York City-Newark-Jersey City CBSA had the most MSM of all CBSAs (n=397,399). CONCLUSIONS: We used a new method to generate small-area estimates of MSM populations, incorporating prior work, recent data, and urbanicity-specific parameters. We also used an imputation approach to estimate MSM in rural areas, where same-sex sexual behavior may be underreported. Our approach yielded estimates of MSM population sizes within states, counties, and metropolitan areas in the United States, which provide denominators for calculation of HIV and STI prevalence and incidence at those geographic levels. |
Complete Sequence of the Smallest Polyomavirus Genome, Giant Guitarfish (Rhynchobatus djiddensis) Polyomavirus 1.
Dill JA , Ng TF , Camus AC . Genome Announc 2016 4 (3) Polyomaviruses are known to infect mammals and birds. Deep sequencing and metagenomic analysis identified the first polyomavirus from a cartilaginous fish, the giant guitarfish (Rhynchobatus djiddensis). Giant guitarfish polyomavirus 1 (GfPyV1) has typical polyomavirus genome organization, but is the smallest polyomavirus genome (3.96 kb) described to date. |
Genomic and Phenotypic Analysis Reveal the Emergence of an Atypical Salmonella Senftenberg Variant in China.
Abd El Ghany M , Shi X , Li Y , Ansari HR , Hill-Cawthorne GA , Ho YS , Naeem R , Pickard D , Klena JD , Xu X , Pain A , Hu Q . J Clin Microbiol 2016 54 (8) 2014-22 Human infections with Salmonella enterica subspecies enterica serovar Senftenberg are often associated with exposure to poultry flocks, farm environments or contaminated food. The recent emergence of multidrug-resistant isolates has raised public health concerns. In this study comparative genomics and phenotypic analysis were used to characterize 14 clinical Salmonella Senftenberg isolates recovered from multiple outbreaks in Shenzhen and Shanghai, China between 2002 and 2011. Single nucleotide polymorphism analyses identified two phylogenetically distinct clades of S. Senftenberg, designated SC1 and SC2, harboring variations in Salmonella Pathogenicity Island-1 and 2 and exhibiting distinct biochemical and phenotypic signatures. Although both variants shared an identical serotype, the SC2 isolates of sequence type-14 (ST14) harbored intact SPI-1 and 2 and hence were characterized by possessing efficient invasion capabilities. In contrast, the SC1 isolates had structural deletion patterns in both SPI-1 and 2 that correlated with an impaired capacity to invade human cultured cells and also the year of their isolation. These atypical SC1 isolates also lacked the capacity to produce hydrogen sulfide. These findings highlight the emergence of atypical Salmonella Senftenberg variants in China and provide genetic validation that variants lacking SPI-1and regions of SPI-2, leading to impaired invasion capacity, can still cause clinical disease. These data have identified an emerging public health concern and highlight the need to strengthen surveillance to detect the prevalence and transmission of non-Typhoidal Salmonella species. |
Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States.
Lockhart SR , Roe CC , Engelthaler DM . Emerg Infect Dis 2016 22 (6) 1098-101 Cryptococcus gattii is a recognized pathogenic fungus along the Pacific coast of the United States from California to Washington. Here we report that C. gattii may also be endemic to the southeastern United States and has probably been present there longer than in the Pacific Northwest. |
Taxonomer: an interactive metagenomics analysis portal for universal pathogen detection and host mRNA expression profiling.
Flygare S , Simmon K , Miller C , Qiao Y , Kennedy B , Di Sera T , Graf EH , Tardif KD , Kapusta A , Rynearson S , Stockmann C , Queen K , Tong S , Voelkerding KV , Blaschke A , Byington CL , Jain S , Pavia A , Ampofo K , Eilbeck K , Marth G , Yandell M , Schlaberg R . Genome Biol 2016 17 (1) 111 BACKGROUND: High-throughput sequencing enables unbiased profiling of microbial communities, universal pathogen detection, and host response to infectious diseases. However, computation times and algorithmic inaccuracies have hindered adoption. RESULTS: We present Taxonomer, an ultrafast, web-tool for comprehensive metagenomics data analysis and interactive results visualization. Taxonomer is unique in providing integrated nucleotide and protein-based classification and simultaneous host messenger RNA (mRNA) transcript profiling. Using real-world case-studies, we show that Taxonomer detects previously unrecognized infections and reveals antiviral host mRNA expression profiles. To facilitate data-sharing across geographic distances in outbreak settings, Taxonomer is publicly available through a web-based user interface. CONCLUSIONS: Taxonomer enables rapid, accurate, and interactive analyses of metagenomics data on personal computers and mobile devices. |
Post-traumatic stress disorder symptoms and mental health over time among low-income women at increased risk of HIV in the U.S
Golin CE , Haley DF , Wang J , Hughes JP , Kuo I , Justman J , Adimora AA , Soto-Torres L , O'Leary A , Hodder S . J Health Care Poor Underserved 2016 27 (2) 891-910 Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods. |
Antibiotic stewardship programs in U.S. acute care hospitals: findings from the 2014 National Healthcare Safety Network (NHSN) Annual Hospital Survey
Pollack LA , van Santen KL , Weiner LM , Dudeck MA , Edwards JR , Srinivasan A . Clin Infect Dis 2016 63 (4) 443-9 BACKGROUND: The National Action Plan to Combat Antibiotic Resistant Bacteria calls for all U.S. hospitals to improve antibiotic prescribing as a key prevention strategy for resistance and Clostridium difficile Antibiotic stewardship programs (ASPs) will be important in this effort but implementation is not well understood. METHODS: We analyzed the 2014 National Healthcare Safety Network (NHSN) Annual Hospital Survey to describe ASPs in U.S. acute care hospitals as defined by CDC's Core Elements for Hospital Antibiotic Stewardship Programs. Univariate analyses were used to assess stewardship infrastructure and practices by facility characteristics and a multivariate model determined factors associated with meeting all ASP core elements. RESULTS: Among 4,184 U.S. hospitals, 39% reported having an ASP that met all seven core elements. Although hospitals with greater than 200 beds (59%) were more likely to have ASPs; one in four (25%) of hospitals with less than 50 beds reported achieving all seven CDC-defined core elements of a comprehensive ASP. The percent of hospitals in each state that reported all seven elements ranged from 7% to 58%. In the multivariate model, written support (adjusted RR 7.2 [95% CI, 6.2-8.4]; P<0.0001) or salary support (adjusted RR 1.5 [95% CI, 1.4-1.6]; P<0.0001) were significantly associated with having a comprehensive ASP. CONCLUSIONS: Our findings show that ASP implementation varies across the U.S. and provide a baseline to monitor progress toward national goals. Comprehensive ASPs can be established in facilities of any size and hospital leadership support for antibiotic stewardship appears to drive the establishment of ASPs. |
Perfluoroalkyl substance serum concentrations and immune response to FluMist vaccination among healthy adults
Stein CR , Ge Y , Wolff MS , Ye X , Calafat AM , Kraus T , Moran TM . Environ Res 2016 149 171-178 Perfluoroalkyl substances (PFAS) were shown to be immunotoxic in laboratory animals. There is some epidemiological evidence that PFAS exposure is inversely associated with vaccine-induced antibody concentration. We examined immune response to vaccination with FluMist intranasal live attenuated influenza vaccine in relation to four PFAS (perfluorooctanoate, perfluorononanoate, perfluorooctane sulfonate, perfluorohexane sulfonate) serum concentrations among 78 healthy adults vaccinated during the 2010-2011 influenza season. We measured anti-A H1N1 antibody response and cytokine and chemokine concentrations in serum pre-vaccination, 3 days post-vaccination, and 30 days post-vaccination. We measured cytokine, chemokine, and mucosal IgA concentration in nasal secretions 3 days post-vaccination and 30 days post-vaccination. Adults with higher PFAS concentrations were more likely to seroconvert after FluMist vaccination as compared to adults with lower PFAS concentrations. The associations, however, were imprecise and few participants seroconverted as measured either by hemagglutination inhibition (9%) or immunohistochemical staining (25%). We observed no readily discernable or consistent pattern between PFAS concentration and baseline cytokine, chemokine, or mucosal IgA concentration, or between PFAS concentration and change in these immune markers between baseline and FluMist-response states. The results of this study do not support a reduced immune response to FluMist vaccination among healthy adults in relation to serum PFAS concentration. Given the study's many limitations, however, it does not rule out impaired vaccine response to other vaccines or vaccine components in either children or adults. |
Humoral and intestinal immunity induced by new schedules of bivalent oral poliovirus vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial
Asturias EJ , Bandyopadhyay AS , Self S , Rivera L , Saez-Llorens X , Lopez E , Melgar M , Gaensbauer JT , Weldon WC , Oberste MS , Borate BR , Gast C , Clemens R , Orenstein W , O'Ryan M , Jimeno J , Clemens SA , Ward J , Ruttimann R . Lancet 2016 388 (10040) 158-69 BACKGROUND: Replacement of the trivalent oral poliovirus vaccine (tOPV) with bivalent types 1 and 3 oral poliovirus vaccine (bOPV) and global introduction of inactivated poliovirus vaccine (IPV) are major steps in the polio endgame strategy. In this study, we assessed humoral and intestinal immunity in Latin American infants after three doses of bOPV combined with zero, one, or two doses of IPV. METHODS: This open-label randomised controlled multicentre trial was part of a larger study. 6-week-old full-term infants due for their first polio vaccinations, who were healthy on physical examination, with no obvious medical conditions and no known chronic medical disorders, were enrolled from four investigational sites in Colombia, Dominican Republic, Guatemala, and Panama. The infants were randomly assigned by permuted block randomisation (through the use of a computer-generated list, block size 36) to nine groups, of which five will be discussed in this report. These five groups were randomly assigned 1:1:1:1 to four permutations of schedule: groups 1 and 2 (control groups) received bOPV at 6, 10, and 14 weeks; group 3 (also a control group, which did not count as a permutation) received tOPV at 6, 10, and 14 weeks; group 4 received bOPV plus one dose of IPV at 14 weeks; and group 5 received bOPV plus two doses of IPV at 14 and 36 weeks. Infants in all groups were challenged with monovalent type 2 vaccine (mOPV2) at 18 weeks (groups 1, 3, and 4) or 40 weeks (groups 2 and 5). The primary objective was to assess the superiority of bOPV-IPV schedules over bOPV alone, as assessed by the primary endpoints of humoral immunity (neutralising antibodies-ie, seroconversion) to all three serotypes and intestinal immunity (faecal viral shedding post-challenge) to serotype 2, analysed in the per-protocol population. Serious and medically important adverse events were monitored for up to 6 months after the study vaccination. This study is registered with ClinicalTrials.gov, number NCT01831050, and has been completed. FINDINGS: Between May 20, 2013, and Aug 15, 2013, 940 eligible infants were enrolled and randomly assigned to the five treatment groups (210 to group 1, 210 to group 2, 100 to group 3, 210 to group 4, and 210 to group 5). One infant in group 1 was not vaccinated because their parents withdrew consent after enrolment and randomisation, so 939 infants actually received the vaccinations. Three doses of bOPV or tOPV elicited type 1 and 3 seroconversion rates of at least 97.7%. Type 2 seroconversion occurred in 19 of 198 infants (9.6%, 95% CI 6.2-14.5) in the bOPV-only groups, 86 of 88 (97.7%, 92.1-99.4) in the tOPV-only group (p<0.0001 vs bOPV-only), and 156 of 194 (80.4%, 74.3-85.4) infants in the bOPV-one dose of IPV group (p<0.0001 vs bOPV-only). A further 20 of 193 (10%) infants in the latter group seroconverted 1 week after mOPV2 challenge, resulting in around 98% of infants being seropositive against type 2. After a bOPV-two IPV schedule, all 193 infants (100%, 98.0-100; p<0.0001 vs bOPV-only) seroconverted to type 2. IPV induced small but significant decreases in a composite serotype 2 viral shedding index after mOPV2 challenge. 21 serious adverse events were reported in 20 patients during the study, including two that were judged to be possibly related to the vaccines. Most of the serious adverse events (18 [86%] of 21) and 24 (80%) of the 30 important medical events reported were infections and infestations. No deaths occurred during the study. INTERPRETATION: bOPV provided humoral protection similar to tOPV against polio serotypes 1 and 3. After one or two IPV doses in addition to bOPV, 80% and 100% of infants seroconverted, respectively, and the vaccination induced a degree of intestinal immunity against type 2 poliovirus. FUNDING: Bill & Melinda Gates Foundation. |
Evaluation of health IT in low-income countries
Oluoch T , de Keizer NF . Stud Health Technol Inform 2016 222 324-35 Low and middle income countries (LMICs) bear a disproportionate burden of major global health challenges. Health IT could be a promising solution in these settings but LMICs have the weakest evidence of application of health IT to enhance quality of care. Various systematic reviews show significant challenges in the implementation and evaluation of health IT. Key barriers to implementation include lack of adequate infrastructure, inadequate and poorly trained health workers, lack of appropriate legislation and policies and inadequate financial 333indicating the early state of generation of evidence to demonstrate the effectiveness of health IT in improving health outcomes and processes. The implementation challenges need to be addressed. The introduction of new guidelines such as GEP-HI and STARE-HI, as well as models for evaluation such as SEIPS, and the prioritization of evaluations in eHealth strategies of LMICs provide an opportunity to focus on strategic concepts that transform the demands of a modern integrated health care system into solutions that are secure, efficient and sustainable. |
Masculine discrepancy stress, emotion-regulation difficulties, and intimate partner violence
Berke DS , Reidy DE , Gentile B , Zeichner A . J Interpers Violence 2016 34 (6) 1163-1182 Research suggests that masculine socialization processes contribute to the perpetration of intimate partner violence (IPV) by men. Although this research has traditionally focused on men who strongly adhere to traditional gender norms, men who negatively evaluate themselves as falling short of these norms (a construct termed masculine discrepancy stress) have proven to be at increased risk of IPV perpetration. Likewise, men experiencing problems with emotion regulation, a multidimensional construct reflecting difficulties in effectively experiencing and responding to emotional states, are also at risk of IPV perpetration. In the present research, we tested the hypothesis that the link between discrepancy stress and IPV perpetration is mediated via difficulties in emotion regulation. Three hundred fifty-seven men completed online surveys assessing their experience of discrepancy stress, emotion-regulation difficulties, and history of IPV perpetration. Results indicated that discrepancy-stressed men's use of physical IPV was fully mediated by emotion-regulation difficulties. In addition, emotion-regulation difficulties partially mediated the association between discrepancy stress and sexual IPV. Findings are discussed in terms of the potential utility of emotion-focused interventions for modifying men's experience and expression of discrepancy stress and reducing perpetration of IPV. |
Fatal abusive head trauma among children aged <5 Years - United States, 1999-2014
Spies EL , Klevens J . MMWR Morb Mortal Wkly Rep 2016 65 (20) 505-9 In the United States, abusive head trauma (AHT) is one of the leading causes of maltreatment fatalities among infants and children, accounting for approximately one third of these deaths (1). Monitoring trends in AHT and evaluating prevention strategies have historically been difficult because of differences in AHT definitions used in research and surveillance. CDC's case definition for AHT and data from the National Vital Statistics System were used to examine the trends in fatal AHT during 1999-2014 using Joinpoint trend analysis software. During this period, AHT resulted in nearly 2,250 deaths among U.S. resident children aged <5 years. Whereas rates were relatively stable during 1999-2009, there was a statistically significant average annual decline of 13.0% in fatal AHT rates during 2009-2014. The fatal AHT rates in 2013 and 2014 (0.41 and 0.43 per 100,000 children aged <5 years, respectively) were the lowest in the 16-year study period. Although this decline in AHT deaths is encouraging, more can be done to prevent AHT, including family-based interventions and policies that create safe, stable, nurturing relationships and environments for children. |
Lateral flow-based antibody testing for Chlamydia trachomatis
Gwyn S , Mitchell A , Dean D , Mkocha H , Handali S , Martin DL . J Immunol Methods 2016 435 27-31 We describe here a lateral flow-based assay (LFA) for the detection of antibodies against immunodominant antigen Pgp3 from Chlamydia trachomatis, the causative agent of urogenital chlamydia infection and ocular trachoma. Optimal signal detection was achieved when the gold-conjugate and test line contained Pgp3, creating a dual sandwich capture assay. The LFA yielded positive signals with serum and whole blood but not with eluted dried blood spots. For serum, the agreement of the LFA with the non-reference multiplex assay was 96%, the specificity using nonendemic pediatric sera was 100%, and the inter-rater agreement was kappa=0.961. For whole blood, the agreement of LFA with multiplex was 81.5%, the specificity was 100%, and the inter-rater agreement was kappa=0.940. The LFA was tested in a field environment and yielded similar results to those from laboratory-based testing. These data show the successful development of a lateral flow assay for detection of antibodies against Pgp3 with reliable use in field settings, which would make antibody-based testing for trachoma surveillance highly practical, especially after cessation of trachoma elimination programs. |
Effect of multiple alcohol-based hand rub applications on the tensile properties of thirteen brands of medical exam nitrile and latex gloves
Gao P , Horvatin M , Niezgoda G , Weible R , Shaffer R . J Occup Environ Hyg 2016 13 (12) 1-35 Current CDC guidance for the disinfection of gloved hands during the doffing of personal protective equipment (PPE) following the care of a patient with Ebola recommends for multiple applications of alcohol-based hand rub (ABHR) on medical exam gloves. To evaluate possible effects of ABHR applications on glove integrity, thirteen brands of nitrile and latex medical exam gloves from five manufacturers and two different ABHRs were included in this study. A pair of gloves were worn by a test operator and the outside surfaces of the gloves were separately treated with an ABHR for 1 to 6 applications. Tensile strength and ultimate elongation of the gloves without any ABHR treatments (control gloves) and gloves after 1 to 6 ABHR applications were measured based on the ASTM D412 standard method. In general, tensile strength decreased with each ABHR application. ABHRs had more effect on the tensile strength of the tested nitrile than latex gloves; while ethanol based ABHR (EBHR) resulted in lesser changes in tensile strength compared to isopropanol based ABHR (IBHR). The results show that multiple EBHR applications on the latex gloves and some of the nitrile gloves tested should be safe for Ebola PPE doffing based on the CDC guidance. Appropriate hospital staff practice using ABHR treatment and doffing gloves is recommended to become more familiar with changes in glove properties. |
Evaluation of urine pneumococcal antigen test performance among adults in Western Kenya
Hampton LM , Bigogo G , Jagero G , da Gloria Carvalho M , Pimenta F , Junghae M , Breiman RF , Whitney CG , Feikin DR , Conklin LM . Diagn Microbiol Infect Dis 2016 85 (4) 405-8 When used in an area of rural western Kenya, the BinaxNOW(R) urine antigen test had a sensitivity of 67% (95% Confidence Interval [CI]: 43-85%) among 21 adults ≥15 years old with acute respiratory illnesses and pneumococcal bacteremia and a specificity of 98% (95% CI: 96-99%) among 660 adults ≥15 years old without fever or cough. The specificity of the test was not significantly affected by pneumococcal colonization, regardless of patients' HIV status, age, or sex. Use of the pneumococcal urine antigen test in clinical assessments of adults in Africa with acute respiratory illness is a viable option regardless of whether a patient is colonized by pneumococci, even among HIV-infected adults, although the moderate sensitivity of the urine antigen test indicates that the test is probably best used clinically as part of a panel with other tests that can detect pneumococci. |
Interferon-gamma release assays and pediatric public health tuberculosis screening: The San Francisco program experience 2005 to 2008
Grinsdale JA , Islam S , Tran OC , Ho CS , Kawamura LM , Higashi JM . J Pediatric Infect Dis Soc 2016 5 (2) 122-30 BACKGROUND: Interferon-gamma release assay utilization in pediatric tuberculosis (TB) screening is limited by a paucity of longitudinal experience, particularly in low-TB burden populations. METHODS: We conducted a retrospective review of QuantiFERON (QFT)-TB Gold results in San Francisco children from 2005 to 2008. Concordance with the tuberculin skin test (TST) was analyzed for a subset of children. Progression to active disease was determined through San Francisco and California TB registry matches. RESULTS: Of 1092 children <15 years of age, 853 (78%) were foreign-born, and 136 (12%) were exposed to active TB cases (contacts). QuantiFERON tests were positive in 72 of 1092 (7%) children; 15 of 136 (11%) recent contacts; 53 of 807 (7%) foreign-born noncontacts; and 4 of 149 (3%) US-born noncontacts. QuantiFERON-negative/TST-positive discordance was seen more often in foreign-born/bacille Calmette-Guerin (BCG)-vaccinated children <5 years of age (52 of 56, 93%) compared to those ≥ 5 years of age (90 of 123, 73%; P = .003). Foreign-born, BCG-vaccinated children were more than twice as likely to have a discordant (79%) result as US-born, non-BCG-vaccinated children (37%; P < .0001). During 5587 person-years of follow-up of untreated children, including 146 TST-positive/QFT-negative children, no cases of active TB were identified, consistent with a negative predictive value of 100%. CONCLUSIONS: Our experience supports the use of QFT to evaluate latent TB infection in children, particularly young BCG-vaccinated children. The proportion of QFT-positive results correlated with risk of exposure, and none of the untreated QFT-negative children developed TB. The low QFT-positive rate highlights the need for more selective testing based on current epidemiology and TB exposure risk. |
Isolation and short-term persistence of Ehrlichia ewingii in cell culture
Killmaster LF , Levin ML . Vector Borne Zoonotic Dis 2016 16 (7) 445-8 Ehrlichia ewingii is the causative agent of human and canine granulocytic ehrlichiosis. Since its discovery in 1970, little work has been done to characterize the pathogen or study the transmission dynamics due to the inability to grow the agent in vitro. The aim of this study was to assess the suitability of multiple cell lines and media formulations for propagation of E. ewingii in cell culture. In this study, we present an overview of attempts to isolate E. ewingii from the buffy coat of goats naturally infected by Amblyomma americanum ticks, as well as a methodology for maintaining the pathogen for up to 16 weeks in culture. The most promising results were seen with HL-60 cells differentiated by the addition of 1.5% DMSO to the media and supplemented with 8 mM l-glutamine. Cultures were passaged multiple times, and fluorescence and morulae were observed by indirect fluorescent antibody test and Diff-Quik staining. It is our hope that this information will provide a foundation for future attempts to propagate and maintain E. ewingii in cell culture. |
Age, serum 25-hydroxyvitamin D and vitamin D receptor (VDR) expression and function in peripheral blood mononuclear cells
Coleman LA , Mishina M , Thompson M , Spencer SM , Reber AJ , Davis WG , Cheng PY , Belongia EA , Talbot HK , Sundaram ME , Griffin MR , Shay DK , Sambhara S . Oncotarget 2016 7 (24) 35512-35521 The relationship between age, vitamin D status, expression and functionality of the vitamin D receptor (VDR), and key genes in the vitamin D pathway in immune cells is unclear. We enrolled adults 50 to 69 years old (20 subjects) and 70+ (20 subjects) and measured: 1) 25(OH)D levels by liquid chromatography/mass spectrometry; and 2) mRNA expression of VDR, 1alpha-OHase, 1,25D3-MARRS, TREM-1, cathelicidin, RIG-I, and interferon-beta by qRT-PCR. Mean serum 25(OH)D was 30 +/- 4 ng/mL and was not associated with age. Baseline expression of VDR, 1alpha-OHase, 1,25D3-MARRS, TREM-1, and RIG-I also did not differ by age; IFN-beta expression, however, was higher in the 70+ year old group. 25(OH)D3- and 1,25(OH)2D3-induced VDR, TREM-1 and cathelicidin expression were similar between age groups, as was LPS-induced expression of VDR and of 1alpha-OHase. Ligand-induced 1,25D3-MARRS expression was higher in subjects ≥ 70 years. Serum 25(OH)D was inversely associated with LPS-stimulated VDR expression and with baseline or vitamin D-induced TREM-1 expression, adjusting for age, self-rated health, and functional status. In healthy adults ≥ 50 years, the expression and functionality of the VDR, 1alpha-OHase and key vitamin D pathway genes were not consistently associated with age. |
Development and validation of a high-throughput online solid phase extraction - liquid chromatography - tandem mass spectrometry method for the detection of tetrodotoxin in human urine
Coleman R , Lemire SW , Bragg W , Garrett A , Ojeda-Torres G , Hamelin E , Johnson RC , Thomas J . Toxicon 2016 119 64-71 Tetrodotoxin (TTX) is an extremely potent paralytic toxin responsible for yearly illness and death around the world. A clinical measurement is necessary to confirm exposure because symptoms of TTX intoxication cannot be distinguished from other paralytic toxins. Our group has developed an online solid phase extraction hydrophilic interaction liquid chromatography (HILIC) method for the analysis of TTX in human urine with tandem mass spectrometry. The reportable range for the method was 2.80 - 249 ng/mL in urine with precision and accuracy within 15% as determined for all quality control samples. No isotopically-labeled internal standard is available for TTX; thus a surrogate internal standard, voglibose, was investigated to compensate for matrix effects and ionization suppression. However, upon evaluation, voglibose was ineffective for this purpose. This new online method rapidly identifies TTX, facilitating the work of public health authorities and providing support to monitoring programs worldwide. |
Prevalence of cerebral palsy among 8-year-old children in 2010 and preliminary evidence of trends in its relationship to low birthweight
Durkin MS , Benedict RE , Christensen D , Dubois LA , Fitzgerald RT , Kirby RS , Maenner MJ , Van Naarden Braun K , Wingate MS , Yeargin-Allsopp M . Paediatr Perinat Epidemiol 2016 30 (5) 496-510 BACKGROUND: The public health objective for cerebral palsy (CP) in the United States is to reduce the percentage of children with CP who were born low birthweight (LBW, <2500 g) by 10% between 2006 and 2020. This study reports the prevalence of CP in a constant surveillance area for the years 2006, 2008, and 2010 and describes initial progress towards the CP public health objective. METHODS: Data on children with CP at age 8 years were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population-based surveillance system that monitored CP in four areas of the United States. RESULTS: CP prevalence in 2010 was 2.9 per 1000 [95% confidence interval (CI) 2.6, 3.2], down from 3.5 (95% CI 3.2, 3.9) in the same surveillance area in 2006. Among CP cases with no documented postneonatal aetiology, 49.1% (95% CI 42.9, 55.2) were born LBW in 2010 compared with 54.3% (95% CI 48.4, 60.1) in 2006. In 2010, 28.1% (95% CI 22.9, 30.4) were born very low birthweight (VLBW, <1500 g) compared with 35.4% (95% CI 30.0, 41.2) in 2006. The relative risks for associations between CP and both LBW and VLBW also declined, though not significantly, during the study period. CONCLUSIONS: Declines in the associations between CP and LBW categories may have contributed to declines during the study period in both the prevalence of CP and the percentage of children with CP who were born LBW or VLBW. Ongoing monitoring of these trends is warranted. |
Association between maternal multivitamin use and preterm birth in 24 states, pregnancy risk assessment monitoring system, 2009-2010
Johnston EO , Sharma AJ , Abe K . Matern Child Health J 2016 20 (9) 1825-34 Objectives The study objective was to examine the prevalence of maternal multivitamin use and associations with preterm birth (<37 weeks gestation) in the United States. We additionally examined whether associations differed by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System, we analyzed 2009-2010 data among women aged ≥18 years with a singleton live birth who completed questions on multivitamin use 1 month prior to pregnancy (24 states; n = 57,348) or in the last 3 months of pregnancy (3 states, n = 5095). Results In the month prior to pregnancy, multivitamin use ≥4 times/week continued to remain low (36.8 %). In the last 3 months of pregnancy, 79.6 % of women reported using multivitamins ≥4 times/week. Adjusting for confounders, multivitamin use 1-3 times/week or ≥4 times/week prior to pregnancy was not associated with preterm birth overall. Though there was no evidence of dose response, any multivitamin use in the last 3 months of pregnancy was associated with a significant reduction in preterm birth among non-Hispanic black women. Conclusions for Practice Multivitamin use during pregnancy may help reduce preterm birth, particularly among populations with the highest burden, though further investigations are warranted. |
Sodium in store and restaurant food environments - Guam, 2015
Jackson SL , VanFrank BK , Lundeen E , Uncangco A , Alam L , King SM , Cogswell ME . MMWR Morb Mortal Wkly Rep 2016 65 (20) 510-3 Compared with the United States overall, Guam has higher mortality rates from cardiovascular disease and stroke (1). Excess sodium intake can increase blood pressure and risk for cardiovascular disease (2,3). To determine the availability and promotion of lower-sodium options in the nutrition environment, the Guam Department of Public Health and Social Services (DPHSS) conducted an assessment in September 2015 using previously validated tools adapted to include sodium measures. Stores (N = 114) and restaurants (N = 63) were randomly sampled by region (north, central, and south). Data from 100 stores and 62 restaurants were analyzed and weighted to account for the sampling design. Across the nine product types assessed, lower-sodium products were offered less frequently than regular-sodium products (p<0.001) with <50% of stores offering lower-sodium canned vegetables, tuna, salad dressing, soy sauce, and hot dogs. Lower-sodium products were also less frequently offered in small stores than large (two or more cash registers) stores. Reduced-sodium soy sauce cost more than regular soy sauce (p<0.001) in stores offering both options in the same size bottle. Few restaurants engaged in promotion practices such as posting sodium information (3%) or identifying lower-sodium entrees (1%). Improving the availability and promotion of lower-sodium foods in stores and restaurants could help support healthier eating in Guam. |
Micronutrient powder use and infant and young child feeding practices in an integrated program
Mirkovic KR , Perrine CG , Subedi GR , Mebrahtu S , Dahal P , Jefferds ME . Asia Pac J Clin Nutr 2016 25 (2) 350-5 Integrated infant and young child feeding (IYCF)/micronutrient powder (MNP) programs are increasingly used to address poor IYCF practices and micronutrient deficiencies in low-income settings; however, little is known about how MNP use may affect IYCF practices. We describe how MNP use was associated with IYCF practices in a pilot program in select districts of Nepal where free MNP for children 6-23 months were added to an existing IYCF platform. Representative cross-sectional surveys were conducted in pilot districts with mothers of eligible children at 3 months (plains ecozone, n=1054) or 15 months (hill ecozone, rural only, n=654) after implementation of an integrated MNP/IYCF program. We used logistic regression to assess how IYCF practices varied by MNP use (none, 1-30, 30-60 sachets). At both time points, consuming 30-60 MNP sachets vs. none was associated with achieving minimum dietary diversity and minimum acceptable diet. In the 3 month survey consuming 30- 60 MNP sachets vs none was also associated with achieving minimum meal frequency and continued breastfeeding at 2 years. In this setting, addition of MNP to an existing platform of IYCF messaging did not appear detrimental to IYCF practices.; Publisher: Abstract available from the publisher.; chi |
Knowledge of sugar content of sports drinks is not associated with sports drink consumption
Zytnick D , Park S , Onufrak SJ , Kingsley BS , Sherry B . Am J Health Promot 2015 30 (2) 101-8 PURPOSE: To examine U.S. adult knowledge of the sugar content of sports drinks and whether this knowledge and other characteristics are associated with their sports drink consumption. DESIGN: Nonexperimental. SETTING: Nationally representative 2011 Summer ConsumerStyles survey data. SUBJECTS: 3929 U.S. adults. MEASURES: The outcome variable was sports drink consumption in the past 7 days. The main exposure variable was knowledge about sports drinks containing sugar. The covariates were sociodemographic characteristics, physical activity, and weight status. ANALYSIS: Multivariable logistic regression analysis was used to estimate adjusted odds ratios (ORs) for adults consuming sports drinks ≥1 times/wk after controlling for other characteristics. RESULTS: Approximately 22% of adults reported consuming sports drinks ≥1 times/wk. Most adults (71%) agreed that sports drinks contain sugar; however, this agreement was not significantly associated with adults' sports drink consumption. The odds of drinking sports drinks ≥1 times/wk were significantly higher among younger adults aged 18 to 64 years (OR range: 5.46-2.71), males (OR = 2.09), high-school graduates (OR = 1.52), and highly active adults (OR = 2.09). CONCLUSION: There were disparities in sports drink consumption by sociodemographic characteristics and physical activity level; however, knowledge of sports drinks' sugar content was not associated with consumption. Understanding why some population groups are higher consumers may assist in the development of education, providing those groups with a better understanding of sports drinks' nutritional value and health consequences of excessive sugar consumption in any form. |
Respirable indium exposures, plasma indium, and respiratory health among indium-tin oxide (ITO) workers
Cummings KJ , Virji MA , Park JY , Stanton ML , Edwards NT , Trapnell BC , Carey B , Stefaniak AB , Kreiss K . Am J Ind Med 2016 59 (7) 522-31 BACKGROUND: Workers manufacturing indium-tin oxide (ITO) are at risk of elevated indium concentration in blood and indium lung disease, but relationships between respirable indium exposures and biomarkers of exposure and disease are unknown. METHODS: For 87 (93%) current ITO workers, we determined correlations between respirable and plasma indium and evaluated associations between exposures and health outcomes. RESULTS: Current respirable indium exposure ranged from 0.4 to 108 mug/m3 and cumulative respirable indium exposure from 0.4 to 923 mug-yr/m3 . Plasma indium better correlated with cumulative (rs = 0.77) than current exposure (rs = 0.54) overall and with tenure ≥1.9 years. Higher cumulative respirable indium exposures were associated with more dyspnea, lower spirometric parameters, and higher serum biomarkers of lung disease (KL-6 and SP-D), with significant effects starting at 22 mug-yr/m3 , reached by 46% of participants. CONCLUSIONS: Plasma indium concentration reflected cumulative respirable indium exposure, which was associated with clinical, functional, and serum biomarkers of lung disease. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
Measurement tools for integrated worker health protection and promotion: Lessons learned from the SafeWell Project
Pronk NP , McLellan DL , McGrail MP , Olson SM , McKinney ZJ , Katz JN , Wagner GR , Sorensen G . J Occup Environ Med 2016 58 (7) 651-8 OBJECTIVES: To describe (a) a conceptual approach, (b) measurement tools and data collection processes, (c) characteristics of an integrated feedback report and action plan, and (d) experiences of three companies with an integrated measurement approach to worker safety and health. METHODS: Three companies implemented measurement tools designed to create an integrated view of health protection and promotion based on organizational- and individual-level assessments. Feedback and recommended actions were presented following assessments at baseline and 1-year follow-up. Measurement processes included group dialogue sessions, walk-through, online surveys, and focus groups. RESULTS: The approach and measurement tools generated actionable recommendations and documented changes in the physical (eg, safety hazards) and psychosocial (eg, health and safety culture) work environment between baseline and 1-year follow-up. CONCLUSIONS: The measurement tools studied were feasible, acceptable, and meaningful to companies in the SafeWell study. |
Evaluation of the irritancy and hypersensitivity potential following topical application of didecyldimethylammonium chloride
Anderson SE , Shane H , Long C , Lukomska E , Meade BJ , Marshall NB . J Immunotoxicol 2016 13 (4) 1-10 Didecyldimethylammonium chloride (DDAC) is a dialkyl-quaternary ammonium compound that is used in numerous products for its bactericidal, virucidal and fungicidal properties. There have been clinical reports of immediate and delayed hypersensitivity reactions in exposed individuals; however, the sensitization potential of DDAC has not been thoroughly investigated. The purpose of these studies was to evaluate the irritancy and sensitization potential of DDAC following dermal exposure in a murine model. DDAC induced significant irritancy (0.5 and 1%), evaluated by ear swelling in female Balb/c mice. Initial evaluation of the sensitization potential was conducted using the local lymph node assay (LLNA) at concentrations ranging from 0.0625-1%. A concentration-dependent increase in lymphocyte proliferation was observed with a calculated EC3 value of 0.17%. Dermal exposure to DDAC did not induce increased production of IgE as evaluated by phenotypic analysis of draining lymph node B-cells (IgE + B220+) and measurement of total serum IgE levels. Additional phenotypic analyses revealed significant and dose-responsive increases in the absolute number of B-cells, CD4 + T-cells, CD8 + T-cells and dendritic cells in the draining lymph nodes, along with significant increases in the percentage of B-cells (0.25% and 1% DDAC) at Day 10 following 4 days of dermal exposure. There was also a significant and dose-responsive increase in the number of activated CD44 + CD4 + and CD8 + T-cells and CD86 + B-cells and dendritic cells following exposure to all concentrations of DDAC. These results demonstrate the potential for development of irritation and hypersensitivity responses to DDAC following dermal exposure and raise concerns about the use of this chemical and other quaternary ammonium compounds that may elicit similar effects. |
Birth defects in infants born to employees of a microelectronics and business machine manufacturing facility
Silver SR , Pinkerton LE , Rocheleau CM , Deddens JA , Michalski AM , Van Zutphen AR . Birth Defects Res A Clin Mol Teratol 2016 106 (8) 696-707 BACKGROUND: Concerns about solvent releases from a microelectronics/business machine manufacturing facility in upstate New York led to interest in the health of former workers, including this investigation of birth defects in children of male and female employees. METHODS: Children born 1983 to 2001 to facility employees were enumerated and matched to New York State's Congenital Malformations Registry. Reported structural birth defects were compared with numbers expected from state rates (excluding New York City), generating standardized prevalence ratios (SPRs). Exposure assessors classified employees as ever/never potentially exposed at the facility to metals, chlorinated hydrocarbons, and other hydrocarbons during windows critical to organogenesis (female workers) or spermatogenesis (male workers). Among workers, adjusted prevalence ratios were generated to evaluate associations between potential exposures and specific birth defects. RESULTS: External comparisons for structural defects were at expectation for infants of male workers (SPR = 1.01; 95% confidence interval [CI], 0.77-1.29; n = 60) and lower for births to female workers (SPR = 0.84; 95% CI, 0.50-1.33; n = 18). Among full-term infants of male workers, ventricular septal defects (VSDs) were somewhat elevated compared with the general population (SPR = 1.58; 95% CI, 0.99-2.39; n = 22). Within the cohort, potential paternal metal exposure was associated with increased VSD risk (adjusted prevalence ratio = 2.70; 95% CI, = 1.09-6.67; n = 7). CONCLUSION: While overall SPRs were near expectation, paternal exposure to metals (primarily lead) appeared to be associated with increased VSD risk in infants. Take-home of occupational exposures, nonoccupational exposures, and chance could not be ruled out as causes. Case numbers for many defects were small, limiting assessment of the role of occupational exposures. |
Legal and regulatory framework for health worker retention in Mozambique: Public health law research to strengthen health systems and services
Verani AR , Cossa D , Malaica A , Mbeve A , Sorneta C , Ramirez L , Boore AL , Mucambe F , Vergara AE . J Public Health Policy 2016 37 (3) 369-384 Realizing the fundamental contribution of human resources to public health, the World Health Organization (WHO) issued policy recommendations for health worker retention. We reviewed Mozambique's laws and regulations and assessed the extent to which this legal and regulatory framework governing public sector health workers aligns with the WHO health worker retention recommendations. We provide guidance for future analysis of non-binding policies that may fill gaps identified in our review. We also indicate how to link legal analysis to the cycle by which research informs policy, policy informs practice, and practice leads to improvements in health systems and population health. Finally, we demonstrate the relevance of understanding and analyzing the impact of domestic laws on global health. Future research should assess implementation of health worker allowances and any associations with increased hiring, more equitable distribution, and improved retention - all are essential to public health in Mozambique. |
The safety of Sino-implant (II) for women with medical conditions or other characteristics: A systematic review
Phillips SJ , Steyn PS , Curtis KM . Contraception 2016 94 (3) 216-25 OBJECTIVES: To systematically review evidence published on the safety of SI (II) among women with medical conditions or characteristics identified by the World Health Organization for eligibility for contraceptive use. STUDY DESIGN: We searched PubMed, WEIPU, CNKI, and Wanfang to identify all relevant evidence published in peer-reviewed journals from 1991 through 2014 regarding the safety of SI (II). We considered studies among women with medical conditions or other characteristics, such as age and parity, as direct evidence, and studies among healthy women or a general population of women as indirect evidence. RESULTS: We identified 108 articles, of which 9 met our inclusion criteria. Among women with medical conditions, no evidence was identified for the outcomes of interest, including serious adverse events or outcomes related to medical conditions. Among healthy women, evidence regarding efficacy of SI (II) for women weighing≥70 kg was conflicting; one study showed an increased pregnancy rate and another showed no relationship. Women with menorrhagia did not experience worsened symptoms and may benefit from SI (II) use. Healthy women using SI (II) were no more likely than users of other methods to gain weight, develop elevated blood pressure, have abnormal liver or bone density tests, nor develop ovarian cysts or uterine myomas. CONCLUSIONS: Evidence among healthy women suggests SI (II) is safe and had health outcomes similar to those of other LNG implants. Studies were limited and conflicting regarding efficacy for women≥70 kg. All included studies were conducted in China, limiting generalizability. |
Family planning knowledge, attitudes and practices among bariatric healthcare providers
Jatlaoui TC , Cordes S , Goedken P , Jamieson DJ , Cwiak C . Contraception 2016 93 (5) 455-62 OBJECTIVE: This survey aimed to identify the family planning knowledge, attitudes and practices of bariatric providers in the perioperative period. STUDY DESIGN: We developed a quantitative survey based on semistructured interviews with six bariatric providers. We mailed the survey to the American Society of Metabolic and Bariatric Surgery members with plans to use data from the first 275 responders to assess knowledge, attitudes and practices regarding family planning. RESULTS: Over 70% of 272 respondents recommended that women avoid pregnancy for 12-24months after bariatric procedures. Most (73.0%) considered female reproductive health discussions very important, and most feel comfortable (70.4%) with these discussions. The majority considered the most effective contraceptive methods to be safe for women after gastric bypass; only a minority (35.3%) provided contraceptive services or referrals, and few (4.9%) have accurate knowledge of contraceptive effectiveness. Respondents most frequently preferred the patient's own gynecologist (80.9%) or bariatric surgeon (71.0%) discuss contraception. Discussing contraception was associated with provider age 40-49years, training region in southeast or midwest and degrees of physician assistant or nurse practitioner with adjusted odds ratios exceeding 2.0. CONCLUSION: Bariatric providers consider reproductive health very important, and while most are comfortable having these conversations, few have accurate knowledge of contraceptive safety and effectiveness. Most would prefer patients see their gynecologists to discuss contraception. These findings suggest an opportunity for gynecologists to educate themselves and bariatric colleagues about contraception recommendations after bariatric surgery and collaborate with bariatric centers in their area to meet the needs of these patients. IMPLICATIONS: Gynecologists must become educated and involved in the care of female bariatric patients to discuss reproductive health concerns and to counsel effectively regarding contraception after bariatric surgery. |
Behavioral Risk Factor Surveillance System state-added questions: leveraging an existing surveillance system to improve knowledge of women's reproductive health
Boulet SL , Warner L , Adamski A , Smith RA , Burley K , Grigorescu V . J Womens Health (Larchmt) 2016 25 (6) 565-70 As the prevalence of chronic conditions among women of reproductive age continues to rise, studies assessing the intersection of chronic disease and women's reproductive health status are increasingly needed. However, many data systems collect only limited information on women's reproductive health, thereby hampering the appraisal of risk and protective factors across the life span. One way to expand the study of women's health with minimal investment in time and resources is to integrate questions on reproductive health into existing surveillance systems. In 2013, previously validated questions on women's self-reported reproductive history, use of contraception, and infertility were added to the Behavioral Risk Factor Surveillance System (BRFSS) by seven states (Connecticut, Kentucky, Massachusetts, Mississippi, Ohio, Texas, and Utah); all female respondents aged 18-50 years were included in the pool of respondents for these state-added questions. Of 8691 women who completed the questions, 13.2% reported ever experiencing infertility and 59.8% of those at risk for unintended pregnancy reported using contraception at last intercourse. The information garnered from the state-added reproductive health questions can be augmented with the BRFSS core questions on health-related risk behaviors, chronic conditions, and use of preventive services. Expanding existing data collection systems with supplemental questions on women's reproductive health can provide important information on risk factors and outcomes that may not be available from other sources. |
Reducing binge drinking in adolescents through implementation of the Strategic Prevention Framework
Anderson-Carpenter KD , Watson-Thompson J , Chaney L , Jones M . Am J Community Psychol 2016 57 36-46 The Strategic Prevention Framework (SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF's effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time (p < .001), although there were no significant differences in improvements between the intervention and matched comparison groups (p > .05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF. |
Modes of ever marijuana use among adult tobacco users and non-tobacco users - Styles 2014
Singh T , Kennedy SM , Sharapova SS , Schauer GL , Rolle IV . J Subst Use 2016 21 (6) 631-635 Background: Tobacco and marijuana use are related behaviors; therefore, it is important to identify how users consume marijuana, and how it varies with tobacco use status. We estimated the modes of ever marijuana use among current, former, and never adult tobacco users. Methods: Weighted data were analyzed for 4181 adults from 2014 Styles, an online consumer panel survey of US adults, to estimate proportions for modes of ever marijuana use. Differences in modes of ever marijuana use between categories of tobacco use status were assessed (p-value <0.05). Results: More than half of current (56.6%) and former tobacco users (50.9%) had ever used marijuana, whereas only 13.0% of never tobacco users had ever used marijuana. Among ever marijuana users, joint use was the most common mode of use among current (86.4%), former (92.5%), and never (79.8%) tobacco users. Similarly, other modes of marijuana use were significantly higher in current and former tobacco users compared to never tobacco users. Conclusions: Prevalence of all modes of ever marijuana use was higher in current and former tobacco users. These findings underscore the importance of considering the relationship between marijuana and tobacco use when developing programs and policies aimed at preventing and reducing marijuana use. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
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CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
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