Cancer in children with nonchromosomal birth defects.
Fisher PG , Reynolds P , Von Behren J , Carmichael SL , Rasmussen SA , Shaw GM . J Pediatr 2012 160 (6) 978-83 OBJECTIVE: To examine whether the incidence of childhood cancer is elevated in children with birth defects but no chromosomal anomalies. STUDY DESIGN: We examined cancer risk in a population-based cohort of children with and without major birth defects born between 1988 and 2004, by linking data from the California Birth Defects Monitoring Program, the California Cancer Registry, and birth certificates. Cox proportional hazards models generated hazard ratios (HRs) and 95% CIs based on person-years at risk. We compared the risk of childhood cancer in infants born with and without specific types of birth defects, excluding infants with chromosomal anomalies. RESULTS: Of the 4869 children in the birth cohort with cancer, 222 had a major birth defect. Although the expected elevation in cancer risk was observed in children with chromosomal birth defects (HR, 12.44; 95% CI, 10.10-15.32), especially for the leukemias (HR, 28.99; 95% CI, 23.07-36.42), children with nonchromosomal birth defects also had an increased risk of cancer (HR, 1.58; 95% CI, 1.33-1.87), but instead for brain tumors, lymphomas, neuroblastoma, and germ cell tumors. CONCLUSION: Children with nonchromosomal birth defects are at increased risk for solid tumors, but not leukemias. Dysregulation of early human development likely plays an important role in the etiology of childhood cancer. |
Uncorrected distance visual impairment among adolescents in the United States
Kemper AR , Wallace DK , Zhang X , Patel N , Crews JE . J Adolesc Health 2012 50 (6) 645-7 PURPOSE: To describe uncorrected distance visual impairment (VI). METHODS: We conducted an analysis of the 3,555 adolescents aged 12 through 21 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. Distance VI was defined as 20/40 or worse in the better-seeing eye. Data were weighted to represent the civilian noninstitutionalized population. RESULTS: Overall, 12.3% (95% confidence interval [CI]: 10.7%-14.1%) had distance VI, which was correctable to 20/30 or better in both eyes in 86.1% (95% CI: 83.6%-89.5%). The prevalence was higher among those who reported not having corrective lenses available (44.3%) compared with those who reported that they did not need them (8.5%) or who had them available (5.2%; p < .001). After adjusting for potential confounders, those who were 12 or 13 years of age had 2.27 (95% CI: 1.32-3.90) greater odds of distance VI than older adolescents, and the odds of distance VI were greater among non-Hispanic blacks (1.66 [95% CI: 1.11-2.48]), Hispanics (1.96 [95% CI: 1.35-2.84]), or other race/ethnicities (2.06 [95% CI: 1.19-3.57]) than among non-Hispanic whites. CONCLUSIONS: More than 1 in 10 adolescents had uncorrected distance VI. To address this, interventions should address case detection, access to eye care, and adherence with corrective lenses. |
Unmet eye care needs among U.S. 5th-grade students
Zhang X , Elliott MN , Saaddine JB , Berry JG , Cuccaro P , Tortolero S , Franklin F , Barker LE , Schuster MA . Am J Prev Med 2012 43 (1) 55-8 BACKGROUND: There is substantial evidence of a disparity in access to eye care services among adults in the U.S.; however, little is known about health disparities for children's eye care. PURPOSE: The goal of the study was to assess the prevalence of and risk factors for 5th-grade students' unmet eye care needs. METHODS: Data were collected from 5147 5th-grade students (aged 10-11 years) and their parents and primary caregivers (hereafter "parents") participating in the Healthy Passages study between fall 2004 and summer 2006 (analyzed in 2011). Logistic regression estimated the probability of inability to afford needed eyeglasses and absence of vision insurance coverage. RESULTS: 1794 5th-grade students wore eyeglasses or were told that they need eyeglasses; 13.7% of their parents were unable to afford needed eyeglasses (new prescription or replacement) for their children; 27.4% of their parents reported no vision insurance coverage for eye examinations and eyeglasses. After controlling for confounders, parents without general children's health insurance were more likely to report being unable to afford eyeglasses than those with health insurance (Medicaid, SCHIP, private/other insurance; adjusted percentages: 22.5% vs 10.9%, 9.6%, 12.5%; all p<0.05). Parents with lower income were more likely to report being unable to afford children's eyeglasses even after controlling for all other factors (17.6% with income <$15,000 vs 2.7% with income ≥$70,000; p<0.001). CONCLUSIONS: SES and health insurance status are strongly associated with 5th-grade students' unmet eye care needs. Policies targeting socioeconomically disadvantaged groups and those without insurance may be needed to reduce disparities in access to appropriate eye care. |
Visit duration for outpatient physician office visits among patients with cancer
Guy GP Jr , Richardson LC . Am J Manag Care 2012 18 SP49-56 OBJECTIVES: To examine the characteristics of patients with cancer and their visits to outpatient, office-based physicians; to analyze any differences between visits to oncologists and visits to other physicians; and to examine the effect of patient, practice, visit, and geographic characteristics on the length of time patients with cancer spend with physicians during office-based visits. METHODS: We examined a total of 2470 patient office visits to nonfederally employed physicians from the 2006 and 2007 National Ambulatory Medical Care Survey. We performed descriptive analyses to examine the characteristics of patients with cancer by physician specialty. We conducted multivariate analyses using a generalized linear model to examine the relationship between visit duration and patient, practice, visit, and geographic characteristics. RESULTS: Forty-two percent of patients with cancer visited an oncologist. Females, females diagnosed with breast cancer, and individuals with advanced-stage cancer were more likely to visit an oncologist. Patients who visited oncologists were more likely to receive an anticancer drug, radiation therapy, and an increased number of diagnostic/screening services than those visiting other physicians. The mean duration of patient visits was 22.9 minutes. Higher percentages of performance-based compensation and capitation rates were associated with visits 4.4 minutes and 5.7 minutes shorter, respectively. CONCLUSIONS: Higher use of performance-based payment mechanisms and capitated arrangements is associated with a decrease in the amount of time physicians spend with their patients with cancer. It is unclear whether shorter visit times impact the quality of medical care provided or whether physicians in these settings have become more proficient in caring for their patients. |
Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis
Underwood JM , Townsend JS , Tai E , White A , Davis SP , Fairley TL . J Cancer Surviv 2012 6 (3) 333-44 INTRODUCTION: People who continue to smoke after a cancer diagnosis have an increased risk for recurrences or development of new malignancies. These risks may be even higher among tobacco-related cancer survivors (TRCS). We describe tobacco use behaviors among TRCS, other cancer survivors, and people without a history of cancer. METHODS: We used 2009 Behavioral Risk Factor Surveillance System data to describe demographic characteristics, smoking history, current smoking prevalence, and smokeless tobacco use among TRCS, other cancer survivors, and people without a history of cancer (cigarette smoking and smokeless tobacco use were calculated after adjusting for age, sex, race, and insurance status). Tobacco-related cancers were defined as lung/bronchial, pharyngeal, laryngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical, and acute myeloid leukemia. RESULTS: A total of 20 % of all cancer survivors were TRCS. TRCS were primarily female (68 %) and white (78 %). Smoking prevalence was higher among TRCS (27 %) compared with other cancer survivors (16 %) and respondents without a history of cancer (18 %). Smokeless tobacco use was higher among respondents without a history of cancer (4 %) compared with TRCS (3 %) and other cancer survivors (3 %). CONCLUSIONS: The self-reported smoking prevalence among TRCS is higher than among other cancer survivors and people without a history of cancer. Targeted smoking prevention and cessation interventions are needed for cancer survivors, especially those diagnosed with a tobacco-related cancer. IMPLICATIONS FOR CANCER SURVIVORS: We recommend all cancer survivors be made aware of the health risks associated with smoking after a cancer diagnosis, and smoking cessation services be offered to those who currently smoke. We provide the first population-based report on demographic characteristics and tobacco use behaviors among self-reported tobacco-related cancer survivors. |
Public health options for improving cardiovascular health among older Americans
Greenlund KJ , Keenan NL , Clayton PF , Pandey DK , Hong Y . Am J Public Health 2012 102 (8) 1498-507 Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e10. doi:10.2105/AJPH.2011.300570). |
High titers of IgE antibody to dust mite allergen and risk for wheezing among asthmatic children infected with rhinovirus
Soto-Quiros M , Avila L , Platts-Mills TA , Hunt JF , Erdman DD , Carper H , Murphy DD , Odio S , James HR , Patrie JT , Hunt W , O'Rourke AK , Davis MD , Steinke JW , Lu X , Kennedy J , Heymann PW . J Allergy Clin Immunol 2012 129 (6) 1499-1505 e5 BACKGROUND: The relevance of allergic sensitization, as judged by titers of serum IgE antibodies, to the risk of an asthma exacerbation caused by rhinovirus is unclear. OBJECTIVE: We sought to examine the prevalence of rhinovirus infections in relation to the atopic status of children treated for wheezing in Costa Rica, a country with an increased asthma burden. METHODS: The children enrolled (n = 287) were 7 through 12 years old. They included 96 with acute wheezing, 65 with stable asthma, and 126 nonasthmatic control subjects. PCR methods, including gene sequencing to identify rhinovirus strains, were used to identify viral pathogens in nasal washes. Results were examined in relation to wheezing, IgE, allergen-specific IgE antibody, and fraction of exhaled nitric oxide levels. RESULTS: Sixty-four percent of wheezing children compared with 13% of children with stable asthma and 13% of nonasthmatic control subjects had positive test results for rhinovirus (P < .001 for both comparisons). Among wheezing subjects, 75% of the rhinoviruses detected were group C strains. High titers of IgE antibodies to dust mite allergen (especially Dermatophagoides species) were common and correlated significantly with total IgE and fraction of exhaled nitric oxide levels. The greatest risk for wheezing was observed among children with titers of IgE antibodies to dust mite of 17.5 IU/mL or greater who tested positive for rhinovirus (odds ratio for wheezing, 31.5; 95% CI, 8.3-108; P < .001). CONCLUSIONS: High titers of IgE antibody to dust mite allergen were common and significantly increased the risk for acute wheezing provoked by rhinovirus among asthmatic children. |
Aging, diabetes, and the public health system in the United States
Caspersen CJ , Thomas GD , Boseman LA , Beckles GL , Albright AL . Am J Public Health 2012 102 (8) 1482-97 Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e16. doi:10.2105/AJPH.2011.300616). |
Associations between overall and abdominal obesity and suicidal ideation among US adult women
Zhao G , Li C , Ford ES , Tsai J , Dhingra SS , Croft JB , McKnight-Eily LR , Balluz LS . J Obes 2012 2012 263142 Obesity is associated with increased risks for mental disorders. This study examined associations of obesity indicators including body mass index (BMI), waist circumference, and waist-height ratio with suicidal ideation among U.S. women. We analyzed data from 3,732 nonpregnant women aged ≥20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We used anthropometric measures of weight, height, and waist circumference to calculate BMI and waist-height ratio. Suicidal ideation was assessed using the Item 9 of the Patient Health Questionnaire-9. Odds ratios with 95% conference intervals were estimated using logistic regression analyses after controlling for potential confounders. The age-adjusted prevalence of suicidal ideation was 3.0%; the prevalence increased linearly across quartiles of BMI, waist circumference, and waist-height ratio (P for linear trend <0.01 for all). The positive associations of waist circumference and waist-height ratio with suicidal ideation remained significant (P < 0.05) after adjustment for sociodemographics, lifestyle-related behavioral factors, and having either chronic conditions or current depression. However, these associations were attenuated after both chronic conditions and depression were entered into the models. Thus, the previously reported association between obesity and suicidal ideation appears to be confounded by coexistence of chronic conditions and current depression among women of the United States. |
Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys
Huffman MD , Capewell S , Ning H , Shay CM , Ford ES , Lloyd-Jones DM . Circulation 2012 125 (21) 2595-602 BACKGROUND: The American Heart Association's 2020 Strategic Impact Goals target a 20% relative improvement in overall cardiovascular health with the use of 4 health behavior (smoking, diet, physical activity, body mass) and 3 health factor (plasma glucose, cholesterol, blood pressure) metrics. We sought to define current trends and forward projections to 2020 in cardiovascular health. METHODS AND RESULTS: We included 35,059 cardiovascular disease-free adults (aged ≥20 years) from the National Health and Nutrition Examination Survey 1988-1994 and subsequent 2-year cycles during 1999-2008. We calculated population prevalence of poor, intermediate, and ideal health behaviors and factors and also computed a composite, individual-level Cardiovascular Health Score for all 7 metrics (poor=0 points; intermediate=1 point; ideal=2 points; total range, 0-14 points). Prevalence of current and former smoking, hypercholesterolemia, and hypertension declined, whereas prevalence of obesity and dysglycemia increased through 2008. Physical activity levels and low diet quality scores changed minimally. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes mellitus could increase to affect 43% and 77% of US men and 42% and 53% of US women, respectively. Overall, population-level cardiovascular health is projected to improve by 6% overall by 2020 if current trends continue. Individual-level Cardiovascular Health Score projections to 2020 (men=7.4 [95% confidence interval, 5.7-9.1]; women=8.8 [95% confidence interval, 7.6-9.9]) fall well below the level needed to achieve a 20% improvement (men=9.4; women=10.1). CONCLUSIONS: The American Heart Association 2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue. |
Genetic characterization of Cryptosporidium spp. in diarrhoeic children from four provinces in South Africa.
Abu Samra N , Thompson PN , Jori F , Frean J , Poonsamy B , du Plessis D , Mogoye B , Xiao L . Zoonoses Public Health 2012 60 (2) 154-9 The diversity of Cryptosporidium at species, subtype family and subtype level in diarrhoeic children was investigated in four provinces in South Africa. A total of 442 stool samples from children <5 years of age were collected under a large rotavirus surveillance programme and analysed by Ziehl-Neelsen acid-fast staining. Fifty-four (12.2%) were positive for Cryptosporidium, of which 25 were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) and DNA sequence analyses of the 18S rRNA gene. The majority of genotyped specimens were identified as C. hominis (76%), and a high genetic diversity was found with five different C. hominis subtype families (Ia, Ib, Id, Ie and If). Cryptosporidium parvum was found in 20% of the isolates, and three subtype families were identified (IIc, IIe and IIb), with subtype family IIc being the most common. One specimen was identified as C. meleagridis of the subtype family IIId. These results are in accordance with findings from other developing countries and report for the first time the presence in South Africa of C. meleagridis, various subtypes of C. parvum and the subtype family Ie of C. hominis. The results suggest that C. hominis and anthroponotic C. parvum subtypes are the major cause of cryptosporidiosis in South Africa. Further molecular studies are needed to better understand the epidemiology and public health importance of Cryptosporidium in humans in South Africa. |
Secondary household transmission of 2009 pandemic influenza A (H1N1) virus among an urban and rural population in Kenya, 2009-2010
Kim CY , Breiman RF , Cosmas L , Audi A , Aura B , Bigogo G , Njuguna H , Lebo E , Waiboci L , Njenga MK , Feikin DR , Katz MA . PLoS One 2012 7 (6) e38166 BACKGROUND: In Kenya, >1,200 laboratory-confirmed 2009 pandemic influenza A (H1N1) (pH1N1) cases occurred since June 2009. We used population-based infectious disease surveillance (PBIDS) data to assess household transmission of pH1N1 in urban Nairobi (Kibera) and rural Lwak. METHODS: We defined a pH1N1 patient as laboratory-confirmed pH1N1 infection among PBIDS participants during August 1, 2009-February 5, 2010, in Kibera, or August 1, 2009-January 20, 2010, in Lwak, and a case household as a household with a laboratory-confirmed pH1N1 patient. Community interviewers visited PBIDS-participating households to inquire about illnesses among household members. We randomly selected 4 comparison households per case household matched by number of children aged <5. Comparison households had a household visit 10 days before or after the matched patient symptom onset date. We defined influenza-like illnesses (ILI) as self-reported cough or sore throat, and a self-reported fever ≤8 days after the pH1N1 patient's symptom onset in case households and ≤8 days before selected household visit in comparison households. We used the Cochran-Mantel-Haenszel test to compare proportions of ILIs among case and comparison households, and log binomial-model to compare that of Kibera and Lwak. RESULTS: Among household contacts of patients with confirmed pH1N1 in Kibera, 4.6% had ILI compared with 8.2% in Lwak (risk ratio [RR], 0.5; 95% confidence interval [CI], 0.3-0.9). Household contacts of patients were more likely to have ILIs than comparison-household members in both Kibera (RR, 1.8; 95% CI, 1.1-2.8) and Lwak (RR, 2.6; 95% CI, 1.6-4.3). Overall, ILI was not associated with patient age. However, ILI rates among household contacts were higher among children aged <5 years than persons aged ≥5 years in Lwak, but not Kibera. CONCLUSIONS: Substantial pH1N1 household transmission occurred in urban and rural Kenya. Household transmission rates were higher in the rural area. |
Transmission of varicella zoster virus from individuals with herpes zoster or varicella in school and day care settings
Viner K , Perella D , Lopez A , Bialek S , Newbern C , Pierre R , Spells N , Watson B . J Infect Dis 2012 205 (9) 1336-41 BACKGROUND: Because the varicella incidence has declined following varicella vaccine licensure, herpes zoster (HZ) cases may play a larger role in varicella zoster virus (VZV) transmission. We investigated how HZ and varicella cases contribute to the varicella incidence in schools and day care centers. METHODS: Surveillance data collected in Philadelphia during September 2003-June 2010 were analyzed. A varicella case was considered to be sporadic if it was reported from a school or day care facility >6 weeks after or ≥10 days before other reports of VZV transmission. A varicella case was considered to be secondary if it occurred 10-21 days after report of a case of HZ or sporadic varicella. Analysis compared VZV transmission from individuals with HZ or sporadic varicella, stratified by varicella vaccination status and disease severity. RESULTS: Of 290 HZ cases reported, 27 (9%) resulted in 84 secondary varicella cases. Of 1358 sporadic varicella cases reported, 205 (15%) resulted in 564 secondary varicella cases. Approximately half of the HZ and sporadic varicella cases resulted in single secondary cases. The proportion of individuals who had secondary cases with mild disease was similar for those exposed to HZ and those exposed to varicella (70% and 72%, respectively). VZV transmission was highest from unvaccinated individuals with sporadic varicella (P < .01). CONCLUSIONS: VZV transmission from individuals with HZ contributes to varicella morbidity. More research is needed to understand risk factors and guide recommendations for preventing VZV transmission from individuals with HZ. |
Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa
Lewis DA , Chirwa TF , Msimang VM , Radebe FM , Kamb ML , Firnhaber CS . Sex Transm Dis 2012 39 (7) 531-536 BACKGROUND: To determine sexually transmitted infection (STI) prevalence, and patient characteristics associated with detection of urethritis/cervicitis pathogens, among HIV-infected individuals offered voluntary STI screening at a South African HIV treatment center. METHODS: Individuals, asymptomatic for genital discharge, were screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) infections (real-time polymerase chain reaction assay), for syphilis and herpes simplex type 2 (serologically), and for bacterial vaginosis and Candida (microscopy, women only). Patients' most recent CD4 and viral load results were recorded. Demographic, clinical, and behavioral data were collected by nurse-administered questionnaire. RESULTS: Compared with men (n = 551), women (n = 558) were younger (mean age, 35.0 vs. 37.9 years; P < 0.001), reported more STIs in the past year (65.5% vs. 56.5%; P = 0.002), had more urethritis/cervicitis pathogens detected (21.3% vs.16.4%, P = 0.035), and were less aware of their partner's HIV status (53.1% vs. 62.3%; P = 0.007). The overall prevalence of individual urethritis/cervicitis pathogens was TV (7.6%), MG (6.1%), NG (5.4%), and C. trachomatis (2.1%). Multivariate analysis highlighted 4 significant factors associated with the detection of specific urethritis/cervicitis pathogens, namely female gender (TV, adjusted odds ratio [aOR] 2.53, 95% confidence interval [CI]: 1.47-4.37), having a regular sexual partner in the past 3 months (NG, aOR 2.26, 95% CI: 1.01-5.08), suboptimal condom use with regular partners (TV, aOR 2.07, 95% CI: 1.25-3.42), and a history of genital warts in the past year (NG, 2.25, 95% CI: 1.26-4.03). CONCLUSIONS: Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients. |
Practice patterns of infectious disease physicians for management of meningococcal disease
Terranella A , Beekmann SE , Polgreen PM , Cohn A , Wu HM , Clark TA . Pediatr Infect Dis J 2012 31 (11) e208-12 BACKGROUND: Although empiric treatment regimens for acute bacterial meningitis are well-established, there are many uncertainties regarding management of meningococcal disease. A survey was conducted to assess meningococcal disease practice patterns and availability of antimicrobial susceptibility testing for Neisseria menigitidis among infectious disease specialists. METHODS: An online survey was distributed to 1342 pediatric and adult infectious disease specialists to assess common practices and opinions regarding the diagnosis, treatment and prevention of meningococcal disease. Specialists were also asked about the availability of antimicrobial susceptibility testing for Neisseria meningitidis at their clinical microbiology laboratory. RESULTS: Six hundred fifty members responded to the survey (48%). Pediatric infectious disease specialists were more likely than adult specialists to use to penicillin as definitive therapy for meningococcal disease (56% vs. 46%; p=0.038). Most pediatric specialists who would narrow therapy report that they would only switch to penicillin upon confirmation of penicillin susceptibility (55%), though 44% would narrow therapy based on a N. meningitidis species confirmation alone. Over one third of respondents reported that susceptibility testing for N. meningitidis is not routinely performed. There was also wide variation in complement deficiency screening criteria and meningococcal disease chemoprophylaxis practices among respondents. CONCLUSIONS: Infectious disease specialists vary significantly in their practices regarding several aspects of meningococcal disease diagnosis, treatment, and prevention. Antimicrobial susceptibility testing for N. meningitidis is not routinely performed in many practices. Consideration of these variations would be useful when developing treatment and prevention recommendations. |
Prevention of novel influenza infection in newborns in hospital settings: considerations and strategies during the 2009 H1N1 pandemic
Zapata LB , Kendrick JS , Jamieson DJ , Macfarlane K , Shealy K , Barfield WD . Disaster Med Public Health Prep 2012 6 (2) 97-103 During the 2009 influenza A (H1N1) pandemic, many pregnant women experienced severe illness and some gave birth while ill with suspected or confirmed pandemic (H1N1) 2009 influenza. Because of concerns about possible transmission of this novel virus to immunologically naive newborns, and the absence of definitive studies regarding this risk, the Centers for Disease Control and Prevention (CDC) reviewed relevant literature to understand the potential burden of disease and routes of transmission affecting newborns. This report describes the issues considered during the 2009 H1N1 pandemic as CDC developed guidance to protect newborns in hospital settings. Also presented is a framework of protection efforts to prevent novel influenza infection in fetuses/newborns before birth and in hospital settings. Although developed specifically for the pandemic, the framework may be useful during future novel influenza outbreaks. |
Epidemiological and virological characteristics of influenza in the Western Pacific Region of the World Health Organization, 2006-2010
Western Pacific Region Global Influenza Surveillance and Response System , Balish Amanda , Corwin Andrew , Kapella Bryan K , Kitsutani Paul , McFarland Jeffrey , Moen Ann , Xu Xiyan . PLoS One 2012 7 (5) e37568 BACKGROUND: Influenza causes yearly seasonal epidemics and periodic pandemics. Global systems have been established to monitor the evolution and impact of influenza viruses, yet regional analysis of surveillance findings has been limited. This study describes epidemiological and virological characteristics of influenza during 2006-2010 in the World Health Organization's Western Pacific Region. METHODOLOGY/PRINCIPAL FINDINGS: Influenza-like illness (ILI) and influenza virus data were obtained from the 14 countries with National Influenza Centres. Data were obtained directly from countries and from FluNet, the web-based tool of the Global Influenza Surveillance and Response System. National influenza surveillance and participation in the global system increased over the five years. Peaks in ILI reporting appeared to be coincident with the proportion of influenza positive specimens. Temporal patterns of ILI activity and the proportion of influenza positive specimens were clearly observed in temperate countries: Mongolia, Japan and the Republic of Korea in the northern hemisphere, and Australia, New Zealand, Fiji and New Caledonia (France) in the southern hemisphere. Two annual peaks in activity were observed in China from 2006 through the first quarter of 2009. A temporal pattern was less evident in tropical countries, where influenza activity was observed year-round. Influenza A viruses accounted for the majority of viruses reported between 2006 and 2009, but an equal proportion of influenza A and influenza B viruses was detected in 2010. CONCLUSIONS/SIGNIFICANCE: Despite differences in surveillance methods and intensity, commonalities in ILI and influenza virus circulation patterns were identified. Patterns suggest that influenza circulation may be dependent on a multitude of factors including seasonality and population movement. Dominant strains in Southeast Asian countries were later detected in other countries. Thus, timely reporting and regional sharing of information about influenza may serve as an early warning, and may assist countries to anticipate the potential severity and burden associated with incoming strains. |
Epidemiological and virological characteristics of seasonal and pandemic influenza in Lao PDR, 2008-2010
Khamphaphongphane B , Ketmayoon P , Lewis HC , Phonekeo D , Sisouk T , Xayadeth S , Ongkhammy S , Vongphrachanh P , Tsuyuoka R , Moen A , Corwin A . Influenza Other Respir Viruses 2012 7 (3) 304-11 BACKGROUND: Information on influenza virology and epidemiology from Lao PDR is limited and the seasonal patterns of influenza have not been previously described. OBJECTIVES: To describe epidemiological and virologic characteristics of influenza in Lao PDR to recommend public health interventions, including improvements in surveillance and response. PATIENTS/METHODS: We performed a descriptive analysis of samples taken from patients with influenza-like-illness (ILI) (fever >38 degrees C with cough and/or sore throat) presenting at seven sentinel hospitals in three regions of Lao PDR, January 2008-December 2010. A nasopharyngeal (NP) swab or combined nasal with oropharyngeal swab was collected from patients with ILI. Samples were tested for influenza by either Luminex RVP, conventional reverse transcriptase PCR (RT-PCR) (January 2008-2009), or by real-time PCR (rRT-PCR) using US CDC reagents (February 2009 onward). RESULTS: Of 2346 samples tested from patients with ILI, 523 (22%) were positive for influenza. The median age of those positive was 12 years (range, <1-60 year). The percentage of samples that were influenza positive was similar over the 3 years (20-23%). Each year 3-4 types/subtypes cocirculated with differing predominant type/subtype. Influenza was detected year-round with the highest proportion of positive specimens in the 3rd and 4th quarter. CONCLUSIONS: Similar to other countries in the region, we found that influenza is present year-round and has a peak activity from July to December. Dominant types or subtypes vary by year. A large proportion of patients with ILI are not influenza positive. ILI surveillance is critical for weighing disease burden, both morbidity and mortality, against the costs of advancing influenza vaccine delivery strategy. |
Evolving epidemiology of hepatitis C virus in the United States
Klevens RM , Hu DJ , Jiles R , Holmberg SD . Clin Infect Dis 2012 55 Suppl 1 S3-9 The impact of hepatitis C virus (HCV) infection on health and medical care in the United States is a major problem for infectious disease physicians. Although the incidence of HCV infection has declined markedly in the past 2 decades, chronic infection in 3 million or more residents now accounts for more disease and death in the United States than does human immunodeficiency virus (HIV)/AIDS. Current trends in the epidemiology of HCV infection include an apparent increase in young, often suburban heroin injection drug users who initiate use with oral prescription opioid drugs; infections in nonhospital healthcare (clinic) settings; and sexual transmission among HIV-infected persons. Infectious disease physicians will increasingly have the responsibility of diagnosing and treating HCV patients. An understanding of how these patients were infected is important for determining whom to screen and treat. |
Fatal case of brucellosis misdiagnosed in early stages of Brucella suis infection in a 46-year-old patient with Marfan syndrome
Carrington M , Choe U , Ubillos S , Stanek D , Campbell M , Wansbrough L , Lee P , Churchwell G , Rosas K , Zaki SR , Drew C , Paddock CD , Deleon-Carnes M , Guerra M , Hoffmaster AR , Tiller RV , De BK . J Clin Microbiol 2012 50 (6) 2173-5 We report a fatal case of Brucella suis endocarditis initially misdiagnosed by automated identification systems as Ochrobactrum anthropi infection in a patient with a history of Marfan syndrome and recreational feral swine hunting. This report emphasizes the need to consider brucellosis as a part of the differential diagnosis of acute febrile illness, particularly in patients with known risk of exposure. |
Global burden of hepatitis C: considerations for healthcare providers in the United States
Averhoff FM , Glass N , Holtzman D . Clin Infect Dis 2012 55 Suppl 1 S10-5 An estimated 2%-3% of the world's population is living with hepatitis C virus (HCV) infection, and each year, >350.000 die of HCV-related conditions, including cirrhosis and liver cancer. The epidemiology and burden of HCV infection varies throughout the world, with country-specific prevalence ranging from <1% to >10%. In contrast to the United States and other developed countries, HCV transmission in developing countries frequently results from exposure to infected blood in healthcare and community settings. Hepatitis C prevention, care, and treatment programs must recognize country-specific epidemiology, which varies by setting and level of economic development. Awareness of the global epidemiology of HCV infection is important for US healthcare providers treating foreign-born patients from countries where HCV infection is endemic and for counseling patients who travel to these countries. Countries with a high burden of HCV infection also would benefit from establishing comprehensive prevention, care, and treatment programs. |
Hepatitis C virus and the infectious diseases community
Holmberg SD . Clin Infect Dis 2012 55 Suppl 1 S1-2 It is a perfect storm for the chronic viral infection associated with the greatest morbidity and mortality in the United States. Of the ≥3 million Americans infected with hepatitis C virus (HCV), only ≥50% know they are infected. Infections acquired many years ago from parenteral exposures—injection drug use, transfusions received before screening assay availability (in 1992), or other healthcare exposures—have either no or nonspecific (but highly prevalent) symptoms, such as fatigue, arthritis, and depression. Clinicians tend to discount the extrahepatic effects of HCV infection, although HCV has been associated with diabetes and other serious morbidities. Now, after latencies of 20–30 years, there are rapidly increasing cases of cirrhosis, end-stage liver disease, hepatocellular carcinoma, and early deaths in the Baby Boom generation. The traditional bulwark for viral hepatitis care has been a small number of board-certified hepatologists—only about 2000—who are now overwhelmed. Although many never studied HCV in medical school, infectious disease and general clinicians are being called on for diagnosis and care for a rapidly increasing number of patients. In conjunction with World Hepatitis Day (28 July), this is an appropriate time to provide an overview of where we are and the immediate future for control and treatment of the HCV epidemic. |
Hepatitis C virus prevention, care, and treatment: from policy to practice
Ward JW , Valdiserri RO , Koh HK . Clin Infect Dis 2012 55 Suppl 1 S58-63 The prevention of hepatitis C virus (HCV) infection and associated health conditions (eg, cirrhosis and hepatocellular carcinoma) is a public health priority in the United States. Hepatitis C virus-related morbidity and mortality is increasing at a time when the advent of highly effective therapies greatly increases opportunities to prevent HCV transmission and disease. In 2010, the Institute of Medicine recommended that national action be taken to address this "underappreciated health concern for the nation." In response, in 2011, the US Department of Health and Human Services (HHS) published a viral hepatitis action plan that guides response to the viral hepatitis epidemic by providing explicit steps to be undertaken by specific HHS agencies to improve provider training and community education; expand access to testing, care, and treatment; strengthen public health surveillance; improve HCV preventive services for injection drug users; develop a hepatitis C vaccine; and prevent HCV transmission in healthcare settings. For all aspects of the action plan, infectious disease specialists and other clinicians assume a key role in efforts to reduce HCV-related morbidity and mortality. With successful collaboration of the public and private sectors, the hepatitis C epidemic can be forever silenced. |
Higher yet suboptimal chlamydia testing rates at community health centers and outpatient clinics compared with physician offices
Eugene JM , Hoover KW , Tao G , Kent CK . Am J Public Health 2012 102 (8) e26-9 To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e4. doi:10.2105/AJPH.2012.300744). |
HIV infection and older Americans: the public health perspective
Brooks JT , Buchacz K , Gebo KA , Mermin J . Am J Public Health 2012 102 (8) 1516-26 HIV disease is often perceived as a condition affecting young adults. However, approximately 11% of new infections occur in adults aged 50 years or older. Among persons living with HIV disease, it is estimated that more than half will be aged 50 years or older in the near future. In this review, we highlight issues related to HIV prevention and treatment for HIV-uninfected and HIV-infected older Americans, and outline unique considerations and emerging challenges for public health and patient management in these 2 populations. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e11. doi:10.2105/AJPH.2012.300844). |
Hospitalization due to human parainfluenza virus-associated lower respiratory tract illness in rural Thailand
Morgan OW , Chittaganpitch M , Clague B , Chantra S , Sanasuttipun W , Prapasiri P , Naorat S , Laosirithavorn Y , Peret TC , Erdman DD , Baggett HC , Olsen SJ , Fry AM . Influenza Other Respir Viruses 2012 7 (3) 280-5 BACKGROUND: Human parainfluenza viruses (HPIVs) are an important cause of acute respiratory illness in young children but little is known about their epidemiology in the tropics. METHODS: From 2003-2007, we conducted surveillance for hospitalized respiratory illness in rural Thailand. We performed reverse-transcriptase polymerase chain reaction on nasopharyngeal specimens and enzyme immunoassay on paired sera. RESULTS: Of 10,097 patients enrolled, 573 (5%) of all ages and 370 (9%) of children <5 years of age had evidence of HPIV infection (HPIV1=189, HPIV2=54, HPIV3=305, untyped=27). Average adjusted annual incidence of HPIV-associated hospitalized respiratory illness was greatest in children aged <1 year (485 per 100,000 person years). CONCLUSIONS: In Thailand, HPIV caused substantial illnesses requiring hospitalization in young children. |
An analysis of hepatitis C virus-related public inquiries from health professionals: 2009-2010
Jorgensen CM , Lewis CA , Liu J . Clin Infect Dis 2012 55 Suppl 1 S54-7 A content analysis was performed on e-mail inquiries about viral hepatitis that were submitted by health professionals to the Centers for Disease Control and Prevention's (CDC's) public inquiry system, CDC-INFO. All hepatitis C virus (HCV)-related inquiries from health professionals were identified, representing 10% of all inquiries received during the 2-year period of 2009-2010. Three-fourths of the inquiries included professional degree and organizational affiliation information, with 35% representing physicians, 33% representing nurses, and 6% representing midlevel clinicians, the majority of whom provided direct clinical care or worked in a healthcare organization. Two independent coders analyzed content, with kappa coefficients for interrater agreement ranging from 0.82 to 0.93. Overall, the inquiries demonstrated important knowledge gaps regarding HCV, with the most frequently asked questions focusing on transmission, serology, and policy/legal issues surrounding patient care and infected healthcare workers. |
Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008
Denniston MM , Klevens RM , McQuillan GM , Jiles RB . Hepatology 2012 55 (6) 1652-61 Many persons infected with hepatitis C virus (HCV) are unknown to the healthcare system because they may be asymptomatic for years, have not been tested for HCV infection, and only seek medical care when they develop liver-related complications. We analyzed data from persons who tested positive for past or current HCV infection during participation in the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2008. A follow-up survey was conducted 6 months after examination to determine (1) how many participants testing positive for HCV infection were aware of their HCV status before being notified by NHANES, (2) what actions participants took after becoming aware of their first positive test, and (3) participants' knowledge about hepatitis C. Of 30,140 participants tested, 393 (1.3%) had evidence of past or current HCV infection and 170 (43%) could be contacted during the follow-up survey and interviewed. Only 49.7% were aware of their positive HCV infection status before being notified by NHANES, and only 3.7% of these respondents reported that they had first been tested for HCV because they or their doctor thought they were at risk for infection. Overall, 85.4% had heard of hepatitis C; correct responses to questions about hepatitis C were higher among persons 40-59 years of age, white non-Hispanics, and respondents who saw a physician after their first positive HCV test. Eighty percent of respondents indicated they had seen a doctor about their first positive HCV test result. CONCLUSION: These data indicate that fewer than half of those infected with HCV may be aware of their infection. The findings suggest that more intensive efforts are needed to identify and test persons at risk for HCV infection. (HEPATOLOGY 2012;55:1652-1661). |
Centers for Disease Control and Prevention initiatives to prevent hepatitis C virus infection: a selective update
Smith BD , Jorgensen C , Zibbell JE , Beckett GA . Clin Infect Dis 2012 55 Suppl 1 S49-53 Hepatitis C virus (HCV) infection is a complex public health problem, characterized by a high prevalence of chronic infection, an increasing burden of HCV-associated disease, low rates of testing and treatment, and the prospect of increasing incidence associated with the epidemic of injection drug use. Three-quarters of chronic HCV infections occur among persons born from 1945 through 1965. Prevention efforts are complicated by limited knowledge among health care professionals, persons at risk and in the public at large. At the Centers for Disease Control and Prevention, efforts to improve primary and secondary prevention effectiveness center on policy development, education and training initiatives, and applied research. This report provides a brief overview of some of these efforts, including the development of testing recommendations for the 1945-1965 birth cohort, research and evaluation studies in settings where persons who inject drugs receive services, and a national viral hepatitis education campaign that targets health care professionals, the public, and persons at risk. |
Rickettsia felis in cat fleas, Ctenocephalides felis parasitizing opossums, San Bernardino County, California
Abramowicz KF , Wekesa JW , Nwadike CN , Zambrano ML , Karpathy SE , Cecil D , Burns J , Hu R , Eremeeva ME . Med Vet Entomol 2012 26 (4) 458-62 Los Angeles and Orange Counties are known endemic areas for murine typhus in California; however, no recent reports of flea-borne rickettsioses are known from adjacent San Bernardino County. Sixty-five opossums (Didelphis virginiana) were trapped in the suburban residential and industrial zones of the southwestern part of San Bernardino County in 2007. Sixty out of 65 opossums were infested with fleas, primarily cat fleas, Ctenocephalides felis (Bouche, 1835) . The flea minimum infection rate with Rickettsia felis was 13.3% in pooled samples and the prevalence was 23.7% in single fleas, with two gltA genotypes detected. In spite of historic records of murine typhus in this area, no evidence for circulation of R. typhi in fleas was found during the present study. Factors contributing to the absence of R. typhi in these cat fleas in contrast to its presence in cat fleas from Orange and Los Angeles Counties are unknown and need to be investigated further in San Bernardino County. |
U.S. census unit population exposures to ambient air pollutants
Hao Y , Flowers H , Monti MM , Qualters JR . Int J Health Geogr 2012 11 3 BACKGROUND: Progress has been made recently in estimating ambient PM(2.5) (particulate matter with aerodynamic diameter < 2.5 mcm) and ozone concentrations using various data sources and advanced modeling techniques, which resulted in gridded surfaces. However, epidemiologic and health impact studies often require population exposures to ambient air pollutants to be presented at an appropriate census geographic unit (CGU), where health data are usually available to maintain confidentiality of individual health data. We aim to generate estimates of population exposures to ambient PM(2.5) and ozone for U.S. CGUs. METHODS: We converted 2001-2006 gridded data, generated by the U.S. Environmental Protection Agency (EPA) for CDC's (Centers for Disease Control and Prevention) Environmental Public Health Tracking Network (EPHTN), to census block group (BG) based on spatial proximities between BG and its four nearest grids. We used a bottom-up (fine to coarse) strategy to generate population exposure estimates for larger CGUs by aggregating BG estimates weighted by population distribution. RESULTS: The BG daily estimates were comparable to monitoring data. On average, the estimates deviated by 2 mcg/m(3) (for PM(2.5)) and 3 ppb (for ozone) from their corresponding observed values. Population exposures to ambient PM(2.5) and ozone varied greatly across the U.S. In 2006, estimates for daily potential population exposure to ambient PM(2.5) in west coast states, the northwest and a few areas in the east and estimates for daily potential population exposure to ambient ozone in most of California and a few areas in the east/southeast exceeded the National Ambient Air Quality Standards (NAAQS) for at least 7 days. CONCLUSIONS: These estimates may be useful in assessing health impacts through linkage studies and in communicating with the public and policy makers for potential intervention. |
Urinary bisphenol A concentrations in girls from rural and urban Egypt: a pilot study
Nahar MS , Soliman AS , Colacino JA , Calafat AM , Battige K , Hablas A , Seifeldin IA , Dolinoy DC , Rozek LS . Environ Health 2012 11 20 BACKGROUND: Exposure to endocrine active compounds, including bisphenol A (BPA), remains poorly characterized in developing countries despite the fact that behavioral practices related to westernization have the potential to influence exposure. BPA is a high production volume chemical that has been associated with metabolic dysfunction as well as behavioral and developmental effects in people, including children. In this pilot study, we evaluate BPA exposure and assess likely pathways of exposure among girls from urban and rural Egypt. METHODS: We measured urinary concentrations of total (free plus conjugated) species of BPA in spot samples in urban (N = 30) and rural (N = 30) Egyptian girls, and compared these concentrations to preexisting data from age-matched American girls (N = 47) from the U.S. National Health and Nutrition Examination Survey (NHANES). We also collected anthropometric and questionnaire data regarding food storage behaviors to assess potential routes of exposure. RESULTS: Urban and rural Egyptian girls exhibited similar concentrations of urinary total BPA, with median unadjusted values of 1.00 and 0.60 ng/mL, respectively. Concentrations of urinary BPA in this group of Egyptian girls (median unadjusted: 0.70 ng/mL) were significantly lower compared to age-matched American girls (median unadjusted: 2.60 ng/mL) according to NHANES 2009-2010 data. Reported storage of food in plastic containers was a significant predictor of increasing concentrations of urinary BPA. CONCLUSIONS: Despite the relatively low urinary BPA concentrations within this Egyptian cohort, the significant association between food storage behaviors and increasing urinary BPA concentration highlights the need to understand food and consumer product patterns that may be closing the gap between urban and rural lifestyles. |
Adverse effects in risk assessment: modeling polychlorinated biphenyls and thyroid hormone disruption outcomes in animals and humans
Parham F , Wise A , Axelrad DA , Guyton KZ , Portier C , Zeise L , Zoeller RT , Woodruff TJ . Environ Res 2012 116 74-84 There is a growing need for quantitative approaches to extrapolate relationships between chemical exposures and early biological perturbations from animals to humans given increasing use of biological assays to evaluate toxicity pathways. We have developed such an approach using polychlorinated biphenyls (PCBs) and thyroid hormone (TH) disruption as a case study. We reviewed and identified experimental animal literature from which we developed a low-dose, linear model of PCB body burdens and decrements in free thyroxine (FT(4)) and total thyroxine (TT(4)), accounting for 33 PCB congeners; extrapolated the dose-response from animals to humans; and compared the animal dose-response to the dose-response of PCB body burdens and TH changes from eleven human epidemiological studies. We estimated a range of potencies for PCB congeners (over 4 orders of magnitude), with the strongest for PCB 126. Our approach to developing toxic equivalency models produced relative potencies similar to the toxicity equivalency factors (TEFs) from the World Health Organization (WHO). We generally found that the dose-response extrapolated from the animal studies tends to under-predict the dose-response estimated from human epidemiological studies. A quantitative approach to evaluating the relationship between chemical exposures and TH perturbations, based on animal data can be used to assess human health consequences of thyroid toxicity and inform decision-making. |
Norovirus disease surveillance using Google internet query share data
Desai R , Hall AJ , Lopman BA , Shimshoni Y , Rennick M , Efron N , Matias Y , Patel MM , Parashar UD . Clin Infect Dis 2012 55 (8) e75-8 Google internet query share (IQS) data for gastroenteritis-related search terms correlated strongly with contemporaneous national (R(2) = 0.70) and regional norovirus surveillance data (R(2) = 0.74) in the US. IQS data may facilitate rapid identification of norovirus season onset, elevated peak activity, and potential emergence of novel strains. |
Herpes zoster-related deaths in the United States: validity of death certificates and mortality rates 1979-2007
Mahamud A , Marin M , Nickell SP , Shoemaker T , Zhang JX , Bialek SR . Clin Infect Dis 2012 55 (7) 960-6 BACKGROUND: Herpes zoster (HZ) vaccine was recommended in the United States to reduce HZ-associated morbidity. Vaccination may reduce HZ-associated mortality, but no strategy exists to monitor mortality trends. METHODS: We validated HZ coding on death certificates from California, using hospital records as the gold standard, and applied the results to national-level data to estimate HZ mortality. RESULTS: In the validation phase of the study, among 40 available hospital records listing HZ as the underlying cause of death, HZ was the underlying cause for 21 (52.5%) and a contributing cause for 5 (12.5%). Among 21 hospital records listing HZ as the underlying cause of death, the median age of decedents was 84 years (range 50-99); 60% had no contraindications for HZ vaccination. Of the 37 available records listing HZ as a contributing cause of death, HZ was a contributing cause for 2 (5.4%) and the underlying cause for 6 (16.2%). Nationally, in the 7 years preceding the HZ vaccination program, the average annual number of deaths in which HZ was reported as the underlying cause of death was 149; however, based on our validation study, we estimate the true number was 78 (range: 31-118). CONCLUSION: National death certificate data greatly overestimate deaths in which HZ is the underlying or contributing cause of death. The HZ vaccination program could prevent some HZ-related deaths but the impact will be difficult to assess using national mortality data. |
ILI-related School Dismissal Monitoring System: an overview and assessment
Kann L , Kinchen S , Modzelski B , Sullivan M , Carr D , Zaza S , Graffunder C , Cetron M . Disaster Med Public Health Prep 2012 6 (2) 104-12 OBJECTIVE: This report provides an overview and assessment of the School Dismissal Monitoring System (SDMS) that was developed by the Centers for Disease Control and Prevention (CDC) and the US Department of Education (ED) to monitor influenza-like illness (ILI)-related school dismissals during the 2009-2010 school year in the United States. METHODS: SDMS was developed with considerable consultation with CDC's and ED's partners. Further, each state appointed a single school dismissal monitoring contact, even if that state also had its own school-dismissal monitoring system in place. The SDMS received data from three sources: (1) direct reports submitted through CDC's Web site, (2) state monitoring systems, and (3) media scans and online searches. All cases identified through any of the three data sources were verified. RESULTS: Between August 3, 2009, and December 18, 2009, a total of 812 dismissal events (ie, a single school dismissal or dismissal of all schools in a district) were reported in the United States. These dismissal events had an impact on 1947 schools, approximately 623,616 students, and 40,521 teachers. CONCLUSIONS: The SDMS yielded real-time, national summary data that were used widely throughout the US government for situational awareness to assess the impact of CDC guidance and community mitigation efforts and to inform the development of guidance, resources, and tools for schools. |
Autism spectrum disorder reclassified: a second look at the 1980s Utah/UCLA autism epidemiologic study
Miller JS , Bilder D , Farley M , Coon H , Pinborough-Zimmerman J , Jenson W , Rice CE , Fombonne E , Pingree CB , Ritvo E , Ritvo RA , McMahon WM . J Autism Dev Disord 2012 43 (1) 200-10 The purpose of the present study was to re-examine diagnostic data from a state-wide autism prevalence study (n = 489) conducted in the 1980s to investigate the impact of broader diagnostic criteria on autism spectrum disorder (ASD) case status. Sixty-four (59 %) of the 108 originally "Diagnosed Not Autistic" met the current ASD case definition. The average IQ estimate in the newly identified group (IQ = 35.58; SD = 23.01) was significantly lower than in the original group (IQ = 56.19 SD = 21.21; t = 5.75; p < .0001). Today's diagnostic criteria applied to participants ascertained in the 1980s identified more cases of autism with intellectual disability. The current analysis puts this historic work into context and highlights differences in ascertainment between epidemiological studies performed decades ago and those of today. |
Nocardia amikacinitolerans sp. nov., an amikacin-resistant human pathogen.
Ezeoke I , Klenk HP , Potter G , Schumann P , Moser BD , Lasker BA , Nicholson A , Brown JM . Int J Syst Evol Microbiol 2012 63 1056-1061 Five isolates from clinical human sources were evaluated. Analysis of the near full length 16S rRNA gene showed 99.9-100 % similarity among the strains. The results of a comparative phylogenetic analysis of the 16S rRNA gene sequences indicated that the isolates belonged to the genus Nocardia. Phenotypic and molecular analyses were performed on the clinical isolates. Traditional phenotypic analyses included morphologic, biochemical/physiological, chemotaxonomic and antimicrobial susceptibility profiling. Molecular studies included 1441-bp 16S rRNA and 1246-bp gyrB gene sequence analyses, as well as DNA-DNA hybridizations. Biochemical analysis failed to differentiate the putative novel species from its phylogenetic neighbors; however, molecular studies were able to distinguish the patient strains and confirm them as a single species. Based on 16S rRNA gene sequence analysis, similarity between the isolates and their closest relatives (Nocardia araoensis, Nocardia arthritidis, Nocardia beijingensis and Nocardia niwae) were less than or equal to 99.3 %. Partial gyrB gene sequence analysis showed 98-99.7 % relatedness among the isolates. Nocardia lijiangensis and Nocardia xishanensis were the isolates' closest related species based on gyrB gene sequence analysis and showed 95.7 and 95.3 % similarity, respectively. Resistance to amikacin and molecular analyses, including DNA-DNA hybridization, distinguished the five patient strains from their phylogenetic neighbors, and the results of this polyphasic study indicated a novel species of Nocardia for which we propose the name Nocardia amikacinitolerans sp. nov., with strain W9988T (=DSM 45539 T = CCUG 59655T) as the type strain. |
Differential association of gene content polymorphisms of killer cell immunoglobulin-like receptors with placental malaria in HIV- and HIV+ mothers.
Omosun YO , Blackstock AJ , Gatei W , Hightower A , van Eijk AM , Ayisi J , Otieno J , Lal RB , Steketee R , Nahlen B , Ter Kuile FO , Slutsker L , Shi YP . PLoS One 2012 7 (6) e38617 Pregnant women have abundant natural killer (NK) cells in their placenta, and NK cell function is regulated by polymorphisms of killer cell immunoglobulin-like receptors (KIRs). Previous studies report different roles of NK cells in the immune responses to placental malaria (PM) and human immunodeficiency virus (HIV-1) infections. Given these references, the aim of this study was to determine the association between KIR gene content polymorphism and PM infection in pregnant women of known HIV-1 status. Sixteen genes in the KIR family were analyzed in 688 pregnant Kenyan women. Gene content polymorphisms were assessed in relation to PM in HIV-1 negative and HIV-1 positive women, respectively. Results showed that in HIV-1 negative women, the presence of the individual genes KIR2DL1 and KIR2DL3 increased the odds of having PM, and the KIR2DL2/KIR2DL2 homozygotes were associated with protection from PM. However, the reverse relationship was observed in HIV-1 positive women, where the presence of individual KIR2DL3 was associated with protection from PM, and KIR2DL2/KIR2DL2 homozygotes increased the odds for susceptibility to PM. Further analysis of the HIV-1 positive women stratified by CD4 counts showed that this reverse association between KIR genes and PM remained only in the individuals with high CD4 cell counts but not in those with low CD4 cell counts. Collectively, these results suggest that inhibitory KIR2DL2 and KIR2DL3, which are alleles of the same locus, play a role in the inverse effects on PM and PM/HIV co-infection and the effect of KIR genes on PM in HIV positive women is dependent on high CD4 cell counts. In addition, analysis of linkage disequilibrium (LD) of the PM relevant KIR genes showed strong LD in women without PM regardless of their HIV status while LD was broken in those with PM, indicating possible selection pressure by malaria infection on the KIR genes. |
Effectiveness of 1 dose of 2009 influenza A (H1N1) vaccine at preventing hospitalization with pandemic H1N1 influenza in children aged 7 months-9 years
Hadler JL , Baker TN , Papadouka V , France AM , Zimmerman C , Livingston KA , Zucker JR . J Infect Dis 2012 206 (1) 49-55 The availability of a well-established immunization registry to provide vaccination information, a school-located vaccination campaign followed by continued 2009 influenza A (H1N1) (pH1N1) activity, and a requirement to report hospitalized influenza cases provided an opportunity to estimate vaccine effectiveness (VE) of an initial dose of pH1N1 monovalent vaccine in children aged 7 months-9 years. Seventy-eight case children and 729 date-of-birth- and zipcode-matched controls were studied. The VE of a single vaccine dose in preventing pH1N1 hospitalization ≥14 days after vaccination was 82% (95% confidence interval [CI], 0%-100%; P = .04) in children aged 3-9 years but was zero (-3%; 95% CI, <0%-75%) in children aged 7-35 months. These findings are consistent with those from prelicensure immunogenicity studies and have implications for interpretation of immunogenicity studies and setting priorities for vaccination of young children in future pandemics. Immunization registries can provide a simple, rapid assessment of VE to evaluate and inform vaccination policy. |
Broad neutralization of wild-type dengue virus isolates following immunization in monkeys with a tetravalent dengue vaccine based on chimeric yellow fever 17D/dengue viruses
Barban V , Munoz-Jordan JL , Santiago GA , Mantel N , Girerd Y , Gulia S , Claude JB , Lang J . Virology 2012 429 (2) 91-8 The objective of the study was to evaluate if the antibodies elicited after immunization with a tetravalent dengue vaccine, based on chimeric yellow fever 17D/dengue viruses, can neutralize a large range of dengue viruses (DENV). A panel of 82 DENVs was developed from viruses collected primarily during the last decade in 30 countries and included the four serotypes and the majority of existing genotypes. Viruses were isolated and minimally amplified before evaluation against a tetravalent polyclonal serum generated during vaccine preclinical evaluation in monkey, a model in which protection efficacy of this vaccine has been previously demonstrated (Guirakhoo et al., 2004). Neutralization was observed across all the DENV serotypes, genotypes, geographical origins and isolation years. These data indicate that antibodies elicited after immunization with this dengue vaccine candidate should widely protect against infection with contemporary DENV lineages circulating in endemic countries. |
Gender differences in seeking care for falls in the aged Medicare population
Stevens JA , Ballesteros MF , Mack KA , Rudd RA , Decaro E , Adler G . Am J Prev Med 2012 43 (1) 59-62 BACKGROUND: One third of adults aged ≥65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. PURPOSE: The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. METHODS: This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged ≥65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values ≤0.05 were considered significant. RESULTS: Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI=28.8%, 33.6%] vs 24.3% [95% CI=21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. CONCLUSIONS: Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors. |
Interpersonal- and community-level predictors of intimate partner violence perpetration among African American men
Raiford JL , Seth P , Braxton ND , Diclemente RJ . J Urban Health 2012 90 (4) 784-95 Intimate partner violence (IPV) has been associated with adverse physical, psychoemotional, and sexual health, and African American women are at higher risk for experiencing IPV. Considering African American women predominantly have African American male partners, it is essential to identify factors associated with IPV perpetration among African American men. The present study examined attitudes toward IPV, ineffective couple conflict resolution, exposure to neighborhood violence, and the interplay of these factors as predictors of IPV perpetration. A community sample of 80 single, heterosexual, African American men between 18 and 29 years completed measures assessing sociodemographics, attitudes towards IPV, perceived ineffective couple conflict resolution, exposure to neighborhood violence, and IPV perpetration during the past 3 months. Hierarchical multiple linear regression analyses, with age, education, and public assistance as covariates, were conducted on 65 men who reported being in a main relationship. Couple conflict resolution and exposure to neighborhood violence moderated the relation between attitudes supporting IPV and IPV perpetration. Among men who reported high ineffective couple conflict resolution and high exposure to neighborhood violence, IPV perpetration increased as attitudes supporting IPV increased. The findings indicated that interpersonal- and community-level factors interact with individual level factors to increase the risk of recent IPV perpetration among African American men. While IPV prevention should include individual-level interventions that focus on skills building, these findings also highlight the importance of couple-, community-, and structural-level interventions. |
Laboratory diagnostics for hepatitis C virus infection
Kamili S , Drobeniuc J , Araujo AC , Hayden TM . Clin Infect Dis 2012 55 Suppl 1 S43-8 Identification of prevalent infection by hepatitis C virus (HCV) is based serologically on detecting anti-HCV immunoglobulin G, using immunoassays, immunoblot assays, and, more recently, immunochromatography-based rapid tests. None discriminate between active and resolved HCV infection. Tests for detecting HCV RNA identify active HCV infection but are costly. Serologic assays for HCV antigens have been developed and show potential for diagnosis of active HCV infection, and their performance characteristics are undergoing evaluation. The diagnosis of acute HCV infection without the demonstration of seroconversion remains elusive. |
Misidentification of Yersinia pestis by automated systems, resulting in delayed diagnoses of human plague infections -- Oregon and New Mexico, 2010-2011
Tourdjman M , Ibraheem M , Brett M , Debess E , Progulske B , Ettestad P , McGivern T , Petersen J , Mead P . Clin Infect Dis 2012 55 (7) e58-60 One human plague case was reported in Oregon in September 2010 and another in New Mexico in May 2011. Misidentification of Yersinia pestis by automated identification systems contributed to delayed diagnoses for both cases. |
P4-mediated antibody therapy in an acute model of invasive pneumococcal disease
Bangert M , Bricio-Moreno L , Gore S , Rajam G , Ades EW , Gordon SB , Kadioglu A . J Infect Dis 2012 205 (9) 1399-407 New treatments against severe bacterial infections are needed because the response to antibiotic treatment is slow in acute settings and is becoming less effective owing to the emergence of antibiotic-resistant pathogens. P4-mediated antibody therapy offers a unique treatment strategy that combines exogenous immunoglobulin with the immunoactivating peptide P4. In an acute model of pneumococcal disease, mice were infected with Streptococcus pneumoniae and treated intravenously or intranasally with P4 and intravenous immunoglobulin (IVIG). Survival of P4-IVIG-treated mice increased from 0% to 60% among those that received intravenous treatment and from 0% to 100% among those that received intranasal treatment. Importantly, intranasal administration of P4 at an early stage of infection prevented the onset of bacteremia and sepsis. Increased survival was associated with reduced bacterial burden in affected tissues and with recruitment and activation of professional phagocytes, as manifested by increased expression of Fc-gamma receptors. In vitro studies involving P4-stimulated alveolar, peritoneal, and J774.2 murine macrophages showed an increased ability of these immune cells to phagocytose pneumococci independent of capsule. The use of adjunct antibody therapies to treat infectious diseases shows promise. |
Experimental inoculation of juvenile rhesus macaques with primate enteric caliciviruses
Sestak K , Feely S , Fey B , Dufour J , Hargitt E , Alvarez X , Pahar B , Gregoricus N , Vinje J , Farkas T . PLoS One 2012 7 (5) e37973 BACKGROUND: Tissue culture-adapted Tulane virus (TV), a GI.1 rhesus enteric calicivirus (ReCV), and a mixture of GII.2 and GII.4 human norovirus (NoV)-containing stool sample were used to intrastomacheally inoculate juvenile rhesus macaques (Macaca mulatta) in order to evaluate infection caused by these viruses. METHODOLOGY & FINDINGS: Two of the three TV-inoculated macaques developed diarrhea, fever, virus-shedding in stools, inflammation of duodenum and 16-fold increase of TV-neutralizing (VN) serum antibodies but no vomiting or viremia. No VN-antibody responses could be detected against a GI.2 ReCV strain FT285, suggesting that TV and FT285 represent different ReCV serotypes. Both NoV-inoculated macaques remained asymptomatic but with demonstrable virus shedding in one animal. Examination of duodenum biopsies of the TV-inoculated macaques showed lymphocytic infiltration of the lamina propria and villous blunting. TV antigen-positive (TV+) cells were detected in the lamina propria. In most of the TV+ cells TV co-localized perinuclearly with calnexin - an endoplasmic reticulum protein. A few CD20+TV+ double-positive B cells were also identified in duodenum. To corroborate the authenticity of CD20+TV+ B cells, in vitro cultures of peripheral blood mononuclear cells (PBMCs) from healthy macaques were inoculated with TV. Multicolor flow cytometry confirmed the presence of TV antigen-containing B cells of predominantly CD20+HLA-DR+ phenotype. A 2-log increase of viral RNA by 6 days post inoculation (p<0.05) suggested active TV replication in cultured lymphocytes. CONCLUSIONS/SIGNIFICANCE: Taken together, our results show that ReCVs represent an alternative cell culture and animal model to study enteric calicivirus replication, pathogenesis and immunity. |
Field-based performance of three pre-market rapid hepatitis C virus antibody assays in STAHR (Study to Assess Hepatitis C Risk) among young adults who inject drugs in San Diego, CA
Jewett A , Smith BD , Garfein RS , Cuevas-Mota J , Teshale EH , Weinbaum CM . J Clin Virol 2012 54 (3) 213-7 BACKGROUND: Approximately 4.1 million Americans are estimated to have been infected with hepatitis C virus (HCV), 45-85% of whom are unaware of their infection. Persons who inject drugs (PWID) account for 55.8% of all persons with HCV antibody (anti-HCV) in the U.S. PWID have limited access to healthcare and are infrequently tested for anti-HCV using conventional laboratory assays. OBJECTIVE: To evaluate performance characteristics (sensitivity and specificity) of three, pre-market rapid point-of-care tests (one oral fluid and two finger-stick assays) from two manufacturers (Chembio and MedMira) in settings providing services to young adult PWID in San Diego, CA. STUDY DESIGN: Behavioral risk assessment surveys and testing for HCV were conducted among persons who reported injection drug use (IDU) within the past 6 months as part of the Study to Assess Hepatitis C Risk (STAHR) among PWID aged 18-40 years in 2009-2010. Sensitivity and specificity of the rapid anti-HCV assays were evaluated among STAHR participants, using two commonly used testing algorithms. RESULTS: Variability in sensitivity (76.6-97.1%) and specificity (99.0-100.0%) was found across assays. The highest sensitivity achieved for the Chembio finger-stick blood, Chembio oral fluid and MedMira finger-stick blood tests was 97.1%, 85.4% and 80.0% respectively; the highest specificity was 99.0%, 100.0% and 100.0%, respectively. In multivariate analysis false negative anti-HCV results were associated with female sex for the MedMira blood assay. CONCLUSIONS: Sensitive anti-HCV rapid assays are appropriate and feasible for high-prevalence, high-risk populations such as young PWID. |
Reducing prenatal smoking: the role of state policies
Adams EK , Markowitz S , Kannan V , Dietz PM , Tong VT , Malarcher AM . Am J Prev Med 2012 43 (1) 34-40 BACKGROUND: Maternal smoking causes adverse health outcomes for both mothers and infants and leads to excess healthcare costs at delivery and beyond. Even with substantial declines over the past decade, around 23% of women enter pregnancy as a smoker and though almost half quit during pregnancy, half or more quitters resume smoking soon after delivery. PURPOSE: To examine the independent effects of higher cigarette taxes and prices, smokefree policies, and tobacco control spending on maternal smoking prior to, during, and after a pregnancy during a period in which states have made changes in such policies. METHODS: Data from pooled cross-sections of women with live births during 2000-2005 in 29 states plus New York City (n=225,445) were merged with cigarette price data inclusive of federal, state, and local excise taxes, full or partial bans on smoking in public places, and tobacco control spending. Probit regression models using a mixed panel, state fixed effects, and time indicators were used to assess effect of policies on smoking (during 3 months before pregnancy); quitting by last 3 months of pregnancy; and having sustained quitting at the time of completing the postpartum survey. RESULTS: Multivariate analysis indicated that a $1.00 increase in taxes and prices increases third-trimester quits by between 4 and 5 percentage points after controlling for the other policies and covariates. Implementing a full private worksite smoking ban increases quits by the third trimester by an estimated 5 percentage points. Cumulative spending on tobacco control had no effect on pregnancy smoking rates overall. Association of tobacco control policies with maternal smoking varied by age. CONCLUSIONS: States can use multiple tobacco control policies to reduce maternal smoking. Combining higher taxes with smokefree policies particularly can be effective. |
The effect of different alcohol drinking patterns in early to mid pregnancy on the child's intelligence, attention, and executive function
Kesmodel U , Bertrand J , Stovring H , Skarpness B , Denny C , Mortensen E . BJOG 2012 119 (10) 1180-90 OBJECTIVE: To conduct a combined analysis of the estimated effects of maternal average weekly alcohol consumption, and any binge drinking, in early to mid pregnancy on general intelligence, attention, and executive function in 5-year-old children. DESIGN: Follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol consumption during early pregnancy. At age 5 years, the children were tested for general intelligence, attention, and executive function. The three outcomes were analysed together in a multivariate model to obtain joint estimates and P values for the association of alcohol across outcomes. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy were adjusted for a wide range of potential confounding factors. MAIN OUTCOME MEASURES: Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Test of Everyday Attention for Children at Five (TEACh-5), and the Behavior Rating Inventory of Executive Functions (BRIEF) scores. Results Multivariate analyses showed no statistically significant effects arising from average weekly alcohol consumption or any binge drinking, either individually or in combination. These results replicate findings from separate analyses of each outcome variable. CONCLUSIONS: The present study contributes comprehensive methodological and statistical approaches that should be incorporated in future studies of low to moderate alcohol consumption and binge drinking during pregnancy. Furthermore, as no safe level of drinking during pregnancy has been established, the most conservative advice for women is not to drink alcohol during pregnancy. However, the present study suggests that small volumes consumed occasionally may not present serious concern. |
The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on executive function in 5-year-old children
Skogerbo A , Kesmodel U , Wimberley T , Stovring H , Bertrand J , Landro N , Mortensen E . BJOG 2012 119 (10) 1201-10 OBJECTIVE: To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on children's executive functions at the age of 5 years. DESIGN: Follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol drinking patterns during early pregnancy. When the children were 5 years old, the parent and teacher forms of the Behaviour Rating Inventory of Executive Function (BRIEF) were completed by the mothers and a preschool teacher. Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, and the child's gender were considered core confounding factors. The full model also included maternal binge drinking or low to moderate alcohol consumption, maternal age, parity, maternal marital status, family home environment, postnatal parental smoking, pre-pregnancy maternal body mass index (BMI), and the health status of the child. Main outcome measures The BRIEF parent and teacher forms. RESULTS: Adjusted for all potential confounding factors, no statistically significant associations between maternal low to moderate average weekly consumption and BRIEF index scores were observed. In adjusted analyses, binge drinking in gestational week 9 or later was significantly associated with elevated Behavioural Regulation Index parent scores (OR 2.04, 95% CI 0.33-3.76), and with the risk of high scores on the Metacognitive Index assessed by the teacher (OR 2.06, 95% CI 1.01-4.23). CONCLUSIONS: This study did not observe significant effects of low to moderate alcohol consumption during pregnancy on executive functioning at the age of 5 years. Furthermore, only weak and no consistent associations between maternal binge drinking and executive functions were observed. |
The effects of low to moderate prenatal alcohol exposure in early pregnancy on IQ in 5-year-old children
Falgreen Eriksen HL , Mortensen E , Kilburn T , Underbjerg M , Bertrand J , Stovring H , Wimberley T , Grove J , Kesmodel U . BJOG 2012 119 (10) 1191-200 OBJECTIVE: To examine the effects of low to moderate maternal alcohol consumption during early pregnancy on children's intelligence (IQ) at age 5 years. DESIGN: Prospective follow-up study. SETTING: Neuropsychological testing in four Danish cities 2003-2008. POPULATION: A cohort of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS: Participants were sampled based on maternal alcohol consumption during pregnancy. At 5 years of age, children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). Parental education, maternal IQ, maternal smoking in pregnancy, the child's age at testing, gender, and tester were considered core confounding factors, whereas the full model also controlled for maternal binge drinking, age, BMI, parity, home environment, postnatal smoking in the home, health status, and indicators for hearing and vision impairments. MAIN OUTCOME MEASURES: The WPPSI-R. RESULTS: No differences in test performance were observed between children whose mothers reported consuming between one and four or between five and eight drinks per week at some point during pregnancy, compared with children of mothers who abstained. For women who reported consuming nine or more drinks per week no differences were observed for mean differences; however, the risks of low full-scale IQ (OR 4.6; 95% CI 1.2-18.2) and low verbal IQ (OR 5.9; 95% CI 1.4-24.9) scores, but not low performance IQ score, were increased. CONCLUSIONS: Maternal consumption of low to moderate quantities of alcohol during pregnancy was not associated with the mean IQ score of preschool children. Despite these findings, acceptable levels of alcohol use during pregnancy have not yet been established, and conservative advice for women continues to be to avoid alcohol use during pregnancy. |
Association of child care providers breastfeeding support with breastfeeding duration at 6 months
Batan M , Li R , Scanlon K . Matern Child Health J 2012 17 (4) 708-13 Many lactating mothers participate in the workforce and have their infants cared for outside of their home, yet little is known about their child care providers' (CCPs') support of breastfeeding. This study examines the association between CCPs' breastfeeding support as reported by mothers at 3 months and mother's breastfeeding at 6 months. Infant Feeding Practices Study II, a longitudinal study, followed mothers of infants via mail questionnaires almost monthly from late pregnancy throughout the first year. This study consisted of 183 mothers who breastfed and had their infant in child care at 3 months and answered 5 questions regarding CCPs' supports. Total number of CCPs' support was a summary of responses to individual items and categorized into 3 levels (0-2, 3-4, or 5 total supports). Multiple logistic regressions examined how each breastfeeding support and total number were associated with breastfeeding at 6 months. Breastfeeding at 6 months was significantly associated with CCP support to feed expressed breast milk (AOR = 4.55; 95 % CI = 1.09, 18.95) and allow mothers to breastfeed at the child care place before or after work (AOR = 6.23; 95 % CI = 1.33, 29.16). Compared to mothers who reported fewer than 3 total supports, mothers who reported 5 supports were 3 times as likely to be breastfeeding at 6 months (AOR = 3.00, 95 % CI = 1.11, 8.13). Our findings suggest that CCPs' breastfeeding support at 3 months, particularly feeding expressed breast milk and allowing mothers to breastfeed before or after work, may help mothers maintain breastfeeding at 6 months. |
Serum soluble transferrin receptor concentrations in US preschool children and non-pregnant women of childbearing age from the National Health and Nutrition Examination Survey 2003-2010
Mei Z , Pfeiffer CM , Looker AC , Flores-Ayala RC , Lacher DA , Mirel LB , Grummer-Strawn LM . Clin Chim Acta 2012 413 1479-84 BACKGROUND: Serum soluble transferrin receptor (sTfR) is recommended as a sensitive and accurate measure of iron deficiency (ID) in populations when only a single indicator can be used. The lack of assay standardization and of representative data on the distribution of sTfR in at-risk populations currently limits its utility. METHODS: Using data from NHANES 2003-2010, we examined the distribution of sTfR and developed assay-specific cutoff values for defining elevated sTfR in 2 US populations groups: children aged 1-5 y (n=2820) and non-pregnant women aged 15-49 y (n=6575). RESULTS: On average, children had higher geometric mean sTfR concentrations (4.09mg/l; 95% CI: 4.04-4.14) than non-pregnant women (3.31mg/l; 95% CI: 3.26-3.35) (p<0.001). Among children, those aged 1-2 y (compared to those aged 3-5 y), boys (compared to girls), and non-Hispanic black (NHB) children (compared to non-Hispanic white (NHW) and Mexican-American (MA) children) had higher sTfR concentrations. Among non-pregnant women, adolescents (15-19 y) had higher sTfR concentrations than adults aged 20-34 y but not compared to adults aged 35-49 y; NHB women (compared to NHW and MA women) and multiparous women (compared to nulliparous women) had higher sTfR concentrations. The derived cutoff values (97.5th percentile in a defined healthy reference population) for defining elevated sTfR in the US were 6.00mg/l for children 1-5 y and 5.33mg/l for non-pregnant women 15-49 y. CONCLUSIONS: A different sTfR cutoff value may be needed in children and non-pregnant women to define ID. |
The Upper Midwest Health Study: a case-control study of pesticide applicators and risk of glioma
Yiin JH , Ruder AM , Stewart PA , Waters MA , Carreon T , Butler MA , Calvert GM , Davis-King KE , Schulte PA , Mandel JS , Morton RF , Reding DJ , Rosenman KD . Environ Health 2012 11 (1) 39 BACKGROUND: An excess incidence of brain cancer in farmers has been noted in several studies. The National Institute for Occupational Safety and Health developed the Upper Midwest Health Study (UMHS) as a case-control study of intracranial gliomas and pesticide uses among rural residents. Previous studies of UMHS participants, using "ever-never" exposure to farm pesticides and analyzing men and women separately, found no positive association of farm pesticide exposure and glioma risks. The primary objective was to determine if quantitatively estimated exposure of pesticide applicators was associated with an increased risk of glioma in male and female participants. METHODS: The study included 798 histologically confirmed primary intracranial glioma cases (45 % with proxy respondents) and 1,175 population-based controls, all adult (age 18-80) nonmetropolitan residents of Iowa, Michigan, Minnesota, and Wisconsin. The analyses used quantitatively estimated exposure from questionnaire responses evaluated by an experienced industrial hygienist with 25 years of work on farm pesticide analyses. Odds ratios (ORs) and 95 % confidence intervals (CIs) using unconditional logistic regression modeling were calculated adjusting for frequency-matching variables (10-year age group and sex), and for age and education (a surrogate for socioeconomic status). Analyses were separately conducted with or without proxy respondents. RESULTS: No significant positive associations with glioma were observed with cumulative years or estimated lifetime cumulative exposure of farm pesticide use. There was, a significant inverse association for phenoxy pesticide used on the farm (OR 0.96 per 10 g-years of cumulative exposure, CI 0.93-0.99). No significant findings were observed when proxy respondents were excluded. Non-farm occupational applicators of any pesticide had decreased glioma risk: OR 0.72, CI 0.52-0.99. Similarly, house and garden pesticide applicators had a decreased risk of glioma: OR 0.79, CI 0.66-0.93, with statistically significant inverse associations for use of 2,4-D, arsenates, organophosphates, and phenoxys. CONCLUSIONS: These results are consistent with our previous findings for UMHS of reported farm pesticide exposure and support a lack of positive association between pesticides and glioma. |
The Upper Midwest Health Study: industry and occupation of glioma cases and controls
Ruder AM , Waters MA , Carreon T , Butler MA , Calvert GM , Davis-King KE , Waters KM , Schulte PA , Mandel JS , Morton RF , Reding DJ , Rosenman KD . Am J Ind Med 2012 55 (9) 747-55 BACKGROUND: Understanding glioma etiology requires determining which environmental factors are associated with glioma. Upper Midwest Health Study case-control participant work histories collected 1995-1998 were evaluated for occupational associations with glioma. "Exposures of interest" from our study protocol comprise our a priori hypotheses. MATERIALS AND METHODS: Year-long or longer jobs for 1,973 participants were assigned Standard Occupational Classifications (SOC) and Standard Industrial Classifications (SIC). The analysis file includes 8,078 SIC- and SOC-coded jobs. For each individual, SAS 9.2 programs collated employment with identical SIC-SOC coding. Distributions of longest "total employment duration" (total years worked in jobs with identical industry and occupation codes, including multiple jobs, and non-consecutive jobs) were compared between cases and controls, using an industrial hygiene algorithm to group occupations. RESULTS: Longest employment duration was calculated for 780 cases and 1,156 controls. More case than control longest total employment duration was in the "engineer, architect" occupational group [16 cases, 10 controls, odds ratio (OR) 2.50, adjusted for age group, sex, age and education, 95% confidence interval (CI) 1.12-5.60]. Employment as a food processing worker [mostly butchers and meat cutters] was of borderline significance (27 cases, 21 controls, adjusted OR: 1.78, CI: 0.99-3.18). CONCLUSIONS: Among our exposures of interest work as engineers or as butchers and meat cutters was associated with increased glioma risk. Significant associations could be due to chance, because of multiple comparisons, but similar findings have been reported for other glioma studies. Our results suggest some possible associations but by themselves could not provide conclusive evidence. (Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
Work counts - so count it
Wagner GR . Respiration 2012 84 (3) 191-2 No abstract available. |
Physician-patient communication regarding asthma and work
Mazurek JM , Storey E . Am J Prev Med 2012 43 (1) 72-5 BACKGROUND: Healthy People 2020-specific respiratory diseases objectives seek to increase the proportion of people with current asthma who receive appropriate asthma care. For adults, this includes a discussion of whether asthma is work-related. PURPOSE: To establish a baseline measure of physician-patient communication regarding asthma and work. METHODS: This study used data from 27,157 non-institutionalized U.S. adult respondents of the 2010 National Health Interview Survey (analyzed in 2011). Adults employed at any time in the 12 months prior to the interview with a health-professional diagnosis of current asthma who have been told by a health professional that their asthma was probably work-related or ever discussed the relatedness of asthma and work were identified. Weighted proportions and, using logistic regression analysis, prevalence ORs for factors that may have predicted communication with a health professional regarding an asthma-work relationship were calculated. RESULTS: An estimated 6.6% (95% CI=5.1%, 8.2%) of employed adults with current asthma have been told that their asthma is work-related. Among those not so informed, 7.4% (95% CI=5.6%, 9.2%) ever discussed the topic. When responses to both questions were considered, the proportion was 13.5% (95% CI=11.3%, 15.8%). Employed adults aged ≥30 years, those reporting adverse asthma outcomes, and those of Hispanic ethnicity had higher odds of having communication with a health professional about the relation between their asthma and their work. CONCLUSIONS: One in seven employed adults with asthma report communicating with their health professional about the role of workplace exposures in their asthma. Opportunities to increase this dialogue should be examined. |
Evaluation and comparison of urinary metabolic biomarkers of exposure for the jet fuel JP-8
B'Hymer C , Krieg E Jr , Cheever KL , Toennis CA , Clark JC , Kesner JS , Gibson R , Butler MA . J Toxicol Environ Health A 2012 75 (11) 661-72 A study of workers exposed to jet fuel propellant 8 (JP-8) was conducted at U.S. Air Force bases and included the evaluation of three biomarkers of exposure: S-benzylmercapturic acid (BMA), S-phenylmercapturic acid (PMA), and (2-methoxyethoxy)acetic acid (MEAA). Postshift urine specimens were collected from various personnel categorized as high (n = 98), moderate (n = 38) and low (n = 61) JP-8 exposure based on work activities. BMA and PMA urinary levels were determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and MEAA urinary levels were determined by gas chromatography-mass spectrometry (GC-MS). The numbers of samples determined as positive for the presence of the BMA biomarker (above the test method's limit of detection [LOD = 0.5 ng/ml]) were 96 (98.0%), 37 (97.4%), and 58 (95.1%) for the high, moderate, and low (control) exposure workgroup categories, respectively. The numbers of samples determined as positive for the presence of the PMA biomarker (LOD = 0.5 ng/ml) were 33 (33.7%), 9 (23.7%), and 12 (19.7%) for the high, moderate, and low exposure categories. The numbers of samples determined as positive for the presence of the MEAA biomarker (LOD = 0.1 mcg/ml) were 92 (93.4%), 13 (34.2%), and 2 (3.3%) for the high, moderate, and low exposure categories. Statistical analysis of the mean levels of the analytes demonstrated MEAA to be the most accurate or appropriate biomarker for JP-8 exposure using urinary concentrations either adjusted or not adjusted for creatinine; mean levels of BMA and PMA were not statistically significant between workgroup categories after adjusting for creatinine. |
Exposure to o-toluidine, aniline, and nitrobenzene in a rubber chemical manufacturing plant: a retrospective exposure assessment update
Hanley KW , Viet SM , Hein MJ , Carreon T , Ruder AM . J Occup Environ Hyg 2012 9 (8) 478-90 The National Institute for Occupational Safety and Health previously conducted a retrospective cancer incidence and mortality study of workers employed at a rubber chemical manufacturing plant. Compared with New York State incidence, the bladder cancer risk was 6.5 times higher for workers considered to have definite exposure to ortho-toluidine and aniline, and 4 times higher for workers with possible exposure. Exposure characterization in the original study utilized a surrogate measure based only on departments in which each worker was ever employed. As part of an update of that study, some departments in the three original exposure groups were reclassified based on a follow-up site visit; interviews with employees, management, and union representatives; and review of records including exposure data. An additional evaluation of department-job combinations, rather than only departments, was used to stratify exposure into four categories. An approximate rank of "relative" exposure level for each department-job-year combination was also assigned using a ranking scale of 0 to 10. The ranks were supported by quantitative exposure levels and by professional judgment. The numerical ranking scale was applied to each worker by multiplying the exposure rank by duration for each job held based on comprehensive individual work histories. The cumulative rank scores for this cohort ranged from 0 to 300 unit-years. The medians of the cumulative rank scores for the exposure categories showed very good agreement with increasing exposure classifications (e.g., 0.72, 4.6, 11, 14 unit-years for the four exposure categories). Workers' breathing zone air sampling data collected at this plant from 1976-2004 were well below published occupational exposure limits for these chemicals, but additional cases of bladder cancer have been reported. The exposure assessment revisions and rank estimates will be used to analyze the updated bladder cancer incidence data. |
The incidence of work-related asthma-like symptoms and dust exposure in Norwegian smelters
Soyseth V , Johnsen HL , Henneberger PK , Kongerud J . Am J Respir Crit Care Med 2012 185 (12) 1280-5 RATIONALE: The prevalence of respiratory symptoms among employees in smelters is positively associated with dust exposure. OBJECTIVES: To investigate the association between the incidence of work-related asthma-like symptoms (WASTH) and dust exposure. METHODS: All the employees were invited to participate in a 5-year longitudinal study. The outcome of WASTH was defined as the combination of dyspnea and wheezing improving on rest days or vacation in an individual who had no asthma previously. Information about smoking and occupational status was obtained from a questionnaire. A job exposure matrix of total dust was developed. Multivariate data analyses were performed using Cox regression. MEASUREMENTS AND MAIN RESULTS: The total follow-up time of the employees (n = 2,476) was 8,469 years, and the median follow-up time for participants was 4.0 years. During the follow-up, 91 employees developed WASTH, and the corresponding incidence rate for WASTH per 1,000 person-years was 8.9 (7.3-10.9) (95% confidence interval in parentheses). The risk ratio of WASTH increased significantly (P = 0.0001) with dust exposure in the middle and high categories (1.0-2.9 and ≥3.0 mg/m(3)). Stratified analyses showed that the effect of current dust exposure varied with both previous exposure (PE) to dust and fumes (P = 0.006) and airflow limitation (AFL) (P = 0.033). The final analyses showed that the risk ratios for WASTH per 1 mg/m(3) increase in current dust exposure were 1.1 (0.93-1.2), 1.4 (1.1-1.8), 1.6 (1.1-2.3), and 1.9 (1.2-3.0) for the categories (PE+/AFL-), (PE-/AFL-), (PE+/AFL+, and (PE-/AFL+). CONCLUSIONS: In conclusion, dust exposure was associated with an increased incidence of WASTH. |
Determinants of atrazine contamination in the homes of commercial pesticide applicators across time
Lozier MJ , Curwin B , Nishioka MG , Sanderson W . J Occup Environ Hyg 2012 9 (5) 289-97 Twenty-nine commercial pesticide applicator households in eastern Iowa were enrolled to investigate in-home contamination of atrazine, the most commonly used corn herbicide in the Unites States. From each home, four vacuum dust samples were collected during atrazine application season (Visit 1) and again 6 months later during winter months (Visit 2). Samples were taken from the following locations: primary entryway for pesticide applicator, living room, master bedroom, and kitchen. The applicator completed an atrazine handling log and household questionnaire with spouse. Of the 230 dust samples, only 2 were below the level of detection, 2 ng of atrazine per gram (ng/g) of fine dust (dust particle size 5-150 mcm). Dust levels were standardized to chemical loading. During application season the entryway (2.68 ng/cm(2)) and kitchen (0.47 ng/cm(2)) had the highest geometric mean atrazine chemical loading. The entryway chemical loading during Visit 2 was the second highest aggregate (0.55 ng/cm(2)). Aggregate concentrations were significantly higher at Visit 1 compared with Visit 2 when paired by location (p≤0.02). Analysis showed that job (application, mixing/loading, or both) was not associated with in-home atrazine contamination. Linear regression showed a strong positive association between atrazine handling (number of acres applied with atrazine, number of days atrazine handled, and pounds of atrazine handled) and aggregate dust chemical loading from both visits (p = 0.06, 0.03, and 0.10, respectively). Frequency of vacuuming was inversely associated with Visit 2 concentrations (p = 0.10) and showed a weaker association with Visit 1 (p = 0.30). Removing shoes outside the home was associated with lower atrazine chemical loading (p = 0.03), and applicators changing work clothes in the master bedroom had significantly increased atrazine chemical loading in master bedrooms (p = 0.01). Changes in hygiene practices for commercial pesticide applicators could significantly reduce atrazine and, likely, other pesticide contaminations in the home. |
A call for action on primary care and public health integration
Koo D , Felix K , Dankwa-Mullan I , Miller T , Waalen J . Am J Prev Med 2012 42 S89-91 The fields of primary care and public health in the U.S. have for the last century generally functioned independently of each other. This is not optimal; our current health challenges require improved efforts to work together in an integrated fashion to address the root causes of illness and prevent additional cases of disease, and to make the default choice a healthy one.1 Effective support of healthy behaviors will require coordination of the work of clinicians, particularly primary care clinicians, with public health agencies, schools, businesses, and community groups to better utilize community resources. In such an integrated system, primary care and public health work together to support individuals, families, patients and their caregivers, and to improve the health of individuals and populations (i.e., a true health system).2 | How will health care in the U.S. evolve to become part of such a health system? On March 28, 2012, the IOM released the report “Primary Care and Public Health: Exploring Integration to Improve Population Health”3 in which the Committee on Integrating Primary Care and Public Health reviewed promising models of primary care and public health integration, often with shared accountability for improved community and population health outcomes. From their review of numerous examples, the IOM committee developed a set of principles that they deem essential for successful integration of primary care and public health: | 1 | a shared goal of population health improvement; | 2 | community engagement in defining and addressing population health needs; | 3 | aligned leadership; | 4 | sustainability, including shared infrastructure; and | 5 | sharing and collaborative use of data and analysis. |
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