Years of potential life lost and productivity losses from male urogenital cancer deaths-United States, 2004
Li C , Ekwueme DU , Rim SH , Tangka FK . Urology 2010 76 (3) 528-35 OBJECTIVES: To estimate years of potential life lost (YPLL) and productivity losses due to deaths from male urogenital cancers in the United States in 2004. METHODS: To estimate YPLL, we applied a life expectancy method using 2004 national mortality data and life tables. To estimate lifetime productivity losses, we used human capital approach accounting for both the market value and the imputed value of housekeeping services. We calculated results for age and racial/ethnic groups and for 8 categories of male urogenital cancers. RESULTS: In 2004, deaths from urological cancers accounted for 244,080 YPLL, with an average of 14.4 YPLL per death, and deaths from genital cancers accounted for 309,921 YPLL, with an average of 10.5 YPLL per death. Kidney cancer accounted for 42.7% YPLL from male urological cancers, and prostate cancer accounted for 94.2% of the YPLL from male genital cancers. Testicular cancer had the highest average number of YPLL per death (37.9). Non-Hispanic whites accounted for 77.9% of the YPLL from male urogenital cancer deaths. Overall, urogenital cancers had the largest relative contribution to YPLL among men aged ≥50 years. In 2004, the estimated lifetime productivity loss because of deaths from male urogenital cancer was $10.4 billion USD, 10.6% of the estimated $97.9 billion USD loss because of deaths from all cancers among US men. CONCLUSIONS: Urogenital cancers impose a considerable health and economic burden in terms of premature deaths and productivity losses in men in the United States, particularly among the elderly and non-Hispanic whites and blacks. |
Dr R Shiffmann's Asthmador: relevant to our times, or a snake oil remedy?
Fedan JS , Piedimonte G . Curr Opin Pharmacol 2010 10 (3) 213-7 We really would have liked to have been able to title this issue: ‘Cures for Respiratory Diseases Found!’ But we and you reading this issue at the time of its publication realize that this claim cannot be made. Alas, lung researchers have amassed a gargantuan level of knowledge about the diseases that are discussed in this issue: how patients present; the several morphological and pathophysiological changes that occur as the disease begins and progresses; some genetic, possibly etiologic, predispositions; and the mechanisms of action of most of the drugs that are used to prevent and/or ameliorate patient symptoms. Not that the ‘cure’ for these diseases lies ultimately in pharmacotherapy. At the outset we decided to limit the areas covered by this issue to asthma and cystic fibrosis. This was not done to slight other diseases such as tuberculosis, pneumonia, sarcoidosis and the many others, but because of the limitations of space. |
Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection
Cannon MJ , Schmid DS , Hyde TB . Rev Med Virol 2010 20 (4) 202-13 Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI=1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations. Published in 2010 by John Wiley & Sons, Ltd. |
Viral hepatitis: continuing the dialogue
Holtzman D . Am J Public Health 2010 100 (8) 1369 For this column, I have selected a topic not covered specifically among articles in this issue but certainly relevant to the theme, “Promote, Prevent, Protect.” The topic is viral hepatitis, and because of recent events, I take this opportunity to continue the discussion here and keep the momentum going. | Viral hepatitis is an important cause of morbidity and mortality in the United States. It has been characterized however as a silent epidemic—silent because there is limited knowledge and general awareness of the disease and because many of those who become infected are not aware they have the disease until decades later when they develop serious complications such as cirrhosis. Over 5 million Americans are estimated to be chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and an estimated 15 000 Americans die every year as a result of these infections. Chronic viral hepatitis is the most common cause of liver disease and the most common indication for liver transplant. Both chronic HBV and HCV infections can lead to primary liver cancer (hepatocellular carcinoma), the ninth leading cause of cancer deaths in the United States. Chronic viral hepatitis is also a leading cause of death among persons coinfected with HIV/AIDS. | Because most persons infected with HBV or HCV are asymptomatic and unaware of their infection, screening is crucial; for those who are infected, referral for treatment can be life saving. Although there is no cure for chronic HBV infection, there are treatments that can reduce the level of virus among those treated and antiviral drugs that can delay progression to more serious disease. For HCV, if treated early in the course of infection, it can be cured for a majority of persons with acute infection; among those with chronic infection, treatment is effective (i.e., virologic cure) for a sizable minority. Moreover, new therapies hold promise both to shorten the duration of treatment while increasing effectiveness. In addition, there have been important advances in treatment of chronic HBV infection that, similar to those for HCV, infection can further delay progression to diseases such as cirrhosis or liver cancer. |
Performance of abdominal ultrasound for diagnosis of tuberculosis in HIV-infected persons living in Cambodia
Sculier D , Vannarith C , Pe R , Thai S , Kanara N , Borann S , Cain KP , Lynen L , Varma JK . J Acquir Immune Defic Syndr 2010 55 (4) 500-2 BACKGROUND: In resource-limited settings, abdominal ultrasound is often used to assist the diagnosis of tuberculosis (TB) in people with HIV (PLHIV), although data on performance characteristics are missing. METHODS: Cross-sectional study of PLHIV in Cambodia receiving a standardized TB diagnostic evaluation, including history, physical examination, chest radiography, microscopy and culture of various specimens, and abdominal ultrasound. Patients with at least one specimen culture positive for Mycobacterium tuberculosis were classified as having TB. RESULTS: TB was diagnosed in 37 (18%) of 212 PLHIV. Abdominal ultrasound was abnormal in 15 of 37 (41%) patients with TB compared with 14 of 175 (8%) without TB (P < 0.01). Predictors of TB disease included multiple enlarged (1.2 cm or greater) abdominal lymph nodes on ultrasound (adjusted odds ratio [OR], 6.4; 95% confidence interval [CI], 1.8-22.4), abnormal chest radiography (OR, 6.8; CI, 2.7-17.0), anorexia (OR, 4.6; CI, 1.8-11.7), and CD4 less than 200 cells/mm (OR, 3.3; CI, 1.2-9.1). Having multiple enlarged abdominal lymph nodes on ultrasound was 97.1% (CI, 93.5%-99.1%) specific for TB with a positive likelihood ratio of 11.4 (CI, 4.3-30.3). CONCLUSIONS: Abdominal ultrasound is a useful diagnostic test for TB disease in PLHIV, increasing the posttest probability of TB when multiple enlarged abdominal lymph nodes are visualized. Its wider use may accelerate access to TB treatment, potentially reducing mortality in PLHIV. |
1918 and 2009: a tale of two pandemics
Redd SC , Frieden TR , Schuchat A , Briss PA . Public Health Rep 2010 125 Suppl 3 3-5 Learning lessons from previous pandemics is not merely an academic exercise. Our experiences from 1918 and other 20th-century pandemics helped us prepare for and respond to the 2009 H1N1 pandemic. In addition to better understanding these earlier pandemics, we must continue to learn and apply lessons from our experience with the current H1N1 pandemic to improve our ability to respond to future pandemics. Any reflection on the first pandemics of the 20th and 21st centuries must begin with gratitude for the fruits of science and technology, many of which were unimaginable in 1918. We can now detect, prevent, and treat disease; clarify the dynamic circumstances of pandemics; and save lives. |
The 1918-1919 influenza pandemic in the United States: lessons learned and challenges exposed
Stern AM , Cetron MS , Markel H . Public Health Rep 2010 125 Suppl 3 6-8 Few have described the influenza pandemic of 1918–1919 better than Dr. Victor Clarence Vaughan, the portly dean of the University of Michigan Medical School and advisor to the U.S. Surgeon General during World War I. In early September 1918, upon surveying the destruction wrought not from bullets but rather from microbes at a military camp outside of Boston, Vaughan bemoaned that influenza had “… encircled the world, visited the remotest corners, taking toll of the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face of science.”1 Striding between the crowded, makeshift hospital wards and the overflowing morgue, Vaughan anxiously recorded that bodies were being stacked about “like cordwood.” | Vaughan's macabre image of the alarming and accelerating loss of thousands of young soldiers in the prime of their lives foreshadowed the overwhelming sickness and death that would engulf the globe in the fall of 1918, as the deadliest wave of this contagious calamity took its harrowing toll. After the pandemic subsided in the winter of 1920, at least 50 million people had died worldwide, including approximately 550,000 in the United States. It reached its height during the final months of “the war to end all wars,” which mobilized tens of millions of young men to the European theater of battle. Moreover, it appeared at a time when public health had made tremendous advances thanks to a combination of sanitarian campaigns and bacteriological science, but several decades before the viral etiology of influenza had been determined. |
"Better off in school": school medical inspection as a public health strategy during the 1918-1919 influenza pandemic in the United States
Stern AM , Reilly MB , Cetron MS , Markel H . Public Health Rep 2010 125 Suppl 3 63-70 During the 1918-1919 influenza pandemic in the United States, most cities responded by implementing community mitigation strategies, such as school closure. However, three cities--New York City, Chicago, and New Haven, Connecticut--diverged from the dominant pattern by keeping their public schools open while the pandemic raged. This article situates the experiences of these three cities in the broader context of the Progressive era, when officials and experts put great faith in expanding public programs in health and education. It adds an important dimension to the historical understanding of the 1918-1919 influenza pandemic and offers lessons for public health practitioners and policymakers today who might face difficult decisions about how to respond to the 2009 H1N1 influenza pandemic. |
Consistent condom use is associated with lower prevalence of human papillomavirus infection in men
Nielson CM , Harris RB , Nyitray AG , Dunne EF , Stone KM , Giuliano AR . J Infect Dis 2010 202 (3) 445-51 INTRODUCTION: Reported associations between condom use and human papillomavirus (HPV) infection in men have been inconsistent. METHODS: We tested 463 men, ages 18-40 years, in 2 cities in the United States for 37 HPV types in samples from 5 anogenital sites. Men answered questionnaires regarding number of partners and frequency of condom use during vaginal sex in the past 3 months (5 categories, from "always" to "never"). Among 393 men who reported 1 female partner in the past 3 months, the proportions of men with HPV detected overall and at each anatomic site by frequency of condom use were calculated. Logistic regression was used to examine associations between frequency of condom use and HPV detection. Effect modification by number of recent partners (1 vs >1) was evaluated. RESULTS: The proportion of men positive for HPV ranged from 37.9% among men who reported they "always" used condoms to 53.9% among those who reported they "never" used condoms (P for trend = .008). Always using condoms (vs using them less frequently) was associated with lower odds of HPV detection (adjusted odds ratio, 0.50 [95% confidence interval, 0.30-0.83]). This association was stronger among men with >1 partner than among men with only 1 partner (P for interaction = .05). CONCLUSIONS: Consistent condom use was strongly associated with lower HPV prevalence in men. |
Obesity prevention and diabetes screening at local health departments
Zhang X , Luo H , Gregg EW , Mukhtar Q , Rivera M , Barker L , Albright A . Am J Public Health 2010 100 (8) 1434-41 OBJECTIVES: We assessed whether local health departments (LHDs) were conducting obesity prevention programs and diabetes screening programs, and we examined associations between LHD characteristics and whether they conducted these programs. METHODS: We used the 2005 National Profile of Local Health Departments to conduct a cross-sectional analysis of 2300 LHDs nationwide. We used multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Approximately 56% of LHDs had obesity prevention programs, 51% had diabetes screening programs, and 34% had both. After controlling for other factors, we found that employing health educators was significantly associated with LHDs conducting obesity prevention programs (OR=2.08; 95% CI=1.54, 2.81) and diabetes screening programs (OR=1.63; 95% CI=1.23, 2.17). We also found that conducting chronic disease surveillance was significantly associated with LHDs conducting obesity prevention programs (OR=1.66; 95% CI=1.26, 2.20) and diabetes screening programs (OR=2.44; 95% CI=1.90, 3.15). LHDs with a higher burden of diabetes prevalence were more likely to conduct diabetes screening programs (OR=1.20; 95% CI=1.11, 1.31) but not obesity prevention programs. CONCLUSIONS: The presence of obesity prevention and diabetes screening programs was significantly associated with LHD structural capacity and general performance. However, the effectiveness and cost-effectiveness of both types of programs remain unknown. |
Survival of bacteriophage MS2 on filtering facepiece respirator coupons
Fisher E , Shaffer R . Appl Biosaf 2010 15 (2) 71-76 The reuse of filtering facepiece respirators (FFRs) after decontamination has been suggested as a strategy to conserve supplies during an influenza pandemic. The feasibility of decontaminating FFRs has been investigated under laboratory conditions; however, the need for decontamination of FFRs is not well characterized. In this study the potential for FFRs to act as fomites was examined using bacteriophage MS2. Virus was applied to FFR coupons as an aerosol or liquid drops and stored at 22 degrees C and 30% relative humidity. Viability of the virus was monitored every 24 hours from 1 to 5 days with a final sampling occurring on day 10. At least 10% of the initial MS2 load was able to survive for 4 days on the FFR coupons regardless of the deposition method. All coupons contained detectable levels of MS2 on the tenth day. MS2 viability did not appear to be affected by the location of deposition within the layers of the coupon under the test conditions. The results indicate that FFRs have the potential to serve as a fomite. |
Hormone therapy and fatal breast cancer
Norman SA , Weber AL , Localio AR , Marchbanks PA , Ursin G , Strom BL , Weiss LK , Burkman RT , Bernstein L , Deapen DM , Folger SG , Simon MS , Nadel MR . Pharmacoepidemiol Drug Saf 2010 19 (5) 440-7 PURPOSE: Among unanswered questions is whether menopausal use of estrogen therapy (ET) or estrogen-plus-progestin therapy (CHT) increases risk of developing fatal breast cancer i.e., developing and dying of breast cancer. Using a population-based case-control design, we estimated incidence rate ratios of fatal breast cancer in postmenopausal hormone therapy (HT) users compared to non-users by type, duration, and recency of HT use. METHODS: HT use prior to breast cancer diagnosis in 278 women who died of breast cancer within 6 years of diagnosis (cases) was compared with use in 2224 controls never diagnosed with breast cancer using conditional logistic regression. Measures taken to address potential bias and confounding inherent in case-control studies included collecting and adjusting for detailed data on demographic and other factors potentially associated both with HT use and breast cancer. RESULTS: Fifty-six per cent of cases and 68% of controls reported HT use. Among current 3+ year HT users, odds ratios and 95% confidence intervals for death were 0.83 (0.50, 1.38) and 0.69 (0.44, 1.09), respectively, for exclusive use of CHT or of ET, and were 0.94 (0.59, 1.48) and 0.70 (0.45, 1.07) for any use of CHT or of ET regardless of other hormone use. CONCLUSION: Point estimates suggest no increased risk of fatal breast cancer with HT use, although 50% increases in risk in longer-term current CHT users cannot be ruled out. |
School policies and practices that improve indoor air quality
Everett Jones S , Smith AM , Wheeler LS , McManus T . J Sch Health 2010 80 (6) 280-6 BACKGROUND: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. METHODS: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of school health programs and policies at the state, district, and school levels. Using chi-square analyses, the rates of policies and practices that promote indoor air quality were compared between schools with and schools without a formal indoor air quality program. RESULTS: The findings of this study show that 51.4% of schools had a formal indoor air quality management program, and that those schools were significantly more likely than were schools without a program to have policies and use strategies to promote superior indoor air quality. CONCLUSIONS: These findings suggest that schools with a formal indoor air quality program are more likely support policies and engage in practices that promote superior indoor air quality. |
Source drinking water quality effects on chlorine disinfection of adenovirus, coxsackievirus, echovirus, and murine norovirus
Kahler AM , Cromeans TL , Roberts JM , Hill VR . Appl Environ Microbiol 2010 76 (15) 5159-64 More information is needed on the disinfection efficacy of chlorine for viruses in source drinking water. In this study, chlorine disinfection efficacy was investigated for USEPA Contaminant Candidate List viruses coxsackievirus B5 (CVB5), echovirus 1 (E1), murine norovirus (MNV), and human adenovirus 2 (HAdV2) in one untreated ground water source and two partially treated surface waters. Disinfection experiments using pH 7 and 8 source water were carried out in duplicate using 0.2 and 1 mg/L free chlorine at 5 and 15 degrees C. The efficiency factor Hom (EFH) model was used to calculate CT values (mg-min/L) required to achieve 2-, 3-, and 4-log10 reductions in viral titers. In all water types, chlorine disinfection was most effective for MNV, with 3-log10 CT values at 5 degrees C ranging from ≤ 0.020-0.034. Chlorine disinfection was least effective for CVB5 in all water types, with 3-log10 CT values at 5 degrees C ranging from 2.3-7.9. Overall, disinfection proceeded faster at 15 degrees C and pH 7 for all water types. Inactivation of the study viruses was significantly different between water types, but no single source water had consistently different inactivation rates than another. CT values for CVB5 in one type of source water exceeded the recommended CT values set forth by USEPA's Guidance Manual for Compliance with the Filtration and Disinfection Requirements for Public Water Systems Using Surface Water Sources. The results of this study demonstrate that water quality plays a substantial role in the inactivation of viruses and should be considered when developing chlorination plans. |
A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability
Allen JD , Coronado GD , Williams RS , Glenn B , Escoffery C , Fernandez M , Tuff RA , Wilson KM , Mullen PD . Vaccine 2010 28 (24) 4027-37 BACKGROUND: The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use. METHODS: A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies. RESULTS: The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one's daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework. CONCLUSIONS: Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions. |
The two faces of Hepatitis E virus
Teshale EH , Hu DJ , Holmberg SD . Clin Infect Dis 2010 51 (3) 328-34 Hepatitis E virus (HEV) has at least 2 distinct epidemiological profiles: (1) large outbreaks and epidemics in developing countries, usually caused by HEV genotype 1, resulting in high morbidity and mortality among pregnant women and young children, and (2) very few symptomatic cases of HEV genotype 3, most cases without symptoms or clear source(s) of infection, but frequent seroreactivity in 5%-21% of asymptomatic persons in developed countries. We urge more epidemiological studies and public health interventions, including the promotion and development of existing and future vaccine candidates and the availability of US Food and Drug Administration-approved serological assays for this underappreciated and poorly understood virus, a major cause of disease throughout the world. |
Perinatal Periods of Risk: analytic preparation and phase 1 analytic methods for investigating feto-infant mortality
Sappenfield WM , Peck MG , Gilbert CS , Haynatzka VR , Bryant T3rd . Matern Child Health J 2010 14 (6) 838-50 The Perinatal Periods of Risk (PPOR) methods provide the necessary framework and tools for large urban communities to investigate feto-infant mortality problems. Adapted from the Periods of Risk model developed by Dr. Brian McCarthy, the six-stage PPOR approach includes epidemiologic methods to be used in conjunction with community planning processes. Stage 2 of the PPOR approach has three major analytic parts: Analytic Preparation, which involves acquiring, preparing, and assessing vital records files; Phase 1 Analysis, which identifies local opportunity gaps; and Phase 2 Analyses, which investigate the opportunity gaps to determine likely causes of feto-infant mortality and to suggest appropriate actions. This article describes the first two analytic parts of PPOR, including methods, innovative aspects, rationale, limitations, and a community example. In Analytic Preparation, study files are acquired and prepared and data quality is assessed. In Phase 1 Analysis, feto-infant mortality is estimated for four distinct perinatal risk periods defined by both birthweight and age at death. These mutually exclusive risk periods are labeled Maternal Health and Prematurity, Maternal Care, Newborn Care, and Infant Health to suggest primary areas of prevention. Disparities within the study community are identified by comparing geographic areas, subpopulations, and time periods. Excess mortality numbers and rates are estimated by comparing the study population to an optimal reference population. This excess mortality is described as the opportunity gap because it indicates where communities have the potential to make improvement. |
Perinatal Periods of Risk: phase 2 analytic methods for further investigating feto-infant mortality
Sappenfield WM , Peck MG , Gilbert CS , Haynatzka VR , Bryant T3rd . Matern Child Health J 2010 14 (6) 851-63 The perinatal periods of risk (PPOR) methods provide a framework and tools to guide large urban communities in investigating their feto-infant mortality problem. The PPOR methods have 11 defined steps divided into three analytic parts: (1) Analytic Preparation; (2) Phase 1 Analysis-identifying the opportunity gaps or populations and risk periods with largest excess mortality; and (3) Phase 2 Analyses-investigating these opportunity gaps. This article focuses on the Phase 2 analytic methods, which systematically investigate the opportunity gaps to discover which risk and preventive factors are likely to have the largest effect on improving a community's feto-infant mortality rate and to provide additional information to better direct community prevention planning. This article describes the last three PPOR epidemiologic steps for investigating identified opportunity gaps: identifying the mechanism for excess mortality; estimating the prevalence of risk and preventive factors; and estimating the impact of these factors. While the three steps provide a common strategy, the specific analytic details are tailored for each of the four perinatal risk periods. This article describes the importance, prerequisites, alternative approaches, and challenges of the Phase 2 methods. Community examples of the methods also are provided. |
Evaluation of a records-review surveillance system used to determine the prevalence of autism spectrum disorders
Avchen RN , Wiggins LD , Devine O , Van Naarden Braun K , Rice C , Hobson NC , Schendel D , Yeargin-Allsopp M . J Autism Dev Disord 2010 41 (2) 227-36 We conducted the first study that estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a population-based autism spectrum disorders (ASD) surveillance system developed at the Centers for Disease Control and Prevention. The system employs a records-review methodology that yields ASD classification (case versus non-ASD case) and was compared with classification based on clinical examination. The study enrolled 177 children. Estimated specificity (0.96, [CI(.95) = 0.94, 0.99]), PPV (0.79 [CI(.95) = 0.66, 0.93]), and NPV (0.91 [CI(.95) = 0.87, 0.96]) were high. Sensitivity was lower (0.60 [CI(.95) = 0.45, 0.75]). Given diagnostic heterogeneity, and the broad array of ASD in the population, identifying children with ASD is challenging. Records-based surveillance yields a population-based estimate of ASD that is likely conservative. |
Microprocessor of microRNAs: regulation and potential for therapeutic intervention
Beezhold KJ , Castranova V , Chen F . Mol Cancer 2010 9 134 MicroRNAs (miRNAs) are a class of small, noncoding RNAs critically involved in a wide spectrum of normal and pathological processes of cells or tissues by fine-tuning the signals important for stem cell development, cell differentiation, cell cycle regulation, apoptosis, and transformation. Considerable progress has been made in the past few years in understanding the transcription, biogenesis and functional regulation of miRNAs. Numerous studies have implicated altered expression of miRNAs in human cancers, suggesting that aberrant expression of miRNAs is one of the hallmarks for carcinogenesis. In this review, we briefly discuss most recent discoveries on the regulation of miRNAs at the level of microprocessor-mediated biogenesis of miRNAs. |
Physical activity and electronic media use in the SEARCH for diabetes in youth case-control study
Lobelo F , Liese AD , Liu J , Mayer-Davis EJ , D'Agostino RBJr , Pate RR , Hamman RF , Dabelea D . Pediatrics 2010 125 (6) e1364-71 OBJECTIVE: The aim of this study was to characterize the physical activity (PA) and electronic media (EM) use habits of a population-based, ascertained sample of youths with diabetes mellitus (DM). METHODS: For this investigation, the Search for Diabetes in Youth Case-Control study (age: 10-20 y; 55% female) recruited 384 youths with provider-diagnosed type 1 DM, 90 youths with type 2 DM, and 173 healthy control subjects between 2003 and 2006, in 2 US centers. PA and EM use were assessed with a 3-day recall of activities, in 30-minute time blocks. Adherence to current recommendations was determined as a report of > or = 2 blocks of moderate/vigorous PA per day and <4 blocks of EM use per day. Differences in PA and EM use for DM/control groups were assessed with adjustment for age, study site, and race/ethnicity. RESULTS: Male subjects with type 2 DM reported lower levels of vigorous PA than did control subjects (1.1 vs 2.3 blocks; P < .05). Compliance with the moderate/vigorous PA recommendation among youths with type 2 DM was lower (68.3%), compared with youths with type 1 DM (81.7%; odds ratio: 0.51 [95% confidence interval: 0.26-1.00]; P = .047) and control subjects (80.4%; odds ratio: 0.48 [95% confidence interval: 0.23-1.02]; P = .05). Rates of compliance with EM use recommendations ranged from 29.5% to 49.1%. CONCLUSION: In this study, large proportions of youths with DM, especially type 2 DM, failed to meet PA and EM use recommendations. |
Health information-seeking behaviors, health indicators, and health risks
Weaver JB , Mays D , Weaver SS , Hopkins GL , Eroglu D , Bernhardt JM . Am J Public Health 2010 100 (8) 1520-5 OBJECTIVES: We examined how different types of health information-seeking behaviors (HISBs)-no use, illness information only, wellness information only, and illness and wellness information combined-are associated with health risk factors and health indicators to determine possible motives for health information seeking. METHODS: A sample of 559 Seattle-Tacoma area adults completed an Internet-based survey in summer 2006. The survey assessed types of HISB, physical and mental health indicators, health risks, and several covariates. Covariate-adjusted linear and logistic regression models were computed. RESULTS: Almost half (49.4%) of the sample reported HISBs. Most HISBs (40.6%) involved seeking a combination of illness and wellness information, but both illness-only (28.6%) and wellness-only (30.8%) HISBs were also widespread. Wellness-only information seekers reported the most positive health assessments and the lowest occurrence of health risk factors. An opposite pattern emerged for illness-only information seekers. CONCLUSIONS: Our findings reveal a unique pattern of linkages between the type of health information sought (wellness, illness, and so on) and health self-assessment among adult Internet users in western Washington State. These associations suggest that distinct health motives may underlie HISB, a phenomenon frequently overlooked in previous research. |
Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings
Kallen AJ , Patel PR , O'Grady NP . Clin Infect Dis 2010 51 (3) 335-41 With the growing recognition of the preventability of catheter-related bloodstream infections (CRBSIs), reducing the number of CRBSIs acquired in health care facilities has become an important patient safety goal. To date, most prevention efforts have been conducted in intensive care units (ICUs); however, many central venous catheters (CVCs) are found outside the ICU, and rates of catheter-associated bloodstream infections in these settings appear to be similar to rates of these infections in ICUs. CVCs are also used in patients who primarily receive their care as outpatients, including those requiring hemodialysis, undergoing treatment for malignancies, and receiving parenteral nutrition. In some of these patients, CVCs might be used for extended periods, prolonging the patient's time at risk for CRBSIs and highlighting the potential need to look beyond insertion-based interventions to prevent infections. To meet the goal of reducing the number of all CRBSIs associated with health care, further attention on CRBSIs occurring outside the ICU is needed; however, this effort will require a better understanding of the epidemiology and prevention of these infections. |
Multiple vaccinations and the risk of medically attended fever
Lin ND , Kleinman K , Chan KA , Soumerai S , Mehta J , Mullooly JP , Shay DK , Kolczak M , Lieu TA . Vaccine 2010 28 (25) 4169-74 Recent increases in the number of vaccinations recommended for infants have triggered concerns about the safety of multiple vaccinations. This study evaluated rates of medically attended fever after infant vaccination using computerized data from 1991 to 2000 from two large U.S. provider groups. The rate of medically attended fever within 7 days after vaccination was low (6.4 per 1000 vaccination visits) and did not increase during the decade. Higher rates of fever occurred during periods when a third dose of oral polio vaccine was used (1994-1995) and when a now-discontinued oral rotavirus vaccine was used (1998-1999). These findings offer reassurance that the multiple vaccinations introduced during the decade studied were not associated with increases in medically attended fever. |
Increases in levels of schistosome-specific immunoglobulin E and CD23(+) B cells in a cohort of Kenyan children undergoing repeated treatment and reinfection with Schistosoma mansoni
Black CL , Muok EM , Mwinzi PN , Carter JM , Karanja DM , Secor WE , Colley DG . J Infect Dis 2010 202 (3) 399-405 BACKGROUND: Age prevalence curves for areas in which schistosomiasis is endemic suggest that humans develop partial immunity to reinfection beginning in early adolescence. We conducted a 2-year longitudinal study to determine whether children infected with Schistosoma mansoni develop protection-related immune responses after treatment with praziquantel and whether the development of these immune responses is accelerated by frequent treatment after reinfection. METHODS: Children (8-10 years old) were tested for S. mansoni every 4 months and treated with praziquantel when positive (arm A; [Formula: see text]) or were tested and treated at the end of the 2-year follow-up period (arm B; [Formula: see text]). RESULTS: Children in arm A who remained free of infection during follow-up had significantly higher baseline levels of schistosome-specific immunoglobulin E (IgE) than did children with 2 repeat diagnoses of S. mansoni infection. Children with 2 repeat diagnoses of S. mansoni infection had significantly increased levels of anti-schistosome IgE and CD23(+) B cells after receiving 3 praziquantel treatments over the course of follow-up. No increase in either parameter was seen in children who received only the baseline praziquantel treatment. CONCLUSIONS: B cell activation and anti-schistosome IgE are associated with resistance to S. mansoni in children, and these immunological parameters can be increased by multiple rounds of infections and praziquantel-induced cures. |
It wouldn't hurt to walk: promoting pedestrian injury research
Sleet DA , Pollack K , Rivara F , Frattaroli S , Peek-Asa C . Inj Prev 2010 16 (3) 211-2 In 2009, the Centers for Disease Control (CDC) National Center for Injury Prevention and Control (NCIPC) developed a comprehensive research agenda that described the research needs and priorities for 2009–18.1 The research priorities were identified as those that warrant the greatest attention and intramural and extramural resources from the NCIPC during the next 10 years. For all priorities in the research agenda, special attention was given to vulnerable populations who experience disparate, increased injury risks. Pedestrian safety was identified as a priority area because pedestrians are a vulnerable population, the burden of pedestrian injuries is large (40 000 pedestrians killed in the United States since 2000), and there is a need to develop and implement effective interventions. SAVIR and CDC have been working together to identify strategies to promote the research agenda and identify resources that could be used to help fund the research priorities. Pedestrian injuries have been identified as a focus area for this partnership with the Division of Unintentional Injury Prevention at CDC. |
Receptor specificity and transmission of H2N2 subtype viruses isolated from the pandemic of 1957
Pappas C , Viswanathan K , Chandrasekaran A , Raman R , Katz JM , Sasisekharan R , Tumpey TM . PLoS One 2010 5 (6) e11158 Influenza viruses of the H2N2 subtype have not circulated among humans in over 40 years. The occasional isolation of avian H2 strains from swine and avian species coupled with waning population immunity to H2 hemagglutinin (HA) warrants investigation of this subtype due to its pandemic potential. In this study we examined the transmissibility of representative human H2N2 viruses, A/Albany/6/58 (Alb/58) and A/El Salvador/2/57 (ElSalv/57), isolated during the 1957/58 pandemic, in the ferret model. The receptor binding properties of these H2N2 viruses was analyzed using dose-dependent direct glycan array-binding assays. Alb/58 virus, which contains the 226L/228S amino acid combination in the HA and displayed dual binding to both alpha 2,6 and alpha 2,3 glycan receptors, transmitted efficiently to naive ferrets by respiratory droplets. Inefficient transmission was observed with ElSalv/57 virus, which contains the 226Q/228G amino acid combination and preferentially binds alpha 2,3 over alpha 2,6 glycan receptors. However, a unique transmission event with the ElSalv/57 virus occurred which produced a 226L/228G H2N2 natural variant virus that displayed an increase in binding specificity to alpha 2,6 glycan receptors and enhanced respiratory droplet transmissibility. Our studies provide a correlation between binding affinity to glycan receptors with terminal alpha 2,6-linked sialic acid and the efficiency of respiratory droplet transmission for pandemic H2N2 influenza viruses. |
Seven direct methods for measuring HDL and LDL cholesterol compared with ultracentrifugation reference measurement procedures
Miller WG , Myers GL , Sakurabayashi I , Bachmann LM , Caudill SP , Dziekonski A , Edwards S , Kimberly MM , Korzun WJ , Leary ET , Nakajima K , Nakamura M , Nilsson G , Shamburek RD , Vetrovec GW , Warnick GR , Remaley AT . Clin Chem 2010 56 (6) 977-86 BACKGROUND: Methods from 7 manufacturers and 1 distributor for directly measuring HDL cholesterol (C) and LDL-C were evaluated for imprecision, trueness, total error, and specificity in nonfrozen serum samples. METHODS: We performed each direct method according to the manufacturer's instructions, using a Roche/Hitachi 917 analyzer, and compared the results with those obtained with reference measurement procedures for HDL-C and LDL-C. Imprecision was estimated for 35 runs performed with frozen pooled serum specimens and triplicate measurements on each individual sample. Sera from 37 individuals without disease and 138 with disease (primarily dyslipidemic and cardiovascular) were measured by each method. Trueness and total error were evaluated from the difference between the direct methods and reference measurement procedures. Specificity was evaluated from the dispersion in differences observed. RESULTS: Imprecision data based on 4 frozen serum pools showed total CVs <3.7% for HDL-C and <4.4% for LDL-C. Bias for the nondiseased group ranged from -5.4% to 4.8% for HDL-C and from -6.8% to 1.1% for LDL-C, and for the diseased group from -8.6% to 8.8% for HDL-C and from -11.8% to 4.1% for LDL-C. Total error for the nondiseased group ranged from -13.4% to 13.6% for HDL-C and from -13.3% to 13.5% for LDL-C, and for the diseased group from -19.8% to 36.3% for HDL-C and from -26.6% to 31.9% for LDL-C. CONCLUSIONS: Six of 8 HDL-C and 5 of 8 LDL-C direct methods met the National Cholesterol Education Program total error goals for nondiseased individuals. All the methods failed to meet these goals for diseased individuals, however, because of lack of specificity toward abnormal lipoproteins. |
TLR-2 independent recognition of Mycobacterium tuberculosis by CD11c(+) pulmonary cells from old mice
Rottinghaus EK , Vesosky B , Turner J . Mech Ageing Dev 2010 131 (6) 405-14 The elderly are particularly susceptible to infectious diseases such as influenza, bacterial pneumonia, and tuberculosis. Current vaccines are only partially protective in old age, which makes the elderly a critical target group for the development of new vaccine strategies. The recognition of pathogens via toll like receptors (TLR) and the subsequent generation of pro-inflammatory cytokines has generated interest in incorporating TLR agonists into new vaccines to enhance immunogenicity. However, TLR function is reportedly decreased in old age, leading to questions regarding the benefit of including TLR agonists into vaccines for the elderly. It is critical that we understand the function and role of TLRs in aged hosts prior to approving new TLR based adjuvants for vaccines that will be delivered to the elderly. In this study we determine the contribution of TLRs on pulmonary macrophages from old mice to recognize and respond to infection with the virulent pathogen Mycobacterium tuberculosis (M. tb). Although pulmonary (CD11c(+)) cells from old mice were fully capable of producing cytokines in response to M. tb infection, we demonstrate that in contrast to young mice, M. tb induced cytokine production occurred independently of TLR-2. Our data indicate that the inclusion of TLR-2 agonists into new vaccines may not be fully effective in the elderly population. Investigation into such age-related differences in TLR function is of critical importance for the design of effective vaccines that will protect the elderly against infectious diseases. |
Monoclonal antibodies against toluene diisocyanate haptenated proteins from vapor-exposed mice
Ruwona TB , Johnson VJ , Schmechel D , Simoyi RH , Beezhold D , Siegel PD . Hybridoma (Larchmt) 2010 29 (3) 221-9 Toluene diisocyanate (TDI) is an industrially important polymer cross-linker used in the production of polyurethane. Workplace exposure to TDI and other diisocyanates is reported to be a leading cause of low molecular weight-induced occupational asthma (OA). Currently we have a limited understanding of the pathogenesis of OA. Monoclonal antibodies (MAbs) that recognize TDI bound proteins would be valuable tools/reagents, both in exposure monitoring and in TDI-induced asthma research. We sought to develop toluene diisocyanate (TDI)-specific MAbs for potential use in the development of standardized immunoassays for exposure and biomarker assessments. Mice were exposed 4 h/day for 12 consecutive weekdays to 50 ppb, 2,4;2,6 TDI vapor (80/20 mixture). Splenocytes were isolated 24 h after the last exposure for hybridoma production. Hybridomas were screened in a solid-phase indirect enzyme-linked immunosorbent assay (ELISA) against a 2,4 TDI-human serum albumin (2,4 TDI-HSA) protein conjugate. Three hybridomas producing 2,4 TDI-HSA reactive IgM MAbs were obtained. The properties of these MAbs (isotype and reactivity to various protein-isocyanate conjugate epitopes) were characterized using ELISA, dot blot, and Western blot analyses. Western blot analyses demonstrated that some TDI conjugates form inter- and intra-molecular links, resulting in multimers and a change in the electrophoretic mobility of the conjugate. These antibodies may be useful tools for the isolation of endogenous diisocyanate-modified proteins after natural or experimental exposures and for characterization of the toxicity of specific dNCOs. |
Enrichment culture and molecular identification of diverse Bartonella species in stray dogs
Bai Y , Kosoy MY , Boonmar S , Sawatwong P , Sangmaneedet S , Peruski LF . Vet Microbiol 2010 146 314-9 Using pre-enrichment culture in Bartonella alpha-Proteobacteria growth medium (BAPGM) followed by PCR amplification and DNA sequence identification that targeted a fragment of the citrate synthase gene (gltA), we provide evidence of common bartonella infections and diverse Bartonella species in the blood of stray dogs from Bangkok and Khon Kaen, Thailand. The overall prevalence of all Bartonella species was 31.3% (60/192), with 27.9% (31/111) and 35.8% (29/81) in the stray dogs from Bangkok and Khon Kaen, respectively. Phylogenetic analyzes of gltA identified eight species/genotypes of Bartonella in the blood of stray dogs, including B. vinsonii subsp. arupensis, B. elizabethae, B. grahamii, B. quintana, B. taylorii, and three novel genotypes (BK1, KK1 and KK2) possibly representing unique species with ≤90.2% similarities to any of the known Bartonella species B. vinsonii subsp. arupensis was the only species detected in dogs from both sites, B. quintana and BK1 were found in the dogs from Bangkok, B. elizabethae, B. taylorii, KK1 and KK2 were found in the dogs from Khon Kaen. We conclude that stray dogs in Thailand are frequently infected with Bartonella species that vary with geographic region. As some Bartonella species detected in the present study are considered pathogenic for humans, stray dogs in Thailand may serve as possible reservoirs for Bartonella causing human illnesses. Further work is needed to determine the role of those newly discovered Bartonella genotypes/species in human and veterinary medicine. |
Gamma/delta T cells promote the maturation of dendritic cells during West Nile virus infection
Fang H , Welte T , Zheng X , Chang GJ , Holbrook MR , Soong L , Wang T . FEMS Immunol Med Microbiol 2010 59 (1) 71-80 Gamma/delta T cells are important for the early control of West Nile virus (WNV) dissemination. Here, we investigated the role of gamma/delta T cells in the regulation of CD4(+) T-cell response following a WNV challenge. Splenic dendritic cells (DCs) of WNV-infected gamma/delta T-cell-deficient (TCRdelta(-/-)) mice displayed lower levels of CD40, CD80, CD86 and major histocompatibility complex (MHC) class II expression and interleukin-12 (IL-12) production than those of wild-type mice. Naive DCs cocultured with WNV-infected gamma/delta T cells showed enhanced levels of costimulatory molecules, MHC class II expression and IL-12 production. Further, coculture of CD4(+) T cells from OT II transgenic mice with DCs of WNV-infected TCRdelta(-/-) mice induced less interferon-gamma (IFN-gamma) and IL-2 production than with those of wild-type controls. Viral antigens were detected in WNV-infected gamma/delta T cells.WNV infection or toll-like receptor (TLR) agonist treatment of gamma/delta T cells induced the production of IFN-gamma, tumor necrosis factor-alpha and IL-6, which are known to promote DC maturation. Nevertheless, the levels of TLRs 2, 3, 4 and 7 expression of WNV-infected gamma/delta T cells were not different from those of noninfected cells. Overall, these data suggest that WNV-induced gamma/delta T-cell activation promotes DC maturation and initiates CD4(+) T-cell priming. |
5'PPP-RNA induced RIG-I activation inhibits drug-resistant avian H5N1 as well as 1918 and 2009 pandemic influenza virus replication
Ranjan P , Jayashankar L , Deyde V , Zeng H , Davis WG , Pearce MB , Bowzard JB , Hoelscher MA , Jeisy-Scott V , Wiens ME , Gangappa S , Gubareva L , Garcia-Sastre A , Katz JM , Tumpey TM , Fujita T , Sambhara S . Virol J 2010 7 (1) 102 BACKGROUND: Emergence of drug-resistant strains of influenza viruses, including avian H5N1 with pandemic potential, 1918 and 2009 A/H1N1 pandemic viruses to currently used antiviral agents, neuraminidase inhibitors and M2 Ion channel blockers, underscores the importance of developing novel antiviral strategies. Activation of innate immune pathogen sensor Retinoic Acid Inducible Gene-I (RIG-I) has recently been shown to induce antiviral state. RESULTS: In the present investigation, using real time RT-PCR, immunofluorescence, immunoblot, and plaque assay we show that 5'PPP-containing single stranded RNA (5PPP-RNA), a ligand for the intracytoplasmic RNA sensor, RIG-I can be used as a prophylactic agent against known drug-resistant avian H5N1 and pandemic influenza viruses. 5'PPP-RNA treatment of human lung epithelial cells inhibited replication of drug-resistant avian H5N1 as well as 1918 and 2009 pandemic influenza viruses in a RIG-I and type 1 interferon dependant manner. Additionally, 5'PPP-RNA treatment also inhibited 2009 H1N1 viral replication in vivo in mice. CONCLUSIONS: Our findings suggest that 5PPP-RNA mediated activation of RIG-I can suppress replication of influenza viruses irrespective of their genetic make-up, pathogenicity, and drug-sensitivity status. |
Astrovirus encephalitis in boy with X-linked agammaglobulinemia
Quan PL , Wagner TA , Briese T , Torgerson TR , Hornig M , Tashmukhamedova A , Firth C , Palacios G , Baisre-De-Leon A , Paddock CD , Hutchison SK , Egholm M , Zaki SR , Goldman JE , Ochs HD , Lipkin WI . Emerg Infect Dis 2010 16 (6) 918-25 Encephalitis is a major cause of death worldwide. Although >100 pathogens have been identified as causative agents, the pathogen is not determined for up to 75% of cases. This diagnostic failure impedes effective treatment and underscores the need for better tools and new approaches for detecting novel pathogens or determining new manifestations of known pathogens. Although astroviruses are commonly associated with gastroenteritis, they have not been associated with central nervous system disease. Using unbiased pyrosequencing, we detected an astrovirus as the causative agent for encephalitis in a 15-year-old boy with agammaglobulinemia; several laboratories had failed to identify the agent. Our findings expand the spectrum of causative agents associated with encephalitis and highlight unbiased molecular technology as a valuable tool for differential diagnosis of unexplained disease. |
Sociodemographic and dietary risk factors for natural infant intussusception in the United States
Johnson B , Gargiullo P , Murphy TV , Parashar UD , Patel MM . J Pediatr Gastroenterol Nutr 2010 51 (4) 458-63 BACKGROUND: In 1999, a US case-control study demonstrated a strong association between intussusception and a rotavirus vaccine (Rotashield). However, because most (87%) cases were not temporally associated with vaccination, we reanalyzed these data to assess risk factors for intussusception cases unrelated to Rotashield. PATIENTS AND METHODS: Case-patients were infants with intussusception between November 1998 and June 1999. Controls were matched by age and hospital of birth. Sociodemographic and feeding practice data were collected through parent and provider interviews. Conditional logistic regression was used to identify risk factors for intussusception, controlling for exposure to Rotashield <21 days before intussusception. RESULTS: Four hundred twenty-nine cases and 1763 controls were enrolled. Among case-patients, 372 (87%) had not received Rotashield within 21 days before intussusception. After adjusting for recent Rotashield administration, factors associated with intussusception included male sex (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.3-2.2), Hispanic (OR 2.1; 95% CI 1.4-3.2) or black (OR 1.8; 95% CI 1.2-2.7) race/ethnicity, and Medicaid enrollment (OR 1.5; 95% CI 1.1-2.0). Feeding practices modified the risk of intussusception. Interaction was found between introduction of solid food (ISF) and type of formula consumption. Using breast milk as the referent group, infants with ISF for at least 5 weeks who consumed soy milk-based formula had a lower risk (OR 0.26; 95% CI 0.1-0.7) and infants without ISF who consumed cow's milk formula had an increased risk (OR 2.33; 95% CI 1.4-3.9). CONCLUSIONS: Risk of intussusception among US infants varies based on sociodemographic characteristics and feeding patterns. |
Parents' death and survival of their children
Yusuf HR , Atrash HK . Lancet 2010 375 (9730) 1944-6 For many years, maternal mortality has been considered to be one of the leading public health problems facing health-care systems in developing countries. Global efforts to address this problem started with the Safe Motherhood Initiative in 1987; the problem was further highlighted during the 1994 International Conference on Population and Development, and most recently when reduction of maternal mortality was identified as one of the eight Millennium Development Goals (MDG 5).1, 2, 3, 4 In response to these initiatives, many countries started programmes to reduce maternal mortality, and it seems that some of these efforts are starting to show successes. A recent study estimated that about 342 000 maternal deaths occurred worldwide compared with the previous estimate of 526 000 maternal deaths in 1980.5 Despite this important progress, the challenge continues: the disparity in maternal mortality rates between developed and developing countries is higher than that of any other health outcome. The range is from fewer than ten deaths per 100 000 livebirths in most European countries to more than 500 deaths per 100 000 livebirths in many African countries. It is estimated that more than 50% of maternal deaths occur in six countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo. Moreover, most maternal deaths are preventable, with 73% of deaths attributed to haemorrhage, sepsis, eclampsia, unsafe abortion, and obstructed labour.6 |
Exposure to antibiotics in a United States-Mexico border birth cohort
Broussard CS , Goodman KJ , Nurgalieva ZZ , Fischbach LA , Gold BD . Pediatrics 2010 125 (6) e1468-74 OBJECTIVE: The goal was to compare the frequency of children's antibiotic intake, emphasizing antibiotics with anti-Helicobacter pylori effects, in El Paso, Texas, and Juarez, Mexico. METHODS: Hispanic children were enrolled prenatally at mother-child clinics in El Paso, and Juarez, in 1998-2000, to identify determinants of H pylori infection. During follow-up examinations targeted every 6 months from 6 to 84 months of age, caretakers reported medication use during the preceding interval. Courses of any systemic and H pylori-effective antibiotics were compared for US and Mexican children. RESULTS: Antibiotic data were available for 602 children, from 2938 follow-up visits. Overall antibiotic intake was higher in Juarez, where 84% of children received > or = 1 course during the follow-up period (52% of visits), compared with El Paso, where 76% of children received > or = 1 course (40% of visits). In contrast, the intake of H pylori-effective antibiotics was higher in El Paso, where 65% of children received > or = 1 course during the follow-up period (27% of visits), compared with Juarez, where 44% of children received > or = 1 course (16% of visits). Of H pylori-effective courses, 94% contained amoxicillin and 2% each clarithromycin, metronidazole, and furazolidone; uses were primarily for throat and ear infections, diarrhea, and cold/flu. CONCLUSIONS: Pediatric antibiotic use was higher in Mexico than on the US side of the border. Apparent misuse of H pylori-effective antibiotics was more frequent in Juarez but also occurred in El Paso. Such misuse of antibiotics may lead to drug resistance and may impair the control of H pylori infection in this region. |
Group B streptococcal disease in infants: progress in prevention and continued challenges
Verani JR , Schrag SJ . Clin Perinatol 2010 37 (2) 375-92 The burden of early-onset disease caused by group B Streptococcus (GBS) has decreased dramatically in the United States over the past 20 years. Universal culture-based screening at 35 to 37 weeks gestational age and use of intrapartum antibiotic prophylaxis are the cornerstones of prevention measures that have led to this decline. GBS, however, remains the leading cause of early-onset neonatal sepsis in the United States. Revised guidelines for prevention of perinatal GBS are planned for issuance in 2010. This article discusses implementation challenges for clinicians caring for pregnant women and newborns and presents an updated algorithm for neonatal management. |
BirthStats: percentage of preterm births, United States and selected European countries, 2004
MacDorman MF , Mathews TJ . Birth 2010 37 (2) 168 Compared with 18 European countries, as shown in the graph below, the United States had the highest percentage of preterm births (12.4%) in 2004 (1). Except for Austria (11.4%), the other countries had levels of 8.9 percent or less. Ireland had the lowest percentage (5.5%) followed by Finland (5.6%), Greece (6.0%), and Sweden and France (6.3%). In other words, 1 of every 8 U.S. babies were born preterm in 2004, compared with 1 of 16 in Sweden and France, 1 of 17 in Greece, and 1 of 18 in Ireland and Finland. Because preterm babies are at greater risk of death than term babies, countries with a higher percentage of preterm births tend to have higher infant mortality rates. European data are from the European Perinatal Health Report (2), whereas data for the United States are from the linked birth/infant death data set (3). Births at less than 22 weeks of gestation were excluded to promote comparability between countries (1,2). |
Safety climate: new developments in conceptualization, theory, and research
Huang YH , Chen PY , Grosch JW . Accid Anal Prev 2010 42 (5) 1421-2 Although the important role of safety climate in safety outcomes has been established and many studies have been done by scholars in different disciplines and across different cultures, there are still gaps in the literature. The articles in this Special Issue explore the topics of new developments in the conceptualization of safety climate and occupational/industry-focused studies of safety climate, with the goal of identifying different challenges and findings that arise within or across various occupations or industries. We are pleased to have a closing article by Dr. Dov Zohar on "Thirty Years of Safety Climate Research: Reflections and Future Directions." |
Metabolic syndrome and salivary cortisol: is there dysregulation among a group of active duty urban police officers?
Austin-Ketch TL , Violanti J , Fekedulegn D , Andrew ME , Burchfiel C , Hartley T , Vena JE . Diabetes Metab Syndr 2010 4 (2) 82-88 OBJECTIVE: Examine metabolic syndrome risk and cortisol patterns in an actively employed group of urban police officers. METHODS: A total of 102 actively employed Upstate New York police officers were randomly selected. Metabolic syndrome risk factor determinations were obtained during a scheduled clinic visit and salivary cortisol measures were subsequently obtained over the next 24 h. RESULTS: 24% of male police officers demonstrated metabolic syndrome as defined by the National Cholesterol Education Program guidelines. Only one female officer met the criteria for metabolic syndrome; however, she declined to participate in the cortisol portion of the study. Among male officers were the most prevalent risk factors, while female officers most often exhibited as the most commonly identified risk factors. The various cortisol measures produced mixed results. Area under the curve cortisol did demonstrate moderate dysregulation. CONCLUSION: Cortisol dysregulation is evident among the male officers with metabolic syndrome who participated in the study. Of interest among those officers with only two syndrome characteristics, dysregulation of awakening area under the curve cortisol measures was also apparent. Continued monitoring of the officer population for manifest diabetic and cardiovascular disease should be undertaken. |
Pulmonary toxicity and extrapulmonary tissue distribution of metals after repeated exposure to different welding fumes
Antonini JM , Roberts JR , Chapman RS , Soukup JM , Ghio AJ , Sriram K . Inhal Toxicol 2010 22 (10) 805-16 Welders are exposed to fumes with different metal profiles. The goals of this study were to compare lung responses in rats after treatment with chemically different welding fumes and to examine the extrapulmonary fate of metals after deposition in the lungs. Rats were treated by intratracheal instillation (0.5 mg/rat, once a week for 7 weeks) with gas metal arc-mild steel (GMAW-MS) or manual metal arc-hardsurfacing (MMAW-HS) welding fumes. Controls were treated with saline. At 1, 4, 35, and 105 days after the last treatment, lung injury and inflammation were measured, and elemental analysis of different organs was determined to assess metal clearance. The MMAW-HS fume was highly water-soluble and chemically more complex with higher levels of soluble Mn and Cr compared to the GMAW-MS fume. Treatments with the GMAW-MS fume had no effect on toxicity when compared with controls. The MMAW-HS fume induced significant lung damage early after treatment that remained elevated until 35 days. Metals associated with each fume sample was cleared at different rates from the lungs. Mn was cleared from the lungs at a faster rate and to a greater extent compared to the other metals over the 105-day recovery period. Mn and Cr in the MMAW-HS fume translocated from the respiratory tract and deposited in other organs. Importantly, increased deposition of Mn, but not other metals, was observed in discrete brain regions, including dopamine-rich areas (e.g., striatum and midbrain). |
Eleven years of occupational mortality in law enforcement: the census of fatal occupational injuries, 1992-2002
Tiesman HM , Hendricks SA , Bell JL , Amandus HA . Am J Ind Med 2010 53 (9) 940-9 BACKGROUND: Occupational injury deaths remain high for Law Enforcement Officers (LEOs). This study describes and compares intentional and transportation-related fatality rates in US LEOs between 1992 and 2002. METHODS: Workplace injury deaths among LEOs from 1992 to 2002 were categorized into "Intentional," "Transportation-related," and "Other," using the Census of Fatal Occupational Injuries. Occupations included in this analysis were sheriffs and bailiffs, police and detectives, non-public service guards, and correctional officers. Fatality rates were compared among law enforcement occupations, cause of death, and demographics with rate ratios and 95% confidence intervals. RESULTS: During the 11-year period, 2,280 workers died from an occupational injury, for a fatality rate of 11.8 per 100,000 across all LEO occupations. Forty-seven percent were homicides (n = 1,072, rate 5.6 per 100,000), 36% transportation-related (n = 815, rate 4.2 per 100,000), 11% were due to other causes (n = 249, rate 1.3 per 100,000), and 5% were workplace suicides (n = 122, rate 0.6 per 100,000). The proportion of fatalities by cause of death differed significantly between occupations (P < 0.0001). Sheriffs and bailiffs experience a high risk for occupational injury death compared to other law enforcement occupations. Of the transportation-related fatalities, LEOs were operating a motor-vehicle in 58% of the incidents and 22% of the fatalities were struck by incidents. CONCLUSIONS: Transportation-related deaths were nearly as common as homicides as a cause of occupational injury death among US LEOs. Struck by vehicle incidents remain an important and overlooked cause of death. This research points to opportunities for the prevention of transportation-related deaths in law enforcement. Am. J. Ind. Med. (c) 2010 Wiley-Liss, Inc. |
Job satisfaction is associated with elevated natural killer cell immunity among healthy white-collar employees
Nakata A , Takahashi M , Irie M , Swanson NG . Brain Behav Immun 2010 24 (8) 1268-75 Although the association of job satisfaction with health has been well documented, little is known about the biological mechanisms underlying this relationship. This study investigates the association of job satisfaction with cell-mediated immunity among Japanese white-collar daytime workers. A total of 306 healthy full-time employees (141 women and 165 men), aged 22-69 (mean 36) years, provided a blood sample for the measurement of circulating immune (natural killer (NK), B, and total T) cells and NK cell cytotoxicity (NKCC) and completed a questionnaire survey during April to June 2002. Job satisfaction was measured by a 4-item scale from the Japanese version of the generic job stress questionnaire with higher scores indicating greater satisfaction. Analyses were done separately for women and men using a hierarchical multiple linear regression model controlling for multiple confounders. The results revealed that greater job satisfaction was positively correlated with NKCC (beta=.207; p=.029) and the number of NK (CD3(-)CD56(+)) cells (beta=.261; p=.008) in women. In men, job satisfaction was marginally correlated with NKCC (beta=.165; p=.050) but was not correlated with the number of NK (CD3(-)CD56(+)) cells (beta=.142; p=.107). Job satisfaction did not correlate with numbers of T (CD3(+)CD56(-)) and B (CD19(+)) cells in both women and men. Our findings suggest an independent association between job satisfaction and NK cells but the association seems to be stronger in women than in men. Although the results provide a support for the biological plausibility of the job satisfaction-health relationship, additional research is required to determine whether greater job satisfaction contributes to recovery/maintenance of NK cell immunity and host defense over time. |
A study of first moments in underground mine emergency response
Kowalski-Trakofler KM , Vaught C , Brnich MJ , Jansky JH . J Homel Secur Emerg Manag 2010 7 (1) Researchers at the National Institute for Occupational Safety and Health (NIOSH) conducted seven focus groups and 10 individual interviews to gather data on what happens in the first crucial moments of a mine emergency. The goal of the project was to learn about responses on-site during the initial phases of a mine emergency to further improve response. The subjects represented underground coal and salt mines in the southern, western, mid-western, and eastern parts of the United States. They included on-site responders, mine rescue team members, and experts in mine emergency response with extensive experience in managing mine disasters. The types of disasters the subjects experienced were diverse, including explosions, fires, and inundations (sudden floods of water or inrushes of dangerous gases). This study was unique in its focus on the first moments in an emergency response, in studying underground coal mine emergencies and in utilizing a focus group methodology. Results indicated that there were common themes in initial response, which included the importance of mine emergency planning and training, quantity and quality of communication providing information for decision-making, leadership and trust, plus individual personal issues. Previous relevant studies are presented and the researchers discuss the data providing specific examples. The article concludes with recommendations to enhance initial response in the first critical moments of an emergency. |
Prevalence of highly active adults-Behavioral Risk Factor Surveillance System, 2007
Adabonyan I , Loustalot F , Kruger J , Carlson SA , Fulton JE . Prev Med 2010 51 (2) 139-43 BACKGROUND: The 2008 Physical Activity Guidelines for Americans (2008 Guidelines) included a novel aerobic physical activity standard, in excess of minimum standards, for more extensive health benefits (>300minutes/week of moderate-intensity, 150minutes/week of vigorous-intensity, or an equivalent combination). Prevalence estimates among US states have yet to be described for this new standard. METHODS: Respondents self-reported physical activity in the 2007 Behavioral Risk Factor Surveillance System was used (n=398,397). Total weekly aerobic activity was calculated for each respondent and 2008 Guidelines standards guided classification. RESULTS: In 2007, 43.5% (95% CI: 43.1%-43.8%) of adults met the new 2008 Guidelines standard and were classified as highly active (male, 48.3%; female, 38.9%). Linear patterns were noted by age and education, where younger age and higher levels of education had a higher proportion of highly active. Non-Hispanic whites (45.7%) had a significantly higher proportion of highly active compared with non-Hispanic blacks (37.5%) and Hispanics (37.6%). Variations in estimates were noted among those categorized as sufficiently active, insufficiently active, and inactive. CONCLUSION: More than half of 2007 Behavioral Risk Factor Surveillance System respondents did not meet the new 2008 Guidelines standard. Aerobic activity levels commensurate with more extensive health benefits should be encouraged among US adults. |
The effect of caregiving on women in families with Duchenne/Becker muscular dystrophy
Kenneson A , Bobo JK . Health Soc Care Community 2010 18 (5) 520-8 Duchenne/Becker muscular dystrophy (DBMD) is a disorder of progressive muscle weakness that causes an increasing need for assistance with activities of daily living. Our objective was to assess the psychosocial health and contributing factors among female caregivers in families with DBMD. We conducted a survey of adult women among families with DBMD in the United States (US) from June 2006 through January 2007, collecting data related to the care recipient, perception of caregiving demands, personal factors, and socio-ecologic factors. Life satisfaction, stress, and distress were assessed as outcomes. Existing validated instruments were used when available. We received responses from 1238 women who were caring for someone with DBMD, 24.2% of whom were caring for two or more people with DBMD. Caregivers were more likely to be married/cohabitating than women in the general US population, and a high level of resiliency was reported by 89.3% of caregivers. However, the rate of serious psychological distress was significantly higher among caregivers than among the general population. Likewise, 46.4% reported a high level of stress, and only 61.7% reported that they were satisfied with their life. A high level of caregiving demands based on the Zarit Burden Interview (ZBI) was reported by 50.4% of caregivers. The post-ambulatory phase of DBMD was associated with decreased social support and increased ZBI scores. In multivariate logistic regression modelling, life satisfaction was dependent on high social support, high resiliency, high income, and form of DBMD. Distress and high stress were predicted by low resiliency, low social support, and low income. Employment outside of the home was also a predictor of high stress. Interventions focused on resiliency and social support are likely to improve the quality of life of DBMD caregivers, and perhaps caregivers of children with other disabilities or special health care needs as well. |
Likelihood-based methods for estimating the association between a health outcome and left- or interval-censored longitudinal exposure data
Wannemuehler KA , Lyles RH , Manatunga AK , Terrell ML , Marcus M . Stat Med 2010 29 (16) 1661-1672 The Michigan Female Health Study (MFHS) conducted research focusing on reproductive health outcomes among women exposed to polybrominated biphenyls (PBBs). In the work presented here, the available longitudinal serum PBB exposure measurements are used to obtain predictions of PBB exposure for specific time points of interest via random effects models. In a two-stage approach, a prediction of the PBB exposure is obtained and then used in a second-stage health outcome model. This paper illustrates how a unified approach, which links the exposure and outcome in a joint model, provides an efficient adjustment for covariate measurement error. We compare the use of empirical Bayes predictions in the two-stage approach with results from a joint modeling approach, with and without an adjustment for left- and interval-censored data. The unified approach with the adjustment for left- and interval-censored data resulted in little bias and near-nominal confidence interval coverage in both the logistic and linear model setting. Published in 2010 by John Wiley & Sons, Ltd. |
Novel norovirus in dogs with diarrhea
Mesquita JR , Barclay L , Jose Nascimento MS , Vinje J . Emerg Infect Dis 2010 16 (6) 980-2 To identify the prevalence and genetic variability of noroviruses in dogs, we tested fecal samples by using reverse transcription-PCR. We found canine norovirus in 40% and 9% of dogs with and without diarrhea, respectively. The virus was genetically unrelated to other noroviruses and constitutes a tentative new genogroup. |
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