Uric acid and mortality from all-causes and cardiovascular disease among adults with and without diagnosed diabetes: findings from the National Health and Nutrition Examination Survey III Linked Mortality Study
Ford ES . Diabetes Res Clin Pract 2011 93 (2) e84-e86 Using data from the National Health and Nutrition Examination Survey III Linked Mortality Study, uric acid concentration was significantly related to mortality from all-causes (978 diabetic participants: hazard ratio per mg/dl, 1.14; 95% confidence interval, 1.01-1.28; 12,824 nondiabetic participants: hazard ratio, 1.06; 95% confidence interval, 1.02-1.11) but not major CVD. |
A population-based survey of chronic pain and its treatment with prescription drugs
Toblin RL , Mack KA , Perveen G , Paulozzi LJ . Pain 2011 152 (6) 1249-55 Chronic pain is a common reason for medical visits, but prevalence estimates vary between studies and have rarely included drug treatment data. This study aimed to examine characteristics of chronic pain and its relation to demographic and health factors, and factors associated with treatment of pain with opioid analgesics. A chronic pain module was added to the 2007 Kansas Behavioral Risk Factor Surveillance System (response rate=61%). Data on prevalence, duration, frequency, and severity of chronic pain, demographics, and health were collected from a representative sample of 4090 adults 18years and older by telephone. Logistic regression was used to examine the association of both chronic pain and opioid use with demographic and health factors. Chronic pain was reported by 26.0% of the participants and was associated with activity limitations (adjusted odds ratio [AOR]=3.6, 95% confidence interval [95% CI] 2.8-4.5), arthritis (AOR=3.3, 95% CI 2.6-4.0), poor mental health (AOR=2.0, 95% CI 1.4-2.8), poor overall health (AOR=1.9; 95% CI 1.5-2.5), and obesity (AOR=1.6; 95% CI 1.2-2.0). Of the 33.4% of people with pain who use prescription pain medication, 45.7% took opioids, including 36.7% of those with mild pain. Chronic pain affects a quarter of adults in Kansas and is associated with poor health. Opioid analgesics are the mainstay of prescribed pharmacotherapy in this group, even among those reporting mild pain. Chronic pain affects 26.0% of adults in the state of Kansas, USA. Overall, 45.7% of people who take prescription drugs for chronic pain reported taking opioid analgesics. |
Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009
Dawood FS , Kamimoto L , D'Mello TA , Reingold A , Gershman K , Meek J , Arnold KE , Farley M , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett N , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatrics 2011 128 (1) e27-32 OBJECTIVE: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type. METHODS: During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus). We collected data from medical records on medical history and clinical course; data on asthma severity and control were not routinely collected. RESULTS: During the 2003-2009 influenza seasons, 701 (32%) of 2165 children hospitalized with influenza had asthma; during the 2009 pandemic, 733 (44%) of 1660 children had asthma. The median age of the asthmatic children was 7 years, and 73% had no additional medical conditions. Compared with asthmatic children with seasonal influenza, a higher proportion with 2009 pandemic H1N1 influenza required intensive care (16% vs 22%; P = .01) and were diagnosed with pneumonia (40% vs 46%; P = .04), whereas equal proportions had respiratory failure (5% vs 5%; P = .8) and died (1% vs 1%; P = .4). More asthmatic children with influenza A (seasonal or pandemic) had diagnoses of asthma exacerbations compared with those with influenza B (51% vs 29%; P < .01). CONCLUSIONS: The majority of asthmatic children hospitalized with influenza have no additional medical conditions. Complications such as pneumonia and need for intensive care occur in a substantial proportion, highlighting the importance of influenza prevention through vaccination among asthmatic children. |
Reduced importation of tuberculosis after the implementation of an enhanced pre-immigration screening protocol
Lowenthal P , Westenhouse J , Moore M , Posey DL , Watt JP , Flood J . Int J Tuberc Lung Dis 2011 15 (6) 761-6 SETTING: Importation of infectious tuberculosis (TB) threatens TB control in California and the United States. OBJECTIVE: To assess the effectiveness of an enhanced pre-immigration screening and treatment protocol to prevent the importation of infectious TB. DESIGN: Retrospective analysis of immigrants ≥15 years of age with TB suspect classifications who were screened for TB in their countries of origin before (pre-intervention cohort) and after (post-intervention cohort) implementation of enhanced pre-immigration screening. Enhanced pre-immigration screening added sputum cultures to the existing screening system based on sputum smears for persons with abnormal chest radiographs. RESULTS: The pre- and post-intervention cohorts included respectively 2049 and 1430 immigrants. The occurrence of tuberculosis ≤6 months after US arrival in this population decreased following the intervention, from 4.2% (86 cases) to 1.5% (22 cases, P < 0.001). Among pre-intervention cohort cases, 14% were sputum acid-fast bacilli (AFB) smear-positive and 81% were sputum culture-positive for TB, compared with 5% sputum AFB smear-positive (P = 0.46) and 68% sputum culture-positive (P = 0.18) among the post-intervention cohort cases. CONCLUSION: The enhanced pre-immigration screening was associated with a decline in the proportion of immigrants with TB suspect classifications identified with TB within 6 months of arrival in the United States. Continued state and national surveillance is critical to monitor the effectiveness of the revised pre-immigration screening as it is implemented in additional countries. |
Mistaken assumptions and missed opportunities: correlates of undiagnosed HIV infection among black and Latino men who have sex with men
Millett GA , Ding H , Marks G , Jeffries WL , Bingham T , Lauby J , Murrill C , Flores S , Stueve A . J Acquir Immune Defic Syndr 2011 58 (1) 64-71 OBJECTIVE: To identify demographic, behavioral, and psychological variables associated with being HIV-positive unaware among black and Latino men who have sex with men (MSM). METHODS: Participants recruited in 3 cities completed a computer-assisted interview and were tested for HIV infection (OraSure Technologies, Bethlehem, PA). HIV-positive unaware MSM were compared with MSM who tested HIV-negative in bivariate and multivariate analyses. RESULTS: Of 1208 MSM (597 black and 611 Latino), 11% were HIV-positive unaware (18% of blacks and 5% of Latinos). In multivariate analysis of the Latino MSM, being HIV-positive unaware was associated with non-gay identity, high perceived risk of currently being HIV-positive, and belief that sex with other Latino men reduces HIV transmission risk. Among black MSM, being HIV-positive unaware was associated with gay identity, moderately higher income, having health insurance, sexuality disclosure to a current healthcare provider, fewer than 3 lifetime HIV tests, high perceived risk of testing HIV-positive, and belief that sex with other black men reduces HIV transmission risk. CONCLUSIONS: HIV prevention efforts should address misperceptions among those black and Latino MSM who believe that assortative (i.e. intraracial) sexual mixing reduces risk of HIV infection. Our findings also revealed missed opportunities to diagnose black MSM with HIV infection who were already engaged in care and had disclosed their sexuality to their healthcare provider. Clinicians should offer HIV testing to all MSM, particularly black MSM, who disclose engaging in recent sex with other men to facilitate earlier diagnosis of HIV infection and reduce transmission risk to sexual partners. |
People aged above 65 treated for latent tuberculosis are at increased risk of admission for a hepatic event compared with untreated controls
Lobue P . Evid Based Med 2011 16 (6) 169-70 Treatment of latent tuberculosis infection (LTBI) is an important tuberculosis prevention and control strategy, especially in high-resource countries. The effectiveness of LTBI treatment, which usually consists of isoniazid (also known as isonicotinylhydrazine (INH)) for 6–9 months, is limited by poor patient adherence because of long treatment duration and adverse effects. The most common serious adverse effect of INH is hepatotoxicity, which increases with age and can be fatal.1 A meta-analysis of six studies found that the pooled rate of INH-associated hepatotoxicity was 0.6%.2 |
Epidemiology of HIV among Asians and Pacific Islanders in the United States, 2001-2008
Adih WK , Campsmith M , Williams CL , Hardnett FP , Hughes D . J Int Assoc Physicians AIDS Care (Chic) 2011 10 (3) 150-9 BACKGROUND: Recent analyses have shown increases in combined annual HIV diagnosis rates for Asians and Pacific Islanders (API). METHODS: Using surveillance data from 33 states and 4 dependent areas we investigated the epidemiology of HIV among API during 2001-2008. RESULTS: HIV diagnoses for API during 2001-2008 were predominantly among persons age 30-39 years (40%) and males (78%). The primary risk factor for males was sexual contact with males (78%) and for females, heterosexual contact (86%). API were the only racial/ethnic groups with a statistically significant estimated annual percentage increase (4.4%) in HIV diagnoses over the time period. Thirty-seven percent of HIV diagnoses among API progressed to AIDS in <12 months, with significantly greater likelihood among those 30 years and older. Survival was lower among API with AIDS diagnosis after 49 years of age, and was higher among persons with AIDS whose primary risk factor for infection was heterosexual contact. CONCLUSIONS: In contrast to other racial/ethnic groups, API were the only groups to show a significant increase in HIV diagnoses. A clearer understanding of the reasons for this trend is needed, so that appropriate interventions can be selected and adapted to prevent increased HIV prevalence among API in the U.S. |
Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand
Simmerman JM , Suntarattiwong P , Levy J , Jarman RG , Kaewchana S , Gibbons RV , Cowling BJ , Sanasuttipun W , Maloney SA , Uyeki TM , Kamimoto L , Chotipitayasunondh T . Influenza Other Respir Viruses 2011 5 (4) 256-67 BACKGROUND: Evidence is needed on the effectiveness of non-pharmaceutical interventions (NPIs) to reduce influenza transmission. METHODOLOGY: We studied NPIs in households with a febrile, influenza-positive child. Households were randomized to control, hand washing (HW), or hand washing plus paper surgical face masks (HW + FM) arms. Study nurses conducted home visits within 24 hours of enrollment and on days 3, 7, and 21. Respiratory swabs and serum were collected from all household members and tested for influenza by RT-PCR or serology. PRINCIPAL FINDINGS: Between April 2008 and August 2009, 991 (16.5%) of 5995 pediatric influenza-like illness patients tested influenza positive. Four hundred and forty-two index children with 1147 household members were enrolled, and 221 (50.0%) were aged <6 years. Three hundred and ninety-seven (89.8%) households reported that the index patient slept in the parents' bedroom. The secondary attack rate was 21.5%, and 56/345 (16.3%; 95% CI 12.4-20.2%) secondary cases were asymptomatic. Hand-washing subjects reported 4.7 washing episodes/day, compared to 4.9 times/day in the HW + FM arm and 3.9 times/day in controls (P = 0.001). The odds ratios (ORs) for secondary influenza infection were not significantly different in the HW arm (OR = 1.20; 95% CI 0.76-1.88; P-0.442), or the HW + FM arm (OR = 1.16; 95% CI .0.74-1.82; P = 0.525). CONCLUSIONS: Influenza transmission was not reduced by interventions to promote hand washing and face mask use. This may be attributable to transmission that occurred before the intervention, poor facemask compliance, little difference in hand-washing frequency between study groups, and shared sleeping arrangements. A prospective study design and a careful analysis of sociocultural factors could improve future NPI studies. |
A diagnostic and public health quandary: acute viral hepatitis in a hospital cafeteria worker
Spradling PR , Selvage D , Drobeniuc J , Sharapov U , Stulberg D , Smelser C . J Clin Virol 2011 51 (4) 215-8 A 53-year-old female hospital-cafeteria-worker in New Mexico presented to a physician in January 2009 with a history of jaundice for one day and dark urine for one week. There was no history of travel or contact with any persons with known illness. She had a history of ongoing alcohol use at four drinks per day but denied ever injecting drugs. In 2005, she developed acute hepatitis B (seropositivity for hepatitis B surface antigen [HBsAg] documented) following sexual contact with a person known to have chronic hepatitis B. During this illness she tested negative for IgG antibody to hepatitis C virus (IgG anti-HCV) and later received one dose of hepatitis A vaccine. Blood testing done on January 27 was positive for: (1) IgM antibody to hepatitis A virus (IgM anti-HAV), (2) IgM antibody to hepatitis B core antigen (IgM anti-HBc), and (3) IgG anti-HCV; HBsAg tested negative. Aspartate aminotransferase (AST) activity was 1894 IU/L and alanine aminotransferase (ALT) activity was 992 IU/L. Based on her jaundice and the concern for occupational food-borne transmission, the physician advised the patient to refrain from her work in food service and reported the case to the New Mexico Department of Health (NMDOH). |
The three Es of healthy swimming
Hlavsa MC , Beach MJ . J Environ Health 2011 73 (9) 26-7 Thankfully, none of us has to know everything or go it alone in public health. | We have colleagues with different | backgrounds who can share their knowledge | and wisdom to help address emerging public | health threats. We, as epidemiologists, are fortunate that our Centers for Disease Control | and Prevention (CDC) environmental health | colleagues, Charles Otto and Pat Bohan, have | taught us to view outbreak investigations and | other recreational water illness (RWI) issues | with an environmental health perspective and | use a systems-based approach to problem solving. Recreational water illnesses (RWIs) are | caused by pathogens transmitted by ingesting, | inhaling aerosols of, or having contact with | contaminated water in pools, hot tubs, interactive fountains, lakes, rivers, oceans, and so | forth. RWIs can also be caused by chemicals | in the water or those that volatilize from the | water and cause indoor air quality problems. | At state and local public health agencies, environmental health specialists like New York | State’s Doug Sackett bring emerging issues to | our attention and remind us of the need to | balance science with what is practical and feasible. One of the many great insights we have | taken from working with Doug is his belief | in the three Es—education, engineering, and | enforcement—to combat public health challenges, including RWIs |
Low-level lead exposure and elevations in blood pressure during pregnancy
Wells EM , Navas-Acien A , Herbstman JB , Apelberg BJ , Silbergeld EK , Caldwell KL , Jones RL , Halden RU , Witter FR , Goldman LR . Environ Health Perspect 2011 119 (5) 664-9 BACKGROUND: Lead exposure is associated with elevated blood pressure during pregnancy; however, the magnitude of this relationship at low exposure levels is unclear. OBJECTIVES: Our goal was to determine the association between low-level lead exposure and blood pressure during late pregnancy. METHODS: We collected admission and maximum (based on systolic) blood pressures during labor and delivery among 285 women in Baltimore, Maryland. We measured umbilical cord blood lead using inductively coupled plasma mass spectrometry. Multivariable models were adjusted for age, race, median household income, parity, smoking during pregnancy, prepregnancy body mass index, and anemia. These models were used to calculate benchmark dose values. RESULTS: Geometric mean cord blood lead was 0.66 mcg/dL (95% confidence interval, 0.61-0.70). Comparing blood pressure measurements between those in the highest and those in the lowest quartile of lead exposure, we observed a 6.87-mmHg (1.51-12.21 mmHg) increase in admission systolic blood pressure and a 4.40-mmHg (0.21-8.59 mmHg) increase in admission diastolic blood pressure after adjustment for confounders. Corresponding values for maximum blood pressure increase were 7.72 (1.83-13.60) and 8.33 (1.14-15.53) mmHg. Benchmark dose lower limit values for a 1-SD increase in blood pressure were < 2 mcg/dL blood lead for all blood pressure end points. CONCLUSIONS: A significant association between low-level lead exposures and elevations in maternal blood pressure during labor and delivery can be observed at umbilical blood lead levels < 2 mcg/dL. |
Perinatal exposure to low doses of dioxin can permanently impair human semen quality
Mocarelli P , Gerthoux PM , Needham LL , Patterson DG , Limonta G , Falbo R , Signorini S , Bertona M , Crespi C , Sarto C , Scott PK , Turner WE , Brambilla P . Environ Health Perspect 2011 119 (5) 713-8 BACKGROUND: In recent decades, young men in some industrialized areas have reportedly experienced a decrease in semen quality. OBJECTIVE: We examined effects of perinatal dioxin exposure on sperm quality and reproductive hormones. METHODS: We investigated sperm quality and hormone concentrations in 39 sons (mean age, 22.5 years) born between 1977 and 1984 to mothers exposed to dioxin after the accident in Seveso, Italy (1976), and 58 comparisons (mean age, 24.6 years) born to mothers exposed only to background dioxin. Maternal dioxin levels at conception were extrapolated from the concentrations measured in 1976 serum samples. RESULTS: The 21 breast-fed sons whose exposed mothers had a median serum dioxin concentration as low as 19 ppt at conception had lower sperm concentration (36.3 vs. 86.3 million/mL; p = 0.002), total count (116.9 vs. 231.1; p = 0.02), progressive motility (35.8 vs. 44.2%; p = 0.03), and total motile count (38.7 vs. 98 million; p = 0.01) than did the 36 breast-fed comparisons. The 18 formula-fed exposed and the 22 formula-fed and 36 breast-fed comparisons (maternal dioxin background 10 ppt at conception) had no sperm-related differences. Follicle-stimulating hormone was higher in the breast-fed exposed group than in the breast-fed comparisons (4.1 vs. 2.63 IU/L; p = 0.03) or the formula-fed exposed (4.1 vs. 2.6 IU/L; p = 0.04), and inhibin B was lower (breast-fed exposed group, 70.2; breast-fed comparisons, 101.8 pg/mL, p = 0.01; formula-fed exposed, 99.9 pg/mL, p = 0.02). CONCLUSIONS: In utero and lactational exposure of children to relatively low dioxin doses can permanently reduce sperm quality. |
Association between presence of visible in-house mold and health-related quality of life in adults residing in four U.S. states
Wen XJ , Balluz L . J Environ Health 2011 73 (9) 8-14 Despite the broad use of health-related quality of life (HRQOL) as one of the measurements to assess health status and effectiveness of health care and interventions, the impact of in-house mold exposure on HRQOL is unknown. The study described in this article examined the relationship between presence of visible in-house mold (PVIM) and HRQOL among adults. Data were analyzed from the 2005 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys that consisted of a random cross-sectional sample of 18,356 adults in four states. The authors examined the relationship between PVIM and three important indicators of the HRQOL by logistic regression analyses. Their results suggest that PVIM is independently associated with the indicators of HRQOL including mentally unhealthy, physically unhealthy, and total unhealthy days. Therefore, implementation of appropriate measures at the household level to eliminate or reduce in-house mold may improve individuals' HRQOL. |
Outbreak of campylobacteriosis associated with consumption of raw peas
Gardner TJ , Fitzgerald C , Xavier C , Klein R , Pruckler J , Stroika S , McLaughlin JB . Clin Infect Dis 2011 53 (1) 26-32 BACKGROUND: Campylobacter jejuni is a leading cause of acute gastroenteritis worldwide, and most cases are identified as sporadic events rather than as parts of recognized outbreaks. We report findings from a substantial 2008 campylobacteriosis outbreak with general implications for fresh produce safety. METHODS: We conducted a matched case-control study to determine the source of the outbreak and enhanced surveillance to identify additional cases. Clinical and environmental specimens were tested for Campylobacter, and isolates were subtyped by pulsed-field gel electrophoresis (PFGE). RESULTS: By routine surveillance, we identified 63 cases of laboratory-confirmed infection. Only raw peas, consumed by 30 (67%) of 45 case-patients and by 15 (17%) of 90 control participants, were associated with illness (adjusted odds ratio: 8.2; P < .001). An additional 69 patients (26 laboratory-confirmed) who reported eating raw peas within 10 days of illness onset were identified through enhanced surveillance. In all, 5 cases were hospitalized, and Guillain-Barre syndrome developed in 1 case; none died. The implicated pea farm was located near a Sandhill crane (Grus canadensis) stopover and breeding site. Of 36 environmental samples collected, 16 were positive for C. jejuni-14 crane-feces samples and 2 pea samples. We identified 25 unique combined SmaI-KpnI PFGE patterns among clinical isolates; 4 of these combined PFGE patterns identified in 15 of 55 human isolates were indistinguishable from PFGE patterns identified in environmental samples. CONCLUSIONS: This investigation established a rare laboratory-confirmed link between a campylobacterosis outbreak and an environmental source and identified wild birds as an underrecognized source of produce contamination. |
Prevalence of HIV risk behaviors between binge drinkers and non-binge drinkers aged 18- to 64-years in US, 2008
Wen XJ , Balluz L , Town M . J Community Health 2011 37 (1) 72-9 Using data from the 2008 Behavioral Risk Factor Surveillance System on 281,303 adults aged 18-64 years in the United States, we examined the relationship between HIV risk behaviors and binge drinking of alcoholic beverages and the frequency of binge drinking among a subgroup of 41,073 respondents who were acknowledged binge drinkers (bingers), based on reported drinking behavior in the year preceding survey. Our findings show that the weighted prevalence of HIV risk behaviors (including injection drug use, exchange of sex for money/drugs, and anal sex without a condom) among binge bingers [7.0%, 95% confidence interval (95% CI): 6.4-7.6%] is twice that among nonbingers (2.9%, 95% CI: 2.7-3.0%). The highest prevalence of HIV risk behaviors is among the bingers aged 18-20 years (14%, 95% CI: 11.2-18.2%). After adjusting for covariates, bingers are 1.77 (95% CI: 1.58-2.00) times more likely than nonbingers to report HIV risk behaviors. Risk increases in bingers with the number of episodes. Compared with bingers reporting 1-2 binge episodes in the month proceeding survey, the adjusted odds of reporting HIV risk behaviors among bingers are 1.27 (1.08-1.49), 1.68 (1.35-2.10), 1.67 (1.08-2.57), and 1.70 (1.34-2.16), respectively for bingers with 3-4, 5-6, 7-8, and ≥9 episodes in the same period. Our results suggest that HIV risk behaviors are strongly linked with binge drinking and its frequency. Effective measures to prevent binge drinking are essential to HIV prevention, especially among youth aged 18-20 years. |
Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial
Rotheram-Borus MJ , Wu Z , Liang LJ , Li L , Detels R , Guan J , Yin Y , Swendeman D . Sex Transm Infect 2011 87 (4) 337-343 OBJECTIVES: A community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out over 2 years in five countries. The main study results did not find significant intervention effects. This paper presents a sub-analysis examining the differential intervention impacts among high-risk and low-risk participants in the China site. METHODS: From 2002 -2006, 3912 migrant market vendors aged 18 and 49 years were recruited at an urban site in China. Markets were randomly assigned to the C-POL intervention (N=20 markets; n=1979) or standard-care control condition (N=20; n=1933). Both study condition venues received HIV/STI education, free condoms, STI testing and treatment, and training for pharmacists in antibiotic treatments. In intervention markets, C-POLs were identified and trained to diffuse messages regarding safer sex, STI treatment and partner discussions of sex. The primary biological outcome was incidence of new STIs (chlamydia, gonorrhoea, syphilis, trichomonas, herpes or HIV). The primary sexual behaviour risk outcome was any unprotected extramarital sex in the prior 3 months. RESULTS: In unadjusted analyses, women had significantly lower rates of STI infection at 24 months in the C-POL intervention (5.7%) compared to controls (8.3%; p=0.043). In mixed-effects regression models, intervention participants with STIs at previous assessments were about half as likely to have STIs at 24 months (OR 0.47, 95% CI 0.25 to 0.90) compared to controls. CONCLUSIONS: The C-POL intervention lowers HIV risk among those at highest risk (ie, with a STI or engaging in high-risk sexual activities) rather than the general population. Trial registration http://Clinicaltrials.gov/ identifier NCT 00710060. |
Utilization of services in a randomized trial testing phone- and web-based interventions for smoking cessation
Zbikowski SM , Jack LM , McClure JB , Deprey M , Javitz HS , McAfee TA , Catz SL , Richards J , Bush T , Swan GE . Nicotine Tob Res 2011 13 (5) 319-27 INTRODUCTION: Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone-Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. METHODS: One thousand two hundred and two participants were randomized to phone, Web, or combined phone-Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. RESULTS: Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone-Web, 41% Web), and those in the phone-Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. CONCLUSIONS: Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities. |
Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients
Ison MG , Llata E , Conover CS , Friedewald JJ , Gerber SI , Grigoryan A , Heneine W , Millis JM , Simon DM , Teo CG , Kuehnert MJ . Am J Transplant 2011 11 (6) 1218-1225 In 2007, a previously uninfected kidney transplant recipient tested positive for human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) infection. Clinical information of the organ donor and the recipients was collected by medical record review. Sera from recipients and donor were tested for serologic and nucleic acid-based markers of HIV and HCV infection, and isolates were compared for genetic relatedness. Routine donor serologic screening for HIV and HCV infection was negative; the donor's only known risk factor for HIV was having sex with another man. Four organs (two kidneys, liver and heart) were transplanted to four recipients. Nucleic acid testing (NAT) of donor sera and posttransplant sera from all recipients were positive for HIV and HCV. HIV nucleotide sequences were indistinguishable between the donor and four recipients, and HCV subgenomic sequences clustered closely together. Two patients subsequently died and the transplanted organs failed in the other two patients. This is the first recognized cotransmission of HIV and HCV from an organ donor to transplant recipients. Routine posttransplant HIV and HCV serological testing and NAT of recipients of organs from donors with suspected risk factors should be considered as routine practice. |
Estimated risk of human immunodeficiency virus and hepatitis C virus infection among potential organ donors from 17 organ procurement organizations in the United States
Ellingson K , Seem D , Nowicki M , Strong DM , Kuehnert MJ . Am J Transplant 2011 11 (6) 1201-1208 To prevent unintentional transmission of bloodborne pathogens through organ transplantation, organ procurement organizations (OPOs) screen potential donors by serologic testing to identify human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. Newly acquired infection, however, may be undetectable by serologic testing. Our objective was to estimate the incidence of undetected infection among potential organ donors and to assess the significance of risk reductions conferred by nucleic acid testing (NAT) versus serology alone. We calculated prevalence of HIV and HCV-stratified by OPO risk designation-in 13 667 potential organ donors managed by 17 OPOs from 1/1/2004 to 7/1/2008. We calculated incidence of undetected infection using the incidence-window period approach. The prevalence of HIV was 0.10% for normal risk potential donors and 0.50% for high risk potential donors; HCV prevalence was 3.45% and 18.20%, respectively. For HIV, the estimated incidence of undetected infection by serologic screening was 1 in 50 000 for normal risk potential donors and 1 in 11 000 for high risk potential donors; for HCV, undetected incidence by serologic screening was 1 in 5000 and 1 in 1000, respectively. Projected estimates of undetected infection with NAT screening versus serology alone suggest that NAT screening could significantly reduce the rate of undetected HCV for all donor risk strata. |
Varicella zoster virus DNA at inoculation sites and in saliva after Zostavax immunization.
Pierson DL , Mehta SK , Gilden D , Cohrs RJ , Nagel MA , Schmid DS , Tyring SK . J Infect Dis 2011 203 (11) 1542-5 Analysis of 36 individuals over age 60 years who were immunized with Zostavax revealed varicella zoster virus (VZV) DNA in swabs of skin inoculation sites obtained immediately after immunization in 18 (50%) of 36 subjects (copy number per nanogram of total DNA, 28 to 2.1 x 10(6)) and in saliva collected over 28 days in 21 (58%) of 36 subjects (copy number, 20 to 248). Genotypic analysis of DNA extracted from 9 random saliva samples identified vaccine virus in all instances. In some immunized individuals over age 60, vaccine virus DNA is shed in saliva up to 4 weeks. |
Immune correlates of protection against influenza: challenges for licensure of seasonal and pandemic influenza vaccines, Miami, FL, USA, March 1-3, 2010
Haaheim LR , Katz JM . Influenza Other Respir Viruses 2011 5 (4) 288-95 The emergence of a novel swine-origin pandemic influenza virus in 2009, together with the continuing circulation of highly pathogenic avian H5N1 viruses and the urgent global need to produce effective vaccines against such public health threats, has prompted a renewed interest in improving our understanding of the immune correlates of protection against influenza. As new influenza vaccine technologies, including non-HA based approaches and novel production platforms are developed and undergo clinical evaluation, it has become clear that existing immune correlates such as serum hemagglutination-inhibition antibodies may be unsuitable to estimate vaccine immunogenicity and protective efficacy of such vaccines. This International Society for Influenza and other Respiratory Virus Diseases (ISIRV) sponsored international meeting held in Miami, Florida USA on March 1-3, 2010, brought together scientists from industry, academia, and government agencies that develop and evaluate seasonal and pandemic influenza vaccines and scientists from regulatory authorities that approve them, to identify approaches to develop expanded immune correlates of protection to aid in vaccine licensure. |
Influenza vaccination coverage among pregnant women--National 2009 H1N1 Flu Survey (NHFS)
Ding H , Santibanez TA , Jamieson DJ , Weinbaum CM , Euler GL , Grohskopf LA , Lu PJ , Singleton JA . Am J Obstet Gynecol 2011 204 S96-106 We sought to describe vaccination with influenza A (H1N1) 2009 monovalent (2009 H1N1) and trivalent seasonal (seasonal) vaccines among pregnant women during the 2009 through 2010 influenza season. A national H1N1 flu survey was conducted April through June 2010. The 2009 H1N1 and seasonal vaccination coverage estimates were 45.7% and 32.1%, respectively, among pregnant women aged 18-49 years. Receipt of a health care provider's recommendation for vaccination, perceived effectiveness of influenza vaccinations, and perceived high chance of influenza infection were independently associated with higher 2009 H1N1 and seasonal vaccination coverage. Pregnancy during October 2009 through January 2010 was independently associated with higher 2009 H1N1 vaccination coverage. The 2009 H1N1 vaccination level among pregnant women was higher than the seasonal vaccination level during the 2009 through 2010 season; it was also higher than vaccination among nonpregnant women with and without high-risk conditions. Health care providers and public health messaging played important roles in influencing vaccination behavior. |
Confidence about vaccines in the United States: understanding parents' perceptions
Kennedy A , Lavail K , Nowak G , Basket M , Landry S . Health Aff (Millwood) 2011 30 (6) 1151-9 The United States has made tremendous progress in using vaccines to prevent serious, often infectious, diseases. But concerns about such issues as vaccines' safety and the increasing complexity of immunization schedules have fostered doubts about the necessity of vaccinations. We investigated parents' confidence in childhood vaccines by reviewing recent survey data. We found that most parents-even those whose children receive all of the recommended vaccines-have questions, concerns, or misperceptions about them. We suggest ways to give parents the information they need and to keep the US national vaccination program a success. |
Detection of fecal shedding of rotavirus vaccine in infants following their first dose of pentavalent rotavirus vaccine
Yen C , Jakob K , Esona MD , Peckham X , Rausch J , Hull JJ , Whittier S , Gentsch JR , Larussa P . Vaccine 2011 29 (24) 4151-5 Studies on rotavirus vaccine shedding and its potential transmission within households including immunocompromised individuals are needed to better define the potential risks and benefits of vaccination. We examined fecal shedding of pentavalent rotavirus vaccine (RV5) for 9 days following the first dose of vaccine in infants between 6 and 12 weeks of age. Rotavirus antigen was detected by enzyme immunoassay (EIA), and vaccine-type rotavirus was identified by nucleotide sequencing based on genetic relatedness to the RV5 VP6 gene. Stool from 22 (21.4%) of 103 children contained rotavirus antigen-positive specimens on ≥1 post-vaccination days. Rotavirus antigen was detected as early as post-vaccination day 3 and as late as day 9, with peak numbers of shedding on post-vaccination days 6 through 8. Vaccine-type rotavirus was detected in all 50 antigen-positive specimens and 8 of 8 antigen-negative specimens. Nine (75%) of 12 EIA-positive and 1 EIA-negative samples tested culture-positive for vaccine-type rotavirus. Fecal shedding of rotavirus vaccine virus after the first dose of RV5 occurred over a wide range of post-vaccination days not previously studied. These findings will help better define the potential for horizontal transmission of vaccine virus among immunocompromised household contacts of vaccinated infants for future studies. |
Association of externalizing behavior disorder symptoms and injury among fifth graders
Schwebel DC , Roth DL , Elliott MN , Visser SN , Toomey SL , Shipp EM , Grunbaum JA , Schuster MA . Acad Pediatr 2011 11 (5) 427-31 OBJECTIVE: Injury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. METHODS: Data were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined. RESULTS: In bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18-1.41) and CD symptoms (OR 1.18; 95% CI 1.07-1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10-1.35). There was no statistically significant interaction between ADHD and CD symptoms. CONCLUSIONS: ADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision). |
An automated genotyping tool for enteroviruses and noroviruses.
Kroneman A , Vennema H , Deforche K , Avoort HV , Penaranda S , Oberste MS , Vinje J , Koopmans M . J Clin Virol 2011 51 (2) 121-5 BACKGROUND: Molecular techniques are established as routine in virological laboratories and virus typing through (partial) sequence analysis is increasingly common. Quality assurance for the use of typing data requires harmonization of genotype nomenclature, and agreement on target genes, depending on the level of resolution required, and robustness of methods. OBJECTIVE: To develop and validate web-based open-access typing-tools for enteroviruses and noroviruses. STUDY DESIGN: An automated web-based typing algorithm was developed, starting with BLAST analysis of the query sequence against a reference set of sequences from viruses in the family Picornaviridae or Caliciviridae. The second step is phylogenetic analysis of the query sequence and a sub-set of the reference sequences, to assign the enterovirus type or norovirus genotype and/or variant, with profile alignment, construction of phylogenetic trees and bootstrap validation. Typing is performed on VP1 sequences of Human enterovirus A to D, and ORF1 and ORF2 sequences of genogroup I and II noroviruses. For validation, we used the tools to automatically type sequences in the RIVM and CDC enterovirus databases and the FBVE norovirus database. RESULTS: Using the typing-tools, 785(99%) of 795 Enterovirus VP1 sequences, and 8154(98.5%) of 8342 norovirus sequences were typed in accordance with previously used methods. Subtyping into variants was achieved for 4439(78.4%) of 5838 NoV GII.4 sequences. DISCUSSION AND CONCLUSIONS: The online typing-tools reliably assign genotypes for enteroviruses and noroviruses. The use of phylogenetic methods makes these tools robust to ongoing evolution. This should facilitate standardized genotyping and nomenclature in clinical and public health laboratories, thus supporting inter-laboratory comparisons. |
Treatment of mice with human monoclonal antibody 24h after lethal aerosol challenge with virulent Venezuelan equine encephalitis virus prevents disease but not infection
Hunt AR , Bowen RA , Frederickson S , Maruyama T , Roehrig JT , Blair CD . Virology 2011 414 (2) 146-52 We recently described a Venezuelan equine encephalitis virus (VEEV)-specific human monoclonal antibody (MAb), F5 nIgG, that recognizes a new neutralization epitope on the VEEV E2 envelope glycoprotein. In this study, we investigated the ability of F5 nIgG given prophylactically or therapeutically to protect mice from subcutaneous or aerosolized VEEV infection. F5 nIgG had potent ability to protect mice from infection by either route when administered 24h before exposure; however, mice treated 24h after aerosol exposure developed central nervous system infections but exhibited no clinical signs of disease. Infectious virus, viral antigen and RNA were detected in brains of both treated and untreated mice 2-6days after aerosol exposure but were cleared from the brains of treated animals by 14-28days after infection. This fully human MAb could be useful for prophylaxis or immediate therapy for individuals exposed to VEEV accidentally in the laboratory or during a deliberate release. |
Performance of six commercial enzyme immunoassays and two alternative HIV-testing algorithms for the diagnosis of HIV-1 infection in Kisumu, Western Kenya
Zeh C , Oyaro B , Vandenhoudt H , Amornkul P , Kasembeli A , Bondo P , Mwaengo D , Thomas TK , Hart C , Laserson KF , Ondoa P , Nkengasong JN . J Virol Methods 2011 176 24-31 Performances of serological parallel and serial testing algorithms were analyzed using a combination of three ELISA and three rapid tests for the confirmation of HIV infection. Each was assessed individually for their sensitivity and specificity on a blinded panel of 769 retrospective sera of known HIV status. Western blot was used as a confirmatory assay for discordant results. Subsequently, one parallel and one serial testing algorithm were assessed on a new panel of 912 HIV-positive and negative samples. Individual evaluation of the ELISAs and rapid tests indicated a sensitivity of 100% for all assays except Uni-Gold with 99.7%. The specificities ranged from 99.1% to 99.4% for rapid assays and from 97.5% to 99.1% for ELISAs. A parallel and serial testing algorithms using Enzygnost and Vironostika, and Determine followed by Uni-Gold respectively, showed 100% sensitivity and specificity. The cost for testing 912 samples was US$4.74 and US$ 1.9 per sample in parallel and serial testing respectively. Parallel or serial testing algorithm yielded a sensitivity and specificity of 100%. This alternative algorithm is reliable and reduces the occurrence of both false negatives and positives. The serial testing algorithm was more cost effective for diagnosing HIV infections in this population. |
Identification of antigenic targets for immunodetection of Balamuthia mandrillaris infection
Kucerova Z , Sriram R , Wilkins PP , Visvesvara GS . Clin Vaccine Immunol 2011 18 (8) 1297-301 The free-living amoeba Balamuthia mandrillaris causes granulomatous amoebic encephalitis (GAE) in humans. Rapid identification of balamuthiasis is critical for effective therapeutic intervention and case management. In the present study we identified target antigens for development of a serologic assay for B. mandrillaris infection. We demonstrated by silver staining that protein profiles for all eight isolates of B. mandrillaris, independent of human or animal origin or geographic origin, appeared to be similar except for some minor differences, indicating the molecular homogeneity of these strains. The profiles of all isolates ranged from 200 to 10 kDa were similar with a prominent protein visible around 30 kDa; all appeared considerably different from protein profiles of the control E6 cells, Acanthamoeba, and Naegleria isolates. Western blot analysis with rabbit hyperimmune serum identified the major immunodominant antigens of 25, 50, 75 and 80 kDa; positive human sera reacted strongly with proteins around 25, 40, 50 and 75 kDa. Proteins around 40 kDa detected by human serum were not recognized by hyperimmune rabbit serum. None of the target proteins were detected by uninfected control sera. Reactivities of five patients sera with 4 different isolates of B. mandrillaris (two strains of human and two strains of animal origins) revealed that patients' sera reacted slightly differently with different B. mandrillaris isolates, although major proteins of approximately 25, 50 and 75kDa were present in all extracts. |
Biomarkers of exposure to triclocarban in urine and serum
Ye X , Zhou X , Furr J , Ahn KC , Hammock BD , Gray EL , Calafat AM . Toxicology 2011 286 69-74 3,4,4'-Trichlorocarbanilide (triclocarban, TCC) is widely used as an antimicrobial agent in a variety of consumer and personal care products. TCC is considered a potential endocrine disruptor, but its potential toxic effects in humans are still largely unknown. Because of its widespread uses, the potential for human exposure to TCC is high. In order to identify adequate exposure biomarkers of TCC, we investigated the metabolic profile of TCC in adult female Sprague Dawley rats after administering TCC once (500mg/kg body weight) by oral gavage. Urine was collected 0-24h before dosing, and 0-24h and 24-48h after dosing. Serum was collected at necropsy 48h after dosing. We identified several metabolites of TCC in urine and serum by on-line solid phase extraction-high performance liquid chromatography-mass spectrometry. We unambiguously identified two major oxidative metabolites of TCC, 3'-hydroxy-TCC and 2'-hydroxy-TCC, by comparing their chromatographic behavior and mass spectral fragmentation patterns with those of authentic standards. By contrast, compared to these oxidative metabolites, we detected very low levels of TCC in the urine or serum. Taken together these data suggest that in rats, oxidation of TCC is a major metabolic pathway. We also measured TCC and its oxidative metabolites in 50 urine and 16 serum samples collected from adults in the United States. The results suggest differences in the metabolic profile of TCC in rats and in humans; oxidation appears to be a minor metabolic pathway in humans. Total (free plus conjugated) TCC could serve as a potential biomarker for human exposure to TCC. |
Characterization of in vivo anti-rotavirus activities of saponin extracts from Quillaja saponaria Molina
Tam KI , Roner MR . Antiviral Res 2011 90 (3) 231-41 Rotavirus is the leading cause of severe diarrhea disease in newborns and young children worldwide with approximately 300,000 pre-adolescent deaths each year. Quillaja saponins are a natural aqueous extract obtained from the Chilean soapbark tree. The extract is approved for use in humans by the FDA for use in beverages as a food addictive. We have demonstrated that Quillaja extracts have strong antiviral activities in vitro against six different viruses. In this study, we evaluated the in vivo antiviral activity of these extracts against rhesus rotavirus (RRV) using a mouse model. We established that at a dosage of 0.015mg/mouse of saponin extract, RRV induced diarrhea can be significantly reduced from 79% to 11% when mice are exposed to 500 plaque-forming-units (PFU) for each of five consecutive days. Additionally, while a reduction of RRV induced diarrhea depended both on the concentration of virus introduced and on the amount of Quillaja extract given to each mouse, the severity and interval of diarrhea under a variety of conditions tested, in all the treated mice were greatly reduced when compared to those that did not receive the Quillaja extracts. Mechanistically, there is strong evidence that the Quillaja extracts are able to "block" rotavirus infection by inhibiting virus-host attachment through disruption of cellular membrane proteins and/or virus receptors. We believe that Quillaja extracts have promise as antivirals to reduce rotavirus infection and the severity of the disease in humans. |
Combined gene expression profiling and RNAi screening in clear cell renal cell carcinoma identify PLK1 and other therapeutic kinase targets
Ding Y , Huang D , Zhang Z , Smith J , Petillo D , Looyenga BD , Feenstra K , Mackeigan JP , Furge KA , Teh BT . Cancer Res 2011 71 (15) 5225-34 In recent years, several molecularly targeted therapies have been approved for clear cell renal cell carcinoma (ccRCC), a highly aggressive cancer. Although these therapies significantly extend overall survival, nearly all patients with advanced ccRCC eventually succumb to the disease. To identify other molecular targets, we profiled gene expression in 90 ccRCC patient specimens for which tumor grade information was available. Gene set enrichment analysis indicated that cell cycle-related genes, in particular Polo-like kinase 1 (PLK1), were associated with disease aggressiveness. We also performed RNAi screening to identify kinases and phosphatases that when inhibited could prevent cell proliferation. As expected, RNAi-mediated knockdown of PLK1 and other cell cycle kinases was sufficient to suppress ccRCC cell proliferation. The association of PLK1 in both disease aggression and in vitro growth prompted us to examine the effects of a small-molecule inhibitor of PLK1, BI 2536, in ccRCC cell lines. BI 2536 inhibited the proliferation of ccRCC cell lines at concentrations required to inhibit PLK1 kinase activity, and sustained inhibition of PLK1 by BI 2536 led to dramatic regression of ccRCC xenograft tumors in vivo. Taken together, these findings highlight PLK1 as a rational therapeutic target for ccRCC. |
Comparison of quantitative airborne fungi measurements by active and passive sampling methods
Yamamoto N , Schmechel D , Chen BT , Lindsley WG , Peccia J . J Aerosol Sci 2011 42 (8) 499-507 The present study compared the airborne fungi collection performance of a two-stage cyclone sampler (active method) to the performance of the Personal Aeroallergen Sampler (passive method) using quantitative polymerase chain reaction (qPCR) assays. Indoor air concentrations of the common fungal species Alternaria alternata, Cladosporium cladosporioides, Epicoccum nigrum, and Penicillium chrysogenum were considered. Good correlations between the two sampling methods for the fungi A. alternata, C. cladosporioides, and E. nigrum were observed and the mean effective passive sampling rates (+/-std. dev.) for these species were 0.032 (+/-0.006), 0.058 (+/-0.006), and 0.066 (+/-0.044) l min-1, respectively. Gravitational settling was the dominant collection mechanism for A. alternata and E. nigrum. The root mean square precisions for the passive sampler measurements were also comparable to those of the active sampler (49-73% and 50-102%, respectively). The passive sampler did not allow for the collection of P. chrysogenum, likely due to the insufficient gravitational settling velocity of the fungal particle with its aerodynamic diameter of less than 5 micrometers. The passive sampler, in conjunction with growth-independent qPCR detection methodologies, can be utilized in future exposure assessment studies to deepen our understanding of how individuals are affected by inhalation of airborne fungal pathogens and allergens, especially for those with an aerodynamic diameter greater than 5 micrometers. |
Composition of the heartwood essential oil of incense cedar (Calocedrus decurrens Torr.)
Veluthoor S , Kelsey RG , Gonzalez-Hernandez MP , Panella N , Dolan M , Karchesy J . Holzforschung 2011 65 (3) 333-336 Incense cedar (Calocedrus decurrens) is a tree native to Oregon and California, perhaps best known for its aromatic wood and use in teh manufacturing of pencils. The wood is also highly values for its decorative appearance and durability in lumber, related sawmill products, and fence posts. Chemical investigations of heartwood extracts have shown the prescence of carvacrol, thymoquinone, related p-cymene and p-menthane based phenols, tropolones. Heartwood durability was shown to be mainly due to the high concentration of the p-cymene phenols, such as carvacol, but as the wood ages these are converted to non-fungicidal compounds, resulting in decreasing durability. Recent investigations have found the steam distilled essential oil from heartwood to have significant biological activity against arthropods of public health importance such as fleas, ticks, and mosquitos, as well as Phytophthora ramorum, the organism responsible for Sudden Oak Death. In this paper we report on the GC-MS analysis of this essential oil. Nakatsuka and Hirose were first to describe the essential oil of incense cedar wood, but the oil had not yet been analyzed by modern methods. In the present paper the GC-MS analysis of this essential oil will be reported. |
Delayed maturation of antibody avidity but not seroconversion in rhesus macaques infected with SHIV during oral pre-exposure prophylaxis
Curtis KA , Kennedy MS , Luckay A , Cong ME , Youngpairoj AS , Zheng Q , Smith J , Hanson D , Heneine W , Owen SM , Garcia-Lerma JG . J Acquir Immune Defic Syndr 2011 57 (5) 355-62 Pre-exposure prophylaxis (PrEP) is a novel intervention strategy for the prevention HIV transmission. As several clinical trials are at various stages of completion, it is important to understand the impact of PrEP treatment on the development of the immune response to HIV, particularly in individuals that exhibit breakthrough infections despite PrEP. A model of HIV infection, using rhesus macaques and the simian/human immunodeficiency virus (SHIV), was employed to evaluate the effects of PrEP on the evolution of the humoral immune response. Time to seroconversion, neutralizing and binding antibody levels, and antibody avidity were measured in 12 rhesus macaques infected during daily or intermittent PrEP with FTC (emtricitabine) or Truvada (FTC/Tenofovir combination) and compared to 11 untreated, SHIV-infected controls. Macaques that became infected while receiving PrEP exhibited significantly lower peak virus loads during acute infection as compared to untreated animals. While the timing of seroconversion and SHIV binding and neutralizing antibody levels were not impacted by treatment, lower maturation rates of antibody avidity for anti-p27, gp120, gp160, and gp41 were observed. This study suggests that reduced virus loads associated with PrEP treatment has little impact on timing of seroconversion and neutralizing/binding antibody levels: however, maturation of antibody avidity was suppressed. |
Pandemic influenza and pregnancy revisited: lessons learned from 2009 pandemic influenza A (H1N1)
Jamieson DJ , Rasmussen SA , Uyeki TM , Weinbaum C . Am J Obstet Gynecol 2011 204 S1-3 So much has changed since May 4, 2009, when the second documented death from 2009 pandemic influenza A (2009 H1N1) virus infection in the United States occurred in a previously healthy pregnant woman.1 Since that time, our knowledge about influenza in pregnancy has expanded dramatically, and much more attention has been focused on pregnancy issues. Before the emergence of the 2009 H1N1 virus, much of what we knew about influenza in pregnancy was based on indirect evidence, such as studies that used acute respiratory hospitalizations during influenza season as a proxy for influenza illness2, 3 and observations from previous pandemics of case series of pregnant women with uncertain representativeness.4, 5, 6 In a very short time, our knowledge of 2009 H1N1 in pregnancy has expanded greatly; with better diagnostic and treatment information, the increased severity of 2009 H1N1 among pregnant women compared with the general population has been documented carefully and consistently in a wide variety of clinical settings. We are pleased to bring you this special issue in the American Journal of Obstetrics and Gynecology entitled “Emerging Issues in the Prevention, Detection, and Treatment of Influenza among Pregnant Women in the United States,” which contains a wide variety of articles that summarize some of what we have learned about influenza in pregnancy from the recent pandemic. This special issue begins with personal reflections on past and present pandemics written by Rear Admiral Anne Schuchat, MD,7 who, as the Chief Health Officer during the pandemic and the Director of the National Center for Immunization and Respiratory Diseases, valiantly led the Centers for Disease Control and Prevention's (CDC's) 2009 H1N1 response with calm, grace, and scientific rigor. |
Impact of pesticide exposure misclassification on estimates of relative risks in the Agricultural Health Study
Blair A , Thomas K , Coble J , Sandler DP , Hines CJ , Lynch CF , Knott C , Purdue MP , Zahm SH , Alavanja MC , Dosemeci M , Kamel F , Hoppin JA , Freeman LB , Lubin JH . Occup Environ Med 2011 68 (7) 537-41 BACKGROUND: The Agricultural Health Study (AHS) is a prospective study of licensed pesticide applicators and their spouses in Iowa and North Carolina. We evaluate the impact of occupational pesticide exposure misclassification on relative risks using data from the cohort and the AHS Pesticide Exposure Study (AHS/PES). METHODS: We assessed the impact of exposure misclassification on relative risks using the range of correlation coefficients observed between measured post-application urinary levels of 2,4-dichlorophenoxyacetic acid (2,4-D) and a chlorpyrifos metabolite and exposure estimates based on an algorithm from 83 AHS pesticide applications. RESULTS: Correlations between urinary levels of 2,4-D and a chlorpyrifos metabolite and algorithm estimated intensity scores were about 0.4 for 2,4-D (n=64), 0.8 for liquid chlorpyrifos (n=4) and 0.6 for granular chlorpyrifos (n=12). Correlations of urinary levels with kilograms of active ingredient used, duration of application, or number of acres treated were lower and ranged from -0.36 to 0.19. These findings indicate that a priori expert-derived algorithm scores were more closely related to measured urinary levels than individual exposure determinants evaluated here. Estimates of potential bias in relative risks based on the correlations from the AHS/PES indicate that non-differential misclassification of exposure using the algorithm would bias estimates towards the null, but less than that from individual exposure determinants. CONCLUSIONS: Although correlations between algorithm scores and urinary levels were quite good (ie, correlations between 0.4 and 0.8), exposure misclassification would still bias relative risk estimates in the AHS towards the null and diminish study power. |
Acute pesticide illnesses associated with off-target pesticide drift from agricultural applications - 11 states, 1998-2006
Lee SJ , Mehler L , Beckman J , Diebolt-Brown B , Prado J , Lackovic M , Waltz J , Mulay P , Schwartz A , Mitchell Y , Moraga-McHaley S , Gergely R , Calvert GM . Environ Health Perspect 2011 119 (8) 1162-9 BACKGROUND: Pesticides are widely used in agriculture and off-target pesticide drift results in exposures to workers and the public. OBJECTIVE: Estimate the incidence of acute illnesses from pesticide drift from outdoor agricultural applications, and describe drift exposure and illness characteristics. METHODS: Data were obtained from the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks-Pesticides Program and the California Department of Pesticide Regulation. Drift included off-target movement of pesticide spray, volatiles, and contaminated dust. Acute illness cases were characterized by demographics, pesticide and application variables, health effects, and contributing factors. RESULTS: During 1998-2006, 2,945 cases associated with agricultural pesticide drift were identified from 11 states. Forty-seven percent had exposures at work, 92% experienced low severity illness, and 14% were children (<15 years). The annual incidence ranged from 1.39 to 5.32 per million persons over the 9-year period. The overall incidence (in million person-years) was 114.3 for agricultural workers, 0.79 for other workers, 1.56 for nonoccupational cases, and 42.2 for residents in 5 agriculture-intensive counties in California. Soil applications with fumigants were responsible for the largest proportion (45%) of cases. Aerial applications accounted for 24% of cases. Common factors contributing to drift cases included weather conditions, improper seal of the fumigation site, and applicator carelessness near non-target areas. CONCLUSIONS: Agricultural workers and residents in agricultural regions were found to have the highest rate of pesticide poisoning from drift exposure, and soil fumigations were a major hazard causing large drift incidents. These findings highlight areas where interventions to reduce off-target drift could be focused. |
AORN Ergonomic Tool 3: lifting and holding the patient's legs, arms, and head while prepping
Waters T , Spera P , Petersen C , Nelson A , Hernandez E , Applegarth S . AORN J 2011 93 (5) 589-92 Lifting the arms, legs, or head of a patient while prepping these areas for surgery can exert strong forces on the muscles and joints of the shoulders and backs of perioperative team members who perform this task, which may lead to work-related musculoskeletal disorders. AORN Ergonomic Tool 3: Lifting and Holding the Patient's Legs, Arms, and Head While Prepping provides scientifically based determinations of the amount of weight perioperative personnel can safely lift and hold manually for up to one, two, and three minutes using one hand or both. If these weight limits are exceeded, additional staff members or assistive devices are needed to help with the task. |
Irrigation and infection: the immunoepidemiology of schistosomiasis in ancient Nubia
Hibbs AC , Secor WE , Van Gerven D , Armelagos G . Am J Phys Anthropol 2011 145 (2) 290-8 Schistosomiasis has been deemed "the most important water-based disease from a global public-health perspective" in modern populations. To better understand the burden of schistosomiasis in ancient populations, we conducted immunologic examinations of desiccated tissue samples from two ancient Nubian populations, Wadi Halfa (N = 46) and Kulubnarti (N = 191). Saqia irrigated agriculture increases the available habitat for the aquatic vector snails and the risk of exposure. On the basis of evidence regarding the impact of saqia irrigation on schistosomiasis prevalence and transmission in modern populations, we predicted that the prevalence of Schistosoma mansoni infection would be higher in Wadi Halfa (saqia irrigation) than Kulubnarti (annual flooding). We also predicted that peak infection prevalence would occur at an earlier age within the Wadi Halfa population than the Kulubnarti population and that in both populations the prevalence of schistosomiasis would be higher in males than females due to differential water contact. The prevalence of S. mansoni was greater in the Wadi Halfa population (26.1%) than at Kulubnarti (9.4%) (P = 0.002). However, peak prevalence of infection did not occur in a younger age category within the Wadi Halfa population; prevalence of infection peaked at 66.7% in the mature adult age group (46+ years) in the Wadi Halfa population and at 16% in the later child age group (6-10 years) in the Kulubnarti population. There were no statistically significant differences in prevalence between males and females of either population. The impact of human alteration of the environment on the transmission of schistosomiasis is clearly shown in these populations. Am J Phys Anthropol, 2011. (c) 2011 Wiley-Liss, Inc. |
Identifying chronic conditions in Medicare claims data: evaluating the Chronic Condition Data Warehouse algorithm
Gorina Y , Kramarow EA . Health Serv Res 2011 46 (5) 1610-27 OBJECTIVE: To examine the strengths and limitations of the Center for Medicare and Medicaid Services' Chronic Condition Data Warehouse (CCW) algorithm for identifying chronic conditions in older persons from Medicare beneficiary data. DATA SOURCES: Records from participants of the NHANES I Epidemiologic Follow-up Study (NHEFS 1971-1992) linked to Medicare claims data from 1991 to 2000. STUDY DESIGN: We estimated the percent of preexisting cases of chronic conditions correctly identified by the CCW algorithm during its reference period and the number of years of claims data necessary to find a preexisting condition. PRINCIPAL FINDINGS: The CCW algorithm identified 69 percent of preexisting diabetes cases but only 17 percent of preexisting arthritis cases. Cases identified by the CCW are a mix of preexisting and newly diagnosed conditions. CONCLUSIONS: The prevalence of conditions needing less frequent health care utilization (e.g., arthritis) may be underestimated by the CCW algorithm. The CCW reference periods may not be sufficient for all analytic purposes. |
Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) deliveries in the United States
MacDorman M , Declercq E , Menacker F . Clin Perinatol 2011 38 (2) 179-92 Cesarean delivery is the most common major surgical procedure for women in the United States, with 1.4 million surgeries annually. In 2008, nearly one-third (32.3%) of US births were by cesarean delivery. Cesarean delivery rates have increased rapidly in the United States in recent years because of an increasing primary cesarean delivery rate and a declining vaginal birth after cesarean (VBAC) rate. In 2007, the VBAC rate was 8.3% in a 22-state reporting area. The US VBAC rate was lowest among 14 industrialized countries; 3 countries had VBAC rates greater than 50%. |
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