New measles virus genotype associated with outbreak, China
Zhang Y , Ding Z , Wang H , Li L , Pang Y , Brown KE , Xu S , Zhu Z , Rota PA , Featherstone D , Xu W . Emerg Infect Dis 2010 16 (6) 943-7 To determine the origin of the virus associated with a measles outbreak in Menglian County, Yunnan Province, People's Republic of China, in 2009, we conducted genetic analyses. Phylogenetic analyses based on nucleoprotein (N) and hemagglutinin (H) gene sequences showed that these Menglian viruses were not closely related to sequences of any World Health Organization (WHO) reference strains representing the 23 currently recognized genotypes. The minimum nucleotide divergence between the Menglian viruses and the most closely related reference strain, genotype D7, was 3.3% for the N gene and 3.0% for the H gene. A search of the databases of GenBank, WHO, and the Health Protection Agency Measles Nucleotide Surveillance showed that the Menglian viruses, together with the 2 older non-Menglian viruses, could be members of a new proposed measles genotype, d11. The new genotype designation will allow for better description of measles transmission patterns, especially in the Southeast Asian and Western Pacific regions. |
Outbreak of pneumonia associated with emergent human adenovirus serotype 14 - Southeast Alaska, 2008
Esposito DH , Gardner TJ , Schneider E , Stockman LJ , Tate JE , Panozzo CA , Robbins CL , Jenkerson SA , Thomas L , Watson CM , Curns AT , Erdman DD , Lu X , Cromeans T , Westcott M , Humphries C , Ballantyne J , Fischer GE , McLaughlin JB , Armstrong G , Anderson LJ . J Infect Dis 2010 202 (2) 214-22 BACKGROUND: In September 2008, an outbreak of pneumonia associated with an emerging human adenovirus (human adenovirus serotype 14 [HAdV-14]) occurred on a rural Southeast Alaska island. Nine patients required hospitalization, and 1 patient died. METHODS: To investigate the outbreak, pneumonia case patients were matched to control participants on the basis of age, sex, and community of residence. Participants in the investigation and their household contacts were interviewed, and serum samples and respiratory tract specimens were collected. Risk factors were evaluated by means of conditional logistic regression. RESULTS: Among 32 pneumonia case patients, 21 (65%) had confirmed or probable HAdV-14 infection. None of 32 matched control participants had evidence of HAdV-14 infection ([Formula: see text] for the difference). Factors independently associated with pneumonia included contact with a known HAdV-14-infected case patient (odds ratio [OR], 18.3 [95% confidence interval {CI}, 2.0]), current smoking (OR, 6.7 [95% CI, 0.9]), and having neither traveled off the island nor attended a large public gathering (OR, 14.7 [95% CI, 2.0]). Fourteen (67%) of 21 HAdV-14-positive case patients belonged to a single network of people who socialized and often smoked together and infrequently traveled off the island. HAdV-14 infection occurred in 43% of case-patient household contacts, compared with 5% of control-participant household contacts ([Formula: see text]) CONCLUSIONS: During a community outbreak in Alaska, HAdV-14 appeared to have spread mostly among close contacts and not widely in the community. Demographic characteristics and illness patterns among the case patients were similar to those observed in other recent outbreaks of HAdV-14 infection in the United States. |
Partner concurrency and the STD/HIV epidemic
Aral SO . Curr Infect Dis Rep 2010 12 (2) 134-139 Conceptually and theoretically, it is easy to see how short gaps and concurrent partnerships fuel the spread of sexually transmitted infections (STI) and HIV in populations. The consequences of concurrency are bounded by the duration of the infectious period and by the relationships between concurrent partnerships and other dimensions of sexual behavior. Consequently, it is difficult to predict how concurrent partnerships or short gaps may be related to the spread of STI and HIV in a particular epidemiologic context in empirical reality. In recent years, analyses of sexual behavior data collected through nationally representative surveys revealed similar prevalences of concurrent sexual partnerships in Western populations. The association between concurrent sexual partnerships and STI/HIV risk is complicated. At the population level, recent findings suggest that the ecological association between polygyny and HIV prevalence is negative at the country level and at the sub-national level. To address the need for agreed-upon standard definitions and measures of concurrent sexual partnerships, which will facilitate comparisons across time and settings, the Joint United Nations Program on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling, and Projections convened a meeting in April 2009. The recommendations developed at this meeting include suggestions for a definition, indicators, and measures of concurrency. |
The prevalence of hepatitis B virus infection in the United States in the era of vaccination
Wasley A , Kruszon-Moran D , Kuhnert W , Simard EP , Finelli L , McQuillan G , Bell B . J Infect Dis 2010 202 (2) 192-201 BACKGROUND: Our objective was to assess trends in the prevalence of hepatitis B virus (HBV) infection in the United States after widespread hepatitis B vaccination. METHODS: The prevalence of HBV infection and immunity was determined in a representative sample of the US population for the periods 1999-2006 and 1988-1994. National Health and Nutrition Examination Surveys participants 6 years of age were tested for antibody to hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), and antibody to hepatitis B surface antigen (anti-HBs). Prevalence estimates were weighted and age-adjusted. RESULTS: During the period 1999-2006, age-adjusted prevalences of anti-HBc (4.7%) and HBsAg (0.27%) were not statistically different from what they were during 1988-1994 (5.4% and 0.38%, respectively). The prevalence of anti-HBc decreased among persons 6-19 years of age (from 1.9% to 0.6%; [Formula: see text]) and 20-49 years of age (from 5.9% to 4.6%; [Formula: see text]) but not among persons 50 years of age (7.2% vs 7.7%). During 1999-2006, the prevalence of anti-HBc was higher among non-Hispanic blacks (12.2%) and persons of "Other" race (13.3%) than it was among non-Hispanic whites (2.8%) or Mexican Americans (2.9%), and it was higher among foreign-born participants (12.2%) than it was among US-born participants (3.5%). Prevalence among US-born children 6-19 years of age (0.5%) did not differ by race or ethnicity. Disparities between US-born and foreign-born children were smaller during 1999-1996 (0.5% vs 2.0%) than during 1988-1994 (1.0% vs 12.8%). Among children 6-19 years of age, 56.7% had markers of vaccine-induced immunity. CONCLUSIONS: HBV prevalence decreased among US children, which reflected the impact of global and domestic vaccination, but it changed little among adults, and approximately 730,000 US residents (95% confidence interval, 550,000-940,000) are chronically infected. |
Prevention of community-associated methicillin-resistant staphylococcus aureus infection among Asian/Pacific Islanders: a qualitative assessment
Ciccarone RM , Kim M , Tice AD , Nakata M , Effler P , Jernigan DB , Cardo DM , Sinkowitz-Cochran RL . Hawaii Med J 2010 69 (6) 142-4 BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasingly reported over the past decade, including in Asian/Pacific Islanders (A/PIs). METHODS: We conducted ethnographic interviews in Oahu and Kauai, Hawaii, with 10 Asian/Pacific Islanders identified as having a history of CA-MRSA infections. RESULTS: Most (7/10) thought skin infections were not a new problem in Hawaii. Most (8/9) attempted to self-treat the infection prior to seeking medical care with a range of home remedies and store- bought solutions. Most respondents did not initially comprehend the severity of their infection and only sought medical treatment after concern from family, unbearable pain, and/or other symptoms of illness. CONCLUSION: Clinicians should be aware of the reportedly frequent use of home remedies by this population, as it may potentially contribute to interactions when treatments are combined. If clinicians and public health professionals do not address perceptions and misperceptions of how MRSA is acquired, it will be very difficult to prevent infection, and may also delay individuals from seeking treatment. |
Clearance of hepatitis B surface antigen and risk of hepatocellular carcinoma in a cohort chronically infected with hepatitis B virus
Simonetti J , Bulkow L , McMahon BJ , Homan C , Snowball M , Negus S , Williams J , Livingston SE . Hepatology 2010 51 (5) 1531-7 Some individuals who are chronically infected with hepatitis B virus (HBV) eventually lose hepatitis B surface antigen (HBsAg). Hepatocellular carcinoma (HCC) has been demonstrated to occur in a few patients after loss of HBsAg. Neither factors associated with loss of HBsAg nor the incidence of HCC thereafter have been clearly elucidated. We performed a prospective population-based cohort study in 1,271 Alaska Native persons with chronic HBV infection followed for an average of 19.6 years to determine factors associated with loss of HBsAg and risk of developing HCC thereafter. HBsAg loss occurred in 158 persons for a rate of HBsAg clearance of 0.7%/year. Older age, but not sex, was associated with clearance of HBsAg, and loss of HBsAg was not associated with any particular HBV genotypes (A, B, C, D, and F) found in this population. Participants were followed for an average of 108.9 months after HBsAg loss. Six patients, two with cirrhosis and four without, developed HCC a mean of 7.3 years after HBsAg clearance (range, 2.0-15.5 years). The incidence of HCC after clearance of HBsAg was 36.8 per 100,000 per year (95% CI 13.5-80.0) which was significantly lower than the rate in those who remained HBsAg-positive (195.7 cases per 100,000 person-years of follow-up [95% CI 141.1-264.5; P < 0.001]). After loss of HBsAg, HBV DNA was detected in the sera of 28 (18%) of those who cleared a median of 3.6 years after clearance. CONCLUSION: HCC can occur in persons with chronic hepatitis B who have lost HBsAg, even in the absence of cirrhosis. These persons should still be followed with periodic liver ultrasound to detect HCC early. |
Detection of rotavirus antigenemia in routinely obtained serum specimens to augment surveillance and vaccine effectiveness evaluations
Patel M , Rench MA , Boom JA , Tate JE , Sahni LC , Hull JA , Gentsch JR , Parashar UD , Baker CJ . Pediatr Infect Dis J 2010 29 (9) 836-9 BACKGROUND: Antigenemia is common among children with rotavirus disease. Because obtaining stool specimens is cumbersome, we evaluated whether detection of antigenemia in sera obtained during routine clinical practice could augment rotavirus surveillance to assess the effect of vaccination. METHODS: We determined the sensitivity, specificity, and positive and negative predictive values of serum/plasma rotavirus antigen detection using fecal antigen positivity as the gold standard. Fecal specimens obtained by active surveillance and residual serum/plasma specimens obtained during routine clinical testing from children 15 days to 23 months of age presenting with acute gastroenteritis (AGE) to a children's hospital in Houston were tested for rotavirus using a commercially available enzyme immunoassay. Using case-control methods, we compared vaccine effectiveness (VE) using cases identified through serum/plasma testing versus stool testing. RESULTS: Of the 205 AGE patients with fecal specimens, 71 (35%) had a serum/plasma sample available. Among these 71 children, antigenemia was detected in 22 of 29 with rotavirus-positive fecal specimens (sensitivity = 75%; 95% confidence interval [CI] = 60%-91%) versus 2 of 42 children with rotavirus-negative fecal specimens (specificity = 95%; 95% CI = 89%-100%). The positive and negative predictive values of rotavirus antigenemia were 92% (95% CI = 81%-100%) and 85% (95% CI = 75%-95%), respectively. Thirty-four of 195 children with AGE without fecal specimens had serum/plasma available; 10 (29%) had rotavirus antigenemia. Three-dose VE using cases identified through serum/plasma testing was similar (VE = 84%; 95% CI = 25%-96%) to that using cases identified though fecal testing (VE = 85%; 95% CI = 55%-95%). CONCLUSIONS: Detection of antigenemia in routinely collected serum/plasma could augment identification of rotavirus disease for postlicensure evaluation of impact and effectiveness of rotavirus vaccination. |
Relationships between polybrominated diphenyl ether concentrations in house dust and serum
Johnson PI , Stapleton HM , Sjodin A , Meeker JD . Environ Sci Technol 2010 44 (14) 5627-32 Polybrominated diphenyl ethers (PBDEs) have been measured in the home environment and in humans, but studies linking environmental levels to body burdens are limited. This study examines the relationship between PBDE concentrations in house dust and serum from adults residing in these homes. We measured PBDE concentrations in house dust from 50 homes and in serum of male-female couples from 12 of the homes. Detection rates, dust-serum, and within-matrix correlations varied by PBDE congener. There was a strong correlation (r = 0.65-0.89, p < 0.05) between dust and serum concentrations of several predominant PBDE congeners (BDE 47, 99, and 100). Dust and serum levels of BDE 153 were not correlated (r < 0.01). The correlation of dust and serum levels of BDE 209 could not be evaluated due to low detection rates of BDE 209 in serum. Serum concentrations of the sum of BDE 47, 99, and 100 were also strongly correlated within couples (r = 0.85, p = 0.0005). This study provides evidence that house dust is a primary exposure pathway of PBDEs and supports the use of dust PBDE concentrations as a marker for exposure to PBDE congeners other than BDE 153. |
The BEACHES Study: health effects and exposures from non-point source microbial contaminants in subtropical recreational marine waters
Fleisher JM , Fleming LE , Solo-Gabriele HM , Kish JK , Sinigalliano CD , Plano L , Elmir SM , Wang JD , Withum K , Shibata T , Gidley ML , Abdelzaher A , He G , Ortega C , Zhu X , Wright M , Hollenbeck J , Backer LC . Int J Epidemiol 2010 39 (5) 1291-8 BACKGROUND: Microbial water-quality indicators, in high concentrations in sewage, are used to determine whether water is safe for recreational purposes. Recently, the use of these indicators to regulate recreational water bodies, particularly in sub/tropical recreational marine waters without known sources of sewage, has been questioned. The objectives of this study were to evaluate the risk to humans from exposure to subtropical recreational marine waters with no known point source, and the possible relationship between microbe densities and reported symptoms in human subjects with random-exposure assignment and intensive individual microbial monitoring in this environment. METHODS: A total of 1303 adult regular bathers were randomly assigned to bather and non-bather groups, with subsequent follow-up for reported illness, in conjunction with extensive environmental sampling of indicator organisms (enterococci). RESULTS: Bathers were 1.76 times more likely to report gastrointestinal illness [95% confidence interval (CI) 0.94-3.30; P = 0.07]; 4.46 times more likely to report acute febrile respiratory illness (95% CI 0.99-20.90; P = 0.051) and 5.91 times more likely to report a skin illness (95% CI 2.76-12.63; P < 0.0001) relative to non-bathers. Evidence of a dose-response relationship was found between skin illnesses and increasing enterococci exposure among bathers [1.46 times (95% CI 0.97-2.21; P = 0.07) per increasing log(10) unit of enterococci exposure], but not for gastrointestinal or respiratory illnesses. CONCLUSIONS: This study indicated that bathers may be at increased risk of several illnesses relative to non-bathers, even in the absence of any known source of domestic sewage impacting the recreational marine waters. There was no dose-response relationship between gastroenteritis and increasing exposure to enterococci, even though many current water-monitoring standards use gastroenteritis as the major outcome illness. |
Reliance on self-reporting underestimates pregnancy smoking rates in Scotland, with more than 2400 pregnant smokers estimated to be missed each year
Tong VT , Dietz PM , England LJ . Evid Based Med 2010 15 (3) 94-5 Smoking during pregnancy is a preventable cause of infant morbidity and mortality, yet prenatal smoking is a persistent problem, with an estimated 6–22% of women in high-income countries reporting smoking cigarettes during pregnancy.1 Clinic-based interventions are effective in increasing cessation and improving pregnancy outcomes2; however, delivery of these interventions depends on the ability of providers to assess a woman's smoking status and readiness to quit accurately. | Shipton and colleagues sought to estimate the biochemically validated prevalence of women in need of smoking cessation services. Using a random sample of all 2004 births from the West of Scotland, they compared routinely collected self-reported smoking status of pregnant women at maternity booking (8–12 weeks of gestation) and serum cotinine levels from prenatal screening (15–16 weeks of gestation). They found that maternal self-reported smoking status underestimated smoking prevalence by 25%. The authors' findings are consistent with previously published clinical and observational studies in which maternal non-disclosure of smoking status was high.3 Because women in the current study did not know in advance that their smoking status would be validated with biochemical measures, the non-disclosure rates reported here can probably be generalised to similar clinical settings in which women's self-reported smoking status is not biochemically validated. |
Sex, menopause, metabolic syndrome, and all-cause and cause-specific mortality--cohort analysis from the Third National Health and Nutrition Examination Survey
Lin JW , Caffrey JL , Chang MH , Lin YS . J Clin Endocrinol Metab 2010 95 (9) 4258-67 OBJECTIVE: This study assessed the mortality risk associated with metabolic syndrome (MetS) for participants from the Third National Health and Nutrition Examination Survey. DESIGN, SETTING AND PATIENTS: The study analyzed mortality data from 1364 men and 1321 women aged 40 yr and older based on their MetS status defined by National Cholesterol Education Program Adult Treatment Panel III. Subjects initially using insulin, oral hypoglycemic, antihypertensive, or lipid-lowering medications were excluded. MAIN OUTCOME MEASURES: All-cause, cardiovascular, cardiac, and noncardiovascular mortality were obtained from the Third National Health and Nutrition Examination Survey-linked mortality follow-up file through December 31, 2000. RESULTS: The prevalence of MetS was 33 and 29% for men and women, respectively. In the male subjects, there was no significant association between MetS and mortality. In the women, MetS was an independent risk factor for all-cause mortality [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.29-2.64, P = 0.001], cardiovascular mortality (HR 1.96, 95% CI 1.21-3.17, P = 0.007), cardiac mortality (HR 1.88, 95% CI 1.15-3.09, P = 0.01), and noncardiovascular mortality (HR 1.80, 95% CI 1.13-2.87, P = 0.01). The HR was stronger when postmenopausal women were analyzed separately and became nonsignificant in the premenopausal cohort. The sex-specific HR remained unchanged, regardless of the MetS criteria used or the inclusion of actively treated subjects. CONCLUSIONS: MetS poses a significant increase in mortality risk through an observation period as long as 12 yr, primarily in postmenopausal women, that is not apparent in men and premenopausal women. Sex is an important effect modifier of all-cause and cause-specific death. |
Trends in frequency of reporting improper diabetes-related cause-of-death statements on death certificates, 1985-2005: an algorithm to identify incorrect causal sequences
Lu TH , Anderson RN , Kawachi I . Am J Epidemiol 2010 171 (10) 1069-78 This study aimed to examine the changes in frequency of reporting improper diabetes-related cause-of-death statements on death certificates based on Multiple-Cause Mortality Files of the United States from 1985 to 2005. An algorithm was developed to identify the causes of death with incorrect causal sequences by using decision tables developed by the National Center for Health Statistics. In 1985, 2 or more diagnoses per line were reported on 35% of death certificates with mention of diabetes in Part I of the death certificate. This percentage decreased to 19% in 2005. In contrast, the prevalence of reporting incorrect causal sequences on death certificates on which diabetes was reported in Part I increased from 22% in 1985 to 35% in 2005. The authors suggest that the most plausible explanation of increasing reporting of incorrect causal sequences was the drastic increase of reporting multiple conditions (especially cardiovascular diseases and cancers) among deaths with mention of diabetes, which made the determination of underlying cause of death much more difficult. |
Prevalence of antimicrobial use among United States nursing home residents: results from a national survey
Pakyz AL , Dwyer LL . Infect Control Hosp Epidemiol 2010 31 (6) 661-2 Infection is one of the primary causes of morbidity and mortality among nursing home residents.1 | Inappropriate antimicrobial use may have negative effects on resident health, | including the potential for adverse drug reactions. A position | paper on antimicrobial use in nursing home facilities by the | Society for Healthcare Epidemiology of America has recommended the monitoring of antimicrobial prescribing and | the linking of use data with infection surveillance data.2 | Previous investigations have examined aspects of antimicrobial prescribing in nursing homes, including use in patients with advanced dementia,3 | in 4 geographically diverse | states,4 | and in 53 facilities in Maryland.5 | However, few studies | have assessed use in a nationally representative sample. The | purpose of this investigation was to assess both the prevalence | and the types of antimicrobial use in a nationally representative sample of nursing home residents |
A comparison of mail and telephone administration of district-level questionnaires for the School Health Policies and Programs Study (SHPPS) 2006: effects on estimates and data quality
Denniston M , Brener N . J Sch Health 2010 80 (6) 304-311 BACKGROUND: The School Health Policies and Programs Study (SHPPS) is a national study periodically conducted to assess school health policies and programs at the state, district, school, and classroom levels. For SHPPS 2006, district-level questionnaires were designed for telephone administration, but mixed-mode data collection that also used paper-and-pencil mail questionnaires was required to obtain an acceptable response rate. Because most mode effect research has involved person-level rather than institution-level data, little is known about the effects of mixed-mode data collection on data quality and prevalence estimates obtained through surveys of school personnel. METHODS: SHPPS 2006 used 1-stage stratified cluster sampling to select a nationally representative sample of public school districts. Personnel in about half of the 538 responding districts completed paper questionnaires and returned them via mail. Analyses were performed comparing data quality and prevalence estimates for mail and telephone administration. RESULTS: Prevalence estimates for only 7.0% (39) of 554 questions tested across the 7 questionnaires differed significantly by response mode at the p < .01 level. Regarding data quality, use of the "don't know" response was higher for telephone administration. CONCLUSIONS: The results of this study demonstrate that SHPPS 2006 successfully used a mixed-mode approach, allowing the data to be used without concern about the mixed-mode administration. The results may also be useful to other researchers interested in using surveys to collect data on schools or school districts or other data that is not person level. |
Women who have sex with women in the United States: prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-: results from National Health and Nutrition Examination Survey 2001-2006
Xu F , Sternberg MR , Markowitz LE . Sex Transm Dis 2010 37 (7) 407-13 OBJECTIVES: To estimate the prevalence of same-sex sexual behavior in women in the United States; to describe demographic and behavioral characteristics and the prevalence of herpes simplex virus type 2 (HSV-2) infection. METHODS: As part of the National Health and Nutrition Examination Surveys during 2001-2006, women aged 18 to 59 years were interviewed about sexual behaviors using audio computer assisted self-interview. Persons aged 14 to 49 years were tested for antibodies to HSV-2. RESULTS: Among sexually experienced women aged 18 to 59 years, 7.1% (95% CI, 6.1-8.2) reported ever having had sex with a woman (WSW-ever) and 2.7% in the past year (WSW-pastyear). The prevalence of WSW-ever correlated negatively with age, highest (9.4%) in 18 to 29-year-olds and lowest (5.5%) in 50 to 59-year-olds. Among WSW-ever, 52.6% self-identified as heterosexual/straight, 28.3% as bisexual, and 19.1% as homosexual/lesbian. Among WSW-ever, demographic characteristics were similar but sexual behaviors were different by sexual orientation: 31.3% of heterosexuals, 38.9% of bisexuals, and 12.9% of homosexuals reported first sex at age 14 or younger (P = 0.005); the median number of lifetime male partners was 10.8, 17.6, and 2.9, respectively (P < 0.0001). Among WSW-ever, the prevalence of HSV-2 was 45.6% in heterosexuals, 35.9% in bisexuals, and 8.2% in homosexuals (P = 0.001). In comparison, among women who reported no same-sex partners, the prevalence of HSV-2 was 23.8%. CONCLUSIONS: In this population-based sample of women, self-reported same-sex behaviors were increasingly more prevalent in younger women. Compared with homosexual WSW-ever and women who reported never having sex with other women, heterosexual or bisexual WSW-ever had higher HSV-2 seroprevalence. |
Prevalent high-risk respiratory hygiene practices in urban and rural Bangladesh
Nasreen S , Azziz-Baumgartner E , Gurley ES , Winch PJ , Unicomb L , Sharker MAY , Southern D , Luby SP . Trop Med Int Health 2010 15 (6) 762-771 OBJECTIVES: To identify existing respiratory hygiene risk practices, and guide the development of interventions for improving respiratory hygiene. METHODS: We selected a convenience sample of 80 households and 20 schools in two densely populated communities in Bangladesh, one urban and one rural. We observed and recorded respiratory hygiene events with potential to spread viruses such as coughing, sneezing, spitting and nasal cleaning using a standardized assessment tool. RESULTS: In 907 (81%) of 1122 observed events, households' participants coughed or sneezed into the air (i.e. uncovered), 119 (11%) into their hands and 83 (7%) into their clothing. Twenty-two per cent of women covered their coughs and sneezes compared to 13% of men (OR 2.6, 95% CI 1.6-4.3). Twenty-seven per cent of persons living in households with a reported monthly income of >72.6 US$ covered their coughs or sneezes compared to 13% of persons living in households with lower income (OR 3.2, 95% CI 1.6-6.2). In 956 (85%) of 1126 events, school participants coughed or sneezed into the air and 142 (13%) into their hands. Twenty-seven per cent of coughssneezes in rural schools were covered compared to 10% of coughssneezes in urban schools (OR 2.3, 95% CI 1.5-3.6). Hand washing was never observed after participants coughed or sneezed into their hands. CONCLUSION: There is an urgent need to develop culturally appropriate, cost-effective and scalable interventions to improve respiratory hygiene practices and to assess their effectiveness in reducing respiratory pathogen transmission. copyright Published 2010. This article is a US Government work and is in the public domain in the USA. |
Postdisaster health communication and information sources: the Iowa flood scenario
Murphy MW , Iqbal S , Sanchez CA , Quinlisk MP . Disaster Med Public Health Prep 2010 4 (2) 129-34 BACKGROUND: During June 2008, heavy precipitation and 500-year flood events resulted in the displacement of thousands of families throughout eastern Iowa. The objectives of this study were to assess the effectiveness and preferred sources of health messages communicated to the public following the disaster. METHODS: Three hundred twenty-seven households were surveyed in 4 counties hit hardest by the flooding. A 48-item questionnaire containing items on demographics, housing, health information sources, and 8 specific health issues was administered. RESULTS: Almost all of the participants (99.0%) received information on at least 1 of the health topics covered by the survey. Most participants received information regarding vaccination (84.1%), mold (79.5%), safe use of well water (62.7%), respirator use (58.7%), or stress (53.8%). Television was the primary (54.7%) and preferred (60.2%) source of health information for most people, followed by the Internet (11.0% and 30.3% as source and preference, respectively). CONCLUSIONS: Public health messages were received by a wide audience in the flood-affected communities. Along with more traditional health communication channels such as television, radio, or newspapers, continued emphasis on the development of health information Web sites and other technological alternatives may result in useful and effective health communication in similar situations. |
Building on partnerships: reconnecting kids with nature for health benefits
Kruger J , Nelson K , Klein P , McCurdy LE , Pride P , Carrier Ady J . Health Promot Pract 2010 11 (3) 340-6 In April 2008, several federal and nonprofit agencies organized an informational Web-based meeting titled "Reconnecting Kids With Nature for Health Benefits." This online meeting was convened by the Society for Public Health Education and delivered to public health educators, health professionals, environmental educators, and land conservationists to raise awareness of national efforts to promote children's involvement in outdoor recreation. This article describes eight programs discussed at this meeting. For public health professionals, partnership with land-management agencies conducting such programs may be an effective way to increase physical activity levels among children. |
Preventing infections in patients undergoing hemodialysis
Kallen AJ , Arduino MJ , Patel PR . Expert Rev Anti Infect Ther 2010 8 (6) 643-55 Infections continue to be a major cause of morbidity and mortality in patients with end-stage renal disease. While rates of all-cause hospitalization of prevalent end-stage renal disease patients receiving hemodialysis reported by the United States Renal Data System fell from 1993 to 2007, rates of hospitalization for infections rose by 26%. Developing a better understanding of the reasons for this rise and employing strategies to reverse it have become a priority for patients, providers and regulatory agencies in the USA. In addition, recent episodes of transmission of bloodborne hepatitis viruses in outpatient healthcare facilities, including hemodialysis centers, related to suboptimal infection control and injection safety practices, have raised concerns about patient safety. In this article, we review many of the current infection control challenges facing outpatient dialysis centers and discuss recommended infection control policies and practices aimed at combating these challenges. |
Rotavirus vaccines for global use: what are the remaining issues and challenges?
Jiang B , Patel M , Parashar U . Hum Vaccin 2010 6 (5) 425-7 In June 2009, the Strategic Advisory Group of Experts (SAGE) of the World Health Organization (WHO) issued a recommendation for global use of the two currently licensed live oral rotavirus vac-cines, a pentavalent human-bovine reas-sortant RotaTeq® developed by Merck and a monovalent attenuated human strain Rotarix™ from GlaxoSmithKline.1This represented an expansion of an ini-tial SAGE recommendation in 2007 that vaccines be used in the Americas and Europe where vaccine efficacy had been established in pivotal pre-licensure trials.2The expansion was based, in large part, on efficacy data from recently completed clinical trials that established the effi-cacy of Rotarix™ in Malawi and South Africa and effectiveness results from post-licensure studies of the two vaccines in El Salvador and Nicaragua. |
The next public health revolution: public health information fusion and social networks
Khan AS , Fleischauer A , Casani J , Groseclose SL . Am J Public Health 2010 100 (7) 1237-42 Social, political, and economic disruptions caused by natural and human-caused public health emergencies have catalyzed public health efforts to expand the scope of biosurveillance and increase the timeliness, quality, and comprehensiveness of disease detection, alerting, response, and prediction. Unfortunately, efforts to acquire, render, and visualize the diversity of health intelligence information are hindered by its wide distribution across disparate fields, multiple levels of government, and the complex interagency environment. Achieving this new level of situation awareness within public health will require a fundamental cultural shift in methods of acquiring, analyzing, and disseminating information. The notion of information "fusion" may provide opportunities to expand data access, analysis, and information exchange to better inform public health action. |
Carbon nanotubes degraded by neutrophil myeloperoxidase induce less pulmonary inflammation
Kagan VE , Konduru NV , Feng W , Allen BL , Conroy J , Volkov Y , Vlasova II , Belikova NA , Yanamala N , Kapralov A , Tyurina YY , Shi J , Kisin ER , Murray AR , Franks J , Stolz D , Gou P , Klein-Seetharaman J , Fadeel B , Star A , Shvedova AA . Nat Nanotechnol 2010 5 (5) 354-9 We have shown previously that single-walled carbon nanotubes can be catalytically biodegraded over several weeks by the plant-derived enzyme, horseradish peroxidase. However, whether peroxidase intermediates generated inside human cells or biofluids are involved in the biodegradation of carbon nanotubes has not been explored. Here, we show that hypochlorite and reactive radical intermediates of the human neutrophil enzyme myeloperoxidase catalyse the biodegradation of single-walled carbon nanotubes in vitro, in neutrophils and to a lesser degree in macrophages. Molecular modelling suggests that interactions of basic amino acids of the enzyme with the carboxyls on the carbon nanotubes position the nanotubes near the catalytic site. Importantly, the biodegraded nanotubes do not generate an inflammatory response when aspirated into the lungs of mice. Our findings suggest that the extent to which carbon nanotubes are biodegraded may be a major determinant of the scale and severity of the associated inflammatory responses in exposed individuals. |
Public health and laboratory considerations regarding newborn screening for congenital cytomegalovirus
Dollard SC , Schleiss MR , Grosse SD . J Inherit Metab Dis 2010 33 S249-54 Congenital cytomegalovirus (CMV) infection is the most common infection in newborns worldwide and causes hearing loss and other neurological disability in 15-20% of infected infants. Only about half of the hearing loss resulting from congenital CMV infection is currently detected by universal newborn hearing screening because of late-onset hearing loss. Thus, much of the hearing loss and the majority of other CMV-associated disabilities remain undetected for years after birth and are never connected to CMV infection. Congenital CMV may be appropriate to include in national newborn screening (NBS) programs because it is more common than other disorders tested for by NBS programs and is a major cause of disability. Significant obstacles to the implementation of screening for congenital CMV include the lack of a standardized, high-throughput screening test and a protocol for follow-up of CMV-infected children. Nonetheless, screening newborns for congenital CMV infection merits further consideration. |
Association of hospitalization for infection in childhood with diagnosis of autism spectrum disorders: a Danish cohort study
Atladottir HO , Thorsen P , Schendel DE , Ostergaard L , Lemcke S , Parner ET . Arch Pediatr Adolesc Med 2010 164 (5) 470-7 OBJECTIVE: To investigate the association between hospitalization for infection in the perinatal/neonatal period or childhood and the diagnosis of autism spectrum disorders (ASDs). DESIGN: A population-based cohort study. SETTING: Denmark. PARTICIPANTS: All children born in Denmark from January 1, 1980, through December 31, 2002, comprising a total of 1 418 152 children. EXPOSURE: Infection requiring hospitalization. MAIN OUTCOME MEASURE: The adjusted hazard ratio (HR) for ASDs among children hospitalized for infection compared with other children. RESULTS: A total of 7379 children were diagnosed as having ASDs. Children admitted to the hospital for any infectious disease displayed an increased rate of ASD diagnoses (HR, 1.38 [95% confidence interval, 1.31-1.45]). This association was found to be similar for infectious diseases of bacterial and viral origin. Furthermore, children admitted to the hospital for noninfectious disease also displayed an increased rate of ASD diagnoses (HR, 1.76 [95% confidence interval, 1.68-1.86]), and admissions for infection increased the rate of mental retardation (2.18 [2.06-2.31]). CONCLUSIONS: The association between hospitalization for infection and ASDs observed in this study does not suggest causality because a general association is observed across different infection groups. Also, the association is not specific for infection or for ASDs. We discuss a number of noncausal explanatory models. |
Total folate and folic acid intakes from foods and dietary supplements of US children aged 1-13 y
Bailey RL , McDowell MA , Dodd KW , Gahche JJ , Dwyer JT , Picciano MF . Am J Clin Nutr 2010 92 (2) 353-8 BACKGROUND: Total folate intake includes naturally occurring food folate and folic acid from fortified foods and dietary supplements. Recent reports have focused on total folate intakes of persons aged ≥14 y. Information on total folate intakes of young children, however, is limited. OBJECTIVE: The objective was to compute total folate and total folic acid intakes of US children aged 1-13 y by using a statistical method that adjusts for within-person variability and to compare these intakes with the Dietary Reference Intake guidelines for adequacy and excess. DESIGN: Data from the 2003-2006 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey, were analyzed. Total folate intakes were derived by combining intakes of food folate (naturally occurring and folic acid from fortified foods) on the basis of 24-h dietary recall results and folic acid intakes from dietary supplements on the basis of a 30-d questionnaire. RESULTS: More than 95% of US children consumed at least the Estimated Average Requirement (EAR) for folate from foods alone. More than one-third (35%) of US children aged 1-13 y used dietary supplements, and 28% used dietary supplements containing folic acid. Supplement users had significantly higher total folate and folic acid intakes than did nonusers. More than half (53%) of dietary supplement users exceeded the Tolerable Upper Intake Level (UL) for total folic acid (fortified food + supplements) as compared with 5% of nonusers. CONCLUSIONS: Total folate intakes of most US children aged 1-13 y meet the EAR. Children who used dietary supplements had significantly higher total folate intakes and exceeded the UL by >50%. |
Physician recognition of work-related asthma among US farm operators
Mazurek JM , Schleiff PL . Fam Med 2010 42 (6) 408-13 BACKGROUND AND OBJECTIVES: The occupational history of every adult patient with asthma provides information critical to the proper diagnosis and effective prevention of work-related asthma. This study determined the proportion of farm operators that reported an asthma attack while doing farm work that required the use of an inhaler or other medical treatment but who had not been told by a doctor, nurse, or other health professional that their asthma was related to work on the farm. METHODS: Asthma and asthma attack prevalences were estimated using data on a nationally representative sample of 12,278 active farm operators who participated in the 2006 Farm and Ranch Safety Survey. RESULTS: An estimated 4.9% of operators reported current asthma. Of these, an estimated 24.8% had been told that their asthma was related to work on the farm. Of those not so informed, 21.6% reported an asthma attack at work in the 12 months prior to the interview. CONCLUSIONS: A large proportion of farm operators who had not been told that their asthma was related to work on the farm experienced an asthma attack that occurred while doing farm work. These results suggest the need for improving clinicians' occupational health practices and clinician-patient communication. |
Effect of exhaled moisture on breathing resistance of N95 filtering facepiece respirators
Roberge RJ , Bayer E , Powell JB , Coca A , Roberge MR , Benson SM . Ann Occup Hyg 2010 54 (6) 671-7 This study evaluated the effect of exhaled moisture on the breathing resistance of three classes of filtering facepiece respirators (FFR) following 4 h of continuous wear at a breathing volume of 40 l min(-1), utilizing an automated breathing and metabolic simulator as a human surrogate. After 4 h, inhalation and exhalation resistance increased by 0.43 and 0.23 mm of H(2)O pressure, respectively, and average moisture retention in the respirators was 0.26 ml. Under ambient conditions similar to those of the current study, and at similar breathing volumes, it is unlikely that exhaled moisture will add significantly to the breathing resistance of filtering facepiece respirators (FFR) over 4 h of use. |
Associations between work schedule characteristics and occupational injury and illness
de Castro A , Fujishiro K , Rue T , Tagalog E , Samaco-Paquiz L , Gee G . Int Nurs Rev 2010 57 (2) 188-194 BACKGROUND: Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer-imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms. AIM: This study investigates how these work characteristics are associated with nurses' work-related injury and illness over and above long work hours. METHODS: In this cross-sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work-related health outcomes. RESULTS: After weekly work hours, shift length and demographic variables were accounted for, non-day shifts were associated with work-related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work-related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work-related injury (OR = 1.22; 95% CI: 1.06, 1.41), work-related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work-related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44). CONCLUSIONS: These findings suggest that non-day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse-to-patient ratios and work-family conflict, should be examined in future studies. |
Rates and costs of respiratory illness in coal mining: a cross-industry comparative analysis
Van Houtven G , Reed WR , Biddle EA , Volkwein JC , Clayton L , Finkelstein E . J Occup Environ Med 2010 52 (6) 610-7 OBJECTIVE: To estimate the prevalence and costs of respiratory illness for workers in coal mining, compared with other US industries. METHODS: Using 5 years of insurance claims data for an annual average of 96,240 adult males, we model the probability and costs of respiratory illness as a function of workers' industry and other factors. RESULTS: Controlling for nonindustry factors, workers in coal mining had significantly higher rates of respiratory illness claims (by 2.1% to 3.3% points) compared with other mining, agriculture, construction, and manufacturing. For coal mining workers with respiratory illness, annual medical care costs for these claims were also significantly higher (by $111 to $289). Surprisingly, drug costs were mostly lower (by $17 to $268). CONCLUSIONS: Our findings underscore the continued importance and potential cost effectiveness of measures to protect miners from harmful occupational exposures, particularly to coal dust. |
Coal workers' pneumoconiosis and progressive massive fibrosis are increasingly more prevalent among workers in small underground coal mines in the United States
Laney AS , Attfield MD . Occup Environ Med 2010 67 (6) 428-31 OBJECTIVE: To determine whether the prevalence of coal workers' pneumoconiosis (CWP) or progressive massive fibrosis (PMF) among United States underground miners is associated with mine size. METHODS: We examined chest radiographs from 1970 to 2009 of working miners who participated in the National Coal Workers Health Surveillance Program for the presence of small and large opacities consistent with pneumoconiosis, based upon the International Labour Organization classification system. RESULTS: A total of 145 512 miners contributed 240 067 radiographs for analysis. From the 1990s to the 2000s, the prevalence of radiographic CWP increased among miners in mines of all sizes, while miners working in mines with fewer than 50 employees had a significantly higher prevalence of CWP compared to miners who worked in mines with 50 or more employees (p<0.0001). When adjusted for age and within-miner correlation, the difference in prevalence of CWP by mine size was significant for all decades. Since 1999, miners from small mines were five times more likely to have radiographic evidence of PMF (1.0% of miners) compared to miners from larger mines (0.2% of miners) with a prevalence ratio of 5.0 and 95% CI 3.3 to 7.5. CONCLUSION: The prevalence of CWP among United States coal miners is increasing in mines of all sizes, while CWP and PMF are much more prevalent among workers from underground mines with fewer than 50 workers. |
Built environment attributes and walking patterns among the elderly population in Bogota
Gomez LF , Parra DC , Buchner D , Brownson RC , Sarmiento OL , Pinzon JD , Ardila M , Moreno J , Serrato M , Lobelo F . Am J Prev Med 2010 38 (6) 592-9 BACKGROUND: There is increasing evidence that the built environment has an influence on physical activity; however, little is known about this relationship in developing countries. PURPOSE: This study examined the associations between attributes of the built environment and walking patterns among the elderly. METHODS: A multilevel cross-sectional study was conducted in 2007. Fifty neighborhoods were selected and 1966 participants aged > or =60 years were surveyed. Objective built environment measures were obtained in a buffer of 500 m using GIS. Environmental perceptions were assessed via questionnaire. RESULTS: People who lived in areas with middle park area (4.53%-7.98% of land) were more likely to walk for at least 60 minutes during a usual week (prevalence OR [POR]=1.42, 95% CI=1.02, 1.98). Those who lived in areas with the highest connectivity index (1.81-1.99) were less likely to report walking for at least 60 minutes (POR=0.64, 95% CI=0.44, 0.93). Participants who reported feeling safe or very safe from traffic were more likely to report walking for at least 60 minutes (POR=1.50, 95% CI=1.11, 2.03). The presence of Ciclovia (recreational program) was marginally associated with having walked at least 150 minutes in a usual week (POR=1.29, 95% CI=0.97, 1.73). CONCLUSIONS: This study showed that certain built and perceived environment characteristics were associated with walking among older adults living in Bogota. Further studies should be conducted to better understand the potential influence of the built environment on physical activity among the elderly population in the context of Latin American cities. |
Deaths preventable in the U.S. by improvements in use of clinical preventive services
Farley TA , Dalal MA , Mostashari F , Frieden TR . Am J Prev Med 2010 38 (6) 600-9 BACKGROUND: Healthcare reform plans refer to improved quality, but there is little quantification of potential health benefits of quality care. PURPOSE: This paper aims to estimate the health benefits by greater use of clinical preventive services. METHODS: Two mathematical models were developed to estimate the number of deaths potentially prevented per year by increasing use of nine clinical preventive services. One model estimated preventable deaths from all causes, and the other estimated preventable deaths from specific categories of causes. Models were based on estimates of the prevalence of risk factors for which interventions are recommended, the effect of those risk factors on mortality, the effect of the interventions on mortality in those at risk, and current and achievable rates of utilization of the interventions. RESULTS: Both models predicted substantial numbers of deaths prevented by greater use of the preventive services, with the greatest increases from services that prevent cardiovascular disease. For example, the all-cause model predicted that every 10% increase in hypertension treatment would lead to an additional 14,000 deaths prevented and every 10% increase in treatment of elevated low-density lipoprotein cholesterol or aspirin prophylaxis would lead to 8000 deaths prevented in those aged <80 years, per year. Overall, the models suggest that optimal use of all of these interventions could prevent 50,000-100,000 deaths per year in those aged <80 years and 25,000-40,000 deaths per year in those aged <65 years. CONCLUSIONS: Substantial improvements in population health are achievable through greater use of a small number of preventive services. Healthcare systems should maximize use of these services. |
Binge drinking and suboptimal self-rated health among adult drinkers
Tsai J , Ford ES , Li C , Pearson WS , Zhao G . Alcohol Clin Exp Res 2010 34 (8) 1465-71 BACKGROUND: Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self-rated health among the general population of adult drinkers in all 50 states and territories in the United States. METHODS: The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ≥5 drinks on 1 occasion for men or ≥4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30-day period. Odds ratios were produced with multivariate logistic regression models using binge-drinking levels as a predictor; status of suboptimal self-rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors. RESULTS: We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge-drinking episodes in a 30-day period. Binge drinking with such levels was associated with a 13-23% increased likelihood of reporting suboptimal self-rated health, when compared to the nonbinge drinkers. CONCLUSIONS: Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self-rated health. Our findings underscore the importance of broad-based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population-based prevention strategies to reduce alcohol-related morbidity and mortality. |
Content Index (Achived Edition)
- Communicable Diseases
- Environmental Health
- Epidemiology and Surveillance
- Health Behavior and Risk
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Physical Activity
- Public Health, General
- Substance Use and Abuse
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