Trends in length of hospice care From 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys
Sengupta M , Park-Lee E , Valverde R , Caffrey C , Jones A . Am J Hosp Palliat Care 2013 31 (4) 356-64 Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year. |
Life's Simple 7 and risk of incident stroke: the Reasons for Geographic And Racial Differences in Stroke study
Kulshreshtha A , Vaccarino V , Judd SE , Howard VJ , McClellan WM , Muntner P , Hong Y , Safford MM , Goyal A , Cushman M . Stroke 2013 44 (7) 1909-14 BACKGROUND AND PURPOSE: The American Heart Association developed Life's Simple 7 (LS7) as a metric defining cardiovascular health. We investigated the association between LS7 and incident stroke in black and white Americans. METHODS: The Reasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based cohort of 30,239 blacks and whites, aged ≥45 years, sampled from the US population from 2003 to 2007. Data were collected by telephone, self-administered questionnaires, and an in-home examination. Incident strokes were identified through biannual participant contact followed by adjudication of medical records. Levels of the LS7 components (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet) were each coded as poor (0 point), intermediate (1 point), or ideal (2 points) health. An overall LS7 score was categorized as inadequate (0-4), average (5-9), or optimum (10-14) cardiovascular health. RESULTS: Among 22,914 subjects with LS7 data and no previous cardiovascular disease, there were 432 incident strokes over 4.9 years of follow-up. After adjusting for demographics, socioeconomic status, and region of residence, each better health category of the LS7 score was associated with a 25% lower risk of stroke (hazard ratios, 0.75; 95% confidence interval, 0.63-0.90). The association was similar for blacks and whites (interaction P value=0.55). A 1-point higher LS7 score was associated with an 8% lower risk of stroke (hazard ratios, 0.92; 95% confidence interval, 0.88-0.95). CONCLUSIONS: In both blacks and whites, better cardiovascular health, on the basis of the LS7 score, is associated with lower risk of stroke, and a small difference in scores was an important stroke determinant. |
An intensive lifestyle intervention increased remission from type 2 diabetes in overweight adults
Gregg EW , Kyithar MP , Dinneen SF . Ann Intern Med 2013 158 (10) 4 Does an intensive lifestyle intervention increase remission from type 2 diabetes in overweight adults? | Methods | Design | Secondary analysis of a randomized controlled trial (Look Action for Health for Diabetes [Look AHEAD] trial). ClinicalTrials.gov NCT00017953. | Allocation | {Concealed}*.† | Blinding | Blinded† {data collectors and outcome adjudicators}*. | Follow-up period | 4 years. | Setting | 16 research centers in the USA. | Patients | 5145 adults 45 to 76 years of age (mean age 59 y, 58% women, mean weight 101 kg) who had type 2 diabetes and a body mass index ≥ 25 kg/m2, or ≥ 27 kg/m2 if using insulin. Exclusion criteria included hemoglobin A1c level > 11%, blood pressure > 160 mm Hg systolic or > 100 mm Hg diastolic, plasma triglyceride level > 600 mg/dL, or inability to perform maximal graded exercise test or complete 2 weeks of diet and activity self-monitoring. | Intervention | Intensive lifestyle intervention (ILI) (n = 2570) or diabetes support and education (DSE) (n = 2575). ILI comprised 6 months of weekly group and individual counseling followed by 3 sessions/mo for the next 6 months, and twice-monthly contact and regular refresher group sessions in years 2 to 4. The target intake was 1200 to 1800 kcal/d with reduced fat intake plus 175 minutes/wk of physical activity. Patients in the DSE group were offered 3 group sessions focusing on diet, physical activity, and social support each year. | Outcomes | Partial (transition from meeting diabetes criteria to a prediabetes level of glycemia without antihyperglycemic medication) or complete (transition from meeting diabetes criteria to full normalization of glucose without antihyperglycemic medication) remission of diabetes. Secondary outcomes included weight. | Patient follow-up | 80%. | Main results | The ILI group lost more weight than the DSE group at year 1 (8.6% vs 0.7%, P < 0.001) and year 4 (4.7% vs 0.8%, P < 0.001) and had more complete remissions than the DSE group across all years of the study (prevalence ratio 6.6, 95% CI 3 to 13). ILI increased partial or complete remission during each year of follow-up (Table). | Conclusion | An intensive lifestyle intervention increased remission from type 2 diabetes in overweight adults compared with diabetes support and education. | Sources of funding: National Institutes of Health and many other federal agencies. |
Prevalence and genetic diversity of norovirus among patients with acute diarrhea in Guatemala.
Estevez A , Arvelo W , Hall AJ , Lopez MR , Lopez B , Reyes L , Moir JC , Gregoricus N , Vinje J , Parashar UD , Lindblade KA . J Med Virol 2013 85 (7) 1293-8 Noroviruses (NoVs) are a leading cause of acute gastroenteritis outbreaks and sporadic cases of diarrhea in industrialized countries. To study the prevalence and genetic diversity of NoVs in Guatemala, stool specimens were collected from hospitalized and ambulatory patients presenting with diarrhea (≥3 loose or liquid stools in a 24-hr period) who were enrolled in a prospective surveillance system in the Departments of Santa Rosa (October 2007 to August 2010) and Quetzaltenango (August 2009 to August 2010), Guatemala. Specimens were tested for rotavirus, enteric bacteria, and parasites by routine methods and for genogroups I and II NoV by real-time reverse transcription-PCR. A total of 2,403 stool specimens were collected from hospitalized (n = 528) and ambulatory patients (n = 1,875). Overall, 341 (14%) samples tested positive for NoVs including 114 (22%) hospitalized and 227 (12%) ambulatory patients. NoVs disease peaked during the winter (November-January) months. Among the 341 NoVs-positive patients, 32 (9%) were also positive for rotavirus, 32 (9%) for bacteria, and 9 (3%) for protozoa. Nucleotide sequences were obtained from 84 samples collected from hospitalized children aged <5 years of age, which could be grouped into nine GII and three GI genotypes with GII.4 (74%) and GI.8 (10%) being the most common. This is the first study on the prevalence of NoVs among hospitalized and ambulatory patients with diarrhea in Guatemala. The findings highlight the need to implement laboratory diagnostics for NoVs to improve appropriate clinical management of diarrheal diseases and guide vaccine development. (J. Med. Virol. (c) 2013 Wiley Periodicals, Inc.) |
Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study
Moonan PK , Teeter LD , Salcedo K , Ghosh S , Ahuja SD , Flood J , Graviss EA . Lancet Infect Dis 2013 13 (9) 777-84 BACKGROUND: Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. METHODS: In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. FINDINGS: 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. INTERPRETATION: About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals. FUNDING: Centers for Disease Control and Prevention. |
Wild poliovirus importation, Central African Republic.
Gouandjika-Vasilache I , Mazitchi A , Gumede N , Manirakiza A , Manenegu C , Koyazegbe TD , Burns C . Emerg Infect Dis 2013 19 (6) 1012-3 Since the Global Polio Eradication Initiative was launched in 1988, indigenous transmission of wild poliovirus (WPV) has been interrupted in all countries except Afghanistan, Pakistan, and Nigeria (1). However, during 2003–2011, outbreaks resulting from importation of WPV occurred in 29 previously polio-free countries in Africa, including Central African Republic (CAR) (1–3). In 2011, 350 WPV cases were reported from 12 countries in Africa, a 47% decrease from the 657 cases reported by 12 countries in Africa in 2010 (1). | In CAR, the last case of poliomyelitis caused by indigenous transmission of wild poliovirus was reported in 2000, but importation of WPV type 1 has been reported (4). We describe the importation of WPV1 and WPV3 into CAR during successive events in 2008, 2009, and 2011. | To investigate importation of WPV into CAR, we conducted a study using fecal samples collected from patients in CAR who had acute flaccid paralysis (AFP) during 2008–2011. The samples were analyzed for virus isolation, typing, and intratypic differentiation at the Regional Reference Laboratory for Polio, Institut Pasteur de Bangui, using World Health Organization (WHO) standard procedures (5). Isolated WPV strains were sent to the Centers for Disease Control and Prevention (Atlanta, Georgia, USA) or the National Institute for Communicable Diseases (Johannesburg, South Africa) for sequencing according to WHO guidelines (6–8). Cases were classified as laboratory confirmed or polio-compatible according to WHO recommendations; a polio-compatible case was defined as AFP for which stool samples were not adequate or a situation in which the patient was lost to follow up or had residual paralysis 60 days after testing. |
Pandemic influenza planning, United States, 1978-2008
Iskander J , Strikas RA , Gensheimer KF , Cox NJ , Redd SC . Emerg Infect Dis 2013 19 (6) 879-85 During the past century, 4 influenza pandemics occurred. After the emergence of a novel influenza virus of swine origin in 1976, national, state, and local US public health authorities began planning efforts to respond to future pandemics. Several events have since stimulated progress in public health emergency planning: the 1997 avian influenza A(H5N1) outbreak in Hong Kong, China; the 2001 anthrax attacks in the United States; the 2003 outbreak of severe acute respiratory syndrome; and the 2003 reemergence of influenza A(H5N1) virus infection in humans. We outline the evolution of US pandemic planning since the late 1970s, summarize planning accomplishments, and explain their ongoing importance. The public health community's response to the 2009 influenza A(H1N1)pdm09 pandemic demonstrated the value of planning and provided insights into improving future plans and response efforts. Preparedness planning will enhance the collective, multilevel response to future public health crises. |
Effect of winter school breaks on influenza-like illness, Argentina, 2005-2008
Garza RC , Basurto-Davila R , Ortega-Sanchez IR , Carlino LO , Meltzer MI , Albalak R , Balbuena K , Orellano P , Widdowson MA , Averhoff F . Emerg Infect Dis 2013 19 (6) 938-44 School closures are used to reduce seasonal and pandemic influenza transmission, yet evidence of their effectiveness is sparse. In Argentina, annual winter school breaks occur during the influenza season, providing an opportunity to study this intervention. We used 2005-2008 national weekly surveillance data of visits to a health care provider for influenza-like illness (ILI) from all provinces. Using Serfling-specified Poisson regressions and population-based census denominators, we developed incidence rate ratios (IRRs) for the 3 weeks before, 2 weeks during, and 3 weeks after the break. For persons 5-64 years of age, IRRs were <1 for at least 1 week after the break. Observed rates returned to expected by the third week after the break; overall decrease among persons of all ages was 14%. The largest decrease was among children 5-14 years of age during the week after the break (37% lower IRR). Among adults, effects were weaker and delayed. Two-week winter school breaks significantly decreased visits to a health care provider for ILI among school-aged children and nonelderly adults. |
Etiology of viral gastroenteritis infections in children <5 years of age in the United States, 2008-2009
Chhabra P , Payne DC , Szilagyi PG , Edwards KM , Staat MA , Shirley SH , Wikswo M , Nix WA , Lu X , Parashar UD , Vinje J . J Infect Dis 2013 208 (5) 790-800 BACKGROUND: Although rotavirus and norovirus cause nearly 40% of severe endemic acute gastroenteritis (AGE) in children <5 years of age in the United States (US), there are limited data on the etiologic role of other enteric viruses in this age group. METHODS: We conducted active population-based surveillance in children presenting with AGE to hospitals, emergency departments, and primary care clinics in three US counties. Stool specimens from these children and from age-matched healthy controls collected between October 2008 and September 2009 were tested for enteric adenovirus, astrovirus, sapovirus, parechovirus, bocavirus and aichivirus. Typing was carried out by sequencing and phylogenetic analysis. RESULTS: Adenovirus, astrovirus, sapovirus, parechovirus, bocavirus and aichivirus were detected in the stool specimens of 11.8%, 4.9%, 5.4%, 4.8%, 1.4% and 0.2% of AGE patients and 1.8%, 3.0%, 4.2%, 4.4%, 2.4% and 0% of healthy controls, respectively. Adenovirus [type-41], astrovirus [types-1, 2, 3, 4, 8], sapovirus [GI and GII], parechovirus [types-1, 3, 4, 5] and bocavirus [types-1, 2, 3] were found co-circulating. CONCLUSIONS: Adenovirus, astrovirus, and sapovirus infections were detected in 22.1% of the specimens from children <5 years of age who had medical visits for AGE and tested negative for rota- and norovirus. No causal role for parechovirus and bocavirus was found. |
Female sex workers incarcerated in New York City jails: prevalence of sexually transmitted infections and associated risk behaviors
Parvez F , Katyal M , Alper H , Leibowitz R , Venters H . Sex Transm Infect 2013 89 (4) 280-4 OBJECTIVES: Sexually transmitted infections (STIs) are an important cause of morbidity among incarcerated women and female sex workers (FSW). Little is known about FSW incarcerated in New York City (NYC) jails. We reviewed jail health records to identify the STI and HIV prevalence among newly incarcerated FSW in NYC jails. We also examined the relationship of demographics and self-reported clinical and risk behaviour history with FSW status and compared FSW with non-FSW incarcerated women to identify FSW predictors and, guide NYC jail programme planning and policy. METHODS: We retrospectively reviewed routinely collected jail health record data to identify the prevalence of chlamydia (Ct), gonorrhoea (Ng) and HIV infection among women newly incarcerated in NYC jails in 2009-2010 (study period) and studied the relationship of STIs, demographics and self-reported clinical and risk behaviour history with FSW status. RESULTS: During the study period, 10,828 women were newly incarcerated in NYC jails. Of these, 10,115 (93%) women were tested for Ct and Ng; positivity was 6.2% (95% CI 5.7% to 6.7%) and 1.7% (95% CI 1.4% to 1.9%), respectively. Nine percent had HIV infection. Seven hundred (6.5%) were defined as FSW. FSW were more likely to have Ct (adjusted OR (AOR): 1.55; 95% CI 1.17 to 2.05; p<0.0001) but not Ng or HIV. FSW were more likely to report age 20-24 years, reside in boroughs other than Manhattan, ≥6 prior incarcerations, ≥2 incarcerations during the study period, condom use with current sex partners, multiple sex partners and current drug use. CONCLUSIONS: Women incarcerated in NYC jails had high rates of Ct, Ng, and HIV infection. FSW were at higher risk for Ct than non-FSW incarcerated women. These findings are being used to design targeted interventions to identify FSW, provide clinical and preventive services in jail and coordinate care with community partners. |
Haemophilus influenzae serotype a invasive disease, Alaska, USA, 1983-2011
Bruce MG , Zulz T , Debyle C , Singleton R , Hurlburt D , Bruden D , Rudolph K , Hennessy T , Klejka J , Wenger JD . Emerg Infect Dis 2013 19 (6) 932-7 Before introduction of Haemophilus influenzae type b (Hib) vaccines, rates of Hib disease in Alaska's indigenous people were among the highest in the world. Vaccination reduced rates dramatically; however, invasive H. influenzae type a (Hia) disease has emerged. Cases of invasive disease were identified through Alaska statewide surveillance during 1983-2011. Of 866 isolates analyzed for serotype, 32 (4%) were Hia. No Hia disease was identified before 2002; 32 cases occurred during 2002-2011 (p<0.001). Median age of case-patients was 0.7 years; 3 infants died. Incidence of Hia infection (2002-2011) among children <5 years was 5.4/100,000; 27 cases occurred in Alaska Native children (18/100,000) versus 2 cases in non-Native children (0.5/100,000) (risk ratio = 36, p<0.001). From 12/2009 to 12/2011, 15 cases of Hia disease occurred in southwestern Alaska (in children <5 years, rate = 204/100,000). Since introduction of the Hib conjugate vaccine, Hia infection has become a major invasive bacterial disease in Alaska Native children. |
Hepatitis E outbreak, Dadaab refugee camp, Kenya, 2012
Ahmed JA , Moturi E , Spiegel P , Schilperoord M , Burton W , Kassim NH , Mohamed A , Ochieng M , Nderitu L , Navarro-Colorado C , Burke H , Cookson S , Handzel T , Waiboci LW , Montgomery JM , Teshale E , Marano N . Emerg Infect Dis 2013 19 (6) 1010-1 Hepatitis E virus (HEV) is transmitted through the fecal-oral route and is a common cause of viral hepatitis in developing countries. HEV outbreaks have been documented among forcibly displaced persons living in camps in East Africa, but for >10 years, no cases were documented among Somali refugees (1,2). On August 15, 2012, the US Centers for Disease Control and Prevention (CDC) in Nairobi, Kenya, was notified of a cluster of acute jaundice syndrome (AJS) cases in refugee camps in Dadaab, Kenya. On September 5, a CDC epidemiologist assisted the United Nations High Commissioner for Refugees (UNHCR) and its partners in assessing AJS case-patients in the camp, enhancing surveillance, and improving medical management of case-patients. We present the epidemiologic and laboratory findings for the AJS cases (defined as acute onset of scleral icterus not due to another underlying condition) identified during this outbreak. | Dadaab refugee camp is located in eastern Kenya near the border with Somalia. It has existed since 1991 and is the largest refugee camp in the world. Dadaab is composed of 5 smaller camps: Dagahaley, Hagadera, Ifo, Ifo II, and Kambioos. As of December 2012, a total of 460,000 refugees, mainly Somalians, were living in the camps; >25% were recent arrivals displaced by the mid-2011 famine in the Horn of Africa (3). Overcrowding and poor sanitation have led to outbreaks of enteric diseases, including cholera and shigellosis (4); in September 2012, an outbreak of cholera occurred simultaneously with the AJS outbreak. |
Absence of Rift Valley fever virus in wild small mammals, Madagascar
Olive MM , Razafindralambo N , Barivelo TA , Rafisandratantsoa JT , Soarimalala V , Goodman SM , Rollin PE , Heraud JM , Reynes JM . Emerg Infect Dis 2013 19 (6) 1025-7 Rift Valley fever virus (RVFV) is a mosquito-borne zoonotic virus in the family Bunyaviridae, genus Phlebovirus, which affects mainly domestic ruminants and humans on continental Africa, Madagascar, and the Arabian Peninsula (1). RVFV is transmitted between ruminants mainly by bites of mosquitoes of several genera (1). Infection can lead to mild symptoms or can cause abortion in pregnant animals and high mortality rates among newborns. Humans are mostly infected by aerosol transmission when handling infected tissues (aborted fetuses or meat), which results in dengue-like illness. Some cases in humans can be in a severe form (hemorrhagic fever and meningoencephalitis), which can be fatal. Outbreaks in southern and eastern Africa are associated with periods of heavy rainfall (1). In eastern Africa, RVFV is believed to be maintained during interepizootic periods through vertical transmission in Aedes spp. mosquitoes (1). It has been suspected that wild mammals, especially rodents, play a role in the maintenance of RVFV during interepizootic periods (2). However, evidence of a wild mammal reservoir in the epidemiologic cycle of RVFV has yet to be demonstrated (2). | In Madagascar, the first RVFV isolate was obtained from mosquitoes captured in the Périnet Forest (Andasibe, Moramanga District) in 1979, outside an epizootic period (3). Two epizootic episodes occurred, during 1990–91 and 2008–09 (4). After the most recent episode, domestic ruminants were shown to be involved in RVFV circulation during interepizootic periods (5,6); together with the potential vertical transmission in Aedes spp. mosquitoes in Madagascar, they might play a role in the maintenance of RVFV. However, genetic evidence indicates that RVFV outbreaks in Madagascar are not associated with emergence from enzootic cycles but that they are associated with recurrent virus introductions from mainland east Africa (7). Although these mechanisms for RVFV epidemiology on Madagascar are documented, the possibility of a wild mammal reservoir cannot be excluded. We therefore explored the role of wild terrestrial small mammals in the maintenance of RVFV in Madagascar, especially the nonnative, abundant, and ubiquitous black rats (Rattus rattus) (8), as has been suggested in rural Egypt (9,10). |
Use of an online survey during an outbreak of Clostridium perfringens in a retirement community-Arizona, 2012
Yasmin S , Pogreba-Brown K , Stewart J , Sunenshine R . J Public Health Manag Pract 2013 20 (2) 205-9 CONTEXT: An outbreak of gastrointestinal (GI) illness among retirement community residents was reported to the Maricopa County Department of Public Health. Online surveys can be useful for rapid investigation of disease outbreaks, especially when local health departments lack time and resources to perform telephone interviews. Online survey utility among older populations, which may lack computer access or literacy, has not been defined. OBJECTIVE: To investigate and implement prevention measures for a GI outbreak and assess the utility of an online survey among retirement community residents. DESIGN: A retrospective cohort investigation was conducted using an online survey distributed through the retirement community e-mail listserv; a follow-up telephone survey was conducted to assess computer literacy and Internet access. A case was defined as any GI illness occurring among residents during March 1-14, 2012. SETTING: A barbecue in a retirement community of 3000 residents. PARTICIPANTS: Retirement community residents. INTERVENTION: Residents were directed to discard leftover food and seek health care for symptoms. A telephone survey was conducted to assess the utility of online surveys in this population. MAIN OUTCOME MEASURES: Computer literacy and Internet access of retirement community residents. RESULTS: Of 1000 residents on the listserv, 370 (37%) completed the online survey (mean age, 69.7 years; 60.6% women); 66 residents (17.8%) reported a GI illness after the barbecue, 63 (95.5%) reported diarrhea, and 5 (7.6%) reported vomiting. Leftover beef from an attendee's refrigerator grew Clostridium perfringens. Of 552 residents contacted by telephone, 113 completed the telephone survey (mean age, 71.3 years; 63.3% women), 101 (89.4%) reported the ability to send e-mail, 82 (81.2%) checked e-mail daily, and 28 (27.7%) checked e-mail on a handheld device. The attack rate was 17.8% for online versus 2.7% for telephone respondents (P < .001). CONCLUSIONS: This outbreak demonstrated the utility of an online survey to rapidly collect information and implement prevention measures among an older demographic. |
Influenza surveillance using electronic health records in the American Indian and Alaska Native population
Keck JW , Redd JT , Cheek JE , Layne LJ , Groom AV , Kitka S , Bruce MG , Suryaprasad A , Amerson NL , Cullen T , Bryan RT , Hennessy TW . J Am Med Inform Assoc 2013 21 (1) 132-8 OBJECTIVE: Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed. MATERIALS AND METHODS: The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100 degrees F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system's results were compared with those of the traditional US ILI Surveillance Network. RESULTS: The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day. DISCUSSION: EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance. |
Isolation and full genomic characterization of Batai virus from mosquitoes, Italy 2009.
Huhtamo E , Lambert AJ , Costantino S , Servino L , Krizmancic L , Boldorini R , Allegrini S , Grasso I , Korhonen EM , Vapalahti O , Lanciotti RS , Ravanini P . J Gen Virol 2013 94 1242-8 In 2009, 2589 mosquitoes were collected in northwest Italy and screened for orthobunyavirus RNA by RT-PCR. One pool of Anopheles maculipennis complex mosquitoes was found to be positive and a virus was isolated from that pool. The isolate was identified as Batai virus (BATV) by sequencing. Previously, BATV was detected in Italy, but limited data and no prior isolates existed. Full-length sequences of the S, M and L segments were determined for the newly isolated Italian strain. For comparison, partial sequences were also determined for the BATV strain Calovo (former Czechoslovakia, 1960). Phylogenetic analyses revealed clustering of the newly derived Italian BATV along with a recent isolate from Germany and the historic strain Calovo. To the best of our knowledge, this represents the first isolation of BATV from Italy, which confirms a broader geographical distribution of BATV in Europe than was previously verified by isolation. |
Telomere length and elevated iron: the influence of phenotype and HFE genotype.
Mainous AG 3rd , Wright RU , Hulihan MM , Twal WO , McLaren CE , Diaz VA , McLaren GD , Argraves WS , Grant AM . Am J Hematol 2013 88 (6) 492-6 Elevated body iron stores are associated with morbidity and mortality due to oxidative stress. Hereditary hemochromatosis, a common condition caused by HFE gene mutations, can lead to excess iron storage and disease but clinical penetrance of HFE gene mutations is low and many people with elevated iron stores lack HFE mutations. We analyzed data from the Hemochromatosis and Iron Overload Screening Study to assess the relationship among HFE genotype (individuals with either homozygous or compound heterozygous status for C282Y and/or H63D HFE mutations were defined as genotype positive, or G+), elevated iron phenotype (individuals exceeding gender-specific transferrin saturation and serum ferritin threshold levels were considered phenotype positive, or P+), and leukocyte telomere length, a marker of biological aging and cumulative oxidative stress. In unadjusted analyses in comparison to individuals who were G-P-, G+P- were not significantly different (OR 0.74; 95% CI 0.26-2.04), while the G+P+ (OR 2.03; 95% CI 1.15-3.56), and G-P+ (OR 2.24; 95% CI 1.5-3.29) had increased risk of short telomeres (<=25th percentile) rather than long telomeres (>=75th percentile). In analyses adjusting for age, gender, and race/ethnicity, the effect of individuals with elevated iron phenotypes having short telomeres persisted with G+P+ individuals (OR 1.94; 95% CI 1.02-3.72), and G-P+ individuals (OR 2.17; 95% CI 1.39-3.39) being significantly different from the G-P- group. In conclusion, elevated iron phenotype, but not HFE genotype, was associated with shortened telomeres. Further studies will be needed to determine whether telomere length provides a marker for morbidities specifically associated with iron overload. (Am. J. Hematol. 88:492-496, 2013. (c) 2013 Wiley Periodicals, Inc.) |
Progress in global surveillance and response capacity 10 years after severe acute respiratory syndrome
Braden CR , Dowell SF , Jernigan DB , Hughes JM . Emerg Infect Dis 2013 19 (6) 864-9 Ten years have elapsed since the World Health Organization issued its first global alert for an unexplained illness named severe acute respiratory syndrome (SARS). The anniversary provides an opportunity to reflect on the international response to this new global microbial threat. While global surveillance and response capacity for public health threats have been strengthened, critical gaps remain. Of 194 World Health Organization member states that signed on to the International Health Regulations (2005), <20% had achieved compliance with the core capacities required by the deadline in June 2012. Lessons learned from the global SARS outbreak highlight the need to avoid complacency, strengthen efforts to improve global capacity to address the next pandemic using all available 21st century tools, and support research to develop new treatment options, countermeasures, and insights while striving to address the global inequities that are the root cause of many of these challenges. |
Poliovirus vaccination options for achieving eradication and securing the endgame
Estivariz CF , Pallansch MA , Anand A , Wassilak SG , Sutter RW , Wenger JD , Orenstein WA . Curr Opin Virol 2013 3 (3) 309-15 In 1988, the World Health Assembly resolved to globally eradicate poliomyelitis. As part of a four-pronged strategy with establishment of enhanced surveillance, institution of national immunization days, strengthening routine immunization, and carrying-out mopping-up activities, oral poliovirus vaccine (OPV) was selected as the vaccine-of-choice for eradication. Massive OPV use decreased the number of polio-endemic countries from >125 countries in 1988 to only 3 in 2012 and led to a >99.9% decrease in polio incidence in the corresponding period. In this communication, we will discuss polio vaccination options to accelerate eradication, to mitigate the risks during the planned withdrawal of type 2 OPV, and to secure eradication for future generations. |
Does a monovalent inactivated rotavirus vaccine induce heterotypic immunity?: Evidence from animal studies
Jiang B , Wang Y , Glass RI . Hum Vaccin Immunother 2013 9 (8) 1634-7 There is substantial evidence for broad cross-reactive immunity and heterotypic protection among human rotavirus strains in children with natural infection or with monovalent Rotarix vaccination. In this commentary, we addressed this same question by testing sera of guinea pigs and gnotobiotic piglets that were intramuscularly immunized with an inactivated human rotavirus vaccine and also demonstrated a broad cross-protective immunity among human rotavirus strains. Our findings from a single human strain in animal studies bode well for a low cost and efficacious inactivated vaccine to protect children against rotavirus disease throughout the world. |
Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study
Wang CY , Cogswell ME , Loria CM , Chen TC , Pfeiffer CM , Swanson CA , Caldwell KL , Perrine CG , Carriquiry AL , Liu K , Sempos CT , Gillespie CD , Burt VL . J Nutr 2013 143 (8) 1276-82 Because of the logistic complexity, excessive respondent burden, and high cost of conducting 24-h urine collections in a national survey, alternative strategies to monitor sodium intake at the population level need to be evaluated. We conducted a calibration study to assess the ability to characterize sodium intake from timed-spot urine samples calibrated to a 24-h urine collection. In this report, we described the overall design and basic results of the study. Adults aged 18-39 y were recruited to collect urine for a 24-h period, placing each void in a separate container. Four timed-spot specimens (morning, afternoon, evening, and overnight) and the 24-h collection were analyzed for sodium, potassium, chloride, creatinine, and iodine. Of 481 eligible persons, 407 (54% female, 48% black) completed a 24-h urine collection. A subsample (n = 133) collected a second 24-h urine 4-11 d later. Mean sodium excretion was 3.54 +/- 1.51 g/d for males and 3.09 +/- 1.26 g/d for females. Sensitivity analysis excluding those who did not meet the expected creatinine excretion criterion showed the same results. Day-to-day variability for sodium, potassium, chloride, and iodine was observed among those collecting two 24-h urine samples (CV = 16-29% for 24-h urine samples and 21-41% for timed-spot specimens). Among all race-gender groups, overnight specimens had larger volumes (P < 0.01) and lower sodium (P < 0.01 -P = 0.26), potassium (P < 0.01), and chloride (P < 0.01) concentrations compared with other timed-spot urine samples, although the differences were not always significant. Urine creatinine and iodine concentrations did not differ by the timing of collection. The observed day-to-day and diurnal variations in sodium excretion illustrate the importance of accounting for these factors when developing calibration equations from this study. |
New Delhi metallo-beta-lactamase-producing Enterobacteriaceae, United States
Rasheed JK , Kitchel B , Zhu W , Anderson KF , Clark NC , Ferraro MJ , Savard P , Humphries RM , Kallen AJ , Limbago BM . Emerg Infect Dis 2013 19 (6) 870-8 We characterized 9 New Delhi metallo-beta-lactamase-producing Enterobacteriaceae (5 Klebsiella pneumoniae, 2 Escherichia coli, 1 Enterobacter cloacae, 1 Salmonella enterica serovar Senftenberg) isolates identified in the United States and cultured from 8 patients in 5 states during April 2009-March 2011. Isolates were resistant to beta-lactams, fluoroquinolones, and aminoglycosides, demonstrated MICs ≤1 microg/mL of colistin and polymyxin, and yielded positive metallo-beta-lactamase screening results. Eight isolates had blaNDM-1, and 1 isolate had a novel allele (blaNDM-6). All 8 patients had recently been in India or Pakistan, where 6 received inpatient health care. Plasmids carrying blaNDM frequently carried AmpC or extended spectrum beta-lactamase genes. Two K. pneumoniae isolates and a K. pneumoniae isolate from Sweden shared incompatibility group A/C plasmids with indistinguishable restriction patterns and a common blaNDM fragment; all 3 were multilocus sequence type 14. Restriction profiles of the remaining New Delhi metallo-beta-lactamase plasmids, including 2 from the same patient, were diverse. |
O-methylated metabolite of 7,8-dihydroxyflavone activates TrkB receptor and displays antidepressant activity
Liu X , Qi Q , Xiao G , Li J , Luo HR , Ye K . Pharmacology 2013 91 185-200 7,8-Dihydroxyflavone (7,8-DHF) acts as a TrkB receptor-specific agonist. It mimics the physiological actions of brain-derived neurotrophic factor (BDNF) and demonstrates remarkable therapeutic efficacy in animal models of various neurological diseases. Nonetheless, its in vivo pharmacokinetic profiles and metabolism remain unclear. Here we report that 7,8-DHF and its O-methylated metabolites distribute in mouse brain after oral administration. Both hydroxy groups can be mono-methylated, and the mono-methylated metabolites activate TrkB in vitro and in vivo. Blocking methylation, using COMT inhibitors, diminishes the agonistic effect of TrkB activation by 7,8-DHF or 4'-dimethylamino-7,8-DHF, supporting the contribution of the methylated metabolite to TrkB activation in mouse brain. Moreover, we have synthesized several methylated metabolite derivatives, and they also potently activate the TrkB receptor and reduce immobility in both forced swim test and tail suspension test, indicating that these methylated metabolites may possess antidepressant activity. Hence, our data demonstrate that 7,8-DHF is orally bioavailable and can penetrate the brain-blood barrier. The O-methylated metabolites are implicated in TrkB receptor activation in the brain. |
An electrochemiluminescence assay for analysis of rabies virus glycoprotein content in rabies vaccines
Smith TG , Ellison JA , Ma X , Kuzmina N , Carson W , Rupprecht CE . Vaccine 2013 31 (33) 3333-8 Vaccine potency testing is necessary to evaluate the immunogenicity of inactivated rabies virus (RABV) vaccine preparations before human or veterinary application. Currently, the NIH test is recommended by the WHO expert committee to evaluate RABV vaccine potency. However, numerous disadvantages are inherent concerning cost, number of animals and biosafety requirements. As such, several in vitro methods have been proposed for the evaluation of vaccines based on RABV glycoprotein (G) quality and quantity, which is expected to correlate with vaccine potency. In this study an antigen-capture electrochemiluminescent (ECL) assay was developed utilizing anti-RABV G monoclonal antibodies (MAb) to quantify RABV G. One MAb 2-21-14 was specific for a conformational epitope so that only immunogenic, natively folded G was captured in the assay. A second MAb (62-80-6) that binds a linear epitope or MAb 2-21-14 was used for detection of RABV G. Vaccine efficacy was also assessed in vivo using pre-exposure vaccination of mice. Purified native RABV G induced a RABV neutralizing antibody (rVNA) response with a geometric mean titer of 4.2IU/ml and protected 100% of immunized mice against RABV challenge, while an experimental vaccine with a lower quality and quantity of G induced a rVNA titer<0.05IU/ml and protected <50% of immunized mice. These preliminary results support the hypothesis that in vivo immunogenicity may be predicted from the in vitro measurement of RABV G using an ECL assay. Based upon these results, the ECL assay may have utility in replacement of the NIH test. |
Graphene oxide, but not fullerenes, targets immunoproteasomes and suppresses antigen presentation by dendritic cells
Tkach AV , Yanamala N , Stanley S , Shurin MR , Shurin GV , Kisin ER , Murray AR , Pareso S , Khaliullin T , Kotchey GP , Castranova V , Mathur S , Fadeel B , Star A , Kagan VE , Shvedova AA . Small 2013 9 1686-1690 Graphene oxide (GO) and C60- or C60-TRIS fullerenes, internalized by murine dendritic cells (DCs), differently affect their abilities to present antigens to T-cells. While C60-fullerenes stimulate the ovalbumin-specific MHC class I-restricted T-cell response, GO impairs the stimulatory potential of DCs. In contrast to C60-fullerenes, GO decreases the intracellular levels of LMP7 immunoproteasome subunits required for processing of protein antigens. This is important for the development of DC-based vaccines. (Copyright 2013 WILEY-VCH Verlag GmbH Co. KGaA, Weinheim.) |
Induction of miR-21-PDCD4 signaling by tungsten carbide-cobalt nanoparticles in JB6 cells involves ROS-mediated MAPK pathways
Hou L , Bowman L , Meighan TG , Shi X , Ding M . J Environ Pathol Toxicol Oncol 2013 32 (1) 41-51 Tungsten carbide-cobalt (WC-Co) nanoparticle composites have wide applications because of their hardness and toughness. WC-Co was classified as "probably carcinogenic" to humans by the International Agency for Research on Cancer (IARC) in 2003. It is believed that the toxicity and carcinogenesis of WC-Co is associated with particle size. Recent studies demonstrated that the tumor suppressor gene programmed cell death 4 (PDCD4) and its upstream regulator miR-21 have been considered as oncogenes for novel cancer prevention or anticancer therapies. The present study examined the effects of WC-Co nanoparticles on miR-21-PDCD4 signaling in a mouse epidermal cell line (JB6 P+). The results showed that (i) exposure of JB6 cells to WC-Co stimulated a increase of miR-21 generation; (ii) WC-Co also caused inhibition of PDCD4, a tumor suppressor protein and downstream target of miR-21, expression in JB6 cells; (iii) inhibition of ERKs with ERK inhibitor U0126 significantly reversed WC-Cominus;induced PDCD4 inhibition, but inhibition of p38 with p38 inhibitor SB203580 did not; and (iv) ROS scavengers, N-acetyl-L-cysteine and catalase, blocked the inhibitory effect of WC-Co on PDCD4 expression, while superoxide dismutase promoted the inhibitory effect. These findings demonstrate that WC-Co nanoparticles induce miR-21 generation, but inhibit PDCD4 production, which may be mediated through ROS, especially endogenous H2O2, and ERK pathways. Unraveling the complex mechanisms associated with these events may provide insights into the initiation and progression of WC-Co-induced carcinogenesis. |
Carbon nanotubes enhance metastatic growth of lung carcinoma via up-regulation of myeloid-derived suppressor cells
Shvedova AA , Tkach AV , Kisin ER , Khaliullin T , Stanley S , Gutkin DW , Star A , Chen Y , Shurin GV , Kagan VE , Shurin MR . Small 2013 9 1691-1695 Metastatic establishment and growth of Lewis lung carcinoma is promoted by single-walled carbon nanotubes (SWCNT) in C57BL6/J mice. The effect is mediated by increased local and systemic accumulation of myeloid-derived suppressor cells (MDSC), as their depletion abrogated pro-tumor activity in vivo. These data are important for the design of novel theranostics platforms with modules capable of depleting or functionally suppressing MDSC to ensure effective immunosurveillance in the tumor microenvironment. (Copyright 2013 WILEY-VCH Verlag GmbH Co. KGaA, Weinheim.) |
Cell culture and electron microscopy for identifying viruses in diseases of unknown cause
Goldsmith CS , Ksiazek TG , Rollin PE , Comer JA , Nicholson WL , Peret TC , Erdman DD , Bellini WJ , Harcourt BH , Rota PA , Bhatnagar J , Bowen MD , Erickson BR , McMullan LK , Nichol ST , Shieh WJ , Paddock CD , Zaki SR . Emerg Infect Dis 2013 19 (6) 864-9 During outbreaks of infectious diseases or in cases of severely ill patients, it is imperative to identify the causative agent. This report describes several events in which virus isolation and identification by electron microscopy were critical to initial recognition of the etiologic agent, which was further analyzed by additional laboratory diagnostic assays. Examples include severe acute respiratory syndrome coronavirus, and Nipah, lymphocytic choriomeningitis, West Nile, Cache Valley, and Heartland viruses. These cases illustrate the importance of the techniques of cell culture and electron microscopy in pathogen identification and recognition of emerging diseases. |
Characterization of methylene diphenyl diisocyanate haptenated human serum albumin and hemoglobin
Mhike M , Chipinda I , Hettick JM , Simoyi RH , Lemons A , Green BJ , Siegel PD . Anal Biochem 2013 440 (2) 197-204 Protein haptenation by polyurethane industrial intermediate methylene diphenyl diisocyanate (MDI) is thought to be an important step in the development of diisocyanate (dNCO)-specific allergic sensitization; however, MDI haptenated albumins used to screen specific antibody are often poorly characterized. Recently, the need to develop standardized immunoassays using a consistent, well characterized dNCO-haptenated protein to screen for the presence of MDI-specific IgE and IgG from workers' sera has been emphasized and recognized. This has been challenging to achieve due to the bivalent, electrophilic nature of dNCO leading to the capability to produce multiple cross-linked protein species and polymeric additions to proteins. In the present study, MDI was reacted with human serum albumin (HSA) and hemoglobin (Hb) at molar ratios ranging from 1:1 to 40:1 MDI: protein. Adducts were characterized by (1) loss of available trinitrobenzene sulfonic acid (TNBS) binding to primary amines, (2) electrophoretic migration in polyacrylamide gels, (3) quantification of methylene diphenyl diamine following acid hydrolysis and (4) immunoassay. Concentration dependent changes in all the above noted parameters were observed demonstrating increase in both number and complexity of conjugates formed with increasing MDI concentration. In conclusion, a series of bio-analytical assays should be performed to standardize MDI-antigen preparations across lots and laboratories for measurement of specific antibody in exposed workers which in total indicate degree of intra- and inter-molecular cross-linking, number of dNCO bound, number of different specific binding sites on the protein and degree of immuno-reactivity. |
Comparison of magnetic field distribution models for a magnetic proximity detection system
Li J , Jobes CC , Carr JL . IEEE Trans Ind Appl 2013 49 (3) 1171-1176 Magnetic proximity detection technology is rapidly advancing as a promising method of protecting underground mine workers from striking and pinning hazards associated with mobile mining machines. A magnetic proximity detection system requires a magnetic distribution model to estimate the proximity of the sensor to the generators. This paper presents a comparative analysis of magnetic flux density distribution models in three different field distribution design patterns. The accuracy of these models is determined with a laboratory magnetic proximity detection system. These field distribution design patterns are spherical, ellipsoidal, and sphere-cosine, respectively. The analyses show that the sphere-cosine model is the most accurate model for the proximity system followed by the ellipsoidal and spherical models. |
Detection and molecular characterisation of noroviruses in hospitalised children in Malawi, 1997-2007
Trainor E , Lopman B , Iturriza-Gomara M , Dove W , Ngwira B , Nakagomi O , Nakagomi T , Parashar U , Cunliffe N . J Med Virol 2013 85 (7) 1299-1306 Despite the increasing recognition of noroviruses as major pathogens associated with community-acquired diarrhoea in children, there are few studies from Africa. Long-term surveillance studies of rotavirus gastroenteritis in Malawian children have provided an opportunity to undertake a study of the importance and epidemiological features of norovirus infection in this population. Faecal specimens were collected from children <5 years of age admitted to hospital with acute diarrhoea, as well as from a comparison group of diarrhoea-free children, in Blantyre, Malawi between 1997 and 2007. Norovirus was detected using real-time PCR and strains genotyped by nucleotide sequence analysis. Norovirus was detected in 220/1,941 (11.3%) faecal specimens, comprising genogroup GI (1.8%), GII (9.4%) and mixed GI/GII (0.1%). The median age of children with norovirus was 6 months (range, 0-48 months). Norovirus was detected throughout the year, with peaks at the end of the rainy season (March) and towards the end of the dry season (August-November). Norovirus GII.4 was the most commonly detected genotype accounting for 70% of strains characterised, followed by GII.2 (6%), GII.6 (4%) and GII.12 (4%). Sub typing of GII.4 noroviruses demonstrated local circulation of strains prior to their subsequent detection in association with global epidemics of gastroenteritis. The prevalence of norovirus in children without diarrhoea was similar to the level in cases. This largest study to date of norovirus infection in African children indicates the potential role of paediatric surveillance in predicting the emergence of norovirus strains with global epidemic potential. (2013 Wiley Periodicals, Inc.) |
Impact of community health educators on the nutrition of children in Gaza province, Mozambique
Kapurura SD , Beke A . J Public Health Epidemiol 2013 5 (4) 192-201 Twenty six percent of children with protein-energy malnutrition live in Africa. This study determines whether Care Groups (CG) in collaboration with Community-based Health Educators (CHE) help reduce malnutrition in children between 0 and 23 months of age. A total of 299 caregivers at baseline (2004) and 380 at follow-up (2007) were interviewed using a structured questionnaire. Caregivers were between 12 and 49 years (mean 26.9 years standard error (SE)=0.33, 95% confidence interval (CI):26.3 to 27.6). Data was analysed with STATA version 10. A two-sample t-test was used to compare the findings while logistic regression analysis was used to test the association between outcome variables and predictor variables. Underweight children decreased from 16.3% at baseline to 7.6% at follow-up, fluid intake during diarrhoea episodes increased from 4.6 to 16.1%, exclusive breastfeeding increased from 91.9 to 95.2%, children attended by skilled health personnel at birth increased from 45.2 to 72.8%. Dehydrated children were 1.61 times more likely to be taken to hospital. Children weighed in the previous three months were 1.3 times more likely to have received food with marula nuts added to it. The world relief project appears to have improved caregivers' knowledge and behaviour regarding child nutrition in Gaza province of Mozambique. |
A literature review of the social and psychological needs of ovarian cancer survivors
Roland KB , Rodriguez JL , Patterson JR , Trivers KF . Psychooncology 2013 22 (11) 2408-18 OBJECTIVE: To identify and comprehensively present the psychosocial needs of ovarian cancer (OvCa) survivors, including young survivors <45 years of age. METHODS: A literature review was conducted using keywords specific to psychosocial health and OvCa survivorship to identify peer-reviewed, original research articles published in English between January 2000 and December 2010; 28 articles were identified as relevant. Articles were abstracted and results categorized according to six psychosocial domains: quality of life (QoL), social support and relationships, self-image and sexual functioning, psychological distress and functioning, fear of death/recurrence, and personal growth and coping. Findings unique to young survivors are presented when applicable. Psychosocial measurement tools used in relevant studies are also presented. RESULTS: Physical complications and side effec ts have significant impact on OvCa survivors' psychosocial health. Access to social support services and relational support is critical, as feelings of isolation are common. Survivors report low levels of sexual activity and satisfaction, potentially causing strain on personal relationships, and survivors experience high levels of distress, depression, and anxiety. However, QoL can improve after diagnosis for some OvCa survivors, many of whom report spiritual growth and strengthened personal relationships. Younger survivors are likely to have greater distress and lower QoL compared with older survivors. CONCLUSIONS: OvCa is the deadliest of all gynecologic cancers, greatly impacting the psychosocial health of survivors. Increased awareness of psychosocial health among OvCa survivors themselves, their social support system, and their health care providers is necessary to adequately address their unique needs. (Published 2013. This article is a U.S. Government work and is in the public domain in the USA.) |
A longitudinal study of youth assets, neighborhood conditions, and youth sexual behaviors
Oman RF , Vesely SK , Aspy CB , Tolma EL , Gavin L , Bensyl DM , Mueller T , Fluhr JD . J Adolesc Health 2013 52 (6) 779-85 PURPOSE: To prospectively determine whether individual, family, and community assets help youth to delay initiation of sexual intercourse (ISI); and for youth who do initiate intercourse, to use birth control and avoid pregnancy. The potential influence of neighborhood conditions was also investigated. METHODS: The Youth Asset Study was a 4-year longitudinal study involving 1,089 youth (mean age = 14.2 years, standard deviation = 1.6; 53% female; 40% white, 28% Hispanic, 23% African American, 9% other race) and their parents. Participants were living in randomly selected census tracts. We accomplished recruitment via door-to-door canvassing. We interviewed one youth and one parent from each household annually. We assessed 17 youth assets (e.g., responsible choices, family communication) believed to influence behavior at multiple levels via in-person interviews methodology. Trained raters who conducted annual windshield tours assessed neighborhood conditions. RESULTS: Cox proportional hazard or marginal logistic regression modeling indicated that 11 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for ISI; seven assets (e.g., educational aspirations for the future, responsible choices) were significantly associated with increased use of birth control at last sex; and 10 assets (e.g., family communication, school connectedness) were significantly associated with reduced risk for pregnancy. Total asset score was significantly associated with all three outcomes. Positive neighborhood conditions were significantly associated with increased birth control use, but not with ISI or pregnancy. CONCLUSIONS: Programming to strengthen youth assets may be a promising strategy for reducing youth sexual risk behaviors. |
Cross-country comparison of waterpipe use: nationally representative data from 13 low and middle-income countries from the Global Adult Tobacco Survey (GATS)
Morton J , Song Y , Fouad H , Awa FE , Abou El Naga R , Zhao L , Palipudi K , Asma S . Tob Control 2013 23 (5) 419-27 OBJECTIVE: Evidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys. METHODS: Data were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008-2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session. RESULTS: GATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness. CONCLUSIONS: GATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use. |
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