Trends in obesity among adults in the United States, 2005 to 2014
Flegal KM , Kruszon-Moran D , Carroll MD , Fryar CD , Ogden CL . JAMA 2016 315 (21) 2284-91 IMPORTANCE: Between 1980 and 2000, the prevalence of obesity increased significantly among adult men and women in the United States; further significant increases were observed through 2003-2004 for men but not women. Subsequent comparisons of data from 2003-2004 with data through 2011-2012 showed no significant increases for men or women. OBJECTIVE: To examine obesity prevalence for 2013-2014 and trends over the decade from 2005 through 2014 adjusting for sex, age, race/Hispanic origin, smoking status, and education. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally representative health examination survey of the US civilian noninstitutionalized population that includes measured weight and height. EXPOSURES: Survey period. MAIN OUTCOMES AND MEASURES: Prevalence of obesity (body mass index ≥30) and class 3 obesity (body mass index ≥40). RESULTS: This report is based on data from 2638 adult men (mean age, 46.8 years) and 2817 women (mean age, 48.4 years) from the most recent 2 years (2013-2014) of NHANES and data from 21,013 participants in previous NHANES surveys from 2005 through 2012. For the years 2013-2014, the overall age-adjusted prevalence of obesity was 37.7% (95% CI, 35.8%-39.7%); among men, it was 35.0% (95% CI, 32.8%-37.3%); and among women, it was 40.4% (95% CI, 37.6%-43.3%). The corresponding prevalence of class 3 obesity overall was 7.7% (95% CI, 6.2%-9.3%); among men, it was 5.5% (95% CI, 4.0%-7.2%); and among women, it was 9.9% (95% CI, 7.5%-12.3%). Analyses of changes over the decade from 2005 through 2014, adjusted for age, race/Hispanic origin, smoking status, and education, showed significant increasing linear trends among women for overall obesity (P = .004) and for class 3 obesity (P = .01) but not among men (P = .30 for overall obesity; P = .14 for class 3 obesity). CONCLUSIONS AND RELEVANCE: In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity in 2013-2014 was 35.0% among men and 40.4% among women. The corresponding values for class 3 obesity were 5.5% for men and 9.9% for women. For women, the prevalence of overall obesity and of class 3 obesity showed significant linear trends for increase between 2005 and 2014; there were no significant trends for men. Other studies are needed to determine the reasons for these trends. |
Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014
Ogden CL , Carroll MD , Lawman HG , Fryar CD , Kruszon-Moran D , Kit BK , Flegal KM . JAMA 2016 315 (21) 2292-9 IMPORTANCE: Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years. OBJECTIVES: To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014. DESIGN, SETTING, AND PARTICIPANTS: Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys. EXPOSURES: Survey period. MAIN OUTCOMES AND MEASURES: Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted. RESULTS: Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87). CONCLUSIONS AND RELEVANCE: In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years. |
Measurement characteristics for two health-related quality of life measures in older adults: The SF-36 and the CDC Healthy Days items
Barile JP , Horner-Johnson W , Krahn G , Zack M , Miranda D , DeMichele K , Ford D , Thompson WW . Disabil Health J 2016 9 (4) 567-74 BACKGROUND: The Short Form Health Survey (SF-36) and the Centers for Disease Control and Prevention (CDC) Healthy Days items are well known measures of health-related quality of life. The validity of the SF-36 for older adults and those with disabilities has been questioned. OBJECTIVE: Assess the extent to which the SF-36 and the Centers for Disease Control and Prevention (CDC) Healthy Days items measure the same aspects of health; whether the SF-36 and the CDC unhealthy days items are invariant across gender, functional status, or the presence of chronic health conditions of older adults; and whether each of the SF-36's eight subscales is independently associated with the CDC Healthy Days items. METHODS: We analyzed data from 66,269 adult Medicare advantage members age 65 and older. We used confirmatory factor analyses and regression modeling to test associations between the CDC Healthy Days items and subscales of the SF-36. RESULTS: The CDC Healthy Days items were associated with the SF-36 global measures of physical and mental health. The CDC physically unhealthy days item was associated with the SF-36 subscales for bodily pain, physical role limitations, and general health, while the CDC mentally unhealthy days item was associated with the SF-36 subscales for mental health, emotional role limitations, vitality and social functioning. The SF-36 physical functioning subscale was not independently associated with either of the CDC Healthy Days items. CONCLUSIONS: The CDC Healthy Days items measure similar domains as the SF-36 but appear to assess HRQOL without regard to limitations in functioning. |
Eye Care Quality and Accessibility Improvement in the Community (EQUALITY): Impact of an eye health education program on patient knowledge about glaucoma and attitudes about eye care
Rhodes LA , Huisingh CE , McGwin G Jr , Mennemeyer ST , Bregantini M , Patel N , Saaddine J , Crews JE , Girkin CA , Owsley C . Patient Relat Outcome Meas 2016 7 37-48 PURPOSE: To assess the impact of the education program of the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) telemedicine program on at-risk patients' knowledge about glaucoma and attitudes about eye care as well as to assess patient satisfaction with EQUALITY. PATIENTS AND METHODS: New or existing patients presenting for a comprehensive eye exam (CEE) at one of two retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: African Americans ≥40 years of age, Whites ≥50 years of age, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. A total of 651 patients were enrolled. A questionnaire was administered prior to the patients' CEE and prior to the patients receiving any of the evidence-based eye health education program; a follow-up questionnaire was administered 2-4 weeks later by phone. Baseline and follow-up patient responses regarding knowledge about glaucoma and attitudes about eye care were compared using McNemar's test. Logistic regression models were used to assess the association of patient-level characteristics with improvement in knowledge and attitudes. Overall patient satisfaction was summarized. RESULTS: At follow-up, all patient responses in the knowledge and attitude domains significantly improved from baseline (P≤0.01 for all questions). Those who were unemployed (odds ratio =0.63, 95% confidence interval =0.42-0.95, P=0.026) or had lower education (odds ratio =0.55, 95% confidence interval =0.29-1.02, P=0.058) were less likely to improve their knowledge after adjusting for age, sex, race, and prior glaucoma diagnosis. This association was attenuated after further adjustment for other patient-level characteristics. Ninety-eight percent (n=501) of patients reported being likely to have a CEE within the next 2 years, whereas 63% (n=326) had a CEE in the previous 2 years. Patient satisfaction with EQUALITY was high (99%). CONCLUSION: Improved knowledge about glaucoma and a high intent to pursue eye care may lead to improved detection of early disease, thus lowering the risk of blindness. |
Incidence of crohn's disease and ulcerative colitis in Rhode Island: Report from the Ocean State Crohn's and Colitis Area Registry
Shapiro JM , Zoega H , Shah SA , Bright RM , Mallette M , Moniz H , Grabert SA , Bancroft B , Merrick M , Flowers NT , Samad Z , Lidofsky S , LeLeiko NS , Sands BE . Inflamm Bowel Dis 2016 22 (6) 1456-61 BACKGROUND: Studies describing the incidence of Crohn's disease (CD) and ulcerative colitis (UC) are uncommon in the United States. We sought to determine the incidence of CD and UC in the state of Rhode Island. METHODS: The Ocean State Crohn's and Colitis Area Registry is a state-based inception cohort of patients newly diagnosed with inflammatory bowel disease (IBD) in Rhode Island. To confirm a diagnosis of CD, UC, or IBD unclassified (IBDU), the National Institute of Diabetes and Digestive and Kidney Diseases IBD Genetics Consortium criteria were applied in a review of medical records from gastroenterology practices located in the state of Rhode Island and adjacent to the Rhode Island border in Massachusetts and Connecticut. Using population-based data, we determined the statewide incidence of IBD in Rhode Island from 2008 to 2010. RESULTS: A total of 971 Rhode Island residents were diagnosed with IBD, including 444 with CD, 486 with UC, and 41 with IBD unclassified from 2008 to 2010. The overall age- and sex-adjusted IBD incidence was 30.2 (95% confidence interval, 28.3-32.1) per 100,000 persons in this time frame with 13.9, 15.1, and 1.3 per 100,000 diagnosed with CD, UC, and IBD unclassified, respectively. Of the total incident cases in Rhode Island, 30% (n = 291) were enrolled in Ocean State Crohn's and Colitis Area Registry for follow-up. CONCLUSIONS: The incidence of IBD in Rhode Island is higher than that previously reported by other population-based cohorts in the United States. Prospective follow-up of individuals enrolled in the community-based Ocean State Crohn's and Colitis Area Registry cohort is ongoing. |
Age at introduction to solid foods and child obesity at 6 years
Barrera CM , Perrine CG , Li R , Scanlon KS . Child Obes 2016 12 (3) 188-92 BACKGROUND: Epidemiological evidence suggests that timing of introduction of solid foods may be associated with subsequent obesity, and the association may vary by whether an infant is breastfed or formula-fed. METHODS: We included 1181 infants who participated in the Infant Feeding Practices Study II (IFPS II) and the Year 6 Follow Up (Y6FU) study. Data from IFPS II were used to calculate the primary exposure and timing of solid food introduction (<4, 4-<6, and ≥6 months), and data from Y6FU were used to calculate the primary outcome and obesity at 6 years of age (BMI ≥95th percentile). We used multivariable logistic regression to assess the association between timing of the introduction of solids and obesity at 6 years and test whether this association was modified by breastfeeding duration (breastfed for 4 months vs. not). RESULTS: Prevalence of obesity in our sample was 12.0%. The odds of obesity was higher among infants introduced to solids <4 months compared to those introduced at 4-<6 months (odds ratio [OR] = 1.66; 95% CI, 1.15, 2.40) in unadjusted analysis; however, this relationship was no longer significant after adjustment for covariates (OR = 1.18; 95% CI, 0.79, 1.77). Introduction of solids ≥6 months was not associated with obesity. We found no interaction between breastfeeding duration and early solid food introduction and subsequent obesity. CONCLUSIONS: Timing of introduction of solid foods was not associated with child obesity at 6 years in this sample. Given the inconsistency in findings with other studies, further studies in larger populations may be needed. |
Combined hormonal contraceptive use among obese women and risk for cardiovascular events: a systematic review
Horton LG , Simmons KB , Curtis KM . Contraception 2016 94 (6) 590-604 CONTEXT: Combined hormonal contraceptive (CHC) use may modify the risk of cardiovascular events in obese [body mass index (BMI) ≥30kg/m2] women. OBJECTIVE: To evaluate from the literature whether CHC use modifies the risk of acute myocardial infarction (AMI), stroke, cerebral venous thrombosis (CVT), and venous thromboembolism (VTE) in obese women, and to evaluate evidence for a dose-response relationship between BMI and VTE. METHODS: We searched PubMed for all articles published between database inception and February 2016 providing direct evidence on BMI, CHCs, and cardiovascular outcomes. We also searched for indirect evidence related to a dose-response relationship between BMI and risk of VTE in the general population, as these data were lacking for CHC users. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force (USPSTF). RESULTS: The direct evidence search yielded three pooled analyses, eleven case-control studies, and one cohort study. There was conflicting evidence about the risk of AMI or stroke among obese combined oral contraceptive (COC) users compared to obese non-users, with one study finding no increased risk for AMI or stroke for COC-users overall or stratified by BMI. A second study found significant increased risk of AMI and stroke for COC-users, with the highest risk estimates for high BMI COC-users. A single study suggested that obese COC-users may be at higher risk for CVT compared with normal weight, non-users. For VTE, obese COC users consistently had a risk that was 5 to 8 times that of obese non-users and approximately 10 times that of non-obese, non-users. Five prospective cohort studies were identified as indirect evidence, and all found increased risk for VTE as BMI increased, suggesting a dose-response relationship between BMI and risk for VTE. No studies on the contraceptive patch or vaginal ring were identified that met the inclusion criteria. CONCLUSION: Limited evidence of Level II-2, fair quality, concerning whether CHC use modifies the risk of AMI and stroke in obese women is inconclusive, while a single study of Level II-2, poor quality found obese COC-users may be at higher risk for CVT compared with normal weight, non-users. Both COC use and higher BMI increase risk for VTE, and the greatest relative risks are for those with both risk factors, based on a body of evidence graded as Level II-2, fair to poor quality. It is not possible to estimate absolute risk of VTE among women with both of these risk factors; however, the absolute risk of VTE in healthy women of reproductive age is small. |
Risk factors for presumed bacterial pneumonia among HIV-uninfected children hospitalized in Soweto, South Africa
Verani JR , Groome MJ , Zar HJ , Zell ER , Kapongo CN , Nzenze SA , Mulligan C , Moore DP , Whitney CG , Madhi SA . Pediatr Infect Dis J 2016 35 (11) 1169-1174 BACKGROUND: Pneumonia is a leading cause of child morbidity and death. Data on risk factors can guide prevention efforts. Within a study on pneumococcal conjugate vaccine effectiveness, we investigated risk factors for presumed bacterial pneumonia (PBP). METHODS: PBP cases were HIV-uninfected children with lower respiratory tract infection and consolidation on chest radiograph or non-consolidated infiltrate with C-reactive protein >40 mg/L hospitalized at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto. Age-matched community controls were identified using CHBAH birth records +/-1 week of case birth date. Data were analyzed using conditional logistic regression. RESULTS: A total of 889 PBP cases (median age 9 months) were matched to 2,628 controls. Crowding was a significant risk factor among well-nourished children (adjusted odds ratio [aOR] 2.29; 95% confidence interval [CI] 1.89-2.78), but not in those with low weight-for-age. Malnutrition was associated with PBP; strength of association was highest in the absence of crowding (aOR 6.68; 95%CI 4.74-9.42). Exclusive breastfeeding was protective only among HIV-unexposed children (aOR 0.65; 95%CI 0.54-0.78). Self-reported maternal HIV infection was a risk factor among children exclusively breastfeed up to 4 months (aOR 2.33; 95%CI 1.53-3.55). Having indoor tap water was protective (aOR 0.65; 95%CI 0.54-0.78), while a primary care giver who smoked was a risk factor (aOR 5.15, 95%CI 2.94-9.03). CONCLUSIONS: Our findings confirm several known pneumonia risk factors, and highlight complex interactions between factors, including HIV exposure, breastfeeding, malnutrition and crowding. Improved housing, reduced secondhand smoke exposure, and HIV prevention among women of reproductive age could lessen the child pneumonia burden. |
The role of the law in reducing tuberculosis transmission in Botswana, South Africa and Zambia
Verani AR , Emerson CN , Lederer P , Lipke G , Kapata N , Lanje S , Peters AC , Zulu I , Marston BJ , Miller B . Bull World Health Organ 2016 94 (6) 415-23 OBJECTIVE: To determine whether laws and regulations in Botswana, South Africa and Zambia - three countries with a high tuberculosis and HIV infection burden - address elements of the World Health Organization (WHO) policy on tuberculosis infection control. METHODS: An online desk review of laws and regulations that address six selected elements of the WHO policy on tuberculosis infection control in the three countries was conducted in November 2015 using publicly available domestic legal databases. The six elements covered: (i) national policy and legal framework; (ii) health facility design, construction and use; (iii) tuberculosis disease surveillance among health workers; (iv) patients' and health workers' rights; (v) monitoring of infection control measures; and (vi) relevant research. FINDINGS: The six elements were found to be adequately addressed in the three countries' laws and regulations. In all three, tuberculosis case-reporting is required, as is tuberculosis surveillance among health workers. Each country's legal and regulatory framework also addresses the need to respect individuals' rights and privacy while safeguarding public health. These laws and regulations create a strong foundation for tuberculosis infection control. Although the legal and regulatory frameworks thoroughly address tuberculosis infection control, their dissemination, implementation and enforcement were not assessed, nor was their impact on public health. CONCLUSION: Laws and regulations in Botswana, South Africa and Zambia address all six selected elements of the WHO policy on tuberculosis infection control. However, the lack of data on their implementation is a limitation. Future research should assess the implementation and public health impact of laws and regulations. |
Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: Implications for STI/HIV prevention
Villar-Loubet O , Weiss SM , Marks G , O'Daniels C , Jones D , Metsch LR , McLellan-Lemal E . Cult Health Sex 2016 18 (11) 1-17 Heterosexual anal intercourse is associated with increased risk for HIV and other sexually transmitted infections. Research on the social and psychological risk factors associated with heterosexual unprotected anal intercourse among Hispanic women in the USA is limited. We examined demographic, mental health, relationship power, sexual self-efficacy, self-esteem, acculturation and HIV knowledge as correlates of unprotected anal intercourse among 514 HIV-negative Hispanic women, 18 to 59 years of age, residing in one urban county in southern Florida. In both unadjusted and adjusted results, the likelihood of engaging in unprotected anal intercourse was associated with food insecurity in the past 30 days (adjusted odds ratio [AOR] = 1.57, 95% confidence interval [CI] 1.03, 2.40) and more interpersonal power attributed to the male partner (AOR = 1.63, 95%CI 1.08, 2.45). Not significant, yet of possible importance, were ever having engaged in exchange sex (AOR = 1.96, 95%CI = 0.97, 3.98) and lower HIV knowledge (AOR = 0.80, 95%CI = 0.63, 1.01). Interventions aimed at reducing heterosexual unprotected anal intercourse risk for HIV infection among Hispanic women may benefit by addressing socioeconomic and interpersonal issues, and assessing HIV knowledge and comprehension. |
Trends in hospitalizations of pregnant HIV-infected women in the USA: 2004-2011
Ewing AC , Datwani HM , Flowers LM , Ellington SR , Jamieson DJ , Kourtis AP . Am J Obstet Gynecol 2016 215 (4) 499 e1-8 BACKGROUND: With the development and widespread use of combination antiretroviral therapy, HIV-infected women live longer, healthier lives. Previous research has shown that, since the adoption of combination antiretroviral therapy in the U.S., rates of morbidity and adverse obstetric outcomes remained higher for HIV-infected pregnant women compared with HIV-uninfected pregnant women. Monitoring trends in the outcomes these women experience is essential, as recommendations for this special population continue to evolve with the progress of HIV treatment and prevention options. OBJECTIVE(S): We conducted an analysis comparing rates of hospitalizations and associated outcomes among HIV-infected and uninfected pregnant women in the United States from 2004-2011. STUDY DESIGN: We used cross-sectional hospital discharge data from the 2004, 2007, and 2011 Nationwide Inpatient Sample, a nationally representative sample of US hospital discharges. Demographic characteristics, morbidity outcomes, and time trends were compared using chi2 tests and multivariate logistic regression. Analyses were weighted to produce national estimates. RESULTS: In 2011, there were 4,751 estimated pregnancy hospitalizations and 3,855 delivery hospitalizations for HIV-infected pregnant women; neither increased since 2004. Compared with those of HIV-uninfected women, pregnancy hospitalizations of HIV-infected women were more likely to be longer, in the South and Northeast, covered by public insurance, and to incur higher charges (all p < 0.005). Hospitalizations among pregnant women who were HIV-infected had higher rates for many adverse outcomes. Compared to 2004, hospitalizations of HIV-infected pregnant women in 2011 had higher odds of gestational diabetes (1.81 [1.16, 2.84]), pre-eclampsia/hypertensive disorders of pregnancy (1.58 [1.12, 2.24]), viral/mycotic/parasitic infections (1.90 [1.69, 2.14]), and bacterial infections (2.54 [1.53, 4.20]). Bacterial infections did not increase among hospitalizations of HIV-uninfected pregnant women. CONCLUSIONS: The numbers of hospitalizations during pregnancy and delivery have not increased for HIV-infected women since 2004, a departure from previously estimated trends. Pregnancy hospitalizations of HIV-infected women remain more medically complex than those of uninfected women. An increasing trend in infections among the delivery hospitalizations of HIV-infected pregnant women warrant further attention. |
Vital Signs: Deficiencies in environmental control identified in outbreaks of Legionnaires' Disease - North America, 2000-2014
Garrison LE , Kunz JM , Cooley LA , Moore MR , Lucas C , Schrag S , Sarisky J , Whitney CG . MMWR Morb Mortal Wkly Rep 2016 65 (22) 576-584 BACKGROUND: The number of reported cases of Legionnaires' disease, a severe pneumonia caused by the bacterium Legionella, is increasing in the United States. During 2000-2014, the rate of reported legionellosis cases increased from 0.42 to 1.62 per 100,000 persons; 4% of reported cases were outbreak-associated. Legionella is transmitted through aerosolization of contaminated water. A new industry standard for prevention of Legionella growth and transmission in water systems in buildings was published in 2015. CDC investigated outbreaks of Legionnaires' disease to identify gaps in building water system maintenance and guide prevention efforts. METHODS: Information from summaries of CDC Legionnaires' disease outbreak investigations during 2000-2014 was systematically abstracted, and water system maintenance deficiencies from land-based investigations were categorized as process failures, human errors, equipment failures, or unmanaged external changes. RESULTS: During 2000-2014, CDC participated in 38 field investigations of Legionnaires' disease. Among 27 land-based outbreaks, the median number of cases was 10 (range = 3-82) and median outbreak case fatality rate was 7% (range = 0%-80%). Sufficient information to evaluate maintenance deficiencies was available for 23 (85%) investigations. Of these, all had at least one deficiency; 11 (48%) had deficiencies in ≥2 categories. Fifteen cases (65%) were linked to process failures, 12 (52%) to human errors, eight (35%) to equipment failures, and eight (35%) to unmanaged external changes. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Multiple common preventable maintenance deficiencies were identified in association with disease outbreaks, highlighting the importance of comprehensive water management programs for water systems in buildings. Properly implemented programs, as described in the new industry standard, could reduce Legionella growth and transmission, preventing Legionnaires' disease outbreaks and reducing disease. |
Wide variations in compliance with tuberculosis screening guidelines and tuberculosis incidence between antiretroviral therapy facilities - Cote d'Ivoire
Auld AF , Blain M , Ekra KA , Kouakou JS , Ettiegne-Traore V , Tuho MZ , Mohamed F , Shiraishi RW , Sabatier J , Essombo J , Adjorlolo-Johnson G , Marlink R , Ellerbrock TV . PLoS One 2016 11 (6) e0157059 BACKGROUND: In Cote d'Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission. METHODS AND FINDINGS: In a retrospective cohort study among 3,682 randomly selected adults (≥15 years old) starting ART during 2004-2007 at 34 randomly selected facilities, documentation of TB screening completion, prevalence of active TB at ART initiation, and incidence of TB during ART were evaluated. At ART initiation, median age was 36 years, 67% were female, and median CD4 count was 135 cells/muL. Among all 3,682 enrollees, 73 (2%) were on TB treatment at the time of referral to the ART facility. Among the 3,609 not on TB treatment, 1,263 (36%) were documented to receive some TB screening before ART initiation; 21% were screened for cough, 21% for weight loss, 18% for fever, 18% for TB contacts, and 12% for night sweats. Among the 1,263 screened, 111 (11%) were diagnosed with TB and started TB treatment before ART. No associations between patient characteristics and probability of being screened were noted. However, documentation of TB screening completion before ART varied widely by ART facility from 0-100%. TB incidence during ART was 3.0 per 100 person-years but varied widely by ART facility from 0/100 person-year to 13.1/100 person-years. CONCLUSIONS: Screening for TB before ART initiation was poorly documented. Facility-level variations in TB screening documentation suggest facility-level factors, such as investment in training programs, might determine documentation practices. Targeting under-performing ART facilities with improvement activities is needed. Variations among facilities in TB incidence warrant further research. These incidence variations could reflect differences between facilities in TB screening, diagnostic tests, documentation practices, or TB risk possibly related to infection control practices or local community TB incidence. |
PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009-2015
Smith DK , Mendoza MC , Stryker JE , Rose CE . PLoS One 2016 11 (6) e0156592 OBJECTIVES: As trials were assessing the safety and efficacy of daily oral antiretroviral preexposure prophylaxis (PrEP) for the prevention of HIV infection, there was a clear need to understand the evolution of knowledge of, and attitudes toward, PrEP among primary care clinicians. METHODS: Physicians and nurse practitioners were surveyed in 2009 (n = 1500), 2010 (n = 1504), 2012 (n = 1503), 2013 (n = 1507), 2014 (n = 1508) and 2015 (n = 1501) to assess their awareness of PrEP, willingness to prescribe PrEP, and whether they support use of public funds to pay for PrEP. Pharmacists (n = 251) were surveyed about PrEP in 2012 only. Descriptive statistics were computed for physician demographics and PrEP-related questions. Prevalence ratios for willingness to prescribe PrEP were computed using Poisson regression analysis. RESULTS: Awareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 66%). Following a description of PrEP with an estimated effectiveness of 75%, across 6 of the study years 91% of clinicians indicated a willingness to prescribe PrEP to at least one group at high risk of HIV acquisition. A smaller majority of clinicians indicated support for public funding of PrEP in 2009: 59%, 2010: 53%, and 2013: 63%. CONCLUSIONS: In surveys conducted before and after the release of PrEP trial results, primary care clinicians were largely unaware of PrEP. They indicated high levels of willingness to prescribe it for patients at high risk of HIV acquisition and expressed interest in education about how to deliver this new clinical HIV prevention method. It will be important to continue monitoring clinician knowledge, attitudes, and practices as the use of PrEP increases in the US. |
The prevalence of HCV infection in Egypt 2015: Implications for future policy on prevention and treatment
Kandeel A , Genedy M , El-Refai S , Funk AL , Fontanet A , Talaat M . Liver Int 2016 BACKGROUND AND AIMS: In 2015, a national Egyptian health issue survey (EHIS) was conducted to describe the prevalence of hepatitis C virus (HCV) infection. In this paper, we describe the HCV burden in 2015, compare the results with the national survey conducted in 2008, and discuss the implications of the new findings on prevention of HCV in Egypt. METHODS: A multistage probability sampling approach was used, similar to the national demographic survey conducted in 2008. More than 90% of sampled individuals complied with the interview and provided blood samples. RESULTS: In the 15-59 year age groups, the prevalence of HCV antibody was found to be 10.0% [95% CI 9.5-10.5] and that of HCV RNA to be 7.0% [95% CI 6.6-7.4]. In children, 1-14 years old, the prevalence of HCV antibody and HCV RNA were 0.4% [95% CI 0.3-0.5] and 0.2% [95% CI 0.1-0.3] respectively. Approximately 3.7 million persons have chronic HCV infection in the age group 15-59 in 2015. An estimated 29% reduction in HCV RNA prevalence has been seen since 2008, which is largely attributable to the aging of the group infected 40-50 years ago during the mass schistosomiasis treatment campaigns. Prevention efforts may have also contributed to this decline, with an estimated 75% [95% CI 6-45] decrease in HCV incidence in the 0-19 year age groups over the past 20 years. CONCLUSIONS: These findings can be used to shape future HCV prevention policies in Egypt. |
Prevalence of hepatitis B virus infection in Kenya, 2007
Ly KN , Kim AA , Umuro M , Drobenuic J , Williamson J , Montgomery JM , Fields BS , Teshale EH . Am J Trop Med Hyg 2016 95 (2) 348-53 Current estimates put the prevalence of hepatitis B virus (HBV) infection in Kenya at 5-8%. We determined the HBV infection prevalence in the human immunodeficiency virus (HIV)-negative Kenyan adult and adolescent population based on samples collected from a national survey. We analyzed data from HIV-negative participants in the 2007 Kenya AIDS Indicator Survey to estimate the HBV infection prevalence. We defined past or present HBV infection as presence of total hepatitis B core antibody (HBcAb), and chronic HBV infection (CHBI) as presence of both total HBcAb and hepatitis B surface antigen (HBsAg). We calculated crude and adjusted odds of HBV infection by demographic characteristics and risk factors using logistic regression analyses. Of 1,091 participants aged 15-64 years, approximately 31.5% (95% confidence interval [CI] = 28.0-35.3%) had exposure to HBV, corresponding to approximately 6.1 million (CI = 5.4-6.8 million) with past or present HBV infection. The estimated prevalence of CHBI was 2.1% (95% CI = 1.4-3.1%), corresponding to approximately 398,000 (CI = 261,000-602,000) with CHBI. CHBI is a major public health problem in Kenya, affecting approximately 400,000 persons. Knowing the HBV infection prevalence at baseline is important for planning and public health policy decision making and for monitoring the impact of viral hepatitis prevention programs. |
Elimination of mother-to-child transmission of HIV - Thailand
Lolekha R , Boonsuk S , Plipat T , Martin M , Tonputsa C , Punsuwan N , Naiwatanakul T , Chokephaibulkit K , Thaisri H , Phanuphak P , Chaivooth S , Ongwandee S , Baipluthong B , Pengjuntr W , Mekton S . MMWR Morb Mortal Wkly Rep 2016 65 (22) 562-566 Thailand experienced a generalized human immunodeficiency virus (HIV) epidemic during the 1990s. HIV prevalence among pregnant women was 2.0% and the mother-to-child transmission (MTCT) rate was >20% (1-3). In June 2016, Thailand became the first country in Asia to validate the elimination of MTCT by meeting World Health Organization (WHO) targets. Because Thailand's experience implementing a successful prevention of MTCT program might be instructive for other countries, Thailand's prevention of MTCT interventions, outcomes, factors that contributed to success, and challenges that remain were reviewed. Thailand's national prevention of MTCT program has evolved with prevention science from national implementation of short course zidovudine (AZT) in 2000 to lifelong highly active antiretroviral therapy regardless of CD4 count (WHO option B+) in 2014 (1). By 2015, HIV prevalence among pregnant women had decreased to 0.6% and the MTCT rate to 1.9% (the elimination of MTCT target is <2% for nonbreastfeeding populations) (4). A strong public health infrastructure, committed political leadership, government funding, engagement of multiple partners, and a robust monitoring system allowed Thailand to achieve this important public health milestone. |
Global update on the susceptibility of human influenza viruses to neuraminidase inhibitors, 2014-2015
Hurt AC , Besselaar TG , Daniels RS , Ermetal B , Fry A , Gubareva L , Huang W , Lackenby A , Lee RT , Lo J , Maurer-Stroh S , Nguyen HT , Pereyaslov D , Rebelo-de-Andrade H , Siqueira MM , Takashita E , Tashiro M , Tilmanis D , Wang D , Zhang W , Meijer A . Antiviral Res 2016 132 178-85 The World Health Organization (WHO) Collaborating Centres for Reference and Research on Influenza (WHO CCs) tested 13,312 viruses collected by WHO recognized National Influenza Centres between May 2014 and May 2015 to determine 50% inhibitory concentration (IC50) data for neuraminidase inhibitors (NAIs) oseltamivir, zanamivir, peramivir and laninamivir. Ninety-four per cent of the viruses tested by the WHO CCs were from three WHO regions: Western Pacific, the Americas and Europe. Approximately 0.5% (n = 68) of viruses showed either highly reduced inhibition (HRI) or reduced inhibition (RI) (n = 56) against at least one of the four NAIs. Of the twelve viruses with HRI, six were A(H1N1)pdm09 viruses, three were A(H3N2) viruses and three were B/Yamagata-lineage viruses. The overall frequency of viruses with RI or HRI by the NAIs was lower than that observed in 2013-14 (1.9%), but similar to the 2012-13 period (0.6%). Based on the current analysis, the NAIs remain an appropriate choice for the treatment and prophylaxis of influenza virus infections. |
Influenza activity - United States, 2015-16 season and composition of the 2016-17 influenza vaccine
Davlin SL , Blanton L , Kniss K , Mustaquim D , Smith S , Kramer N , Cohen J , Cummings CN , Garg S , Flannery B , Fry AM , Grohskopf LA , Bresee J , Wallis T , Sessions W , Garten R , Xu X , Elal AI , Gubareva L , Barnes J , Wentworth DE , Burns E , Katz J , Jernigan D , Brammer L . MMWR Morb Mortal Wkly Rep 2016 65 (22) 567-575 During the 2015-16 influenza season (October 4, 2015-May 21, 2016) in the United States, influenza activity was lower and peaked later compared with the previous three seasons (2012-13, 2013-14, and 2014-15). Activity remained low from October 2015 until late December 2015 and peaked in mid-March 2016. During the most recent 18 influenza seasons (including this season), only two other seasons have peaked in March (2011-12 and 2005-06). Overall influenza activity was moderate this season, with a lower percentage of outpatient visits for influenza-like illness (ILI), lower hospitalization rates, and a lower percentage of deaths attributed to pneumonia and influenza (P&I) compared with the preceding three seasons. Influenza A(H1N1)pdm09 viruses predominated overall, but influenza A(H3N2) viruses were more commonly identified from October to early December, and influenza B viruses were more commonly identified from mid-April through mid-May. The majority of viruses characterized this season were antigenically similar to the reference viruses representing the recommended components of the 2015-16 Northern Hemisphere influenza vaccine. This report summarizes influenza activity in the United States during the 2015-16 influenza season (October 4, 2015-May 21, 2016) section sign and reports the vaccine virus components recommended for the 2016-17 Northern Hemisphere influenza vaccines. |
Turtles as a Possible Reservoir of Nontyphoidal Salmonella in Shanghai, China.
Zhang J , Kuang D , Wang F , Meng J , Jin H , Yang X , Liao M , Klena JD , Wu S , Zhang Y , Xu X . Foodborne Pathog Dis 2016 13 (8) 428-33 Terrapins and turtles are known to transmit Salmonella to humans. However, little was known about the occurrence of this pathogen in soft-shelled terrapin that is a popular delicacy in Chinese and other East Asian cuisines. We isolated and characterized 82 (24.4%) isolates of Salmonella from 336 fecal samples of soft-shelled terrapins (51 of 172; 29.7%) and pet turtles (31 of 164; 18.9%) in Shanghai. Salmonella Thompson was the most common serotype (17.1%) among others. Many isolates (84.1%) were resistant to multiple antimicrobials (≥3). Molecular analysis of Salmonella Thompson and Salmonella Typhimurium using pulsed-field gel electrophoresis unveiled a close genetic relationship between several human and terrapin isolates. Our results highlight the risk associated with the handling and consumption of turtles and their role in the spread of Salmonella in the human salmonellosis. |
Evidence of rickettsia and orientia infections among abattoir workers in Djibouti
Horton KC , Jiang J , Maina A , Dueger E , Zayed A , Ahmed AA , Pimentel G , Richards AL . Am J Trop Med Hyg 2016 95 (2) 462-5 Of 49 workers at a Djiboutian abattoir, eight (16%, 95% confidence interval [CI]: 9-29) were seropositive against spotted fever group rickettsiae (SFGR), two (4%, 95% CI: 1-14) against typhus group rickettsiae, and three (6%, 95% CI: 2-17) against orientiae. One worker (9%, 95% CI: 2-38) seroconverted against orientiae during the study period. This is the first evidence of orientiae exposure in the Horn of Africa. SFGR were also identified by polymerase chain reaction in 32 of 189 (11%, 95% CI: 8-15) tick pools from 26 of 72 (36%) cattle. Twenty-five (8%, 95% CI: 6-12) tick pools were positive for Rickettsia africae, the causative agent of African tick-bite fever. Health-care providers in Djibouti should be aware of the possibility of rickettsiae infections among patients, although further research is needed to determine the impact of these infections in the country. |
Diapause in ticks of the medically important Ixodes ricinus species complex
Gray JS , Kahl O , Lane RS , Levin ML , Tsao JI . Ticks Tick Borne Dis 2016 7 (5) 992-1003 Four members of the Ixodes ricinus species complex, Ixodes pacificus, Ixodes persulcatus, Ixodes ricinus and Ixodes scapularis, have, between them, a worldwide distribution within the northern hemisphere. They are responsible for the transmission of several animal and human pathogens, including the causal agents of Lyme borreliosis, tick-borne encephalitis, human granulocytic anaplasmosis and human babesiosis. Despite the importance of these ticks as vectors, the knowledge and understanding of the role that diapause plays in their complex life cycles are confused and incomplete. In view of the continuing geographic spread of these tick species, as well as the effects of climate change on vector-borne diseases, it is timely to encourage research on diapause phenomena to improve understanding of their biology and of pathogen transmission dynamics. In our review we seek to clarify thinking on the topic and to address gaps in our knowledge that require the attention of researchers. |
Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians
Bao Y , Pan Y , Taylor A , Radakrishnan S , Luo F , Pincus HA , Schackman BR . Health Aff (Millwood) 2016 35 (6) 1045-51 State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose. We used data from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010. We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of non-opioid analgesics were limited. Increased use of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the policies' comparative effectiveness. |
Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis
Chang HY , Lyapustina T , Rutkow L , Daubresse M , Richey M , Faul M , Stuart EA , Alexander GC . Drug Alcohol Depend 2016 165 1-8 BACKGROUND: Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. METHODS: We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. RESULTS: We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, p<0.01), and had more prescription-filling patients receiving opioids (47% vs. 19%, p<0.01). Following policy implementation, Florida's high-risk providers experienced large relative reductions in opioid patients and opioid prescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. CONCLUSIONS: High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers. |
Long-term stability of volatile nitrosamines in human urine
Hodgson JA , Seyler TH , Wang L . J Anal Toxicol 2016 40 (6) 414-8 Volatile nitrosamines (VNAs) are established teratogens and carcinogens in animals and classified as probable (group 2A) and possible (group 2B) carcinogens in humans by the IARC. High levels of VNAs have been detected in tobacco products and in both mainstream and sidestream smoke. VNA exposure may lead to lipid peroxidation and oxidative stress (e.g., inflammation), chronic diseases (e.g., diabetes) and neurodegenerative diseases (e.g., Alzheimer's disease). To conduct epidemiological studies on the effects of VNA exposure, short-term and long-term stabilities of VNAs in the urine matrix are needed. In this report, the stability of six VNAs (N-nitrosodimethylamine, N-nitrosomethylethylamine, N-nitrosodiethylamine, N-nitrosopiperidine, N-nitrosopyrrolidine and N-nitrosomorpholine) in human urine is analyzed for the first time using in vitro blank urine pools fortified with a standard mixture of all six VNAs. Over a 24-day period, analytes were monitored in samples stored at approximately 20 degrees C (collection temperature), 4-10 degrees C (transit temperature) and -20 and -70 degrees C (long-term storage temperatures). All six analytes were stable for 24 days at all temperatures (n = 15). The analytes were then analyzed over a longer time period at -70 degrees C; all analytes were stable for up to 1 year (n = 62). A subset of 44 samples was prepared as a single batch and stored at -20 degrees C, the temperature at which prepared samples are stored. These prepared samples were run in duplicate weekly over 10 weeks, and all six analytes were stable over the entire period (n = 22). |
Assessing commitment and reporting fidelity to a text message-based participatory surveillance in rural Western Uganda
Lester J , Paige S , Chapman CA , Gibson M , Holland Jones J , Switzer WM , Ting N , Goldberg TL , Frost SD . PLoS One 2016 11 (6) e0155971 Syndromic surveillance, the collection of symptom data from individuals prior to or in the absence of diagnosis, is used throughout the developed world to provide rapid indications of outbreaks and unusual patterns of disease. However, the low cost of syndromic surveillance also makes it highly attractive for the developing world. We present a case study of electronic participatory syndromic surveillance, using participant-mobile phones in a rural region of Western Uganda, which has a high infectious disease burden, and frequent local and regional outbreaks. Our platform uses text messages to encode a suite of symptoms, their associated durations, and household disease burden, and we explore the ability of participants to correctly encode their symptoms, with an average of 75.2% of symptom reports correctly formatted between the second and 11th reporting timeslots. Concomitantly we identify divisions between participants able to rapidly adjust to this unusually participatory style of data collection, and those few for whom the study proved more challenging. We then perform analyses of the resulting syndromic time series, examining the clustering of symptoms by time and household to identify patterns such as a tendency towards the within-household sharing of respiratory illness. |
Complete and Closed Genome Sequences of 10 Salmonella enterica subsp. enterica Serovar Anatum Isolates from Human and Bovine Sources.
Nguyen SV , Harhay DM , Bono JL , Smith TP , Fields PI , Dinsmore BA , Santovenia M , Kelley CM , Wang R , Bosilevac JM , Harhay GP . Genome Announc 2016 4 (3) Salmonella enterica is an important pathogen transmitted by numerous vectors. Genomic comparisons of Salmonella strains from disparate hosts have the potential to further our understanding of mechanisms underlying host specificities and virulence. Here, we present the closed genome and plasmid sequences of 10 Salmonella enterica subsp. enterica serovar Anatum isolates from bovine and human sources. |
A knowledge base for tracking the impact of genomics on population health.
Yu W , Gwinn M , Dotson WD , Green RF , Clyne M , Wulf A , Bowen S , Kolor K , Khoury MJ . Genet Med 2016 18 (12) 1312-1314 PURPOSE: We created an online knowledge base (the Public Health Genomics Knowledge Base (PHGKB)) to provide systematically curated and updated information that bridges population-based research on genomics with clinical and public health applications. METHODS: Weekly horizon scanning of a wide variety of online resources is used to retrieve relevant scientific publications, guidelines, and commentaries. After curation by domain experts, links are deposited into Web-based databases. RESULTS: PHGKB currently consists of nine component databases. Users can search the entire knowledge base or search one or more component databases directly and choose options for customizing the display of their search results. CONCLUSION: PHGKB offers researchers, policy makers, practitioners, and the general public a way to find information they need to understand the complicated landscape of genomics and population health. |
Common occurrence of Cryptosporidium hominis in horses and donkeys.
Jian F , Liu A , Wang R , Zhang S , Qi M , Zhao W , Shi Y , Wang J , Wei J , Zhang L , Xiao L . Infect Genet Evol 2016 43 261-6 Extensive genetic variation is observed within the genus Cryptosporidium and the distribution of Cryptosporidium species/genotypes in humans and animals appears to vary by geography and host species. To better understand the genetic diversity of Cryptosporidium spp. in horses and donkeys, we characterized five horse-derived and 82 donkey-derived Cryptosporidium isolates from five provinces or autonomous regions (Sichuan, Gansu, Henan, Inner Mongolia and Shandong) in China at the species/genotype and subtype levels. Three Cryptosporidium species/genotypes were identified based on the analysis of the SSU rRNA gene, including Cryptosporidium parvum (n=22), the Cryptosporidium horse genotype (n=4), and Cryptosporidium hominis (n=61). The identification of C. hominis was confirmed by sequence analysis of the HSP70 and actin genes. Subtyping using sequence analysis of the 60kDa glycoprotein gene identified 21 C. parvum isolates as subtype IIdA19G1, the four horse genotype isolates as subtypes VIaA15G4 (n=2) and VIaA11G3 (n=2), and the 61 C. hominis isolates as IkA16G1 (n=59) and IkA16 (n=2). The common finding of C. hominis reaffirms the heterogeneity of Cryptosporidium spp. in horses and donkeys and is possibly a reflection of endemic transmission of C. hominis in these animals. Data of the study suggest that horses and donkeys as companion animals may potentially transmit Cryptosporidium infections to humans. |
Youth risk behavior surveillance - United States, 2015
Kann L , McManus T , Harris WA , Shanklin SL , Flint KH , Hawkins J , Queen B , Lowry R , Olsen EO , Chyen D , Whittle L , Thornton J , Lim C , Yamakawa Y , Brener N , Zaza S . MMWR Surveill Summ 2016 65 (6) 1-174 PROBLEM: Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. REPORTING PERIOD COVERED: September 2014-December 2015. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national survey, 37 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. RESULTS: Results from the 2015 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.5% of high school students nationwide among the 61.3% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 32.8% had drunk alcohol, and 21.7% had used marijuana. During the 12 months before the survey, 15.5% had been electronically bullied, 20.2% had been bullied on school property, and 8.6% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 41.2% of students had ever had sexual intercourse, 30.1% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 56.9% had used a condom during their last sexual intercourse. Results from the 2015 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 10.8% of high school students had smoked cigarettes and 7.3% had used smokeless tobacco. During the 7 days before the survey, 5.2% of high school students had not eaten fruit or drunk 100% fruit juices and 6.7% had not eaten vegetables. More than one third (41.7%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day and 14.3% had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard on at least 1 day during the 7 days before the survey. Further, 13.9% had obesity and 16.0% were overweight. INTERPRETATION: Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long-term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., riding with a driver who had been drinking alcohol, physical fighting, current cigarette use, current alcohol use, and current sexual activity), but the prevalence of other behaviors and health outcomes has not changed (e.g., suicide attempts treated by a doctor or nurse, smokeless tobacco use, having ever used marijuana, and attending physical education classes) or has increased (e.g., having not gone to school because of safety concerns, obesity, overweight, not eating vegetables, and not drinking milk). Monitoring emerging risk behaviors (e.g., texting and driving, bullying, and electronic vapor product use) is important to understand how they might vary over time. PUBLIC HEALTH ACTION: YRBSS data are used widely to compare the prevalence of health behaviors among subpopulations of students; assess trends in health behaviors over time; monitor progress toward achieving 21 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth. |
The use of economic evaluation to inform newborn screening policy decisions: the Washington State experience
Grosse SD , Thompson JD , Ding Y , Glass M . Milbank Q 2016 94 (2) 366-91 POLICY POINTS: Newborn screening not only saves lives but can also yield net societal economic benefit, in addition to benefits such as improved quality of life to affected individuals and families. Calculations of net economic benefit from newborn screening include the monetary equivalent of avoided deaths and reductions in costs of care for complications associated with late-diagnosed individuals minus the additional costs of screening, diagnosis, and treatment associated with prompt diagnosis. Since 2001 the Washington State Department of Health has successfully implemented an approach to conducting evidence-based economic evaluations of disorders proposed for addition to the state-mandated newborn screening panel. CONTEXT: Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost-benefit models in Washington State as part of the rule-making process that resulted in the implementation of screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014. METHODS: We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer-reviewed literature. FINDINGS: The MCAD model projected a benefit-cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit-cost ratio of 4.0-5.4 to 1 for a discount rate of 3%-4% and a plausible range of 1-2 percentage point reductions in deaths up to age 10 years. CONCLUSIONS: The Washington State cost-benefit models of newborn screening were broadly consistent with peer-reviewed literature, and their findings of net benefit appear to be robust to uncertainty in parameters. Public health newborn screening programs can develop their own capacity to project expected costs and benefits of expansion of newborn screening panels, although it would be most efficient if this capacity were shared among programs. |
Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: A prospective, active-controlled, observer-blind, randomised phase 4 trial
Tapia MD , Sow SO , Tamboura B , Teguete I , Pasetti MF , Kodio M , Onwuchekwa U , Tennant SM , Blackwelder WC , Coulibaly F , Traore A , Keita AM , Haidara FC , Diallo F , Doumbia M , Sanogo D , DeMatt E , Schluterman NH , Buchwald A , Kotloff KL , Chen WH , Orenstein EW , Orenstein LA , Villanueva J , Bresee J , Treanor J , Levine MM . Lancet Infect Dis 2016 16 (9) 1026-1035 BACKGROUND: Despite the heightened risk of serious influenza during infancy, vaccination is not recommended in infants younger than 6 months. We aimed to assess the safety, immunogenicity, and efficacy of maternal immunisation with trivalent inactivated influenza vaccine for protection of infants against a first episode of laboratory-confirmed influenza. METHODS: We did this prospective, active-controlled, observer-blind, randomised phase 4 trial at six referral centres and community health centres in Bamako, Mali. Third-trimester pregnant women (≥28 weeks' gestation) were randomly assigned (1:1), via a computer-generated, centre-specific list with alternate block sizes of six or 12, to receive either trivalent inactivated influenza vaccine or quadrivalent meningococcal vaccine. Study personnel administering vaccines were not masked to treatment allocation, but allocation was concealed from clinicians, laboratory personnel, and participants. Infants were visited weekly until age 6 months to detect influenza-like illness; laboratory-confirmed influenza diagnosed with RT-PCR. We assessed two coprimary objectives: vaccine efficacy against laboratory-confirmed influenza in infants born to women immunised any time prepartum (intention-to-treat population), and vaccine efficacy in infants born to women immunised at least 14 days prepartum (per-protocol population). The primary outcome was the occurrence of a first case of laboratory-confirmed influenza by age 6 months. This trial is registered with ClinicalTrials.gov, number NCT01430689. FINDINGS: We did this trial from Sept 12, 2011, to Jan 28, 2014. Between Sept 12, 2011, and April 18, 2013, we randomly assigned 4193 women to receive trivalent inactivated influenza vaccine (n=2108) or quadrivalent meningococcal vaccine (n=2085). There were 4105 livebirths; 1797 (87%) of 2064 infants in the trivalent inactivated influenza vaccine group and 1793 (88%) of 2041 infants in the quadrivalent meningococcal vaccine group were followed up until age 6 months. We recorded 5279 influenza-like illness episodes in 2789 (68%) infants, of which 131 (2%) episodes were laboratory-confirmed influenza. 129 (98%) cases of laboratory-confirmed influenza were first episodes (n=77 in the quadrivalent meningococcal vaccine group vs n=52 in the trivalent inactivated influenza vaccine group). In the intention-to-treat population, overall infant vaccine efficacy was 33.1% (95% CI 3.7-53.9); in the per-protocol population, vaccine efficacy was 37.3% (7.6-57.8). Vaccine efficacy remained robust during the first 4 months of follow-up (67.9% [95% CI 35.1-85.3] by intention to treat and 70.2% [35.7-87.6] by per protocol), before diminishing during the fifth month (57.3% [30.6-74.4] and 60.7 [33.8-77.5], respectively). Adverse event rates in women and infants were similar among groups. Pain at the injection site was more common in women given quadrivalent meningococcal vaccine than in those given trivalent inactivated influenza vaccine (n=253 vs n=132; p<0.0001), although 354 [92%] reactions were mild. Obstetrical and non-obstetrical serious adverse events were reported in 60 (3%) women in the quadrivalent meningococcal vaccine group and 61 (3%) women in the trivalent inactivated influenza vaccine group. Presumed neonatal infection was more common in infants in the trivalent inactivated influenza vaccine group than in those in the quadrivalent meningococcal vaccine group (n=60 vs n=37; p=0.02). No serious adverse events were related to vaccination. INTERPRETATION: Vaccination of pregnant women with trivalent inactivated influenza vaccine in Mali-a poorly resourced country with high infant mortality-was technically and logistically feasible and protected infants from laboratory-confirmed influenza for 4 months. With adequate financing to procure the vaccine, implementation will parallel the access to antenatal care and immunisation coverage of pregnant women with tetanus toxoid. |
Measles outbreak response vaccination in the Federated States of Micronesia
Gopalani SV , Helgenberger L , Apaisam C , Donre S , Takiri K , Charley J , Yomai A , Judicpa P , Nakazono N , Johnson E , Setik E , Taulung L , Elias A , Barrow-Kohler L . Int J Epidemiol 2016 45 (5) 1394-1400 Measles is an acute, highly infectious, viral disease transmitted through respiratory droplets and aerosolized droplet nuclei.1 It is characterized by fever, cough, coryza, conjunctivitis and generalized maculopapular rash typical of the disease. | After 20 years with no reported measles cases, a widespread outbreak occurred in the Federated States of Micronesia (FSM), an Oceanic island nation just north of the Equator.2 From February to August 2014, a multi-state outbreak affected three of the four FSM states. As part of a systematic outbreak-response following the first laboratory-confirmed case of measles, an emergency mass vaccination campaign was launched successively in each FSM state, to interrupt transmission and contain the outbreak. |
Effect of booster doses of poliovirus vaccine in previously vaccinated children, clinical trial results 2013
Habib MA , Soofi S , Mach O , Samejo T , Alam D , Bhatti Z , Weldon WC , Oberste MS , Sutter R , Bhutta ZA . Vaccine 2016 34 (33) 3803-9 BACKGROUND: Considering the current polio situation Pakistan needs vaccine combinations to reach maximum population level immunity. The trial assessed whether inactivated poliovirus vaccine (IPV) can be used to rapidly boost immunity among children in Pakistan. METHODS: A five-arm randomized clinical trial was conducted among children (6-24months, 5-6years and 10-11years). Children were randomized in four intervention arms as per the vaccines they received (bOPV, IPV, bOPV+vitamin A, and bOPV+IPV) and a control arm which did not receive any vaccine. Baseline seroprevalence of poliovirus antibodies and serological immune response 28days after intervention were assessed. RESULTS: The baseline seroprevalence was high for all serotypes and the three age groups [PV1: 97%, 100%, 96%, PV2: 86%, 100%, 99%, PV3: 83%, 95%, 87% for the three age groups respectively]. There was significantly higher rate of immune response observed in the study arms which included IPV (95-99%) compared with bOPV only arms (11-43%), [p<0.001]; Vitamin A was not associated with improved immune response. Immune response rates in the IPV only arm and IPV+bOPV arm were similar [p>0.5]. CONCLUSION: IPV has shown the ability to efficiently close existing immunity gaps in a vulnerable population of children in rural Pakistan. |
Febrile seizure risk after vaccination in children 6 to 23 months
Duffy J , Weintraub E , Hambidge SJ , Jackson LA , Kharbanda EO , Klein NP , Lee GM , Marcy SM , Nakasato CC , Naleway A , Omer SB , Vellozzi C , DeStefano F . Pediatrics 2016 138 (1) BACKGROUND AND OBJECTIVE: An increased risk of febrile seizure (FS) was identified with concomitant administration of trivalent inactivated influenza vaccine (IIV3) and pneumococcal conjugate vaccine (PCV) 13-valent during the 2010-2011 influenza season. Our objective was to determine whether concomitant administration of IIV3 with other vaccines affects the FS risk. METHODS: We examined the risk of FS 0 to 1 day postvaccination for all routinely recommended vaccines among children aged 6 through 23 months during a period encompassing 5 influenza seasons (2006-2007 through 2010-2011). We used a population-based self-controlled risk interval analysis with a control interval of 14 to 20 days postvaccination. We used multivariable regression to control for receipt of concomitant vaccines and test for interaction between vaccines. RESULTS: Only PCV 7-valent had an independent FS risk (incidence rate ratio [IRR], 1.98; 95% confidence interval [CI], 1.00 to 3.91). IIV3 had no independent risk (IRR, 0.46; 95% CI, 0.21 to 1.02), but risk was increased when IIV3 was given with either PCV (IRR, 3.50; 95% CI, 1.13 to 10.85) or a diphtheria-tetanus-acellular-pertussis (DTaP)-containing vaccine (IRR, 3.50; 95% CI, 1.52 to 8.07). The maximum estimated absolute excess risk due to concomitant administration of IIV3, PCV, and DTaP-containing vaccines compared with administration on separate days was 30 FS per 100 000 persons vaccinated. CONCLUSIONS: The administration of IIV3 on the same day as either PCV or a DTaP-containing vaccine was associated with a greater risk of FS than when IIV3 was given on a separate day. The absolute risk of postvaccination FS with these vaccine combinations was small. |
Immune Responses in U.S. Military Personnel Who Received Meningococcal Conjugate Vaccine (MenACWY) Concomitantly with Other Vaccines Were Higher than in Personnel Who Received MenACWY Alone
Broderick MP , Romero-Steiner S , Rajam G , Johnson SE , Milton A , Kim E , Choi LJ , Radin JM , Schmidt DS , Carlone GM , Messonnier N , Faix DJ . Clin Vaccine Immunol 2016 23 (8) 672-80 Immunological responses to vaccination can differ depending on whether the vaccine is given alone or with other vaccines. This study was a retrospective evaluation of the immunogenicity of a tetravalent meningococcal conjugate vaccine (MenACWY) administered alone (n = 41) or concomitantly with other vaccines (n = 279) to United States military personnel (mean age = 21.6 years) entering the military between 2006 and 2008. Concomitant vaccines included tetanus/diphtheria (Td), inactivated polio vaccine (IPV), hepatitis vaccines, various influenza vaccines, among others; two vaccine groups excluded Tdap and IPV. Immune responses were evaluated in baseline and post-vaccination sera for Neisseria meningitidis serogroups C and Y 1-12 months (mean = 4.96) following vaccination. Functional antibodies were measured by using a serum bactericidal antibody assay with rabbit complement (rSBA) and by measurement of serogroup-specific immunoglobulin G (IgG) antibodies. The percentage of vaccinees reaching threshold levels (IgG ≥2 mug/mL; rSBA titer ≥8) corresponding to an immunologic response was higher post-vaccination than at baseline (p < 0.001). Administration of MenACWY along with other vaccines was associated with higher geometric means of IgG concentrations and rSBA titers than those measured 4.60 months after a single dose of MenACWY. In addition, higher percentages of vaccinees reached the immunological threshold (odds ratios [ORs] range = 1.5 to 21.7) and more of them seroconverted (ORs range = 1.8 to 4.8) when MenACWY was administered with any other vaccine than when administered alone. Additional prospective randomized clinical trials are needed to confirm the observed differences among groups in the immune response to MenACWY when given concomitantly with other vaccines to United States military personnel. |
The Violence Prevention Community Meeting: a multi-site study
Lanza M , Ridenour M , Hendricks S , Rierdan J , Zeiss R , Schmidt S , Lovelace J , Amandus H . Arch Psychiatr Nurs 2016 30 (3) 382-6 OBJECTIVE: The Violence Prevention Community Meeting (VPCM) is a specialized form of community meeting in which avoiding violence and promoting non-violent problem solving and interpersonal civility are focal points. A nationwide study to assess the VPCM as an effective intervention to reduce workplace violence was undertaken. PARTICIPANTS: Seven acute locked psychiatric units of the Veterans Health Administration (VHA) throughout the United States participated in the study. METHODS: All patients and all staff on the seven in-patient locked psychiatry units participated in the intervention (VPCM) or as a control (treatment as usual). The study was 21weeks at each site. The three time periods were pre-treatment weeks 1-3, treatment weeks 4-18, and post-treatment weeks 19-21. The VPCM was conducted during the treatment weeks. RESULTS: Overall rates of aggression declined by 0.6% (95% CI: -5.6%, 6.5%; nonsignificant) per week in the intervention hospitals and by 5.1% (95% CI: 0.4%, 9.6%; significant) per week for the control hospitals. CONCLUSIONS: Aggression decreased for both the intervention and control hospitals which could be due to enrollment in a research study and thus being more aware of their ability to address workplace violence at their site. |
Notes from the field: Intoxication and deaths associated with ingestion of a racing fuel and carbonated soft drink mixture - Tennessee, January 2016
Fill MA , Seger DL , Dunn JR , Schaffner W , Jones TF . MMWR Morb Mortal Wkly Rep 2016 65 (22) 585-586 In January 2016, the Tennessee Poison Center and Tennessee Department of Health learned of the deaths of two adolescents, and the nonfatal intoxication of two other adolescents, after ingestion of a mixture of racing fuel (approximately 100% methanol) and a carbonated soft drink. The Tennessee Department of Health reviewed medical records and police reports to learn more about the racing fuel source, assess ongoing risk, and guide prevention efforts. These are the first reported deaths in the United States associated with ingestion of this racing fuel mixture. |
Anthrax Toxin-Expressing Bacillus cereus Isolated from an Anthrax-Like Eschar.
Marston CK , Ibrahim H , Lee P , Churchwell G , Gumke M , Stanek D , Gee JE , Boyer AE , Gallegos-Candela M , Barr JR , Li H , Boulay D , Cronin L , Quinn CP , Hoffmaster AR . PLoS One 2016 11 (6) e0156987 Bacillus cereus isolates have been described harboring Bacillus anthracis toxin genes, most notably B. cereus G9241, and capable of causing severe and fatal pneumonias. This report describes the characterization of a B. cereus isolate, BcFL2013, associated with a naturally occurring cutaneous lesion resembling an anthrax eschar. Similar to G9241, BcFL2013 is positive for the B. anthracis pXO1 toxin genes, has a multi-locus sequence type of 78, and a pagA sequence type of 9. Whole genome sequencing confirms the similarity to G9241. In addition to the chromosome having an average nucleotide identity of 99.98% when compared to G9241, BcFL2013 harbors three plasmids with varying homology to the G9241 plasmids (pBCXO1, pBC210 and pBFH_1). This is also the first report to include serologic testing of patient specimens associated with this type of B. cereus infection which resulted in the detection of anthrax lethal factor toxemia, a quantifiable serum antibody response to protective antigen (PA), and lethal toxin neutralization activity. |
Human infective potential of Cryptosporidium spp., Giardia duodenalis and Enterocytozoon bieneusi in urban wastewater treatment plant effluents.
Ma J , Feng Y , Hu Y , Villegas EN , Xiao L . J Water Health 2016 14 (3) 411-423 Cryptosporidiosis, giardiasis, and microsporidiosis are important waterborne diseases. In the standard for wastewater treatment plant (WWTP) effluents in China and other countries, the fecal coliform count is the only microbial indicator, raising concerns about the potential for pathogen transmission through WWTP effluent reuse. In this study, we collected 50 effluent samples (30 L/sample) from three municipal WWTPs in Shanghai, China, and analyzed for Cryptosporidium spp., Giardia duodenalis and Enterocytozoon bieneusi by microscopy and/or polymerase chain reaction (PCR). Moreover, propidium monoazide (PMA)-PCR was used to assess the viability of oocysts/cysts. The microscopy and PCR-positive rates for Cryptosporidium spp. were 62% and 40%, respectively. The occurrence rates of G. duodenalis were 96% by microscopy and 92-100% by PCR analysis of three genetic loci. Furthermore, E. bieneusi was detected in 70% (35/50) of samples by PCR. Altogether, 10 Cryptosporidium species or genotypes, two G. duodenalis genotypes, and 11 E. bieneusi genotypes were found, most of which were human-pathogenic. The chlorine dioxide disinfection employed in WWTP1 and WWTP3 failed to inactivate the residual pathogens; 93% of the samples from WWTP1 and 83% from WWTP3 did not meet the national standard on fecal coliform levels. Thus, urban WWTP effluents often contain residual waterborne human pathogens. |
A simple modification to the mosquito homogenization protocol safely inactivates West Nile virus and allows virus detection by the Rapid Analyte Measurement Platform (RAMP) ASSAY
Burkhalter KL , Biggerstaff BJ , Horiuchi K , Savage HM . J Am Mosq Control Assoc 2016 32 (2) 77-82 We evaluated the ability of the Rapid Analyte Measurement Platform (RAMP(R)) mosquito-grinding buffer to inactivate West Nile virus (WNV) by subjecting WNV-positive samples ground in RAMP buffer to incubation intervals ranging from 5 min to 60 min. At each time point an aliquot was removed and serially diluted in bovine albumin (BA)-1 cell culture media to stop the inactivation process by RAMP buffer. Each BA-1 sample was tested for viable virus using Vero 6-well cell culture plaque assay and observed for plaques. We observed very limited inactivation of WNV (1-2 log10 plaque-forming units/ml) by RAMP buffer. Concerned for RAMP operators who may be using this assay in low-level biocontainment facilities, we developed an alternate sample homogenization protocol using Triton X-100 detergent that ensures complete WNV inactivation without compromising the performance of the RAMP assay. |
Topical delivery of tenofovir disoproxil fumarate and emtricitabine from pod-intravaginal rings protects macaques from multiple SHIV exposures
Srinivasan P , Moss JA , Gunawardana M , Churchman SA , Yang F , Dinh CT , Mitchell JM , Zhang J , Fanter R , Miller CS , Butkyavichene I , McNicholl JM , Smith TJ , Baum MM , Smith JM . PLoS One 2016 11 (6) e0157061 Topical preexposure prophylaxis (PrEP) against HIV has been marginally successful in recent clinical trials with low adherence rates being a primary factor for failure. Controlled, sustained release of antiretroviral (ARV) drugs may help overcome these low adherence rates if the product is protective for extended periods of time. The oral combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is currently the only FDA-approved ARV drug for HIV PrEP. A novel pod-intravaginal ring (IVR) delivering TDF and FTC at independently controlled rates was evaluated for efficacy at preventing SHIV162p3 infection in a rigorous, repeat low-dose vaginal exposure model using normally cycling female pigtailed macaques. Six macaques received pod-IVRs containing TDF (65 mg) and FTC (68 mg) every two weeks, and weekly vaginal exposures to 50 TCID50 of SHIV162p3 began one week after the first pod-IVR insertion. All pod-IVR-treated macaques were fully protected throughout the study (P = 0.0002, Log-rank test), whereas all control animals became infected with a median of 4 exposures to infection. The topical, sustained release of TDF and FTC from the pod-IVR maintained protective drug levels in macaques over four months of virus exposures. This novel and versatile delivery system has the capacity to deliver and maintain protective levels of multiple drugs and the protection observed here warrants clinical evaluation of this pod-IVR design. |
Gender differences in murine pulmonary responses elicited by cellulose nanocrystals
Shvedova AA , Kisin ER , Yanamala N , Farcas MT , Menas AL , Williams A , Fournier PM , Reynolds JS , Gutkin DW , Star A , Reiner RS , Halappanavar S , Kagan VE . Part Fibre Toxicol 2016 13 (1) 28 BACKGROUND: Cellulose-based materials have been used for centuries to manufacture different goods derived from forestry and agricultural sources. In the growing field of nanocellulose applications, its uniquely engineered properties are instrumental for inventive products coming to competitive markets. Due to their high aspect ratio and stiffness, it is speculated that cellulose nanocrystals (CNC) may cause similar pulmonary toxicity as carbon nanotubes and asbestos, thus posing a potential negative impact on public health and the environment. METHODS: The present study was undertaken to investigate the pulmonary outcomes induced by repeated exposure to respirable CNC. C57BL/6 female and male mice were exposed by pharyngeal aspiration to CNC (40 mug/mouse) 2 times a week for 3 weeks. Several biochemical endpoints and pathophysiological outcomes along with gene expression changes were evaluated and compared in the lungs of male and female mice. RESULTS: Exposure to respirable CNC caused pulmonary inflammation and damage, induced oxidative stress, elevated TGF-beta and collagen levels in lung, and impaired pulmonary functions. Notably, these effects were markedly more pronounced in females compared to male mice. Moreover, sex differences in responses to pulmonary exposure to CNC were also detected at the level of global mRNA expression as well as in inflammatory cytokine/chemokine activity. CONCLUSIONS: Overall, our results indicate that there are considerable differences in responses to respirable CNC based on gender with a higher pulmonary toxicity observed in female mice. |
A framework for assessing outcomes from newborn screening: on the road to measuring its promise.
Hinton CF , Homer CJ , Thompson AA , Williams A , Hassell KL , Feuchtbaum L , Berry SA , Comeau AM , Therrell BL , Brower A , Harris KB , Brown C , Monaco J , Ostrander RJ , Zuckerman AE , Kaye C , Dougherty D , Greene C , Green NS . Mol Genet Metab 2016 118 (4) 221-9 Newborn screening (NBS) is intended to identify congenital conditions prior to the onset of symptoms in order to provide early intervention that leads to improved outcomes. NBS is a public health success, providing reduction in mortality and improved developmental outcomes for screened conditions. However, it is less clear to what extent newborn screening achieves the long-term goals relating to improved health, growth, development and function. We propose a framework for assessing outcomes for the health and well-being of children identified through NBS programs. The framework proposed here, and this manuscript, were approved for publication by the Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). This framework can be applied to each screened condition within the Recommended Uniform Screening Panel (RUSP), recognizing that the data elements and measures will vary by condition. As an example, we applied the framework to sickle cell disease and phenylketonuria (PKU), two diverse conditions with different outcome measures and potential sources of data. Widespread and consistent application of this framework across state NBS and child health systems is envisioned as useful to standardize approaches to assessment of outcomes and for continuous improvement of the NBS and child health systems. SIGNIFICANCE: Successful interventions for newborn screening conditions have been a driving force for public health newborn screening for over fifty years. Organizing interventions and outcome measures into a standard framework to systematically assess outcomes has not yet come into practice. This paper presents a customizable outcomes framework for organizing measures for newborn screening condition-specific health outcomes, and an approach to identifying sources and challenges to populating those measures. |
Pregnancy loss history at first parity and selected adverse pregnancy outcomes
Ahrens KA , Rossen LM , Branum AM . Ann Epidemiol 2016 26 (7) 474-481 e9 PURPOSE: To evaluate the association between pregnancy loss history and adverse pregnancy outcomes. METHODS: Pregnancy history was captured during a computer-assisted personal interview for 21,277 women surveyed in the National Survey of Family Growth (1995-2013). History of pregnancy loss (<20 weeks) at first parity was categorized in three ways: number of losses, maximum gestational age of loss(es), and recency of last pregnancy loss. We estimated risk ratios for a composite measure of selected adverse pregnancy outcomes (preterm, stillbirth, or low birthweight) at first parity and in any future pregnancy, separately, using predicted margins from adjusted logistic regression models. RESULTS: At first parity, compared with having no loss, having 3+ previous pregnancy losses (adjusted risk ratio (aRR) = 1.66 [95% CI = 1.13, 2.43]), a maximum gestational age of loss(es) at ≥10 weeks (aRR = 1.28 [1.04, 1.56]) or having experienced a loss 24+ months ago (aRR = 1.36 [1.10, 1.68]) were associated with increased risks of adverse pregnancy outcomes. For future pregnancies, only having a history of 3+ previous pregnancy losses at first parity was associated with increased risks (aRR = 1.97 [1.08, 3.60]). CONCLUSION: Number, gestational age, and recency of pregnancy loss at first parity were associated with adverse pregnancy outcomes in U.S. women. |
Comparison of children's food and beverage intakes with national recommendations in New York City child-care centres
Dixon LB , Breck A , Kettel Khan L . Public Health Nutr 2016 19 (13) 1-7 OBJECTIVE: The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations. DESIGN: The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institutes Automated Self-Administered 24 h Recall system. SETTING: Meal and snack time at 108 child-care centres in low-income communities in NYC. SUBJECTS: Children aged 34 years old in classrooms selected by the directors of the participating child-care centres. RESULTS: Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were <30 % of the DRI. Foods and beverages provided >50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %. CONCLUSIONS: Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve childrens diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations. |
Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres
Breck A , Dixon LB , Kettel Khan L . Public Health Nutr 2016 19 (15) 1-8 OBJECTIVE: The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. DESIGN: Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. SETTING: Child-care centres were located in low-income neighbourhoods in NYC. RESULTS: Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. CONCLUSIONS: In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day. |
The Respiratory Protection Effectiveness Clinical Trial (ResPECT): A cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel
Radonovich LJ Jr , Bessesen MT , Cummings DA , Eagan A , Gaydos C , Gibert C , Gorse GJ , Nyquist AC , Reich NG , Rodrigues-Barradas M , Savor-Price C , Shaffer RE , Simberkoff MS , Perl TM . BMC Infect Dis 2016 16 (1) 243 BACKGROUND: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. METHODS: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. DISCUSSION: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010). |
Scale-up of integrated malaria vector control: lessons from Malawi
Chanda E , Mzilahowa T , Chipwanya J , Ali D , Troell P , Dodoli W , Mnzava AP , Ameneshewa B , Gimnig J . Bull World Health Organ 2016 94 (6) 475-80 PROBLEM: Indoor residual spraying and long-lasting insecticidal nets (LLINs) are key tools for malaria vector control. Malawi has struggled to scale up indoor residual spraying and to improve LLIN coverage and usage. APPROACH: In 2002, the Malawian National Malaria Control Programme developed guidelines for insecticide treated net distribution to reach the strategic target of at least 60% coverage of households with an LLIN. By 2005, the target coverage was 80% of households and the Global Fund financed the scale-up. The US President's Malaria Initiative funded the indoor residual spraying intervention. LOCAL SETTING: Malawi's entire population is considered to be at risk of malaria. Poor vector control, insecticide resistance in malaria vectors and insufficient technical and financial support have exacerbated the malaria burden. RELEVANT CHANGES: Between 2002 and 2012, 18 248 206 LLINs had been distributed. The coverage of at least one LLIN per household increased from 27% (3689/13 664) to 58% (1974/3404). Indoor residual spraying coverage increased from 28 227 to 653 592 structures between 2007 and 2011. However, vector resistance prompted a switch from pyrethroids to organophosphates for indoor residual spraying, which increased the cost and operations needed to be cut back from seven to one district. Malaria cases increased from 2 853 315 in 2002 to 6 748 535 in 2010, and thereafter dropped to 4 922 596 in 2012. LESSONS LEARNT: A single intervention-based approach for vector control may have suboptimal impact. Well-coordinated integrated vector management may offer greater benefits. A resistance management plan is essential for effective and sustainable vector control. |
The safety of intrauterine contraception initiation among women with current asymptomatic cervical infections or at increased risk of sexually transmitted infections
Jatlaoui TC , Simmons KB , Curtis KM . Contraception 2016 94 (6) 701-712 OBJECTIVE: To assess risk of pelvic inflammatory disease (PID) among women with current asymptomatic undiagnosed cervical infection or who are at high risk of sexually transmitted infections (STIs), comparing those who have a copper-bearing (Cu-) or levonorgestrel (LNG-) intrauterine device (IUD) placed with women who do not. STUDY DESIGN: We searched PubMed and Cochrane Library for articles from January 1984 through January 2016 addressing our objective. We assessed study quality using the United States Preventive Services Task Force evidence grading system. RESULTS: Our search strategy yielded 2220 articles, of which ten met inclusion criteria. Two studies provided direct evidence of PID rates in women with undiagnosed gonococcal or chlamydial (GC/CT) infection or at high risk for STIs initiating IUDs versus other contraceptive methods (level II-2, fair to poor), and neither study found a difference. Eight studies provided indirect evidence (II-2 to II-3, fair to poor). One study found no difference in PID rates between initiators of Cu versus LNG IUDs. Five studies compared algorithms based on patient factors with laboratory GC/CT screening to predict cervical infection. Based on likelihood ratios, none of these algorithms adequately identified women at high risk of asymptomatic cervical infection who should not undergo IUD placement. Two studies compared IUD placement on the same day as STI screening with delayed placement after screening, and found no difference in PID rates. CONCLUSION: Limited evidence suggests that IUD placement does not increase the risk of PID compared with no IUD placement among women with asymptomatic undiagnosed cervical infection or at high risk of STIs. Algorithms based on patient characteristics to identify women with asymptomatic GC/CT may be overly restrictive, leading to missed opportunities for IUD initiation. Historical concerns about higher PID risk among women at risk for STIs who use IUDs may not be relevant with modern devices and STI screening and treatment practices. |
Factors associated with pregnancy among incarcerated African American adolescent girls
Gray SC , Holmes K , Bradford DR . J Urban Health 2016 93 (4) 709-18 The purpose of this study was to examine the social and behavioral factors associated with pregnancy history among a sample of African American adolescent girls recruited from a short-term juvenile detention center in order to better understand the needs of this vulnerable population. Data were collected from a sample of 188 detained African American, 13-17-year-old girls in Atlanta, Georgia, who participated in a larger HIV prevention study. An audio computer-assisted self-interviewing survey was completed by participants to obtain information on socioecological factors to include individual, parental/familial, sexual risk, psychosocial, and substance use factors. Among the 188 participants, 25.5 % reported a history of pregnancy. A multivariable logistic regression model showed that girls with a history of pregnancy were more likely to live in a household receiving government aid, use hormonal contraceptives at last sex, participate in sex trading, have casual sex partners, have condomless sex in the past 90 days, and have a history of physical abuse. Girls with no history of pregnancy were more likely to have been incarcerated at least twice and to have previously used alcohol. Detention-based interventions and pregnancy prevention programs for this vulnerable population may benefit by addressing factors related to sexual behavior and development, substance use, individual background, and psychosocial health. |
Electronic cigarette use among working adults - United States, 2014
Syamlal G , Jamal A , King BA , Mazurek JM . MMWR Morb Mortal Wkly Rep 2016 65 (22) 557-561 Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver a heated aerosol, which typically contains nicotine, flavorings, and other additives, to the user. The e-cigarette marketplace is rapidly evolving, but the long-term health effects of these products are not known. Carcinogens and toxins such as diacetyl, acetaldehyde, and other harmful chemicals have been documented in the aerosol from some e-cigarettes (1-3). On May 5, 2016, the Food and Drug Administration (FDA) finalized a rule extending its authority to all tobacco products, including e-cigarettes.* The prevalence of e-cigarette use among U.S. adults has increased in recent years, particularly among current and former conventional cigarette smokers (4); in 2014, 3.7% of all U.S. adults, including 15.9% of current cigarette smokers, and 22.0% of former cigarette smokers, used e-cigarettes every day or some days (5). The extent of current e-cigarette use among U.S. working adults has not been assessed. Therefore, CDC analyzed 2014 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were working during the week before the interview, to provide national estimates of current e-cigarette use among U.S. working adults by industry and occupation. Among the estimated 146 million working adults, 3.8% (5.5 million) were current (every day or some days) e-cigarette users; the highest prevalences were among males, non-Hispanic whites, persons aged 18-24 years, persons with annual household income <$35,000, persons with no health insurance, cigarette smokers, other combustible tobacco users, and smokeless tobacco users. By industry and occupation, workers in the accommodation and food services industry and in the food preparation and serving-related occupations had the highest prevalence of current e-cigarette use. Higher prevalences of e-cigarette use among specific groups and the effect of e-cigarette use on patterns of conventional tobacco use underscore the importance of continued surveillance of e-cigarette use among U.S. working adults to inform public health policy, planning, and practice. |
Bartonella melophagi in blood of domestic sheep (Ovis aries) and sheep keds (Melophagus ovinus) from the southwestern US: Cultures, genetic characterization, and ecological connections.
Kosoy M , Bai Y , Enscore R , Rizzo MR , Bender S , Popov V , Albayrak L , Fofanov Y , Chomel B . Vet Microbiol 2016 190 43-49 Bartonella melophagi sp. nov. was isolated from domestic sheep blood and from sheep keds (Melophagus ovinus) from the southwestern United States. The sequence analyses of the reference strain performed by six molecular markers consistently demonstrated that B. melophagi relates to but differ from other Bartonella species isolated from domestic and wild ruminants. Presence of 183 genes specific for B. melophagi, being absent in genomes of other Bartonella species associated with ruminants also supports the separation of this bacterial species from species of other ruminants. Bartonella DNA was detected in all investigated sheep keds; however, culturing of these bacteria from sheep blood rejects a speculation that B. melophagi is an obligatory endosymbiont. Instead, the results support the hypothesis that the domestic sheep is a natural host reservoir for B. melophagi and the sheep ked its main vector. This bacterium was not isolated from the blood of bighorn sheep and domestic goats belonging to the same subfamily Caprinae. B. melophagi has also been shown to be zoonotic and needs to be investigated further. |
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