Rapid-learning system for cancer care
Abernethy AP , Etheredge LM , Ganz PA , Wallace P , German RR , Neti C , Bach PB , Murphy SB . J Clin Oncol 2010 28 (27) 4268-74 Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care." In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled "A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care" in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action. |
Serum transforming growth factor-beta 1 is not a robust biomarker of incident and progressive radiographic osteoarthritis at the hip and knee: the Johnston County Osteoarthritis Project
Nelson AE , Golightly YM , Kraus VB , Stabler T , Renner JB , Helmick CG , Jordan JM . Osteoarthritis Cartilage 2010 18 (6) 825-9 PURPOSE: To test whether serum transforming growth factor-beta 1 (TGF-beta1) predicts incident and progressive hip or knee radiographic OA (rOA). METHODS: Serum TGF-beta1 was measured for 330 participants aged 45 years and older in the Johnston County Osteoarthritis Project, with paired longitudinal films available for 618 hips and 658 knees. Incident and progressive rOA were defined using Kellgren-Lawrence (K-L) grade as well as osteophyte (OST) and joint space narrowing (JSN) scores. Natural logarithm transformation was used to produce near-normal distributions for continuous TGF-beta1 (lnTGF-beta1). Separate multivariable Weibull regression models were used to provide hazard ratios (HRs) for a 1-unit increase lnTGF-beta1 with each rOA outcome, accounting for variable follow-up times and clustering by individual, adjusted for age, race, gender, and body mass index (BMI). Interaction terms were considered statistically significant at P<0.10. RESULTS: The mean (+/-SD) age of the sample was 61.9+/-9.7 years, the mean BMI was 30.3+/-6.9 kg/m(2), with 60.6% women and 42.4% AA. The mean (+/-SD) TGF-beta1 was 17.8+/-6.1 ng/ml; follow-up time was 6.1+/-1.3 years. There were no significant interactions by race or gender. HRs showed no significant relationship between lnTGF-beta1 and incident or progressive rOA, OST, or JSN, at the knee or the hip. CONCLUSIONS: Levels of TGF-beta1 do not predict incident or progressive rOA, OST, or JSN at the hip or knee in this longitudinal, population-based study, making it unlikely that TGF-beta1 will be a robust biomarker for rOA in future studies. |
Acute radiation syndrome: assessment and management
Donnelly EH , Nemhauser JB , Smith JM , Kazzi ZN , Farfan EB , Chang AS , Naeem SF . South Med J 2010 103 (6) 541-546 Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time to onset of ARS is dependent on the dose received, but even at the lowest doses capable of causing illness, this will occur within a matter of hours to days. This article describes the clinical manifestations of ARS, provides guidelines for assessing its severity, and makes recommendations for managing ARS victims. Copyright copyright 2010 by The Southern Medical Association. |
Developing a public health research agenda for women with blood disorders
Byams VR , Beckman MG , Grant AM , Parker CS . J Womens Health (Larchmt) 2010 19 (7) 1231-4 Bleeding and clotting in women is an issue that directly affects the life of every woman, child, and family worldwide. This article summarizes recent activities undertaken by the Division of Blood Disorders (DBD) at the Centers for Disease Control and Prevention (CDC) to identify risk factors through evidence-based research and surveillance to prevent complications of blood disorders in women. Specific focus is given to our efforts to improve early identification and diagnosis of blood disorders among women, improve our understanding of maternal and infant outcomes, and develop surveillance systems to monitor the prevalence and incidence of these events. |
Rotavirus disease burden, Nicaragua 2001-2005: defining the potential impact of a rotavirus vaccination program
Amador JJ , Vasquez J , Orozco M , Pedreira C , Malespin O , De Oliveira LH , Tate J , Parashar U , Patel M . Int J Infect Dis 2010 14 (7) e592-5 BACKGROUND: In October 2006, a rotavirus vaccine was introduced in Nicaragua for routine immunization of all children. We document the baseline diarrheal disease burden in Nicaragua prior to the vaccine program to facilitate future studies to measure vaccine impact. METHODS: We analyzed national data for 2001-2005 on total acute gastroenteritis healthcare visits, hospitalizations, and mortality in Nicaraguan children aged <5 years. RESULTS: Prior to vaccine introduction, by age 5 years, one in four Nicaraguan children required an outpatient consultation, one in 34 were hospitalized, and one in 2487 died from rotavirus-associated diarrhea, representing approximately 41,122 outpatient visits, 4460 hospitalizations, and 60 deaths per year that are preventable through vaccination. Almost half of the total acute gastroenteritis burden was in children <1 year of age. Two distinct seasonal peaks were noted in acute gastroenteritis hospitalizations and deaths. CONCLUSIONS: Existing data sources on all-cause acute gastroenteritis could be useful for establishing diarrhea disease burden and monitoring trends after vaccine introduction. Blunting of winter season peaks in rates of diarrhea, particularly among children aged <1-2 years, would be a useful indicator of impact from rotavirus vaccination. |
STD screening of HIV-infected MSM in HIV clinics
Hoover KW , Butler M , Workowski K , Carpio F , Follansbee S , Gratzer B , Hare B , Johnston B , Theodore JL , Wohlfeiler M , Tao G , Brooks JT , Chorba T , Irwin K , Kent CK . Sex Transm Dis 2010 37 (12) 771-6 BACKGROUND: National guidelines for the care of human immunodeficiency virus (HIV)-infected persons recommend asymptomatic routine screening for sexually transmitted diseases (STDs). Our objective was to determine whether providers who care for HIV-infected men who have sex with men (MSM) followed these guidelines. METHODS: We abstracted medical records to evaluate STD screening at 8 large HIV clinics in 6 US cities. We estimated the number of men who had at least one test for syphilis, chlamydia (urethral and/or rectal), or gonorrhea (urethral, rectal, and/or pharyngeal) in 2004, 2005, and 2006. Urethral testing included nucleic acid amplification tests of both urethral swabs and urine. We also calculated the positivity of syphilis, chlamydia, and gonorrhea among screened men. RESULTS: Medical records were abstracted for 1334 HIV-infected MSM who made 14,659 visits from 2004-2006. The annual screening rate for syphilis ranged from 66.0% to 75.8% during 2004-2006. Rectal chlamydia and rectal and pharyngeal gonorrhea annual screening rates ranged from 2.3% to 8.5% despite moderate to high positivity among specimens from asymptomatic patients (3.0%-9.8%) during this period. Annual urethral chlamydia and gonorrhea screening rates were higher than rates for nonurethral sites, but were suboptimal, and ranged from 13.8% to 18.3%. CONCLUSIONS: Most asymptomatic HIV-infected MSM were screened for syphilis, indicating good provider adherence to this screening guideline. Low screening rates for gonorrhea and chlamydia, especially at rectal and pharyngeal sites, suggest that substantial barriers exist for complying with these guidelines. The moderate to high prevalence of asymptomatic chlamydial and gonococcal infections underscores the importance of screening. A range of clinical quality improvement interventions are needed to increase screening, including increasing the awareness of nucleic acid amplification tests for nonurethral screening. |
Studies needed to address public health challenges of the 2009 H1N1 influenza pandemic: insights from modeling
Van Kerkhove MD , Asikainen T , Becker NG , Bjorge S , Desenclos JC , dos Santos T , Fraser C , Leung GM , Lipsitch M , Longini Jr IM , McBryde ES , Roth CE , Shay DK , Smith DJ , Wallinga J , White PJ , Ferguson NM , Riley S . PLoS Med 2010 7 (6) e1000275 In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making. |
Extensive drug resistance in malaria and tuberculosis
Wongsrichanalai C , Varma JK , Juliano JJ , Kimerling ME , Macarthur JR . Emerg Infect Dis 2010 16 (7) 1063-7 Drug resistance in malaria and in tuberculosis (TB) are major global health problems. Although the terms multidrug-resistant TB and extensively drug-resistant TB are precisely defined, the term multidrug resistance is often loosely used when discussing malaria. Recent declines in the clinical effectiveness of antimalarial drugs, including artemisinin-based combination therapy, have prompted the need to revise the definitions of and/or to recategorize antimalarial drug resistance to include extensively drug-resistant malaria. Applying precise case definitions to different levels of drug resistance in malaria and TB is useful for individual patient care and for public health. |
HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: the importance of transmission behaviors
Des Jarlais DC , Arasteh K , McKnight C , Hagan H , Perlman DC , Torian LV , Beatice S , Semaan S , Friedman SR . Drug Alcohol Depend 2010 109 154-60 OBJECTIVES: As no single HIV prevention program has eliminated HIV transmission, there is growing interest in the effectiveness of "combined" prevention programming. To compare HIV infection among persons injecting in the initial programs environment (IPE) in New York City (self-initiated risk reduction, methadone, education/outreach, and HIV testing) to HIV infection among persons injecting in a combined programs environment (CPE) (above programs plus large-scale syringe exchange). To identify potential behavioral mechanisms through which combined programs are effective. METHODS: Subjects were recruited from the Beth Israel drug detoxification program. A risk behavior questionnaire was administered and HIV testing conducted. Subjects who injected only between 1984 and 1994 (IPE) were compared to subjects who injected only between 1995 and 2008 (CPE). RESULTS: 261 IPE subjects and 1153 CPE subjects were recruited. HIV infection was significantly lower among the CPE subjects compared to IPE subjects: prevalence 6% versus 21%, estimated incidence 0.3/100 person-years versus 4/100 person-years (both p<0.001). The percentage of subjects at risk of acquiring HIV through receptive syringe sharing was similar across CPE and IPE subjects (30% versus 33%). The percentage of subjects at risk of transmitting HIV through injection-related behaviors (who were both HIV seropositive and reported passing on used needles/syringes), was much lower among the CPE subjects than among the IPE subjects (1% versus 10%, p<0.001). CONCLUSIONS: Combined prevention programs can greatly reduce HIV transmission. Reducing distributive sharing by HIV seropositive injecting drug users (IDUs) may be a critical component in reducing HIV transmission in high seroprevalence settings. |
Increased incidence of meningococcal disease in HIV-infected individuals associated with higher case-fatality ratios in South Africa
Cohen C , Singh E , Wu HM , Martin S , de Gouveia L , Klugman KP , Meiring S , Govender N , von Gottberg A . AIDS 2010 24 (9) 1351-60 OBJECTIVES: We aimed to compare the incidence of meningococcal disease amongst HIV-infected and uninfected individuals and to evaluate whether HIV is a risk factor for mortality and bacteremia amongst patients with meningococcal disease. DESIGN: Cohort surveillance study. METHODS: We conducted laboratory-based surveillance for meningococcal disease in Gauteng Province, South Africa. HIV status and outcome data were obtained at sentinel sites. Incidence in HIV-infected and uninfected persons was calculated assuming a similar age-specific HIV prevalence in tested and untested individuals. Risk factors for death and bacteremia (as compared with meningitis) were evaluated using multivariable logistic regression. RESULTS: From 2003 to 2007, 1336 meningococcal cases were reported. Of 504 patients at sentinel sites with known outcome, 308 (61%) had HIV serostatus data. HIV prevalence amongst cases of meningococcal disease was higher than the population HIV prevalence in all age groups. The incidence of meningococcal disease in HIV-infected individuals was elevated in all age groups with an age-adjusted relative risk of 11.3 [95% confidence interval (CI) 8.9-14.3, P < 0.001]. The case-fatality ratio (CFR) was 20% (27/138) amongst HIV-infected and 11% (18/170) amongst HIV-uninfected individuals [odds ratio (OR) 2.1, 95% CI 1.1-3.9]. On multivariable analysis, CFR was greater amongst patients with bacteremia (35%, 29/82) compared with meningitis (7%, 16/226) (OR 7.8, 95% CI 3.4-17.7). HIV infection was associated with increased odds of bacteremia (OR 2.7, 95% CI 1.5-5.0). CONCLUSION: HIV-infected individuals may be at increased risk of meningococcal disease. The increased CFR in HIV-infected patients may be explained by their increased odds of bacteremia compared to meningitis. |
Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003-2008
Dawood FS , Fiore A , Kamimoto L , Nowell M , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatr Infect Dis J 2010 29 (7) 585-90 BACKGROUND: Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators. METHODS: Through Emerging Infections Program Network population based surveillance, children aged <18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis. RESULTS: Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia.When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P < 0.01), develop respiratory failure (11% versus 3%, P < 0.01), and die(0.9% vs. 0.3% P 0.01). In multivariate analysis, age 6 to 23 months(adjusted OR: 2.1, CI: 1.6 -2.8), age 2 to 4 years (adjusted OR: 1.7, CI:1.3-2.2), and asthma (adjusted OR: 1.4, CI: 1.1-1.8) were significantly associated with influenza-associated pneumonia. CONCLUSIONS: Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia. Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications. |
Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008
Dawood FS , Fiore A , Kamimoto L , Bramley A , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Mueller M , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . J Pediatr 2010 157 (5) 808-14 OBJECTIVES: To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008. STUDY DESIGN: Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data. RESULTS: The highest hospitalization rates occurred in children aged <6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged <2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%). CONCLUSIONS: Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden. |
The utility of animal surveillance in the detection of West Nile virus activity in Puerto Rico, 2007
Phoutrides E , Jusino-Mendez T , Perez-Medina T , Seda-Lozada R , Garcia-Negron M , Davila-Toro F , Hunsperger E . Vector Borne Zoonotic Dis 2010 11 (4) 447-50 After the isolation of West Nile virus (WNV) from humans, mosquitoes, and chickens in 2007, an analysis of animal surveillance involving multiple species (horses, monkeys, sheep, dogs, and birds) used to track WNV transmission from 2006 to 2008 was performed. During this period 13.4% of all the animal samples collected were seropositive by blocking ELISA for WNV. The most complete island-wide sampling was obtained from horses of which 22% were serologically positive and 96% were confirmed as WNV infections by plaque-reduction neutralization test. Our conclusion from this 3-year study is that animal surveillance is an early indicator of WNV activity before the identification of human cases. Additionally, the results indicated that horses have a greater geographical range and should be continued to be used as sentinels for passive surveillance in the tropics. |
Potential influence of climate change on vector-borne and zoonotic diseases: a review and proposed research plan
Mills JN , Gage KL , Khan AS . Environ Health Perspect 2010 118 (11) 1507-14 OBJECTIVE: We describe known and potential effects of climate change on vector-borne and zoonotic diseases (VBZD), and propose specific studies to increase our understanding of these effects. The non-vector-borne zoonotic diseases have received scant treatment and are emphasized herein. DATA SOURCES AND SYNTHESIS: We use a review of the existing literature and extrapolations from observations of short-term climate variation to suggest potential impacts of climate change on VBZD. Using published Centers for Disease Control and Prevention (CDC) climate change public health priorities we develop 6 specific goals for increasing understanding of the interaction between climate and VBZD and improving capacity for predicting climate change effects on incidence and distribution of VBZD. CONCLUSIONS: Climate change may affect incidence of VBZD through its effect on four principal characteristics of host and vector populations that relate to pathogen transmission to humans: geographic distribution, population density, prevalence of infection by zoonotic pathogens, and the pathogen load in individual hosts and vectors. These mechanisms may interact with each other and with other factors such as anthropogenic disturbance to produce varying effects on pathogen transmission within host and vector populations and to humans. Because climate change effects on most VBZD act through wildlife hosts and vectors, understanding these effects will require multidisciplinary teams to conduct and interpret ecosystem-based studies of VBZ pathogens in host and vector populations and identify the hosts, vectors and pathogens with the greatest potential to affect human populations under climate-change scenarios. |
Co-feeding as a route for transmission of Rickettsia conorii israelensis between Rhipicephalus sanguineus ticks
Zemtsova G , Killmaster LF , Mumcuoglu KY , Levin ML . Exp Appl Acarol 2010 52 (4) 383-92 Rickettsia conorii is widely distributed in Europe, Asia, and Africa. The brown dog tick, Rhipicephalus sanguineus, is the recognized vector of R. conorii. In this study, we assessed the efficiency of R. conorii israelensis transmission between co-feeding Rh. sanguineus ticks. Infected Rh. sanguineus adults and uninfected nymphs were fed simultaneously upon either naive dogs or a dog previously exposed to this agent. When ticks were placed upon naive dogs, 92-100% of nymphs acquired the infection and 80-88% of infected engorged nymphs transmitted it transstadially. When ticks were placed upon a seropositive dog, only 8-28.5% of recipient nymphs became infected. Our results establish the first evidence for efficient natural transmission of R. conorii israelensis between co-feeding ticks upon both naive and seropositive dogs. This route of transmission can ensure continuous circulation of R. conorii israelensis in tick vectors even in the absence of naive reservoir hosts. |
Neurobehavioral deficits and increased blood pressure in school-age children prenatally exposed to pesticides
Harari R , Julvez J , Murata K , Barr D , Bellinger DC , Debes F , Grandjean P . Environ Health Perspect 2010 118 (6) 890-6 BACKGROUND: The long-term neurotoxicity risks caused by prenatal exposures to pesticides are unclear, but a previous pilot study of Ecuadorian school children suggested that blood pressure and visuospatial processing may be vulnerable. OBJECTIVES: In northern Ecuador, where floriculture is intensive and relies on female employment, we carried out an intensive cross-sectional study to assess children's neurobehavioral functions at 6-8 years of age. METHODS: We examined all 87 children attending two grades in the local public school with an expanded battery of neurobehavioral tests. Information on pesticide exposure during the index pregnancy was obtained from maternal interview. The children's current pesticide exposure was assessed from the urinary excretion of organophosphate metabolites and erythrocyte acetylcholine esterase activity. RESULTS: Of 84 eligible participants, 35 were exposed to pesticides during pregnancy via maternal occupational exposure, and 23 had indirect exposure from paternal work. Twenty-two children had detectable current exposure irrespective of their prenatal exposure status. Only children with pre-natal exposure from maternal greenhouse work showed consistent deficits after covariate adjustment, which included stunting and socioeconomic variables. Exposure-related deficits were the strongest for motor speed (Finger Tapping Task), motor coordination (Santa Ana Form Board), visuospatial performance (Stanford-Binet Copying Test), and visual memory (Stanford-Binet Copying Recall Test). These associations corresponded to a developmental delay of 1.5-2 years. Prenatal pesticide exposure was also significantly associated with an average increase of 3.6 mmHg in systolic blood pressure and a slight decrease in body mass index of 1.1 kg/m2. Inclusion of the pilot data strengthened these results. CONCLUSIONS: These findings support the notion that prenatal exposure to pesticides-at levels not producing adverse health outcomes in the mother-can cause lasting adverse effects on brain development in children. Pesticide exposure therefore may contribute to a "silent pandemic" of developmental neurotoxicity. EDITOR'S SUMMARY: Long-term neurotoxicity risks resulting from prenatal exposures to pesticides are uncertain, but a previous study of Ecuadorian schoolchildren suggested that blood pressure and visuospatial processing may be vulnerable to these exposures. Harari et al. (p. 890) conducted a cross-sectional study of cardiovascular and neurobehavioral functions among 84 Ecuadorian children 6-8 years of age. Using an expanded battery of neurobehavioral tests, the investigators examined children in the two lowest grades in the local public school. Information on pesticide exposure during the index pregnancy was obtained from maternal interview, and each child's current pesticide exposure was assessed from the urinary excretion of organophosphate metabolites and erythrocyte acetylcholine esterase activity. Exposure-related deficits were the strongest for motor speed (Finger Tapping Task), motor coordination (Santa Ana Form Board), visuospatial performance (Stanford-Binet Copying Test), and visual memory (Stanford-Binet Copying Recall Test). According to the authors, these associations correspond to a developmental delay of 1.5-2 years. Prenatal pesticide exposure was also significantly associated with an increase in systolic blood pressure. |
Predictors of serum dioxin, furan, and PCB concentrations among women from Chapaevsk, Russia
Humblet O , Williams PL , Korrick SA , Sergeyev O , Emond C , Birnbaum LS , Burns JS , Altshul L , Patterson DG , Turner WE , Lee MM , Revich B , Hauser R . Environ Sci Technol 2010 44 (14) 5633-40 Dioxins, furans, and polychlorinated biphenyls (PCBs) are persistent and bioaccumulative toxic chemicals that are ubiquitous in the environment. We assessed predictors of their serum concentrations among women living in a Russian town contaminated by past industrial activity. Blood samples from 446 mothers aged 23-52 years were collected between 2003-2005 as part of the Russian Children's Study. Serum dioxin, furan, and PCB concentrations were quantified using high-resolution gas chromatography-mass spectrometry. Potential determinants of exposure were collected through interviews. Multivariate linear regression models were used to identify predictors of serum concentrations and toxic equivalencies (TEQs). The median total PCB concentrations and total TEQs were 260 ng/g lipid and 25 pg TEQ/g lipid, respectively. In multivariate analyses, both total PCB concentrations and total TEQs increased significantly with age, residential proximity to a local chemical plant, duration of local farming, and consumption of local beef. Both decreased with longer breastfeeding, recent increases in body mass index, and later blood draw date. These demographic and lifestyle predictors showed generally similar associations with the various measures of serum dioxins, furans, and PCBs. |
Association of exposure to phthalates with endometriosis and uterine leiomyomata: findings from NHANES, 1999-2004
Weuve J , Hauser R , Calafat AM , Missmer SA , Wise LA . Environ Health Perspect 2010 118 (6) 825-32 BACKGROUND: Phthalates are ubiquitous chemicals used in consumer products. Some phthalates are reproductive toxicants in experimental animals, but human data are limited. OBJECTIVE: We conducted a cross-sectional study of urinary phthalate metabolite concentrations in relation to self-reported history of endometriosis and uterine leiomyomata among 1,227 women 20-54 years of age from three cycles of the National Health and Nutrition Examination Survey (NHANES), 1999-2004. METHODS: We examined four phthalate metabolites: mono(2-ethylhexyl) phthalate (MEHP), monobutyl phthalate (MBP), monoethyl phthalate (MEP), and monobenzyl phthalate (MBzP). From the last two NHANES cycles, we also examined mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP). We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS: Eighty-seven (7%) and 151 (12%) women reported diagnoses of endometriosis and leiomyomata, respectively. The ORs comparing the highest versus lowest three quartiles of urinary MBP were 1.36 (95% CI, 0.77-2.41) for endometriosis, 1.56 (95% CI, 0.93-2.61) for leiomyomata, and 1.71 (95% CI, 1.07-2.75) for both conditions combined. The corresponding ORs for MEHP were 0.44 (95% CI, 0.19-1.02) for endometriosis, 0.63 (95% CI, 0.35-1.12) for leiomyomata, and 0.59 (95% CI, 0.37-0.95) for both conditions combined. Findings for MEHHP and MEOHP agreed with findings for MEHP with respect to endometriosis only. We observed null associations for MEP and MBzP. Associations were similar when we excluded women diagnosed > 7 years before their NHANES evaluation. CONCLUSION:The positive associations for MBP and inverse associations for MEHP in relation to endometriosis and leiomyomata warrant investigation in prospective studies. EDITOR'S SUMMARY: Phthalates, ubiquitous chemicals used in consumer products, are known reproductive toxicants in experimental animals, but human data are limited. Weuve et al (p. 825) conducted a cross-sectional study of urinary phthalate metabolite concentrations in relation to endometriosis and uterine leiomyomata among women 20-54 years of age from three cycles of the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The authors measured mono(2-ethyhexyl) phthalate (MEHP), monobutyl phthalate (MBP), monoethyl phthalate, monobenzyl phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP). Seven percent and 12% of the women reported diagnoses of endometriosis and leiomyomata, respectively. Odds ratios [ORs (95% CIs)] comparing the highest versus lowest three quartiles of urinary MBP were 1.36 (0.77-2.41) for endometriosis, 1.56 (0.93-2.61) for leiomyomata, and 1.71 (1.07-2.75) for both conditions combined. The corresponding ORs (95% CIs) for MEHP were 0.44 (0.19-1.02) for endometriosis, 0.63 (0.35-1.12) for leiomyomata, and 0.59 (0.37-0.95) for both conditions combined. The findings for MEHHP and MEOHP agreed with those for MEHP with respect to endometriosis only. The authors conclude that the positive associations for MBP and the inverse associations for MEHP in relation to endometriosis and leiomyomata warrant investigation in prospective studies. |
Comparison of current-use pesticide and other toxicant urinary metabolite levels among pregnant women in the CHAMACOS Cohort and NHANES
Castorina R , Bradman A , Fenster L , Barr DB , Bravo R , Vedar MG , Harnly ME , McKone TE , Eisen EA , Eskenazi B . Environ Health Perspect 2010 118 (6) 856-63 BACKGROUND: We measured 34 metabolites of current-use pesticides and other precursor compounds in urine samples collected twice during pregnancy from 538 women living in the Salinas Valley of California, a highly agricultural area (1999-2001). Precursors of these metabolites included fungicides, carbamate, organochlorine, organophosphorus (OP), and pyrethroid insecticides, and triazine and chloroacetanilide herbicides. We also measured ethylenethiourea, a metabolite of the ethylene-bisdithiocarbamate fungicides. Repeat measurements of the compounds presented here have not been reported in pregnant women previously. To understand the impact of the women's regional environment on these findings, we compared metabolite concentrations from the CHAMACOS (Center for the Health Assessment of Mothers and Children of Salinas) cohort with U.S. national reference data for 342 pregnant women sampled by the National Health and Nutrition Examination Survey (1999-2002). RESULTS: The eight metabolites detected in > 50% of samples [2,4-dichlorophenol (2,4-DCP); 2,5-dichlorophenol (2,5-DCP); 1- and 2-naphthol; ortho-phenylphenol (ORTH); para-nitrophenol (PNP); 2,4,6-trichlorophenol (2,4,6-TCP); and 3,4,6-trichloro-2-pyridinol (TCPy)] may be related to home or agricultural pesticide use in the Salinas Valley, household products, and other sources of chlorinated phenols. More than 78% of women in this study had detectable levels of at least one of the OP pesticide-specific metabolites that we measured, and > 30% had two or more. The 95th percentile values of six of the most commonly detected (> 50%) compounds were significantly higher among the CHAMACOS women after controlling for age, race, socioeconomic status, and smoking [(2,4-DCP; 2,5-DCP; ORTH; PNP; 2,4,6-TCP; and TCPy); quantile regression p < 0.05]. CONCLUSIONS: Findings suggest that the CHAMACOS cohort has an additional burden of precursor pesticide exposure compared with the national sample, possibly from living and/or working in an agricultural area. EDITOR'S SUMMARY: Few studies have investigated maternal exposures during pregnancy to pesticides currently in use. Castorina et al. (p. 856) measured metabolites of current-use pesticides and other precursor compounds in urine samples collected twice during pregnancy from 538 California women enrolled in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort. Precursors of these metabolites included fungicides; carbamate, organochlorine, organophosphorus (OP), and pyrethroid insecticides; and triazine and chloroacetanilide herbicides. The authors also measured ethylenethiourea, a metabolite of the ethylene-bisdithiocarbamate fungicides. To understand the impact of the women's regional environment on these findings, they compared metabolite concentrations from the CHAMACOS cohort with U.S. national reference data for pregnant women sampled by the National Health and Nutrition Examination Survey (1999-2002). Eight metabolites detected in > 50% of samples may be related to home or agricultural pesticide use in the Salinas Valley, household products, and other sources of chlorinated phenols. Over 78% of women in this study had detectable levels of at least one of the OP pesticide-specific metabolites and > 30% had two or more. The 95th percentile values of five of the most commonly detected (> 50%) compounds were significantly higher among the CHAMACOS women than the NHANES sample after controlling for age, race, socioeconomic status, and smoking. The authors conclude that the CHAMACOS cohort has an additional burden of precursor pesticide exposure compared with the national sample, possibly from living and/or working in an agricultural area. |
Statistical and practical issues in the design of a national probability sample of births for the Vanguard Study of the National Children's Study
Montaquila JM , Brick JM , Curtin LR . Stat Med 2010 29 (13) 1368-76 The National Children's Study is a national household probability sample designed to identify 100,000 children at birth and follow the sampled children for 21 years. Data from the study will support examining numerous hypotheses concerning genetic and environmental effects on the health and development of children. The goals of the study present substantial challenges. For example, the need for preconception, prenatal, and postnatal data requires identifying women in the early stages of pregnancy, the collection of many types of data, and the retention of the children over time. In this paper, we give an overview of the sample design used in a pilot study called the Vanguard Study, and highlight the approaches used to address these challenges. We will also describe the rationale for the sampling choices made at each stage, the unique organizational structure of the NCS and issues we expect to face during implementation. |
The effect of different recall periods on estimates of acute gastroenteritis in the United States, FoodNet Population Survey 2006-2007
Cantwell LB , Henao OL , Hoekstra RM , Scallan E . Foodborne Pathog Dis 2010 7 (10) 1225-8 BACKGROUND: A number of countries have estimated the prevalence of acute gastroenteritis by asking survey respondents to recall past episodes of diarrhea; however, the recall period used varies between studies. We conducted a survey to examine the effects of 7-day and 1-month recall periods on the estimated annual episodes of acute gastroenteritis. Further, we examine whether asking first about illness in the previous 7 days affects a person's response to a 1-month recall period. METHODS: The Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based telephone survey that included asking respondents about the occurrence of gastrointestinal symptoms. From February through April 2007, we randomly split respondents into two groups to examine effect of recall periods and question order. One group was first asked about symptoms in the 7 days before interview and then asked about symptoms in the month before interview. The other group was asked only about symptoms in the month before interview. RESULTS: Overall, the monthly prevalence of acute diarrheal illness (≥3 loose stools in 24-hours, lasting >1 day, or restricting daily activities) was 7.7%. This proportion was consistent among the respondents who were first asked about a 7-day recall period (n = 1436) and those asked only about symptoms in the past month (n = 2132). Extrapolation from the reported 7-day prevalence of 3.1% to an annual rate of 1.6 episodes per person, however, was almost twice the rate of episodes estimated when extrapolating from the month recall period. Similar findings were found with acute gastroenteritis (acute diarrheal illness or vomiting without respiratory symptoms). CONCLUSIONS: First asking respondents about a 7-day recall period did not affect the prevalence of acute gastroenteritis reported for a 1-month recall period. Recall period length did, however, have a major impact on estimates of acute gastroenteritis. Retrospective studies using different recall periods may not be comparable. |
Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies
Johnston LG , Whitehead S , Simic-Lawson M , Kendall C . AIDS Care 2010 22 (6) 784-92 Respondent-driven sampling (RDS) is widely adopted as a method to assess HIV and other sexually transmitted infection prevalence and risk factors among hard-to-reach populations. Failures to properly implement RDS in several settings could potentially have been avoided, had formative research been conducted. However, to date there is no published literature addressing the use of formative research in preparing for RDS studies. This paper uses examples from Banja Luka, Bosnia and Herzegovina; Bangkok, Thailand; Podgorica, Montenegro; and St Vincent's and Grenadine Islands, Eastern Caribbean; among populations of men who have sex with men, female sex workers, and injecting drug users to describe how formative research was used to plan, implement, and predict outcomes of RDS surveys and to provide a template of RDS-specific questions for conducting formative research in preparation for RDS surveys. We outline case studies to illustrate how formative research may help researchers to determine whether RDS methodology is appropriate for a particular population and sociocultural context, and to decide on implementation details that lead to successful study outcomes. |
Candidemia surveillance in Brazil: evidence for a boundary defining an abatement of Candida albicans group two strains
Da Matta DA , Melo AS , Colombo AL , Frade JP , Nucci M , Lott TJ . J Clin Microbiol 2010 48 (9) 3062-7 Prospective population surveillance has been conducted for candidemia in Brazil (5). In the present study, a total of 63 isolates from 61 patients, representing 11 medical centers from 9 geographic regions, were characterized by multi-locus sequence typing (MLST). A total of 48 unique profiles or diploid sequence types (DST) were observed, with 9 new sequence types (STs) and 32 new DSTs. There were no apparent correlations between center/region and DST patterns. Subtypes were compared to those in a known characterized reference set including a large database of strains obtained worldwide. Significantly, only one C. albicans Group 2 isolate was found in our collection, although isolates from this particular group are commonly found worldwide. These data, combined with information from other published studies, establish a statistically significant diminishment of Group 2 strains in Central and South America, including Mexico and portions of the Southwestern United States. |
High diversity and ancient common ancestry of lymphocytic choriomeningitis virus
Albarino CG , Palacios G , Khristova ML , Erickson BR , Carroll SA , Comer JA , Hui J , Briese T , St George K , Ksiazek TG , Lipkin WI , Nichol ST . Emerg Infect Dis 2010 16 (7) 1093-100 Lymphocytic choriomeningitis virus (LCMV) is the prototype of the family Arenaviridae. LCMV can be associated with severe disease in humans, and its global distribution reflects the broad dispersion of the primary rodent reservoir, the house mouse (Mus musculus). Recent interest in the natural history of the virus has been stimulated by increasing recognition of LCMV infections during pregnancy, and in clusters of LCMV-associated fatal illness among tissue transplant recipients. Despite its public health importance, little is known regarding the genetic diversity or distribution of virus variants. Genomic analysis of 29 LCMV strains collected from a variety of geographic and temporal sources showed these viruses to be highly diverse. Several distinct lineages exist, but there is little correlation with time or place of isolation. Bayesian analysis estimates the most recent common ancestor to be 1,000-5,000 years old, and this long history is consistent with complex phylogeographic relationships of the extant virus isolates. |
Dont forget the distributor! the importance of field testing draft educational materials with key gatekeepers before production and dissemination
Flores AL , Prue CE , Panissidi P . Health Educ J 2010 69 (2) 164-174 OBJECTIVE: This article presents the results of testing draft folic acid educational materials with key gatekeepers, leading to the development of a Spanish-language print advertisement, poster, and radio public service announcement (PSA) aimed at promoting folic acid consumption among 18- to 25-year-old young Latina adults, as well as a Spanish-language print advertisement, poster, brochure, and radio PSA for 26- to 34-year-old Latina mothers. DESIGN: Individual in-person interviews yielded both qualitative and quantitative data. METHOD: In-person interviews with key gatekeepers who work closely with Spanish-speaking Latinas. SETTING: Interviews were conducted in Miami, Florida; Chicago, Illionis; Los Angeles, California; New York, New York; Denver, Colorado; and San Antonio, Texas, USA. RESULTS: Overall, the gatekeepers ratings of the materials were high. Important concerns that emerged helped guide changes that were made to the materials to ultimately enhance their reach and effectiveness. CONCLUSION: Testing draft educational materials with key gatekeepers who work closely with Spanish-speaking Latinas before final development and dissemination is a critical component of an educational outreach effort. Incorporating feedback from these professionals can help enhance the quality of the end product; such feedback can also help researchers assess whether and how the materials will be disseminated. copyright The Author(s) 2010. |
Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007-2008
Fischer GE , Schaefer MK , Labus BJ , Sands L , Rowley P , Azzam IA , Armour P , Khudyakov YE , Lin Y , Xia G , Patel PR , Perz JF , Holmberg SD . Clin Infect Dis 2010 51 (3) 267-73 BACKGROUND: In January 2008, 3 persons with acute hepatitis C who all underwent endoscopy at a single facility in Nevada were identified. METHOD: We reviewed clinical and laboratory data from initially detected cases of acute hepatitis C and reviewed infection control practices at the clinic where case patients underwent endoscopy. Persons who underwent procedures on days when the case patients underwent endoscopy were tested for hepatitis C virus (HCV) infection and other bloodborne pathogens. Quasispecies analysis determined the relatedness of HCV in persons infected. RESULTS: In addition to the 3 initial cases, 5 additional cases of clinic-acquired HCV infection were identified from 2 procedure dates included in this initial field investigation. Quasispecies analysis revealed 2 distinct clusters of clinic-acquired HCV infections and a source patient related to each cluster, suggesting separate transmission events. Of 49 HCV-susceptible persons whose procedures followed that of the source patient on 25 July 2007, 1 (2%) was HCV infected. Among 38 HCV-susceptible persons whose procedures followed that of another source patient on 21 September 2007, 7 (18%) were HCV infected. Reuse of syringes on single patients in conjunction with use of single-use propofol vials for multiple patients was observed during normal clinic operations. CONCLUSION: Patient-to-patient transmission of HCV likely resulted from contamination of single-use medication vials that were used for multiple patients during anesthesia administration. The resulting public health notification of approximately 50,000 persons was the largest of its kind in United States health care. This investigation highlighted breaches in aseptic technique, deficiencies in oversight of outpatient settings, and difficulties in detecting and investigating such outbreaks. |
Optimal vaccine stockpile design for an eradicated disease: application to polio
Tebbens RJ , Pallansch MA , Alexander JP , Thompson KM . Vaccine 2010 28 (26) 4312-27 Eradication of a disease promises significant health and financial benefits. Preserving those benefits, hopefully in perpetuity, requires preparing for the possibility that the causal agent could re-emerge (unintentionally or intentionally). In the case of a vaccine-preventable disease, creation and planning for the use of a vaccine stockpile becomes a primary concern. Doing so requires consideration of the dynamics at different levels, including the stockpile supply chain and transmission of the causal agent. This paper develops a mathematical framework for determining the optimal management of a vaccine stockpile over time. We apply the framework to the polio vaccine stockpile for the post-eradication era and present examples of solutions to one possible framing of the optimization problem. We use the framework to discuss issues relevant to the development and use of the polio vaccine stockpile, including capacity constraints, production and filling delays, risks associated with the stockpile, dynamics and uncertainty of vaccine needs, issues of funding, location, and serotype dependent behavior, and the implications of likely changes over time that might occur. This framework serves as a helpful context for discussions and analyses related to the process of designing and maintaining a stockpile for an eradicated disease. |
Effectiveness of adolescent and adult tetanus, reduced-dose diphtheria, and acellular pertussis vaccine against pertussis
Wei SC , Tatti K , Cushing K , Rosen J , Brown K , Cassiday P , Clark T , Olans R , Pawloski L , Martin M , Tondella ML , Martin SW . Clin Infect Dis 2010 51 (3) 315-21 BACKGROUND: Pertussis is among the most poorly controlled bacterial vaccine-preventable diseases in the United States. In 2006, a tetanus, reduced-dose diphtheria, and acellular pertussis (Tdap) booster was recommended for adolescents and adults. Tdap vaccines were licensed on the basis of antibody response without vaccine effectiveness data. METHODS: From 30 September 2007 through 19 December 2007, a pertussis outbreak occurred at a nursery through twelfth grade school on St. Croix, US Virgin Islands. We screened all students for cough and collected clinical history, including Tdap receipt. Coughing students were offered diagnostic testing. We defined clinical case patients as students with cough 14 days in duration plus either whoop, paroxysms, or post-tussive vomiting, and we defined confirmed case patients as students with any cough with isolation of Bordetella pertussis or those with clinical cases and polymerase chain reaction or serological evidence of pertussis; other clinical cases were classified as probable. RESULTS: There were 51 confirmed or probable cases among 499 students (attack rate, 10%). Disease clustered in grades 6-12, with a peak attack rate of 38% among 10th graders. Of 266 students aged 11 years with complete data, 31 (12%) had received Tdap. Forty-one unvaccinated students (18%) had confirmed or probable pertussis, compared with 2 (6%) of the vaccinated students (relative risk, 2.9); vaccine effectiveness was 65.6% (95% confidence interval, -35.8% to 91.3%; [Formula: see text]). CONCLUSIONS: This first evaluation of Tdap vaccine effectiveness in the outbreak setting suggests that Tdap provides protection against pertussis. Increased coverage is needed to realize the full benefit of the vaccine program. Serological testing was an important tool for case identification and should be considered for inclusion in the Council of State and Territorial Epidemiologists case definition. |
Are adolescent girls with a physical disability at increased risk for sexual violence?
Alriksson-Schmidt AI , Armour BS , Thibadeau JK . J Sch Health 2010 80 (7) 361-7 BACKGROUND: The purpose of this study was to investigate whether US female adolescents who self-reported having a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than US female adolescents without a physical disability or long-term health problem. METHODS: Using data from the 2005 U.S. National Youth Risk Behavior Survey (YRBS), we employed logistic regression analyses to estimate the association between physical disability (and other variables) and the risk for sexual violence among US high school girls. RESULTS: Female high school students who reported a physical disability or long-term health problem were more likely to report having been physically forced to have sexual intercourse than those who did not (19.6% vs 9.4%;chi(2) = 14.51, p = .003). Results from our multivariate analysis reveal that this association remained significant (adjusted odds ratio [AOR], 1.57; 95% confidence interval [CI], 1.10-2.23) after adjusting for certain demographic characteristics, physical health problems, behavioral health risks, and violent conduct. CONCLUSIONS: Our findings suggest that adolescent girls in the United States with a physical disability or long-term health problem may be at increased risk for sexual violence. It is important that national efforts to reduce sexual violence consider how to address the unmet needs of children and adolescents with disabilities. As most adolescent girls spend the majority of their time in a school setting, it is of particular importance that school health professionals are aware of the current findings. |
Role of BC loop residues in structure, function and antigenicity of the West Nile virus envelope protein receptor-binding domain III
Zhang S , Bovshik EI , Maillard R , Gromowski GD , Volk DE , Schein CH , Huang CY , Gorenstein DG , Lee JC , Barrett AD , Beasley DW . Virology 2010 403 (1) 85-91 Site-directed mutagenesis of residues in the BC loop (residues 329-333) of the envelope (E) protein domain III in a West Nile virus (WNV) infectious clone and in plasmids encoding recombinant WNV and dengue type 2 virus domain III proteins demonstrated a critical role for residues in this loop in the function and antigenicity of the E protein. This included a strict requirement for the tyrosine at residue 329 of WNV for virus viability and E domain III folding. The absence of an equivalent residue in this region of yellow fever group viruses and most tick-borne flavivirus suggests there is an evolutionary divergence in the molecular mechanisms of domain III folding employed by different flaviviruses. |
Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: pangenotypic evaluation of performances
Drobeniuc J , Meng J , Reuter G , Greene-Montfort T , Khudyakova N , Dimitrova Z , Kamili S , Teo CG . Clin Infect Dis 2010 51 (3) e24-7 Six immunoassays for detecting immunoglobulin M antibodies to hepatitis E virus were evaluated. Serum samples representing acute infection by each of the 4 viral genotypes as well as nonacute hepatitis E virus infection constituted the test panels. Diagnostic sensitivities and specificities as well as interassay agreement varied widely. Analytical sensitivity limits also were determined and were found to be particularly disparate. |
Nerve agent exposure elicits site-specific changes in protein phosphorylation in mouse brain
Zhu H , O'Brien JJ , O'Callaghan JP , Miller DB , Zhang Q , Rana M , Tsui T , Peng Y , Tomesch J , Hendrick JP , Wennogle LP , Snyder GL . Brain Res 2010 1342 11-23 Organophosphorus (OP) compounds cause toxic symptoms, including convulsions, coma, and death, as the result of irreversible inhibition of acetylcholinesterase (AChE). The development of effective treatments to block these effects and attenuate long-term cognitive and motor disabilities that result from OP intoxication is hampered by a limited understanding of the CNS pathways responsible for these actions. We employed a candidate method (called CNSProfile) to identify changes in the phosphorylation state of key neuronal phosphoproteins evoked by the OP compound, diisopropyl fluorophosphate (DFP). Focused microwave fixation was used to preserve the phosphorylation state of phosphoproteins in brains of DFP-treated mice; hippocampus and striatum were analyzed by immunoblotting with a panel of phospho-specific antibodies. DFP exposure elicited comparable effects on phosphorylation of brain phosphoproteins in both C57BL/6 and FVB mice. DFP treatment significantly altered phosphorylation at regulatory residues on glutamate receptors, including Serine897 (S897) of the NR1 NMDA receptor. NR1 phosphorylation was bi-directionally regulated after DFP in striatum versus hippocampus. NR1 phosphorylation was reduced in striatum, but elevated in hippocampus, compared with controls. DARPP-32 phosphorylation in striatum was selectively increased at the Cdk5 kinase substrate, Threonine75 (T75). Phencynonate hydrochloride, a muscarinic cholinergic antagonist, prevented seizure-like behaviors and the observed changes in phosphorylation induced by DFP. The data reveal region-specific effects of nerve agent exposure on intracellular signaling pathways that correlate with seizure-like behavior and which are reversed by the muscarinic receptor blockade. This approach identifies specific targets for nerve agents, including substrates for Cdk5 kinase, which may be the basis for new anti-convulsant therapies. |
Performance of the Aptima HIV-1 RNA qualitative assay on 16- and 32-member specimen pools
Ethridge SF , Hart C , Hanson DL , Parker MM , Sullivan TJ , Bennett B , Stephens P , Hilliard J , Patel P . J Clin Microbiol 2010 48 (9) 3343-5 The Aptima HIV-1 RNA Qualitative Assay tested with a WHO-approved HIV-1 RNA standard in 16- and 32-member pools detected 100% of the pools (1,070 and 2,130 HIV-1 RNA copies/ml/pool, respectively) thus exceeding the FDA-required lower limit of detection. The Aptima test can be used to screen for acute HIV-infection. |
Prophylactic treatment with a G glycoprotein monoclonal antibody reduces pulmonary inflammation in RSV challenged naive and formalin-inactivated RSV immunized BALB/c mice
Radu GU , Caidi H , Miao C , Tripp RA , Anderson LJ , Haynes LM . J Virol 2010 84 (18) 9632-6 We examined whether prophylactically administered anti-RSV G monoclonal antibody (mAb) would decrease the pulmonary inflammation associated with primary RSV infection and formalin-inactivated (FI-RSV) enhanced disease in mice. mAb 131-2G administration one day prior to primary infection reduced the pulmonary inflammatory response and the level of RSV replication. Further, intact or F(ab')2 forms of mAb 131-2G mAB administered one day prior to infection in FI-RSV vaccinated mice reduced enhanced inflammation and disease. This study shows that an anti-RSV G protein mAb might provide prophylaxis against both primary infection and FI-RSV associated enhanced disease. It is possible that antibodies with similar reactivities might prevent enhanced disease and improve the safety of non-live virus vaccines. |
Assessment of pandemic and seasonal influenza A (H1N1) virus susceptibility to neuraminidase inhibitors in three enzyme activity inhibition assays
Nguyen HT , Sheu TG , Mishin VP , Klimov AI , Gubareva LV . Antimicrob Agents Chemother 2010 54 (9) 3671-7 Neuraminidase inhibitors (NAIs) zanamivir and oseltamivir are currently the only effective antiviral drugs for treatment and prophylaxis of 2009 pandemic influenza A (H1N1) virus infections. The proven potential of these viruses to acquire NAI resistance during treatment emphasizes the need to assess their NAI susceptibility. IC50 values are known to vary depending on the neuraminidase inhibition (NI) test used; however, few side-by-side comparisons of different NI assays have been done. In this study, a panel of 11 isolates representing 2009 seasonal and pandemic influenza H1N1 viruses, including oseltamivir-resistant H275Y variants, were tested in three functional NI assays: chemiluminescent (CL), fluorescent (FL), and colorimetric (CM). The sensitivity of viruses was assessed against zanamivir, oseltamivir, and three investigational NAIs (peramivir, R-125489, and A-315675). All isolates were sensitive to all five NAIs by all three NI assays, with the exception of H275Y variants which showed substantially elevated IC50 values against oseltamivir and peramivir. The three NI assays generally yielded consistent results; thus, the choice of NI assay does not appear to affect conclusions based on drug susceptibility surveillance. Each assay, however, offers certain advantages when compared to the others: CL required less virus volume, FL provided the greatest difference in the IC50 values between wild type and variant, whereas the IC50 values obtained from CM may be most predictive of drug concentrations needed to inhibit enzyme activity in humans. It would be desirable to develop an NI assay which combines the advantages of all three currently available assays but lacks their shortcomings. |
Congenital cytomegalovirus: an update
Stowell JD , Forlin-Passoni DF , Cannon MJ . Contemp Pediatr 2010 27 (5) 38-51 Cytomegalovirus (CMV) is the most commong source of congential infection in newborns and is a leading cause of hearing loss and intellectual disability in the United Sates. As a result of its substantial disease burden, congential CMV is associated with an estimated $1 billion to $2 billion in direct ecnomic costs each year. However, there has been limited progress in developing interventions to prevent or treat CMV infection. Researchers across disciplines are striving to better understand the epidemiology of congenital CMV, improve diagnostic tools, develop new treatments, and explore interventions for preventing infection and improving outcomes for infected infants. |
Research recommendations for selected IARC-classified agents
Ward EM , Schulte PA , Straif K , Hopf NB , Caldwell JC , Carreon T , Demarini DM , Fowler BA , Goldstein BD , Hemminki K , Hines CJ , Husgafvel Pursiainen K , Kuempel E , Lewtas J , Lunn RM , Lynge E , McElvenny DM , Muhle H , Nakajima T , Robertson LW , Ruder AM , Schubauer-Berigan MK . Environ Health Perspect 2010 118 (10) 1355-62 OBJECTIVES: There are some common occupational agents and exposure circumstances where evidence of carcinogenicity is substantial but not yet conclusive for humans. The objectives are to identify research gaps and needs for twenty agents prioritized for review based on evidence of widespread human exposures and potential carcinogenicity in animals or humans. DATA SOURCES: A systematic review was conducted of new data published since the most recent pertinent IARC monograph meeting. DATA EXTRACTION: Reviewers were charged with identifying data gaps and general and specific approaches to address them, focusing on research that would be important in resolving classification uncertainties. An expert meeting brought reviewers together to discuss each agent and the identified data gaps and approaches. DATA SYNTHESIS: Several overarching issues were identified that pertained to multiple agents; these included the importance of recognizing that carcinogenic agents can act through multiple toxicity pathways and mechanisms, including epigenetic mechanisms, oxidative stress and immuno- and hormonal modulation. CONCLUSIONS: Studies in occupational populations provide important opportunities to understand the mechanisms through which exogenous agents cause cancer and intervene to prevent human exposure and/or prevent or detect cancer among those already exposed. Scientific developments are likely to increase the challenges and complexities of carcinogen testing and evaluation in the future, and epidemiologic studies will be particularly critical to inform carcinogen classification and risk assessment processes. |
Simple respiratory protection--evaluation of the filtration performance of cloth masks and common fabric materials against 20-1000 nm size particles
Rengasamy S , Eimer B , Shaffer RE . Ann Occup Hyg 2010 54 (7) 789-98 A shortage of disposable filtering facepiece respirators can be expected during a pandemic respiratory infection such as influenza A. Some individuals may want to use common fabric materials for respiratory protection because of shortage or affordability reasons. To address the filtration performance of common fabric materials against nano-size particles including viruses, five major categories of fabric materials including sweatshirts, T-shirts, towels, scarves, and cloth masks were tested for polydisperse and monodisperse aerosols (20-1000 nm) at two different face velocities (5.5 and 16.5 cm s(-1)) and compared with the penetration levels for N95 respirator filter media. The results showed that cloth masks and other fabric materials tested in the study had 40-90% instantaneous penetration levels against polydisperse NaCl aerosols employed in the National Institute for Occupational Safety and Health particulate respirator test protocol at 5.5 cm s(-1). Similarly, varying levels of penetrations (9-98%) were obtained for different size monodisperse NaCl aerosol particles in the 20-1000 nm range. The penetration levels of these fabric materials against both polydisperse and monodisperse aerosols were much higher than the penetrations for the control N95 respirator filter media. At 16.5 cm s(-1) face velocity, monodisperse aerosol penetrations slightly increased, while polydisperse aerosol penetrations showed no significant effect except one fabric mask with an increase. Results obtained in the study show that common fabric materials may provide marginal protection against nanoparticles including those in the size ranges of virus-containing particles in exhaled breath. |
Lung function loss associated with occupational dust exposure in metal smelting
Hnizdo E . Am J Respir Crit Care Med 2010 181 (11) 1162-3 Chronic obstructive pulmonary disease (COPD) is a preventable disease characterized by airflow limitation that is usually progressive and not fully reversible (1). COPD is an important cause of morbidity and mortality worldwide (2) and is especially prevalent among blue-collar workers (3). Even when it is not life-threatening, COPD often profoundly diminishes the affected individual's quality of life. Evidence shows that excessive decline in lung function is associated with premature functional impairment, disability, early retirement from work, and increased morbidity and mortality (4–6). Fortunately, severe consequences of COPD can be prevented through early recognition and effective interventions directed at controlling known risk factors. Current knowledge of the pathogenesis of COPD indicates that chronic inhalation of toxic particles and gases can lead to progressive tissue injury via a cascade of inflammatory processes in the lung (1). Tobacco smoking is recognized as the most important risk factor for COPD. Among blue-collar workers, however, occupational exposures contribute to an increased risk of the disease (7). In developed countries, an estimated 15% of all COPD is attributable to occupational exposure (8). In some occupations, the effect of occupational exposure can be as damaging as that of smoking. A study of autopsied U.S. coal miners found that the amount of emphysema associated with coal mine dust can be equivalent to that associated with tobacco smoking (9). | Metal smelting is one of the oldest human activities, dating to prehistoric times. Mining and smelting, the two most prominent industries providing metals needed for the industrial development of the nineteenth and twentieth centuries, have contributed to the burden of occupational lung diseases (10). Smelting requires heat and carbon from such sources as coke, coal, and in some cases charcoal and woodchips to reduce mineral ores to smelted metals. Dust emitted into the workplace atmosphere during smelting is a risk factor for occupational lung diseases and therefore the exposure–response relationship needs to be established to identify safe exposure levels to prevent adverse health effects. |
The NIOSH Construction Program: research to practice, impact, and developing a National Construction Agenda
Gillen M . J Safety Res 2010 41 (3) 289-299 The U.S. National Institute for Occupational Safety and Health (NIOSH) conducts research to improve and protect the health and safety of workers. This paper describes the experience of the NIOSH Construction Program with two recent program planning initiatives intended to improve the program: (a) an independent external review of work over the past decade and (b) the development of strategic goals organized into a "National Construction Agenda" to guide a decade of future work. These goals, developed with input from construction industry stakeholders and researchers, are a part of the NIOSH National Occupational Research Agenda (NORA) initiative. The NORA goals are intended to provide an ambitious set of goals for all construction stakeholders to work together on. Both efforts relate to ensuring the relevance and impact of research, reflecting an emerging policy perspective that research programs should be judged not just by the quality and quantity of science produced, but by the industry impact and tangible benefit resulting from the research. This paper describes how views on research planning have evolved to incorporate lessons learned about how research leads to improved safety and health for workers. It also describes the process used to develop the goals and the resulting strategic and intermediate goals that comprise the National Construction Agenda. |
Factorial invariance, scale reliability, and construct validity of the job control and job demands scales for immigrant workers: the Multi-Ethnic Study of Atherosclerosis
Fujishiro K , Landsbergis PA , Diez-Roux AV , Stukovsky KH , Shrager S , Baron S . J Immigr Minor Health 2010 13 (3) 533-40 Immigrants have a different social context from those who stay in their home country or those who were born to the country that immigrants now live. Cultural theory of risk perception suggests that social context influences one's interpretation of questionnaire items. We examined psychometric properties of job control and job demand scales with US- and foreign-born workers who preferred English, Spanish, or Chinese (n = 3,114, mean age = 58.1). Across all groups, the job control scale had acceptable Cronbach's alpha (0.78-0.83) and equivalent factor loadings (DeltaCFI < 0.01). Immigrants had low alpha (0.42-0.65) for the job demands scale regardless of language, education, or age of migration. Two job-demand items had different factor loadings across groups. Among immigrants, both scales had inconsistent associations with perceived job stress and self-rated health. For a better understanding of immigrants' job stress, the concept of job demands should be expanded and immigrants' expectations for job control explored. |
Direct-reading methods for workplace air monitoring
Coffey CC , Pearce TA . J Chem Health Saf 2010 17 (3) 10-21 Direct-reading methods (DRMs) are valuable tools for detecting and measuring worker exposure to inhalation hazards. A DRM can be either a device or instrument capable of measuring gases and vapors and aerosols such as dusts, fumes, and mists without manipulation of the sample by the user or sending the sample to an offsite laboratory. Devices are those DRMs that are simple, single point in time measurement of exposure. Instruments are DRMs that contain a sampling system, signal-processing electronics, a display system, and a detector. This manuscript will describe the DRMs which may be used to evaluate worker exposure to gases, vapors, and aerosols. The manuscript will also discuss factors to consider when selecting a DRM and recent developments and events related to DRMs. |
School-based physical education programs: evidence-based physical activity interventions for youth in Latin America
Ribeiro IC , Parra DC , Hoehner CM , Soares J , Torres A , Pratt M , Legetic B , Malta DC , Matsudo V , Ramos LR , Simoes EJ , Brownson RC . Glob Health Promot 2010 17 (2) 5-15 This article focuses on results of the systematic review from the Guide for Useful Interventions for Activity in Latin America project related to school-based physical education (PE) programs in Latin America. The aims of the article are to describe five school-based PE programs from Latin America, discuss implications for effective school-based PE recommendations, propose approaches for implementing these interventions, and identify gaps in the research literature related to physical activity promotion in Latin American youth. Following the US Community Guide systematic review process, five school-based PE intervention studies with sufficient quality of design, execution and detail of intervention and outcomes were selected for full abstraction. One study was conducted in Brazil, two studies were conducted in Chile and two studies were conducted on the US/Mexico border. While studies presented assorted outcomes, methods and duration of interventions, there were consistent positive increases in physical activity levels for all outcomes measured during PE classes, endurance and active transportation to school in all three randomized studies. Except for one cohort from one study, the non-randomized studies showed positive intervention effects for moderate and vigorous physical activity levels during PE classes. The core elements of these five interventions included capacity building and staff training (PE specialists and/or classroom teachers); changes in the PE curricula; provision of equipment and materials; and adjustment of the interventions to specific target populations. In order to translate the strong evidence for school-based PE into practice, systematic attention to policy and implementation issues is required. |
When the third world comes to the first: ethical considerations when working with Hispanic immigrants
Eggerth DE , Flynn MA . Ethics Behav 2010 20 229-242 This article briefly reviews concerns related to the "cultural colonialism" of applying Western biomedical models of research ethics to non-Western groups. The feasibility of alternate ethical models is discussed and found wanting. In practical terms, many academic researchers in the United States are funded by federal agencies and are required to adhere to Title 45, Part 46 of the Code of Federal Regulations, legislation that is clearly grounded in the Western biomedical research tradition. Consequently, the question is not whether this system of ethics should be applied but rather how it can be applied most sensitively, appropriately, and wisely. The remainder of this article discusses of how the authors have attempted to do so in each stage of their own research with Hispanic immigrants to the United States. |
Examination of trends and evidence-based elements in state physical education legislation: a content analysis
Eyler AA , Brownson RC , Aytur SA , Cradock AL , Doescher M , Evenson KR , Kerr J , Maddock J , Pluto DL , Steinman L , Tompkins NO , Troped P , Schmid TL . J Sch Health 2010 80 (7) 326-332 METHODS: State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed. RESULTS: In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted). CONCLUSIONS: Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation. |
Nephrogenic systemic fibrosis: a survey of nephrologists' perceptions and practices
Abdel-Kader K , Patel PR , Kallen AJ , Sinkowitz-Cochran RL , Bolton WK , Unruh ML . Clin J Am Soc Nephrol 2010 5 (6) 964-71 BACKGROUND AND OBJECTIVES: Nephrogenic systemic fibrosis (NSF) is a disorder that can affect patients with renal dysfunction exposed to a gadolinium-based contrast agent (GBCA). Given the unique role nephrologists play in caring for patients at risk to develop NSF, this study surveyed their perceptions and practices regarding NSF. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An internet-based, cross-sectional survey of clinical nephrologists in the United States was performed. Perceptions and self-reported practices regarding NSF and local facility policies were assessed concerning GBCA use in renal dysfunction. RESULTS: Of the 2310 eligible nephrologists e-mailed to participate in the survey, 171 (7.4%) responded. Respondents spent 85% of their time in direct patient care and 83% worked in private practice; 59% had cared for a patient with NSF. Although over 90% were aware of the morbidity and mortality associated with NSF, 31% were unaware of an association with specific GBCA brand and 50% believed chronic kidney disease stage 3 patients were at risk to develop NSF. Changes in facility policies concerning GBCA use in renal dysfunction were widespread (>90%). Most nephrologists (56%) felt that enacted policies were appropriate, yet 58% were uncertain if the changes had benefited patients. CONCLUSIONS: These results indicate that nephrologists are generally familiar with the risk factors and consequences of NSF, but their perceptions do not always align with current evidence. Local policy changes in GBCA use are pervasive. Most nephrologists are comfortable with these policy changes but have mixed feelings regarding their effectiveness. |
Equal weights but different weight perceptions among US adolescents
Martin MA , May AL , Frisco ML . J Health Psychol 2010 15 (4) 493-504 We investigate sex and race/ethnic differences in adolescents' perceptions of the same objectively measured weight in a nationally representative US sample. At the same BMI z-score, girls perceive themselves as heavier than boys. Regardless of sex and relative to Whites, African-Americans perceive the same BMI z-score as leaner and Native Americans are more likely to perceive objectively heavier weights as 'about the right weight'. Asian boys consider a narrower weight range to be 'about the right weight' relative to White boys, and Asian girls are less likely than White girls to perceive objectively lower weights as 'about the right weight'. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Health Communication and Education
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Physical Activity
- Public Health Ethics
- Public Health Law
- Public Health Leadership and Management
- Social and Behavioral Sciences
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure