Trends in hospitalizations and cost associated with stroke by age, United States 2003-2012
Tong X , George MG , Gillespie C , Merritt R . Int J Stroke 2016 11 (8) 874-881 BACKGROUND: The disease burden associated with stroke by age is not well known. AIM: To assess the trends in stroke hospitalizations and associated cost among adults aged ≥18 years by age groups in the United States. METHODS: The study population consisted of 2003-2012 adult hospitalizations from the National Inpatient Sample of the Healthcare Cost and Utilization Project. Subarachnoid hemorrhage, intracerebral hemorrhage, and acute ischemic stroke hospitalizations were identified by the principal diagnosis ICD-9-CM code. We estimated national hospitalization rates and inflation-adjusted hospital costs across five consecutive 2-year time intervals, stratified by seven age groups. RESULTS: Hospitalization rates for subarachnoid hemorrhage decreased significantly from 2003-2004 to 2011-2012 for ages 35-44 (relative percent change (RPC): -23%) and 45-54 (RPC: -22%), respectively. For intracerebral hemorrhage, the rates decreased significantly for ages ≥65 years. Acute ischemic stroke hospitalization rates increased significantly for ages 18-54 and decreased significantly for ages 65-84 years. The average per-hospitalization cost for subarachnoid hemorrhage increased 7-35% among all age groups, except those aged 65-74, and increased 10-29% for intracerabral hemorrhage except those aged 75-84, and increased 6-19% among all ages for acute ischemic stroke, respectively. Overall, the estimated total national cost increased 7% for subarachnoid hemorrhage, 10% for intracerebral hemorrhage, and 18% for acute ischemic stroke from 2003-2004 to 2011-2012. CONCLUSIONS: From 2003 to 2012, subarachnoid hemorrhage and intracerabral hemorrhage stroke hospitalization rates declined across all age groups. While US acute ischemic stroke hospitalizations among ages 65-84 declined significantly, the hospitalization rates increased significantly among ages 18-54. The estimated hospital costs increased across all stroke subtypes during the study period. |
Obesity trends among adults with doctor-diagnosed arthritis - United States, 2009-2014
Barbour KE , Helmick CG , Boring M , Qin J , Pan L , Hootman JM . Arthritis Care Res (Hoboken) 2016 69 (3) 376-383 Objective Arthritis and obesity are common co-occurring conditions which can increase disability and risk of adverse outcomes (e.g., total knee replacement). Methods We estimated recent obesity trends among adults with arthritis from 2009 to 2014, overall, and by various sociodemographic and health characteristics using data from National Health Interview Survey, an ongoing, nationally representative, in-person household self-reported survey of the noninstitutionalized civilian U.S. A secondary aim was to examine the distribution of body mass index (BMI) categories among adults with and without arthritis. Results Obesity prevalence did not change significantly over time among middle-aged and younger adults with doctor-diagnosed arthritis either overall (p-trend=0.925 for both groups), or by demographic and health characteristics. Among older adults with doctor-diagnosed arthritis the unadjusted obesity prevalence was 29.4% in 2009 and 34.3% in 2014; after adjusting for all demographic and health characteristics there was a significant relative increase in obesity prevalence (15% (95% CI: 6-25)) and over time (p-trend=0.001). The 2014 distribution of BMI categories for adults with doctor-diagnosed arthritis (compared with adults without doctor-diagnosed arthritis) was skewed toward the obese category and its subclasses, but there were no significant changes in these relationships from 2009. Conclusions Obesity increased significantly over time among older adults with arthritis and remains high when compared with adults without arthritis. Greater dissemination of interventions focused on physical activity and diet are needed to reduce the adverse outcomes associated with obesity and arthritis. |
Prevalence of smoking and obesity among U.S. cancer survivors: Estimates from the National Health Interview Survey, 2008-2012
Shoemaker ML , White MC , Hawkins NA , Hayes NS . Oncol Nurs Forum 2016 43 (4) 436-41 PURPOSE/OBJECTIVES: To describe smoking and obesity prevalence among male and female cancer survivors in the United States.. DESIGN: Cross-sectional survey.. SETTING: Household interviews.. SAMPLE: 9,753 survey respondents who reported ever having a malignancy, excluding nonmelanoma skin cancers. . METHODS: Data from the National Health Interview Survey (2008-2012) were used to calculate weighted smoking status prevalence estimates. Cross-tabulations of smoking and weight status were produced, along with Wald chi-square tests and linear contrasts.. MAIN RESEARCH VARIABLES: Cancer history, smoking status, obesity status, gender, age, and age at diagnosis.. FINDINGS: Seventeen percent of cancer survivors reported current smoking. Female survivors had higher rates of current smoking than males, particularly in the youngest age category. Male survivors who currently smoked had lower obesity prevalence rates than males who previously smoked or never smoked. Among female survivors, 31% were obese and no significant differences were seen in obesity prevalence by smoking status for all ages combined. . CONCLUSIONS: The findings highlight the variation in smoking status and weight by age and gender. Smoking interventions may need to be targeted to address barriers specific to subgroups of cancer survivors.. IMPLICATIONS FOR NURSING: Nurses can be instrumental in ensuring that survivors receive comprehensive approaches to address both weight and tobacco use to avoid trading one risk for another. |
Growing fit: Georgia's model for engaging early care environments in preventing childhood obesity
McDavid K , Piedrahita C , Hashima P , Vall EA , Kay C , O'Connor J . J Ga Public Health Assoc 2016 5 (3) 266-275 BACKGROUND: In the United States, one in three children is overweight or obese by their fifth birthday. In Georgia, 35 percent of children are overweight or obese. Contrary to popular belief, children who are overweight or obese are likely to be the same weight status as adults, making early childhood an essential time to address weight status. An estimated 380,000 Georgia children attend early care and education environments, such as licensed child care centers, Head Start, and pre-kindergarten programs, which provide an opportunity to reach large numbers of children, including those at risk for obesity and overweight. METHODS: To address this opportunity, the Georgia Department of Public Health, Georgia Shape - the Governor's Initiative to prevent childhood obesity, and HealthMPowers, Inc., created the Growing Fit training and toolkit to assist early childhood educators in creating policy, systems, and environmental changes that support good nutrition and physical activity. This report, the first related to this project, describes the training and its dissemination between January and December 2015. RESULTS: A total of 103 early childcare educators from 39 early childcare education centers (22 individual childcare systems) from 19 counties in Georgia were trained. Fifteen systems completed a pre and post-test assessment of their system, demonstrating slight improvements. Training for an additional 125 early childcare education centers is planned for 2016. CONCLUSIONS: Lessons learned from the first year of the training include the need for more robust assessment of adoption and implementation of policy, systems, and environmental changes in trained centers. |
Among adults with epilepsy reporting recent seizures, one of four on antiseizure medication and three of four not on medication had not seen a neurologist/epilepsy specialist within the last year, the 2010 and 2013 US National Health Interview Surveys
Cui W , Kobau R , Zack MM . Epilepsy Behav 2016 61 78-79 We combined 2010 and 2013 National Health Interview Survey (NHIS) data to examine the prevalence of seeing a neurologist/epilepsy specialist and/or a general doctor among US adults with active epilepsy who either took antiseizure medications or had at least one seizure in the past 12months. Among adults with recent seizures, about 76% of adults who did not take antiseizure medication (including 55% of those who saw only a general doctor and 21% of those who saw neither a specialist nor a general doctor) and 26% of those who took medication (including 23% of those who saw only a general doctor and 3% of those who saw neither a specialist nor a general doctor) had not seen a specialist within the past year-indicating gaps in quality care putting patients with uncontrolled seizures at risk of negative outcomes. The US Healthy People 2020 objectives call for increasing the proportion of people with epilepsy and uncontrolled seizures who receive appropriate medical care. Epilepsy stakeholders can work with community services/organizations to improve provider education about epilepsy, eliminate barriers to specialized care, and promote self-management support to reduce the burden of uncontrolled seizures in people with epilepsy. |
Safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi
Kohler PK , Tippett Barr BA , Kang'ombe A , Hofstee C , Kilembe F , Galagan S , Chilongozi D , Namate D , Machaya M , Kabwere K , Mwale M , Msunguma W , Reed J , Chimbwandira F . J Acquir Immune Defic Syndr 2016 72 Suppl 1 S49-s55 INTRODUCTION: Nonsurgical adult male circumcision devices present an alternative to surgery where health resources are limited. This study aimed to assess the safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi. METHODS: A prospective single-arm cohort study was conducted at 3 sites (1 urban static, 1 rural static, 1 rural tent) in Malawi. Adverse event (AE) outcomes were stratified to include/exclude pain, and confidence intervals (CIs) were corrected for clinic-level clustering. RESULTS: Among 935 men screened, 131 (14.0%) were not eligible, 13 (1.4%) withdrew before placement, and 791 (84.6%) received the device. Moderate and severe AEs totaled 7.1% including pain [95% CI: 3.4-14.7] and 4.0% excluding pain (95% CI: 2.6 to 6.4). Severe AEs included pain (n = 3), insufficient skin removal (n = 4), and early removal (n = 4). Among early removals, 1 had immediate surgical circumcision, 1 had surgery after 48 hours of observation, 1 declined surgery, and 1 did not return to our site although presented at a nearby clinic. More than half of men (51.9%) reported odor; however, few (2.2%) stated they would not recommend the device to others because of odor. Median levels of reported pain (scale, 1-10) were 2 (interquartile range, 2-4) during application and removal, and 0 (interquartile range, 0-2) at all other time points. CONCLUSIONS: Severe AEs were rare and similar to other programs. Immediate provision of surgical services after displacement or early removal proved a challenge. Cases of insufficient skin removal were linked to poor technique, suggesting provider training requires reinforcement and supervision. |
Statin use and hospital length of stay among adults hospitalized with community-acquired pneumonia
Havers F , Bramley AM , Finelli L , Reed C , Self WH , Trabue C , Fakhran S , Balk R , Courtney DM , Girard TD , Anderson EJ , Grijalva CG , Edwards KM , Wunderink RG , Jain S . Clin Infect Dis 2016 62 (12) 1471-8 BACKGROUND: Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. METHODS: Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012. Adults receiving statins before and throughout hospitalization (statin users) were compared with those who did not receive statins (nonusers). Proportional subdistribution hazards models were used to examine the association between statin use and hospital length of stay (LOS). In-hospital mortality was a secondary outcome. We also compared groups matched on propensity score. RESULTS: Of 2016 adults enrolled, 483 (24%) were statin users; 1533 (76%) were nonusers. Statin users were significantly older, had more comorbidities, had more years of education, and were more likely to have health insurance than nonusers. Multivariable regression demonstrated that statin users and nonusers had similar LOS (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], .88-1.12), as did those in the propensity-matched groups (HR, 1.03; 95% CI, .88-1.21). No significant associations were found between statin use and LOS or in-hospital mortality, even when stratified by pneumonia severity. CONCLUSIONS: In a large prospective study of adults hospitalized with CAP, we found no evidence to suggest that statin use before and during hospitalization improved LOS or in-hospital mortality. |
Low HIV testing among persons who inject drugs - National HIV Behavioral Surveillance, 20 U.S. cities, 2012
Cooley LA , Wejnert C , Spiller MW , Broz D , Paz-Bailey G . Drug Alcohol Depend 2016 165 270-4 INTRODUCTION: Persons who inject drugs (PWID) continue to be disproportionately affected by HIV. HIV testing is key to reducing HIV transmission by increasing awareness of HIV status and linking HIV-positive persons to care. Using data from PWID participating in CDC's National HIV Behavioral Surveillance (NHBS) system, we examined prevalence of recent HIV testing among PWID by certain characteristics to guide interventions to increase HIV testing. METHODS: We analyzed NHBS data from PWID 18 years or older recruited via respondent-driven sampling in 20 US cities in 2012. We examined demographic and behavioral factors associated with recent HIV testing (within 12 months before interview) using a Poisson model to calculate adjusted prevalence ratios (aPRs). RESULTS: Of 9555 PWID, 53% had recently tested for HIV. In multivariable analysis, HIV testing was more frequent among participants who visited a healthcare provider (aPR 1.50, P<0.001), participated in alcohol or drug treatment (aPR 1.21, P<0.001), or received an HIV prevention intervention (aPR 1.26, P<0.001). HIV testing was also more frequent among participants who received free sterile syringes (aPR 1.12, P<0.001). DISCUSSION: Only half of PWID participating in NHBS in 2012 reported recent HIV testing. HIV testing was more frequent among participants who accessed health and HIV prevention services. To increase HIV testing among PWID, it is important for providers in healthcare and HIV prevention settings to proactively assess risk factors for HIV, including injection drug use, and offer a wide range of appropriate interventions, such as HIV testing. |
Participant experiences and views of odor and PrePex device removal pain in a VMMC pilot study in Botswana
Musiige AM , Ashengo TA , Stolarsky G , Dialwa RT , Manda R , Ntsuape CO , Mafeni J , Busang L , Curran K , Motlhoiwa K , Mwangemi FJ , Lukobo-Durrell M , Glenshaw MT . J Acquir Immune Defic Syndr 2016 72 Suppl 1 S73-s77 OBJECTIVE: To assess participant experiences and perceptions of removal pain and odor associated with the PrePex device procedure. METHODS: We analyzed data from a PrePex device pilot implementation study of 802 male participants aged 18-49 years at 2 clinics in Botswana, 2013. Study staff administered survey questions on device-related odor and assessed pain using visual analog scale scores categorized as no pain (0), mild (1-4), moderate (5-7), or severe pain (8-10). RESULTS: Mean participant age was 27.7 (range = 18-48) years. Of the 802 participants, 751 (94%) reported to have noticed an unusual or unpleasant odor while wearing the device. Of these, 193 (26%) participants tried something to combat the odor. A total of 84 (10%) participants reported no pain, 655 (82%) mild pain, 48 (6%) moderate pain, and 15 (2%) severe pain at 2 minutes after device removal. Pain reports at 15 minutes after removal were 553 (69%) no pain, 247 (31%) mild pain, and 2 (0.25%) moderate pain, with no report of severe pain at this time point. Of 740 participants interviewed on day 42 after device placement, 678 (92%) were satisfied with the procedure and 681 (92%) would recommend it to another man considering circumcision, including 488 (66%) who would recommend it strongly. CONCLUSIONS: An unusual or unpleasant odor while wearing the PrePex device and mild self-limiting pain at device removal were common, but overall, these did neither seem to impair satisfaction nor deter participants from recommending PrePex to others, which could suggest good prospects for uptake of the device in this setting. |
Evaluation of the impact of National HIV Testing Day - United States, 2011-2014
Lecher SL , Hollis N , Lehmann C , Hoover KW , Jones A , Belcher L . MMWR Morb Mortal Wkly Rep 2016 65 (24) 613-8 Human immunodeficiency virus (HIV) testing is the first step in the continuum of HIV prevention, care, and treatment services, without which, gaps in HIV diagnosis cannot be addressed. National HIV testing campaigns are useful for promoting HIV testing among large numbers of persons. However, the impact of such campaigns on identification of new HIV-positive diagnoses is unclear. To assess whether National HIV Testing Day (NHTD, June 27) was effective in identifying new HIV-positive diagnoses, National HIV Prevention Program Monitoring and Evaluation (NHM&E) data for CDC-funded testing events conducted during 2011-2014 were analyzed. The number of HIV testing events and new HIV-positive diagnoses during June of each year were compared with those in other months by demographics and target populations. The number of HIV testing events and new HIV-positive diagnoses were also compared for each day leading up to and after NHTD in June and July of each year. New HIV-positive diagnoses peaked in June relative to other months and specifically on NHTD. During 2011-2014, NHTD had a substantial impact on increasing the number of persons who knew their HIV status and in diagnosing new HIV infections. NHTD also proved effective in reaching persons at high risk disproportionately affected by HIV, including African American (black) men, men who have sex with men (MSM), and transgender persons. Promoting NHTD can successfully increase the number of new HIV-positive diagnoses, including HIV infections among target populations at high risk for HIV infection. |
Health care use and HIV testing of males aged 15-39 years in physicians' offices - United States, 2009-2012
Ham DC , Huang YL , Gvetadze R , Peters PJ , Hoover KW . MMWR Morb Mortal Wkly Rep 2016 65 (24) 619-22 In 2014, 81% of new human immunodeficiency virus (HIV) infection diagnoses in the United States were in males, with the highest number of cases among those aged 20-29 years. Racial and ethnic minorities continue to be disproportionately affected by HIV; there are 13 new diagnoses each year per 100,000 white males, 94 per 100,000 black males, and 42 per 100,000 Hispanic males. Despite the recommendation by CDC for HIV testing of adults and adolescents, in 2014, only 36% of U.S. males aged ≥18 years reported ever having an HIV test, and in 2012, an estimated 15% of males living with HIV had undiagnosed HIV infection. To identify opportunities for HIV diagnosis in young males, CDC analyzed data from the 2009-2012 National Ambulatory Medical Care Survey (NAMCS) and U.S. Census data to estimate rates of health care use at U.S. physicians' offices and HIV testing at these encounters. During 2009-2012, white males visited physicians' offices more often (average annual rate of 1.6 visits per person) than black males (0.9 visits per person) and Hispanic males (0.8 visits per person). Overall, an HIV test was performed at 1.0% of visits made by young males to physicians' offices, with higher testing rates among black males (2.7%) and Hispanic males (1.4%), compared with white males (0.7%). Although higher proportions of black and Hispanic males received HIV testing at health care visits compared with white males, this benefit is likely attenuated by a lower rate of health care visits. Interventions to routinize HIV testing at U.S physicians' offices could be implemented to improve HIV testing coverage. |
Acceptability and satisfaction associated with the introduction of the PrePex circumcision device in Maputo, Mozambique
Cummings B , Necochea E , Ferreira T , Soares B , Mahomed M , Muquingue H , Nhambi L , Bossemeyer D , Ashengo TA . J Acquir Immune Defic Syndr 2016 72 Suppl 1 S56-s62 BACKGROUND: Adult device circumcision may potentially reach more men in Sub-Saharan Africa, with fewer human resource and capacity needs than surgical procedures. Despite these advantages, little is known about device acceptability, including pain and maintaining the device in situ. METHODS: Healthy, HIV-negative men, between 18 and 49 years, in a Maputo clinic, were consecutively asked to participate in a circumcision device study that included assessing acceptability. Clinical forms and self-administered surveys were used to collect data at various times during the circumcision process for consenting men. Data were entered into a central database and analyzed using statistical software. RESULTS: Between May and July, 2013, 504 men received device circumcision. Placement was painless for 98.2% of the male population, but the pain was more common during removal with 38.3% reporting severe or unbearable and 21.5% moderate pain. Satisfaction was high at both time points with 88.8% and 92.6% of men being very or somewhat satisfied at placement and removal, respectively. Half of the male population (50.2%) was very or somewhat comfortable with the device in situ; whereas, 36.8% were somewhat or very uncomfortable. Common device difficulties experienced were painful erections (38.5%) and difficult urination (21.8%) and hygiene (21.4%). By the final clinic visit at day 49, 90.4% of them were very or somewhat satisfied with the procedure. DISCUSSION: High levels of satisfaction were reported for device circumcision, despite the pain noted during removal and some challenges with the device in situ. Given the advantages and acceptability among Mozambican men in this study, device circumcision could be offered, when clinically appropriate, as an alternative to surgery. |
Acute flaccid myelitis in the United States-August - December 2014: Results of nation-wide surveillance
Sejvar JJ , Lopez AS , Cortese MM , Leshem E , Pastula DM , Miller L , Glaser C , Kambhampati A , Shioda K , Aliabadi N , Fischer M , Gregoricus N , Lanciotti R , Nix WA , Sakthivel SK , Schmid DS , Seward JF , Tong S , Oberste MS , Pallansch M , Feikin D . Clin Infect Dis 2016 63 (6) 737-745 BACKGROUND: During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the U.S., coincident with a national outbreak of enterovirus-D68 (EV-D68)-associated severe respiratory illness. METHODS: Clinicians and health departments reported to Centers for Disease Control and Prevention (CDC) standardized clinical, epidemiologic, and radiologic information on AFM cases, and submitted biological samples for testing. Cases were≤21 years old, with acute onset of limb weakness 01 August-31 December 2014 and spinal MRI showing lesions predominantly restricted to gray matter. RESULTS: From August-December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but one case was hospitalized; none died. CSF pleocytosis (>5 white blood cells/mm3) was common (81%). At CDC, one CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time PCR, although the specimen had >3,000 red blood cells/mm3 The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 14 AFM cases reported from 11 states. CONCLUSIONS: Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology and etiology of AFM. |
CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >750 cells/mm3 and mortality risk
Palella FJ Jr , Armon C , Chmiel JS , Brooks JT , Hart R , Lichtenstein K , Novak RM , Yangco B , Wood K , Durham M , Buchacz K . J Antimicrob Chemother 2016 71 (9) 2654-62 OBJECTIVES: We sought to evaluate associations between CD4 at ART initiation (AI), achieving CD4 >750 cells/mm3 (CD4 >750), long-term immunological recovery and survival. METHODS: This was a prospective observational cohort study. We analysed data from ART-naive patients seen in 1996-2012 and followed ≥3 years after AI. We used Kaplan-Meier (KM) methods and log-rank tests to compare time to achieving CD4 >750 by CD4 at AI (CD4-AI); and Cox regression models and generalized estimating equations to identify factors associated with achieving CD4 >750 and mortality risk. RESULTS: Of 1327 patients, followed for a median of 7.9 years, >85% received ART for ≥75% of follow-up time; 64 died. KM estimates evaluating likelihood of CD4 >750 during 5 years of follow-up, stratified by CD4-AI <50, 50-199, 200-349, 350-499 and 500-750, were 20%, 25%, 56%, 80% and 87%, respectively (log-rank P < 0.001). In adjusted models, CD4-AI ≥200 (versus CD4-AI <200) was associated with achievement of CD4 >750 [adjusted HR (aHR) = 4.77]. Blacks were less likely than whites to achieve CD4 >750 (33% versus 49%, aHR = 0.77). Mortality rates decreased with increasing CD4-AI (P = 0.004 across CD4 strata for AIDS causes and P = 0.009 for non-AIDS death causes). Among decedents with CD4-AI ≥50, 56% of deaths were due to non-AIDS causes. CONCLUSIONS: Higher CD4-AI resulted in greater long-term CD4 gains, likelihood of achieving CD4 >750, longer survival and decreased mortality regardless of cause. Over 80% of persons with CD4-AI ≥350 achieved CD4 >750 by 4 years while 75% of persons with CD4-AI <200 did not. These data confirm the hazards of delayed AI and support early AI. |
Crimean-Congo hemorrhagic fever knowledge, attitudes, practices, risk factors, and seroprevalence in rural Georgian villages with known transmission in 2014
Greiner AL , Mamuchishvili N , Kakutia N , Stauffer K , Geleishvili M , Chitadze N , Chikviladze T , Zakhashvili K , Morgan J , Salyer SJ . PLoS One 2016 11 (6) e0158049 In 2014 the highest annual case count of Crimean-Congo hemorrhagic fever (CCHF) was detected in Georgia since surveillance began in 2009. CCHF is a high-fatality hemorrhagic syndrome transmitted by infected ticks and animal blood. In response to this immediate public health threat, we assessed CCHF risk factors, seroprevalence, and CCHF-related knowledge, attitudes, and practices in the 12 rural villages reporting a 2014 CCHF case, to inform CCHF prevention and control measures. Households were randomly selected for interviewing and serum sample collection. Data were weighted by non-response and gender; percentages reflect weighting. Among 618 respondents, median age was 54.8 years (IQR: 26.5, range: 18.6-101.4); 215 (48.8%) were male. Most (91.5%) participants reported ≥1 CCHF high-risk activity. Of 389 participants with tick exposure, 286 (46.7%) participants handled ticks bare-handed; 65/216 (29.7%) knew the risk. Of 605 respondents, 355 (57.9%) reported animal blood exposure; 32/281 (12.7%) knew the risk. Of 612 responding, 184 (28.8%) knew protective measures against CCHF and tick exposures, but only 54.3% employed the measures. Of 435 serum samples collected, 12 were anti-CCHF IgG positive, indicating a weighted 3.0% seroprevalence. Most (66.7%) seropositive subjects reported tick exposure. In these villages, CCHF risk factors are prevalent, while CCHF-related knowledge and preventive practices are limited; these findings are critical to informing public health interventions to effectively control and prevent ongoing CCHF transmission. Additionally, CCHF seroprevalence is higher than previously detected (0.03%), highlighting the importance of this disease in the South Caucuses and in supporting ongoing regional investigations. |
Economic evaluation of school-based health centers: A Community Guide systematic review
Ran T , Chattopadhyay SK , Hahn RA . Am J Prev Med 2016 51 (1) 129-38 CONTEXT: A recent Community Guide systematic review of effectiveness of school-based health centers (SBHCs) showed that SBHCs improved educational and health outcomes. This review evaluates the economic cost and benefit of SBHCs. EVIDENCE ACQUISITION: Using economic systematic review methods developed for The Community Guide, 6,958 papers were identified for the search period January 1985 to September 2014. After two rounds of screening, 21 studies were included in this review: 15 studies reported on cost and nine on benefit; three studies had both cost and benefit information. All expenditures in this review were presented in 2013 U.S. dollars. EVIDENCE SYNTHESIS: Analyses were conducted in 2014. Intervention cost had two main components: start-up cost and operating cost. All but two of the cost studies reported operating cost only (ranging from $16,322 to $659,684 per SBHC annually). Benefits included healthcare cost averted and productivity and other loss averted. From the societal perspective, total annual benefit per SBHC ranged from $15,028 to $912,878. From healthcare payers' perspective, particularly Medicaid, SBHCs led to net savings ranging from $30 to $969 per visit. From patients' perspective, savings were also positive. Additionally, two benefit studies used regression analysis to show that Medicaid cost and hospitalization cost decreased with SBHCs. Finally, results from seven estimates in two cost-benefit studies showed that societal benefit per SBHC exceeded intervention cost, with the benefit-cost ratio ranging from 1.38:1 to 3.05:1. CONCLUSIONS: The economic benefit of SBHCs exceeds the intervention operating cost. Further, SBHCs result in net savings to Medicaid. |
Molecular survey of arthropod-borne pathogens in sheep keds (Melophagus ovinus), Central Europe.
Rudolf I , Betasova L , Bischof V , Venclikova K , Blazejova H , Mendel J , Hubalek Z , Kosoy M . Parasitol Res 2016 115 (10) 3679-82 In the study, we screened a total of 399 adult sheep keds (Melophagus ovinus) for the presence of RNA and DNA specific for arboviral, bacterial, and protozoan vector-borne pathogens. All investigated keds were negative for flaviviruses, phleboviruses, bunyaviruses, Borrelia burgdorferi, Rickettsia spp., Anaplasma phagocytophilum, "Candidatus Neoehrlichia mikurensis," and Babesia spp. All ked pools were positive for Bartonella DNA. The sequencing of the amplified fragments of the gltA and 16S-23S rRNA demonstrated a 100 % homology with Bartonella melophagi previously isolated from a sheep ked and from human blood in the USA. The identification of B. melophagi in sheep keds in Central Europe highlights needs extending a list of hematophagous arthropods beyond ticks and mosquitoes for a search of emerging arthropod-borne pathogens. |
Pathogenesis of vesicular stomatitis New Jersey virus infection in deer mice (Peromyscus maniculatus) transmitted by black flies (Simulium vittatum)
Mesquita LP , Diaz MH , Howerth EW , Stallknecht DE , Noblet R , Gray EW , Mead DG . Vet Pathol 2016 54 (1) 74-81 The natural transmission of vesicular stomatitis New Jersey virus (VSNJV), an arthropod-borne virus, is not completely understood. Rodents may have a role as reservoir or amplifying hosts. In this study, juvenile and nestling deer mice (Peromyscus maniculatus) were exposed to VSNJV-infected black fly (Simulium vittatum) bites followed by a second exposure to naive black flies on the nestling mice. Severe neurological signs were observed in some juvenile mice by 6 to 8 days postinoculation (DPI); viremia was not detected in 25 juvenile deer mice following exposure to VSNJV-infected fly bites. Both juvenile and nestling mice had lesions and viral antigen in the central nervous system (CNS); in juveniles, their distribution suggested that the sensory pathway was the most likely route to the CNS. In contrast, a hematogenous route was probably involved in nestling mice, since all of these mice developed viremia and had widespread antigen distribution in the CNS and other tissues on 2 DPI. VSNJV was recovered from naive flies that fed on viremic nestling mice. This is the first report of viremia in a potential natural host following infection with VSNJV via insect bite and conversely of an insect becoming infected with VSNJV by feeding on a viremic host. These results, along with histopathology and immunohistochemistry, show that nestling mice have widespread dissemination of VSNJV following VSNJV-infected black fly bite and are a potential reservoir or amplifying host for VSNJV. |
Presence of species within the Anopheles gambiae complex in the Democratic Republic of Congo
Bobanga T , Umesumbu SE , Mandoko AS , Nsibu CN , Dotson EB , Beach RF , Irish SR . Trans R Soc Trop Med Hyg 2016 110 (6) 373-5 BACKGROUND: Anopheles gambiae s.l. is the primary vector of malaria in the Democratic Republic of Congo, however, there is little data on the species from this complex present in the country. METHODS: This paper presents the species collected (as determined by PCR) between 2004 and 2011 in 16 locations across the country. RESULTS AND CONCLUSIONS: The two species from the An. gambiae complex that were detected were An. coluzzii and An. gambiae s.s. An. gambiae s.s. was predominant in eastern DRC, whereas An. coluzzii was the main species found in several locations in Bandundu. The species were also found in sympatry in several locations (Kinshasa, Kisangani, Lodja). These results provide a basis for future work, which is needed to accurately describe the distribution of the An. gambiae complex species in DRC. |
Critical evaluation of the linkage between tick-based risk measures and the occurrence of Lyme disease cases
Eisen L , Eisen RJ . J Med Entomol 2016 53 (5) 1050-1062 The nymphal stage of the blacklegged tick, Ixodes scapularis Say, is considered the primary vector to humans in the eastern United States of the Lyme disease spirochete Borrelia burgdorferi sensu stricto. The abundance of infected host-seeking nymphs is commonly used to estimate the fundamental risk of human exposure to B. burgdorferi, for the purpose of environmental risk assessment and as an outcome measure when evaluating environmentally based tick or pathogen control methods. However, as this tick-based risk measure does not consider the likelihoods of either human encounters with infected ticks or tick bites resulting in pathogen transmission, its linkage to the occurrence of Lyme disease cases is worth evaluating. In this Forum article, we describe different tick-based risk measures, discuss their strengths and weaknesses, and review the evidence for their capacity to predict the occurrence of Lyme disease cases. We conclude that: 1) the linkage between abundance of host-seeking B. burgdorferi-infected nymphs and Lyme disease occurrence is strong at community or county scales but weak at the fine spatial scale of residential properties where most human exposures to infected nymphs occur in Northeast, 2) the combined use of risk measures based on infected nymphs collected from the environment and ticks collected from humans is preferable to either one of these risk measures used singly when assessing the efficacy of environmentally based tick or pathogen control methods aiming to reduce the risk of human exposure to B. burgdorferi, 3) there is a need for improved risk assessment methodology for residential properties that accounts for both the abundance of infected nymphs and the likelihood of human-tick contact, and 4) we need to better understand how specific human activities conducted in defined residential microhabitats relate to risk for nymphal exposures and bites. |
Housing characteristics and indoor air quality in households of Alaska native children with chronic lung conditions
Singleton R , Salkoski AJ , Bulkow L , Fish C , Dobson J , Albertson L , Skarada J , Kovesi T , McDonald C , Hennessy TW , Ritter T . Indoor Air 2016 27 (2) 478-486 Alaska Native children experience high rates of respiratory infections and conditions. Household crowding, indoor smoke, lack of piped water, and poverty have been associated with respiratory infections. We describe the baseline household characteristics of children with severe or chronic lung disease participating in a 2012-2015 indoor air study. We monitored indoor PM2.5, CO2 , relative humidity %, temperature and VOCs, and interviewed caregivers about children's respiratory symptoms. We evaluated the association between reported children's respiratory symptoms and indoor air quality indicators using multiple logistic regression analysis. Compared with general U.S. households, study households were more likely overcrowded 73% (62%-82%) vs. 3.2% (3.1%-3.3%); had higher woodstove use as primary heat source 16% (9%-25%) vs. 2.1% (2.0%-2.2%); and higher proportion of children in a household with a smoker 49% (38%-60%) vs. 26.2% (25.5%-26.8%). Median PM2.5 was 33 mug/m3 . Median CO2 was 1401ppm. VOCs were detectable in all homes. VOCs, smoker, primary wood heat and PM2.5 >25 mug/m3 were associated with higher risk for cough between colds; VOCs were associated with higher risk for wheeze between colds and asthma diagnosis. High indoor air pollutants levels were associated with respiratory symptoms in household children, likely related to overcrowding, poor ventilation, woodstove use, and tobacco smoke. |
Complete Genome Sequences of Four Strains from the 2015-2016 Elizabethkingia anophelis Outbreak.
Nicholson AC , Whitney AM , Emery BD , Bell ME , Gartin JT , Humrighouse BW , Loparev VN , Batra D , Sheth M , Rowe LA , Juieng P , Knipe K , Gulvik C , McQuiston JR . Genome Announc 2016 4 (3) The complete circularized genome sequences of selected specimens from the largest known Elizabethkingia anophelis outbreak to date are described here. Genomic rearrangements observed among the outbreak strains are discussed. |
Comparative genomics of Campylobacter fetus from reptiles and mammals reveals divergent evolution in host-associated lineages.
Gilbert MJ , Miller WG , Yee E , Zomer AL , van der Graaf-van Bloois L , Fitzgerald C , Forbes KJ , Meric G , Sheppard SK , Wagenaar JA , Duim B . Genome Biol Evol 2016 8 (6) 2006-19 Campylobacter fetus currently comprises three recognized subspecies, which display distinct host association. C fetus subsp. fetus and C fetus subsp. venerealis are both associated with endothermic mammals, primarily ruminants, whereas C fetus subsp. testudinum is primarily associated with ectothermic reptiles. Both C. fetus subsp. testudinum and C. fetus subsp. fetus have been associated with severe infections, often with a systemic component, in immunocompromised humans. To study the genetic factors associated with the distinct host dichotomy in C. fetus, whole-genome sequencing and comparison of mammal- and reptile-associated C fetus was performed. The genomes of C fetus subsp. testudinum isolated from either reptiles or humans were compared to elucidate the genetic factors associated with pathogenicity in humans. Genomic comparisons showed conservation of gene content and organization amongst C fetus subspecies, but a clear distinction between mammal- and reptile-associated C fetus was observed. Several genomic regions appeared to be subspecies specific, including a putative tricarballylate catabolism pathway, exclusively present in C fetus subsp. testudinum strains. Within C fetus subsp. testudinum, sapA, sapB, and sapAB type strains were observed. The recombinant locus iamABC (mlaFED) was exclusively associated with invasive C fetus subsp. testudinum strains isolated from humans. A phylogenetic reconstruction was consistent with divergent evolution in host-associated strains and the existence of a barrier to lateral gene transfer between mammal- and reptile-associated C fetus Overall, this study shows that reptile-associated C fetus subsp. testudinum is genetically divergent from mammal-associated C fetus subspecies. |
Cost-effectiveness analysis of catch-up hepatitis A vaccination among unvaccinated/partially-vaccinated children
Hankin-Wei A , Rein DB , Hernandez-Romieu A , Kennedy MJ , Bulkow L , Rosenberg E , Trigg M , Nelson NP . Vaccine 2016 34 (35) 4243-4249 BACKGROUND: Since 2006, the US Centers for Disease Control and Prevention has recommended hepatitis A (HepA) vaccination routinely for children aged 12-23months to prevent hepatitis A virus (HAV) infection. However, a substantial proportion of US children are unvaccinated and susceptible to infection. We present results of economic modeling to assess whether a one-time catch-up HepA vaccination recommendation would be cost-effective. METHODS: We developed a Markov model of HAV infection that followed a single cohort from birth through death (birth to age 95years). The model compared the health and economic outcomes from catch-up vaccination interventions for children at target ages from two through 17years vs. outcomes resulting from maintaining the current recommendation of routine vaccination at age one year with no catch-up intervention. RESULTS: Over the lifetime of the cohort, catch-up vaccination would reduce the total number of infections relative to the baseline by 741 while increasing doses of vaccine by 556,989. Catch-up vaccination would increase net costs by $10.2million, or $2.38 per person. The incremental cost of HepA vaccine catch-up intervention at age 10years, the midpoint of the ages modeled, was $452,239 per QALY gained. Across age-cohorts, the cost-effectiveness of catch-up vaccination is most favorable at age 12years, resulting in an Incremental Cost-Effectiveness Ratio of $189,000 per QALY gained. CONCLUSIONS: Given the low baseline of HAV disease incidence achieved by current vaccination recommendations, our economic model suggests that a catch-up vaccination recommendation would be less cost-effective than many other vaccine interventions, and that HepA catch-up vaccination would become cost effective at a threshold of $50,000 per QALY only when incidence of HAV rises about 5.0 cases per 100,000 population. |
The cost-effectiveness of syphilis screening among men who have sex with men: An exploratory modeling analysis
Chesson HW , Kidd S , Bernstein KT , Fanfair RN , Gift TL . Sex Transm Dis 2016 43 (7) 429-32 We adapted a published model to estimate the costs and benefits of screening men who have sex with men for syphilis, including the benefits of preventing syphilis-attributable human immunodeficiency virus. The cost per quality-adjusted life year gained by screening was <US $0 (cost-saving) and US $16,100 in the dynamic and static versions of the model, respectively. |
Rotavirus vaccination and intussusception - science, surveillance, and safety: a review of evidence and recommendations for future research priorities in low and middle income countries
Yen C , Healy K , Tate JE , Parashar UD , Bines J , Neuzil K , Santosham M , Steele AD . Hum Vaccin Immunother 2016 12 (10) 0 As of January 2016, 80 countries have introduced rotavirus vaccines into their national immunization programs. Many have documented significant declines in rotavirus-specific and all-cause diarrheal illnesses following vaccine introduction. Two globally licensed rotavirus vaccines have been associated with a low risk of intussusception in several studies. In July 2014, the Rotavirus Organization of Technical Allies Council convened a meeting of research and advocacy organizations, public health experts, funders, and vaccine manufacturers to discuss post-marketing intussusception surveillance and rotavirus vaccine impact data. Meeting objectives were to evaluate updated data, identify and prioritize research gaps, discuss best practices for intussusception monitoring in lower-income settings and risk communication, and provide insight to country-level stakeholders on best practices for intussusception monitoring and communication. Meeting participants agreed with statements from expert bodies that the benefits of vaccination with currently available rotavirus vaccines outweigh the low risk of vaccination-associated intussusception. However, further research is needed to better understand the relationship of intussusception to wild-type rotavirus and rotavirus vaccines and delineate potential etiologies and mechanisms of intussusception. Additionally, evidence from research and post-licensure evaluations should be presented with evidence of the benefits of vaccination to best inform policymakers deciding on vaccine introduction or vaccination program sustainability. |
Hitting the optimal vaccination percentage and the risks of error: Why to miss right
Harvey MJ , Prosser LA , Messonnier ML , Hutton DW . PLoS One 2016 11 (6) e0156737 OBJECTIVE: To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage. METHODS: A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved. RESULTS: Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease. DISCUSSION AND CONCLUSION: These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level. |
Nursing Informatics Research Priorities for the Future: Recommendations from an International Survey.
Peltonen LM , Topaz M , Ronquillo C , Pruinelli L , Sarmiento RF , Badger MK , Ali S , Lewis A , Georgsson M , Jeon E , Tayaben JL , Kuo CH , Islam T , Sommer J , Jung H , Eler GJ , Alhuwail D . Stud Health Technol Inform 2016 225 222-226 We present one part of the results of an international survey exploring current and future nursing informatics (NI) research trends. The study was conducted by the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA-NISIG) Student Working Group. Based on findings from this cross-sectional study, we identified future NI research priorities. We used snowball sampling technique to reach respondents from academia and practice. Data were collected between August and September 2015. Altogether, 373 responses from 44 countries were analyzed. The identified top ten NI trends were big data science, standardized terminologies (clinical evaluation/implementation), education and competencies, clinical decision support, mobile health, usability, patient safety, data exchange and interoperability, patient engagement, and clinical quality measures. Acknowledging these research priorities can enhance successful future development of NI to better support clinicians and promote health internationally. |
Current Trends in Nursing Informatics: Results of an International Survey.
Peltonen LM , Alhuwail D , Ali S , Badger MK , Eler GJ , Georgsson M , Islam T , Jeon E , Jung H , Kuo CH , Lewis A , Pruinelli L , Ronquillo C , Sarmiento RF , Sommer J , Tayaben JL , Topaz M . Stud Health Technol Inform 2016 225 938-939 Nursing informatics (NI) can help provide effective and safe healthcare. This study aimed to describe current research trends in NI. In the summer 2015, the IMIA-NI Students Working Group created and distributed an online international survey of the current NI trends. A total of 402 responses were submitted from 44 countries. We identified a top five NI research areas: standardized terminologies, mobile health, clinical decision support, patient safety and big data research. NI research funding was considered to be difficult to acquire by the respondents. Overall, current NI research on education, clinical practice, administration and theory is still scarce, with theory being the least common. Further research is needed to explain the impact of these trends and the needs from clinical practice. |
Think twice: A cognitive perspective of an antibiotic timeout intervention to improve antibiotic use
Jones M , Butler J , Graber CJ , Glassman P , Samore MH , Pollack LA , Weir C , Goetz MB . J Biomed Inform 2016 71S S22-S31 OBJECTIVES: To understand clinicians' impressions of and decision-making processes regarding an informatics-supported antibiotic timeout program to re-evaluate the appropriateness of continuing vancomycin and piperacillin/tazobactam. METHODS: We implemented a multi-pronged informatics intervention, based on Dual Process Theory, to prompt discontinuation of unwarranted vancomycin and piperacillin/tazobactam on or after day three in a large Veterans Affairs Medical Center. Two workflow changes were introduced to facilitate cognitive deliberation about continuing antibiotics at day three: 1) teams completed an electronic template note, and 2) a paper summary of clinical and antibiotic-related information was provided to clinical teams. Shortly after starting the intervention, six focus groups were conducted with users or potential users. Interviews were recorded and transcribed. Iterative thematic analysis identified recurrent themes from feedback. RESULTS: Themes that emerged are represented by the following quotations: 1) captures and controls attention ("it reminds us to think about it"), 2) enhances informed and deliberative reasoning ("it makes you think twice"), 3) redirects decision direction ("...because [there was no indication] I just [discontinued] it without even trying"), 4) fosters autonomy and improves team empowerment ("the template... forces the team to really discuss it"), and 5) limits use of emotion-based heuristics ("my clinical concern is high enough I think they need more aggressive therapy..."). CONCLUSIONS: Requiring template completion to continue antibiotics nudged clinicians to re-assess the appropriateness of specified antibiotics. Antibiotic timeouts can encourage deliberation on overprescribed antibiotics without substantially curtailing autonomy. An effective nudge should take into account clinician's time, workflow, and thought processes. |
On Bayesian inference with complex survey data
Kang J , Bernstein K . Biom Biostat Int J 2016 3 (5) Nationally representative probability sample surveys (e.g., the National Health and Nutrition Examination Survey, or NHANES [1], and the National Survey of Family Growth, NSFG [2]) have immense value in helping develop estimates of the prevalence of disease, morbidity, and risk factors [3,4]. These surveys were designed to utilize survey weights to approximate nationally representative parameters. Any survey data analysis that uses the survey weights is called design-based estimation. Such analyses are implemented in major statistical software programs (e.g. SAS [5] and R [6]). | While commonly used, weighting complex survey data is a foreign concept to Bayesian modelers, according to Gelman [7]. A typical Bayesian analyst does not use weights, but focuses instead on updating assumed prior distributions with observed data likelihood. Much of this disconnect may be a function of differing goals; Bayesian approaches are focused on reliable statistical models [8] rather than on assessing the degree to which their estimates are nationally representative or not. However, Bayesian approaches, which have been successfully applied to multilevel data [8], missing data, and measurement errors [9], may represent a natural partner in complex survey data analysis. Measurement errors, missing data, and multilevel variables in complex survey data sets can be all treated as unobserved random variables in the Bayesian framework and they can be assessed by updating assumed prior distributions of related parameters with observed data sets [8,9]. |
Advancing nursing informatics in the next decade: Recommendations from an international survey
Topaz M , Ronquillo C , Peltonen LM , Pruinelli L , Sarmiento RF , Badger MK , Ali S , Lewis A , Georgsson M , Jeon E , Tayaben JL , Kuo CH , Islam T , Sommer J , Jung H , Eler GJ , Alhuwail D . Stud Health Technol Inform 2016 225 123-127 In the summer of 2015, the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NISIG) Student Working Group developed and distributed an international survey of current and future trends in nursing informatics. The survey was developed based on current literature on nursing informatics trends and translated into six languages. Respondents were from 31 different countries in Asia, Africa, North and Central America, South America, Europe, and Australia. This paper presents the results of responses to the survey question: "What should be done (at a country or organizational level) to advance nursing informatics in the next 5-10 years?" (n responders = 272). Using thematic qualitative analysis, responses were grouped into five key themes: 1) Education and training; 2) Research; 3) Practice; 4) Visibility; and 5) Collaboration and integration. We also provide actionable recommendations for advancing nursing informatics in the next decade. |
Using Multiplex Molecular Testing to Determine the Etiology of Acute Gastroenteritis in Children.
Nicholson MR , Van Horn GT , Tang YW , Vinje J , Payne DC , Edwards KM , Chappell JD . J Pediatr 2016 176 50-56 e2 OBJECTIVE: To detect the etiologic agents of acute gastroenteritis (AGE) in children using broad molecular-based techniques, and compare clinical presentations among etiologies. STUDY DESIGN: This was a prospective population-based surveillance study of children aged <6 years with AGE conducted between 2008 and 2011 as part of the New Vaccine Surveillance Network. Stools from patients and healthy controls were tested for 21 gastrointestinal pathogens using the analyte-specific reagent Gastrointestinal Pathogen Panel and an additional reverse transcription real-time polymerase chain reaction assay for sapovirus and astrovirus. RESULTS: Of the 216 stool samples from patients with AGE, 152 (70.4%) tested positive for a pathogen, with norovirus genogroup II (n = 78; 36.1%) and Clostridium difficile (n = 35; 16.2%) the most common pathogens detected. Forty-nine patients (22.7%) tested positive for more than 1 pathogen, including 25 (71%) with a C difficile detection. There were no significant clinical differences among the patients with no pathogen detected, those with a single pathogen detected, and those with ≥2 pathogens detected. CONCLUSION: Using a broad molecular testing approach, high rates of enteropathogens were detected in children with AGE, dominated by norovirus genogroup II and C difficile. Coinfections were common but had no identifiable impact on clinical manifestations. As routine diagnostics of AGE progressively evolve toward nucleic acid-based pathogen detection, ongoing systematic studies are needed to better analyze the clinical significance of results. |
Strain-Specific Virolysis Patterns of Human Noroviruses in Response to Alcohols.
Park GW , Collins N , Barclay L , Hu L , Prasad BV , Lopman BA , Vinje J . PLoS One 2016 11 (6) e0157787 Alcohol-based hand sanitizers are widely used to disinfect hands to prevent the spread of pathogens including noroviruses. Alcohols inactivate norovirus by destruction of the viral capsid, resulting in the leakage of viral RNA (virolysis). Since conflicting results have been reported on the susceptibility of human noroviruses against alcohols, we exposed a panel of 30 human norovirus strains (14 GI and 16 GII strains) to different concentrations (50%, 70%, 90%) of ethanol and isopropanol and tested the viral RNA titer by RT-qPCR. Viral RNA titers of 10 (71.4%), 14 (100%), 3 (21.4%) and 7 (50%) of the 14 GI strains were reduced by > 1 log10 RNA copies/ml after exposure to 70% and 90% ethanol, and 70% and 90% isopropanol, respectively. RNA titers of 6 of the 7 non-GII 4 strains remained unaffected after alcohol exposure. Compared to GII strains, GI strains were more susceptible to ethanol than to isopropanol. At 90%, both alcohols reduced RNA titers of 8 of the 9 GII.4 strains by ≥ 1 log10 RNA copies/ml. After exposure to 70% ethanol, RNA titers of GII.4 Den Haag and Sydney strains decreased by ≥ 1.9 log10, whereas RNA reductions for GII.4 New Orleans strains were < 0.5 log10. To explain these differences, we sequenced the complete capsid gene of the 9 GII.4 strains and identified 17 amino acid substitutions in the P2 region among the 3 GII.4 variant viruses. When comparing with an additional set of 200 GII.4 VP1 sequences, only S310 and P396 were present in all GII.4 New Orleans viruses but not in the ethanol-sensitive GII.4 Sydney and GII.4 Den Haag viruses Our data demonstrate that alcohol susceptibility patterns between different norovirus genotypes vary widely and that virolysis data for a single strain or genotype are not representative for all noroviruses. |
Transmission of Heartland virus (Bunyaviridae: Phlebovirus) by experimentally infected Amblyomma americanum (Acari: Ixodidae)
Godsey MS Jr , Savage HM , Burkhalter KL , Bosco-Lauth AM , Delorey MJ . J Med Entomol 2016 53 (5) 1226-1233 Heartland virus (HRTV; Bunyaviridae: Phlebovirus) is a recently described cause of human illness in the United States. After field studies conducted in 2012 implicated Amblyomma americanum (L.) as a vector of HRTV, we initiated experiments to assess the vector competence of A. americanum Larval and nymphal ticks were immersed in high-titered suspensions of HRTV, and then tested for virus at various intervals postimmersion. In a later trial larval ticks were immersed in HRTV, followed by engorgement on a rabbit. A subset of postmolt nymphs was tested for HRTV to document transstadial transmission. Putatively infected nymphs were cofed with uninfected colony larvae to assess nonviremic transmission. In another trial, nymphs were fed on a rabbit and allowed to molt to the adult stage. Male and female ticks fed and mated upon a rabbit, and females were allowed to oviposit. Male and spent female ticks were tested for HRTV, and offspring of infected females were tested to assess vertical transmission. Infection rates of ≤50% were observed in immersed larvae and nymphs tested at intervals following immersion. Transstadial transmission from larvae to nymphs and then to adults was documented. HRTV was detected in a pool of nymphs molted from uninfected larvae cofed with infected nymphs. Vertical transmission of HRTV was observed in progeny of infected females. Infected females took longer to oviposit and produced fewer offspring. Serologic conversions (without viremia) in rabbits fed upon by immersed larvae or transstadially infected ticks indicate horizontal transmission of HRTV. |
Patterns, variability, and predictors of urinary bisphenol A concentrations during childhood
Stacy SL , Eliot M , Calafat AM , Chen A , Lanphear BP , Hauser R , Papandonatos GD , Sathyanarayana S , Ye X , Yolton K , Braun JM . Environ Sci Technol 2016 50 (11) 5981-90 We examined the patterns, variability, and predictors of urinary bisphenol A (BPA) concentrations in 337 children from the Cincinnati, Ohio HOME Study. From 2003 to 2014, we collected two urine samples from women at 16 and 26 weeks of pregnancy and six urine samples from children at 1-5 and 8 years of age. We used linear mixed models to calculate intraclass correlation coefficients (ICCs) as a measure of within-person BPA variability and to identify sociodemographic and environmental predictors. For the 8-year visit, we used multivariable linear regression to explore associations between urinary BPA concentrations and exposure-related factors. We calculated daily intakes using equations estimating creatinine excretion rates and creatinine-standardized BPA concentrations. Urinary BPA concentrations, which decreased over childhood, had a low degree of reproducibility (ICC < 0.2). Estimated daily intakes decreased with age and were below the reference dose of 50 mug/kg body weight/day. BPA concentrations were positively associated with consuming food stored or heated in plastic, consuming canned food and beverages, and handling cash register receipts. Our results suggest that there are multiple sources of BPA exposure in young children. Etiological studies should collect serial urine samples to accurately classify BPA exposure and consider sociodemographic and environmental factors as possible confounders. |
Peripheral leukocyte migration in ferrets in response to infection with seasonal influenza virus
Music N , Reber AJ , Kim JH , York IA . PLoS One 2016 11 (6) e0157903 In order to better understand inflammation associated with influenza virus infection, we measured cell trafficking, via flow cytometry, to various tissues in the ferret model following infection with an A(H3N2) human seasonal influenza virus (A/Perth/16/2009). Changes in immune cells were observed in the blood, bronchoalveolar lavage fluid, and spleen, as well as lymph nodes associated with the site of infection or distant from the respiratory system. Nevertheless clinical symptoms were mild, with circulating leukocytes exhibiting rapid, dynamic, and profound changes in response to infection. Each of the biological compartments examined responded differently to influenza infection. Two days after infection, when infected ferrets showed peak fever, a marked, transient lymphopenia and granulocytosis were apparent in all infected animals. Both draining and distal lymph nodes demonstrated significant accumulation of T cells, B cells, and granulocytes at days 2 and 5 post-infection. CD8+ T cells significantly increased in spleen at days 2 and 5 post-infection; CD4+ T cells, B cells and granulocytes significantly increased at day 5. We interpret our findings as showing that lymphocytes exit the peripheral blood and differentially home to lymph nodes and tissues based on cell type and proximity to the site of infection. Monitoring leukocyte homing and trafficking will aid in providing a more detailed view of the inflammatory impact of influenza virus infection. |
Polyvalent effect enhances diglycosidic antiplasmodial activity
Zhang WQ , He Y , Yu Q , Liu HP , Wang DM , Li XB , Luo J , Meng X , Qin HJ , Lucchi NW , Udhayakumar V , Iyer SS , Yang Y , Yu P . Eur J Med Chem 2016 121 640-648 An efficient and facile total synthesis of diglycoside Matayoside D isolated from the root bark of Matayba guianensis with antiplasmodial activity have been accomplished in 11 steps with 5% overall yields starting from commercially available glucose and rhamnose. Furthermore, a class of the diglycosidic derivatives with different lengths of the linker and valences were also prepared and evaluated for their antiplasmodial activities against chloroquine-susceptible (3D7) and chloroquine-resistant (W2) strains of Plasmodium falciparum. Low valent and short linker attached diglycoside show no enhancement of the antiplasmodial activity while polyvalent conjugates showed enhanced antiplasmodial activity with IC50 value at least 20 fold better than that of the corresponding diglycosidic monomer. The polyvalent diglycoside were non-cytotoxic against normal mammalian cells under 50,000 mug/L. |
Ebola laboratory response at the Eternal Love Winning Africa Campus, Monrovia, Liberia, 2014-2015
de Wit E , Rosenke K , Fischer RJ , Marzi A , Prescott J , Bushmaker T , van Doremalen N , Emery SL , Falzarano D , Feldmann F , Groseth A , Hoenen T , Juma B , McNally KL , Ochieng M , Omballa V , Onyango CO , Owuor C , Rowe T , Safronetz D , Self J , Williamson BN , Zemtsova G , Grolla A , Kobinger G , Rayfield M , Stroher U , Strong JE , Best SM , Ebihara H , Zoon KC , Nichol ST , Nyenswah TG , Bolay FK , Massaquoi M , Feldmann H , Fields B . J Infect Dis 2016 214 S169-S176 West Africa experienced the first epidemic of Ebola virus infection, with by far the greatest number of cases in Guinea, Sierra Leone, and Liberia. The unprecedented epidemic triggered an unparalleled response, including the deployment of multiple Ebola treatment units and mobile/field diagnostic laboratories. The National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention deployed a joint laboratory to Monrovia, Liberia, in August 2014 to support the newly founded Ebola treatment unit at the Eternal Love Winning Africa (ELWA) campus. The laboratory operated initially out of a tent structure but quickly moved into a fixed-wall building owing to severe weather conditions, the need for increased security, and the high sample volume. Until May 2015, when the laboratory closed, the site handled close to 6000 clinical specimens for Ebola virus diagnosis and supported the medical staff in case patient management. Laboratory operation and safety, as well as Ebola virus diagnostic assays, are described and discussed; in addition, lessons learned for future deployments are reviewed. |
Evaluation of pulmonary and systemic toxicity following lung exposure to graphite nanoplates: A member of the graphene-based nanomaterial family
Roberts JR , Mercer RR , Stefaniak AB , Seehra MS , Geddam UK , Chaudhuri IS , Kyrlidis A , Kodali VK , Sager T , Kenyon A , Bilgesu SA , Eye T , Scabilloni JF , Leonard SS , Fix NR , Schwegler-Berry D , Farris BY , Wolfarth MG , Porter DW , Castranova V , Erdely A . Part Fibre Toxicol 2016 13 (1) 34 BACKGROUND: Graphene, a monolayer of carbon, is an engineered nanomaterial (ENM) with physical and chemical properties that may offer application advantages over other carbonaceous ENMs, such as carbon nanotubes (CNT). The goal of this study was to comparatively assess pulmonary and systemic toxicity of graphite nanoplates, a member of the graphene-based nanomaterial family, with respect to nanoplate size. METHODS: Three sizes of graphite nanoplates [20 mum lateral (Gr20), 5 mum lateral (Gr5), and <2 mum lateral (Gr1)] ranging from 8-25 nm in thickness were characterized for difference in surface area, structure,, zeta potential, and agglomeration in dispersion medium, the vehicle for in vivo studies. Mice were exposed by pharyngeal aspiration to these 3 sizes of graphite nanoplates at doses of 4 or 40 mug/mouse, or to carbon black (CB) as a carbonaceous control material. At 4 h, 1 day, 7 days, 1 month, and 2 months post-exposure, bronchoalveolar lavage was performed to collect fluid and cells for analysis of lung injury and inflammation. Particle clearance, histopathology and gene expression in lung tissue were evaluated. In addition, protein levels and gene expression were measured in blood, heart, aorta and liver to assess systemic responses. RESULTS: All Gr samples were found to be similarly composed of two graphite structures and agglomerated to varying degrees in DM in proportion to the lateral dimension. Surface area for Gr1 was approximately 7-fold greater than Gr5 and Gr20, but was less reactive reactive per m(2). At the low dose, none of the Gr materials induced toxicity. At the high dose, Gr20 and Gr5 exposure increased indices of lung inflammation and injury in lavage fluid and tissue gene expression to a greater degree and duration than Gr1 and CB. Gr5 and Gr20 showed no or minimal lung epithelial hypertrophy and hyperplasia, and no development of fibrosis by 2 months post-exposure. In addition, the aorta and liver inflammatory and acute phase genes were transiently elevated in Gr5 and Gr20, relative to Gr1. CONCLUSIONS: Pulmonary and systemic toxicity of graphite nanoplates may be dependent on lateral size and/or surface reactivity, with the graphite nanoplates > 5 mum laterally inducing greater toxicity which peaked at the early time points post-exposure relative to the 1-2 mum graphite nanoplate. |
Finite element modeling of finite deformable, biphasic biological tissues with transversely isotropic statistically distributed fibers: Toward a practical solution
Wu JZ , Herzog W , Federico S . Z Angew Math Phys 2016 67 The distribution of collagen fibers across articular cartilage layers is statistical in nature. Based on the concepts proposed in previous models, we developed a methodology to include the statistically distributed fibers across the cartilage thickness in the commercial FE software COMSOL which avoids extensive routine programming. The model includes many properties that are observed in real cartilage: finite hyperelastic deformation, depth-dependent collagen fiber concentration, depth- and deformation-dependent permeability, and statistically distributed collagen fiber orientation distribution across the cartilage thickness. Numerical tests were performed using confined and unconfined compressions. The model predictions on the depth-dependent strain distributions across the cartilage layer are consistent with the experimental data in the literature. |
Newborn screening for X-linked adrenoleukodystrophy: evidence summary and advisory committee recommendation.
Kemper AR , Brosco J , Comeau AM , Green NS , Grosse SD , Jones E , Kwon JM , Lam WK , Ojodu J , Prosser LA , Tanksley S . Genet Med 2016 19 (1) 121-126 The secretary of the US Department of Health and Human Services in February 2016 recommended that X-linked adrenoleukodystrophy (X-ALD) be added to the recommended uniform screening panel for state newborn screening programs. This decision was informed by data presented on the accuracy of screening from New York, the only state that currently offers X-ALD newborn screening, and published and unpublished data showing health benefits of earlier treatment (hematopoietic stem cell transplantation and adrenal hormone replacement therapy) for the childhood cerebral form of X-ALD. X-ALD newborn screening also identifies individuals with later-onset disease, but poor genotype-phenotype correlation makes predicting health outcomes difficult and might increase the risk of unnecessary treatment. Few data are available regarding the harms of screening and presymptomatic identification. Significant challenges exist for implementing comprehensive X-ALD newborn screening, including incorporation of the test, coordinating follow-up diagnostic and treatment care, and coordination of extended family testing after case identification. |
Rate of second and third trimester weight gain and preterm delivery among underweight and normal weight women
Sharma AJ , Vesco KK , Bulkley J , Callaghan WM , Bruce FC , Staab J , Hornbrook MC , Berg CJ . Matern Child Health J 2016 20 (10) 2030-6 Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m2. However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m2 who delivered a live-birth ≥28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care ≤13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWGrate) during the second and third trimesters of pregnancy. We also estimated GWGrate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWGrate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWGrate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWGrate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWGrate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWGrate within the second quartile. Further stratifying by reason, GWGrate in the lowest quartile was positively associated with spontaneous PTD while GWGrate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWGrate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents. |
School-based health centers to advance health equity: A Community Guide systematic review
Knopf JA , Finnie RK , Peng Y , Hahn RA , Truman BI , Vernon-Smiley M , Johnson VC , Johnson RL , Fielding JE , Muntaner C , Hunt PC , Phyllis Jones C , Fullilove MT . Am J Prev Med 2016 51 (1) 114-26 CONTEXT: Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. EVIDENCE ACQUISITION: A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. EVIDENCE SYNTHESIS: Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. CONCLUSIONS: Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity. |
Twinning and major birth defects, National Birth Defects Prevention Study, 1997-2007
Dawson AL , Tinker SC , Jamieson DJ , Hobbs CA , Berry RJ , Rasmussen SA , Anderka M , Keppler-Noreuil KM , Lin AE , Reefhuis J . J Epidemiol Community Health 2016 70 (11) 1114-1121 BACKGROUND: Twinning has been associated with many types of birth defects, although previous studies have had inconsistent findings. Many studies lack information about potential confounders, particularly use of fertility treatment. Our objective was to assess the association between twinning and birth defects in the National Birth Defects Prevention Study (NBDPS). METHODS: We used data from the NBDPS, a population-based, case-control study of major birth defects in the USA, to evaluate associations between twinning and birth defects. The study population included mothers of twin and singleton controls (live-born infants without major birth defects), and cases (fetuses or infants with a major birth defect) born October 1997-December 2007. Adjusted ORs and 95% CIs were estimated using multivariable logistic regression stratified by use of fertility treatment. Twin sex-pairing data and a simulation approach were used to estimate the zygosity of twins. RESULTS: In the unassisted conception stratum, we observed significant positive associations between twinning and 29 of 45 defect groups. The largest effect estimates were observed for multiple ventricular septal defects and cloacal exstrophy. Among mothers reporting any use of fertility treatments, we observed a significant association with twinning for 5 of 25 defect groups, with the largest effect estimates for hypoplastic left heart syndrome and omphalocele. OR estimates in the estimated monozygotic stratum were generally further from the null than in the dizygotic stratum. CONCLUSIONS: Compared with singletons, a wide range of birth defects are significantly more common among twins. Birth defect risk in twins may be differential by use of fertility treatment. |
Recognizing occupational effects of diacetyl: What can we learn from this history?
Kreiss K . Toxicology 2016 388 48-54 For half of the 30-odd years that diacetyl-exposed workers have developed disabling lung disease, obliterative bronchiolitis was unrecognized as an occupational risk. Delays in its recognition as an occupational lung disease are attributable to the absence of a work-related temporal pattern of symptoms; failure to recognize clusters of cases; complexity of exposure environments; and absence of epidemiologic characterization of workforces giving rise to case clusters. Few physicians are familiar with this rare disease, and motivation to investigate the unknown requires familiarity with what is known and what is anomalous. In pursuit of the previously undescribed risk, investigators benefited greatly from multi-disciplinary collaboration, in this case including physicians, epidemiologists, environmental scientists, toxicologists, industry representatives, and worker advocates. In the 15 years since obliterative bronchiolitis was described in microwave popcorn workers, alpha-dicarbonyl-related lung disease has been found in flavoring manufacturing workers, other food production workers, diacetyl manufacturing workers, and coffee production workers, alongside case reports in other industries. Within the field of occupational health, impacts include new ventures in public health surveillance, attention to spirometry quality for serial measurements, identifying other indolent causes of obliterative bronchiolitis apart from accidental over-exposures, and broadening the spectrum of diagnostic abnormalities in the disease. Within toxicology, impacts include new attention to appropriate animal models of obliterative bronchiolitis, pertinence of computational fluid dynamic-physiologically based pharmacokinetic modeling, and contributions to mechanistic understanding of respiratory epithelial necrosis, airway fibrosis, and central nervous system effects. In these continuing efforts, collaboration between laboratory scientists, clinicians, occupational public health practitioners in government and industry, and employers remains critical for improving the health of workers inhaling volatile alpha-dicarbonyl compounds. |
Treated and untreated rock dust: Quartz content and physical characterization
Soo JC , Lee T , Chisholm WP , Farcas D , Schwegler-Berry D , Harper M . J Occup Environ Hyg 2016 13 (11) 0 Rock dusting is used to prevent secondary explosions in coal mines, but inhalation of rock dusts can be hazardous if the crystalline silica (e.g., quartz) content in the respirable fraction is high. The objective of this study is to assess the quartz content and physical characteristics of four selected rock dusts, consisting of limestone or marble in both treated (such as treatment with stearic acid or stearates) and untreated forms. Four selected rock dusts (an untreated and treated limestone and an untreated and treated marble) were aerosolized in an aerosol chamber. Respirable size-selective sampling was conducted along with particle size-segregated sampling using a Micro-Orifice Uniform Deposit Impactor. Fourier Transform Infrared spectroscopy and scanning electron microscopy with energy-dispersive X-ray (SEM-EDX) analyses were used to determine quartz mass and particle morphology, respectively. Quartz percentage in the respirable dust fraction of untreated and treated forms of the limestone dust was significantly higher than in bulk samples, but since the bulk percentage was low the enrichment factor would not have resulted in any major change to conclusions regarding the contribution of respirable rock dust to the overall airborne quartz concentration. The quartz percentage in the marble dust (untreated and treated) was very low and the respirable fractions showed no enrichment. The spectra from SEM-EDX analysis for all materials were predominantly from calcium carbonate, clay, and gypsum particles. No free quartz particles were observed. The four rock dusts used in this study are representative of those presented for use in rock dusting, but the conclusions may not be applicable to all available materials. |
The attributable proportion of specific leisure-time physical activities to total leisure activity volume among US adults, National Health and Nutrition Examination Survey 1999-2006
Watson KB , Dai S , Paul P , Carlson SA , Carroll DD , Fulton J . J Phys Act Health 2016 13 (11) 1192-1201 BACKGROUND: Previous studies have examined participation in specific leisure-time physical activities (PA) among US adults. The purpose of this study was to identify specific activities that contribute substantially to total volume of leisure-time PA in US adults. METHODS: Proportion of total volume of leisure-time PA moderate-equivalent minutes attributable to 9 specific types of activities was estimated using self-reported data from 21,685 adult participants (≥ 18 years) in the National Health and Nutrition Examination Survey 1999- 2006. RESULTS: Overall, walking (28%), sports (22%), and dancing (9%) contributed most to PA volume. Attributable proportion was higher among men than women for sports (30% vs. 11%) and higher among women than men for walking (36% vs. 23%), dancing (16% vs. 4%), and conditioning exercises (10% vs. 5%). The proportion was lower for walking, but higher for sports, among active adults than those insufficiently active and increased with age for walking. Compared with other racial/ethnic groups, the proportion was lower for sports among non- Hispanic white men and for dancing among non-Hispanic white women. CONCLUSIONS: Walking, sports, and dance account for the most activity time among US adults overall, yet some demographic variations exist. Strategies for PA promotion should be tailored to differences across population subgroups. |
State and local comprehensive smoke-free laws for worksites, restaurants, and bars - United States, 2015
Tynan MA , Holmes CB , Promoff G , Hallett C , Hopkins M , Frick B . MMWR Morb Mortal Wkly Rep 2016 65 (24) 623-6 Exposure to secondhand smoke from burning tobacco products causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth. Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year. This report updates a previous CDC report that evaluated state smoke-free laws in effect from 2000-2010, and estimates the proportion of the population protected by comprehensive smoke-free laws. The number of states, including the District of Columbia (DC), with comprehensive smoke-free laws (statutes that prohibit smoking in indoor areas of worksites, restaurants, and bars) increased from zero in 2000 to 26 in 2010 and 27 in 2015. The percentage of the U.S. population that is protected increased from 2.72% in 2000 to 47.8% in 2010 and 49.6% in 2015. Regional disparities remain in the proportions of state populations covered by state or local comprehensive smoke-free policies, as no state in the southeast has a state comprehensive law. In addition, nine of the 24 states that lack state comprehensive smoke-free laws also lack any local comprehensive smoke-free laws. Opportunities exist to accelerate the adoption of smoke-free laws in states that lack local comprehensive smoke-free laws, including those in the south, to protect nonsmokers from the harmful effects of secondhand smoke exposure. |
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