Prognostic implications of the urinary albumin to creatinine ratio in veterans of different ages with diabetes
O'Hare AM , Hailpern SM , Pavkov ME , Rios-Burrows N , Gupta I , Maynard C , Todd-Stenberg J , Rodriguez RA , Hemmelgarn BR , Saran R , Williams DE . Arch Intern Med 2010 170 (11) 930-6 BACKGROUND: Albuminuria is associated with an increased risk of death independent of level of renal function. Whether this association is similar for adults of all ages is not known. METHODS: We examined the association between the albumin to creatinine ratio (ACR) and all-cause mortality after stratification by estimated glomerular filtration rate (eGFR) and age group in 94 934 veterans with diabetes mellitus. Cohort members had at least 1 ACR recorded in the Veterans Affairs Health Care System between October 1, 2002, and September 30, 2003, and were followed up for death through October 15, 2009. RESULTS: From the youngest to the oldest age group, the prevalence of an eGFR less than 60 mL/min/1.73 m(2) ranged from 11% to 41%; microalbuminuria (ACR 30-299 mg/g) ranged from 19% to 28%; and macroalbuminuria (ACR > or =300 mg/g) ranged from 3.2% to 3.7%. Of patients with an eGFR less than 60 mL/min/1.73 m(2), 72% of those younger than 65 years, 74% of those 65 to 74 years old, and 59% of those 75 years and older had an eGFR of 45 to 59 mL/min/1.73 m(2). In all age groups, less than 35% of these patients had albuminuria (ie, ACR > or =30 mg/g). In patients 75 years and older, the ACR was independently associated with an increased risk of death at all levels of eGFR after adjusting for potential confounders. In younger age groups, this association was present at higher levels of eGFRs but seemed to be attenuated at lower levels. CONCLUSION: The ACR is independently associated with mortality at all levels of eGFR in older adults with diabetes and may be particularly helpful for risk stratification in the large group with moderate reductions in eGFR. |
Molecular epidemiology of syphilis-San Francisco, 2004-2007
Katz KA , Pillay A , Ahrens K , Kohn RP , Hermanstyne K , Bernstein KT , Ballard RC , Klausner JD . Sex Transm Dis 2010 37 (10) 660-3 We describe the molecular epidemiology of syphilis in San Francisco (SF) using Treponema pallidum specimens obtained from patients examined at the SF municipal sexually transmitted diseases clinic during 2004-2007. Of 69 specimens, 52 (75%) were subtype 14d9. Single subtype predominance might reflect a closely linked sexual network in SF. |
Expedited partner therapy: a robust intervention
Shiely F , Hayes K , Thomas KK , Kerani RP , Hughes JP , Whittington WL , Holmes KK , Handsfield HH , Hogben M , Golden MR . Sex Transm Dis 2010 37 (10) 602-7 BACKGROUND: Expedited partner therapy (EPT) has been shown to reduce the risk of persistent or recurrent gonorrhea and chlamydial infection in heterosexuals, and to increase the proportion of sex partners receiving treatment. The objective of this analysis was to evaluate the consistency of EPT's effect across sociodemographic and behavioral subgroups. METHODS: Subset analyses from a randomized controlled trial compared EPT to standard partner referral (SPR) in sociodemographic and behaviorally defined subgroups. Outcomes included persistent or recurrent infection in study participants and participants' report that their partners received treatment. RESULTS: Reinfection risk was lower among EPT recipients than nonrecipients in 21 of 22 subgroups, with relative risks (RRs) varying from 0.4 to 0.94. Compared to persons receiving SPR, persons receiving EPT were more likely to report that their partners were very likely to have been treated in 33 of 34 subgroups (RRs range, 1.03-1.36). Although EPT reduced the risk of persistent or recurrent infection somewhat more in men (RR, 0.56; 95% CI, 0.3-1.08) than in women (RR, 0.81; 95% CI, 0.61-1.07) and more in persons with gonorrhea (RR, 0.32; 95% CI, 0.13-0.78) than those with chlamydial infection (RR, 0.82; 95% CI, 0.63-1.07), the RR of partners being treated associated with EPT was similar in men (RR, 1.21; 95% CI, 1.05-1.39) and women (RR, 1.18; 95% CI, 1.10-1.27), and also in persons with gonorrhea (RR, 1.33; 95% CI, 0.80-2.23) and chlamydial infection (RR, 1.33; 95% CI, 1.07-1.66). CONCLUSIONS: In this study, EPT is shown to be superior to SPR across a wide spectrum of sociodemographic and behaviorally defined subgroups. |
Incubation periods of yellow fever virus
Johansson MA , Arana-Vizcarrondo N , Biggerstaff BJ , Staples JE . Am J Trop Med Hyg 2010 83 (1) 183-8 Yellow fever virus is a global health threat due to its endemicity in parts of Africa and South America where human infections occur in residents and travelers. To understand yellow fever dynamics, it is critical to characterize the incubation periods of the virus in vector mosquitoes and humans. Here, we compare four statistical models of the yellow fever incubation periods fitted with historical data. The extrinsic incubation period in the urban vector Aedes aegypti was best characterized with a temperature-dependent Weibull model with a median of 10 days at 25 degrees C (middle 95% = 2.0-37 days). The intrinsic incubation period, fitted with a log-normal model, had a median of 4.3 days (middle 95% = 2.3-8.6 days). These estimates and their associated statistical models provide a quantitative basis to assist in exposure assessments, model potential outbreaks, and evaluate the effectiveness of public health interventions. |
Identification of potential vectors of and detection of antibodies against Rift Valley fever virus in livestock during interepizootic periods
Rostal MK , Evans AL , Sang R , Gikundi S , Wakhule L , Munyua P , Macharia J , Feikin DR , Breiman RF , Njenga MK . Am J Vet Res 2010 71 (5) 522-6 OBJECTIVE: To evaluate the prevalence of Rift Valley fever virus (RVFV) antibodies in livestock and presence of competent mosquito vectors of RVFV during an interepizootic period (IEP) in Kenya. ANIMALS: 208 sheep and 84 goats ranging in age from 4 months to 15 years, from 2 breeding herds. PROCEDURES: Blood specimens were collected from the sheep and goats during the 1999-2006 IEP in Rift Valley Province, and serum was harvested. Serum specimens were tested for IgG and IgM antibodies against RVFV by use of an ELISA. In addition, 7,134 mosquitoes were trapped in Naivasha, Nairobi, and Northeastern Province, and speciation was performed. RESULTS: No animals were seropositive for IgM against RVFV. Of the animals born after the 1997-1998 epizootic, 18% (34/188) of sheep were seropositive for IgG against RVFV, compared with 3% (2/75) of goats. Seventy percent (8,144/11,678) of the mosquitoes collected were of the Culex subgenera; 18% (2,102/11,678) were Aedes spp. CONCLUSIONS AND CLINICAL RELEVANCE: Detection of IgG in the sera of sheep and goats born after the 1997-1998 epizootic and before the 2006 epizootic indicated that virus activity existed during the IEP. Detection of Aedes mosquitoes, which are competent vectors of RVFV, suggested that a cryptic vector-to-vertebrate cycle may exist during IEPs. |
Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected Lyme Disease
Holzbauer SM , Kemperman MM , Lynfield R . Clin Infect Dis 2010 51 (3) 369-70 Clostridium difficile infections can occur outside the hospital in association with antibiotic use and can result in fulminant colitis and death. In December 2009, the Minnesota Department of Health investigated a death due to C. difficile of a 52-year-old woman with no recent hospitalizations. | In June 2009, the patient sought care for symptoms of fatigue, insomnia, achy joints, memory loss, and confusion. These symptoms had been present for >5 years and had worsened in the past 2 years. She received a diagnosis of a relapse of depression. In August, on the basis of responses to a “Lyme Disease Questionnaire/Checklist” given at a health care visit, Lyme disease serologic tests were performed in a California laboratory. Results were indeterminate by immunofluorescence assay and were IgM-positive (2 of 3 bands) but IgG-negative (3 of 10 bands) on Western blot. She was placed on a 5week course of doxycycline for possible Lyme disease. The patient's symptoms improved but then worsened after completion of antibiotics. Both her primary physician and a rheumatologist found no objective evidence of Lyme disease in October. In November, without further Lyme disease testing, another physician prescribed oral cefuroxime and telithromycin for a planned 2–4 months to treat chronic Lyme disease. Five weeks after initiating this therapy, the patient developed diarrhea for 3 days and received a diagnosis of C. difficile colitis. An enzyme immunoassay was positive for C. difficile toxin A and B. Because she had no overnight stays in a health care facility in the 12 weeks prior, she was classified as having a community-associated C. difficile infection. The patient was started on oral metronidazole therapy but was hospitalized 2 days later with severe abdominal pain secondary to diffuse colitis and abdominal ascites. The next morning, she experienced cardiac arrest twice and succumbed to cardiac arrest during an emergency colectomy. Pseudomembranes were noted in the colon, and C. difficile was isolated from stool. The isolate was toxinotype III, binary toxin positive, and contained a 36– base pair tcdC deletion. |
Disinfection by-product formation and mitigation strategies in point-of-use chlorination with sodium dichloroisocyanurate in Tanzania
Lantagne DS , Cardinali F , Blount BC . Am J Trop Med Hyg 2010 83 (1) 135-43 Almost a billion persons lack access to improved drinking water, and diarrheal diseases cause an estimated 1.87 million deaths per year. Sodium dichloroisocyanurate (NaDCC) tablets are widely recommended for household water treatment to reduce diarrhea. Because NaDCC is directly added to untreated water sources, concerns have been raised about the potential health impact of disinfection by-products. This study investigated trihalomethane (THM) production in water from six sources used for drinking (0.6-888.5 nephelometric turbidity units) near Arusha, Tanzania. No sample collected at 1, 8, and 24 hours after NaDCC addition exceeded the World Health Organization guideline values for either individual or total THMs. Ceramic filtration, sand filtration, cloth filtration, and settling and decanting were not effective mitigation strategies to reduce THM formation. Chlorine residual and THM formation were not significantly different in NaDCC and sodium hypochlorite treatment. Household chlorination of turbid and non-turbid waters did not create THM concentrations that exceeded health risk guidelines. |
Rocky mountain spotted fever in the United States, 2000-2007: interpreting contemporary increases in incidence
Openshaw JJ , Swerdlow DL , Krebs JW , Holman RC , Mandel E , Harvey A , Haberling D , Massung RF , McQuiston JH . Am J Trop Med Hyg 2010 83 (1) 174-82 Rocky Mountain spotted fever (RMSF), a potentially fatal tick-borne infection caused by Rickettsia rickettsii, is considered a notifiable condition in the United States. During 2000 to 2007, the annual reported incidence of RMSF increased from 1.7 to 7 cases per million persons from 2000 to 2007, the highest rate ever recorded. American Indians had a significantly higher incidence than other race groups. Children 5-9 years of age appeared at highest risk for fatal outcome. Enzyme-linked immunosorbent assays became more widely available beginning in 2004 and were used to diagnose 38% of cases during 2005-2007. The proportion of cases classified as confirmed RMSF decreased from 15% in 2000 to 4% in 2007. Concomitantly, case fatality decreased from 2.2% to 0.3%. The decreasing proportion of confirmed cases and cases with fatal outcome suggests that changes in diagnostic and surveillance practices may be influencing the observed increase in reported incidence rates. |
Understanding people who have never received HIV medical care: a population-based approach
Fagan JL , Bertolli J , McNaghten AD . Public Health Rep 2010 125 (4) 520-7 A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis. Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project. |
Molecular epidemiology of group A rotavirus in Buenos Aires, Argentina 2004-2007: reemergence of G2P[4] and emergence of G9P[8] strains
Esteban LE , Rota RP , Gentsch JR , Jiang B , Esona M , Glass RI , Glikmann G , Castello AA . J Med Virol 2010 82 (6) 1083-1093 Detection and characterization of group A rotavirus in Buenos Aires, Argentina, was conducted on 710 fecal samples from children 0-15 years old collected between 2004 and 2007. Rotavirus was detected in 140 (19.7%) samples with G9P[8] (30.0%) and G2P[4] (21.4%) as the most common genotypes. Mixed (G and/or P) infections accounted for 17.9% of the samples and the emerging G12 strain was detected during 2004 (3.5%) and 2007 (2.5%). Genotype G2 was the most prevalent during 2004 (43.9%) and 2007 (57.5%) and G9 during 2005 (58.0%) and 2006 (61.5%). Analysis of genotype prevalences from studies performed since 1996 in the same area showed striking natural fluctuations in G and P genotype frequencies. In particular, G2P[4] strains disappeared after 1999 and reemerged in 2004 to become the predominant strain by 2007 with a concomitant major decrease in G1P[8] prevalence. The VP7 genes from Argentinian G9 and G2 strains were sequenced and phylogenetic analysis was conducted in order to compare with sequences from strains isolated in regional countries reported previously. Several changes in the deduced amino acid sequence in antigenic regions of the VP7 protein from Argentinian and Brazilian strains were identified compared to vaccine strains. Overall, this study revealed relationships in the circulation of rotavirus strains in South American countries and major replacements in dominant genotypes, including the virtual disappearance of G1P[8] strains in a non-vaccinated population. High numbers of mixed infections speeding up evolution, circulation of rare serotypes, and antigenic drift could, eventually,become challenges for new vaccines. copyright 2010 Wiley-Liss, Inc. |
Quantification of print, radio and television exposure among previous blood donors in Kenya: an opportunity for encouraging repeat donation in a resource-limited setting?
Basavaraju SV , Mwangi J , Kellogg TA , Odawo L , Marum LH , 2007 Kenya AIDS Indicator Survey Group . Vox Sang 2010 99 (3) 274-7 Blood services in sub-Saharan Africa experience blood shortages and low retention of voluntary, non-remunerated donors. To boost collections by encouraging repeat donations, the Kenya National Blood Transfusion Service is exploring the likelihood of reaching previous donors through targeted print, radio and television advertising. We analysed data from a national AIDS Indicator Survey to determine whether previous donors have significant exposure to media. Respondents reporting history of blood donation had significantly higher exposure to print, radio and television media than those without history of blood donation. Targeted media campaigns encouraging repeat donation are likely to reach previous donors even in resource-limited settings. |
Maternal or infant antiretroviral drugs to reduce HIV-1 transmission
Chasela CS , Hudgens MG , Jamieson DJ , Kayira D , Hosseinipour MC , Kourtis AP , Martinson F , Tegha G , Knight RJ , Ahmed YI , Kamwendo DD , Hoffman IF , Ellington SR , Kacheche Z , Soko A , Wiener JB , Fiscus SA , Kazembe P , Mofolo IA , Chigwenembe M , Sichali DS , van der Horst CM . N Engl J Med 2010 362 (24) 2271-81 BACKGROUND: We evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 (HIV-1) in Malawi. METHODS: We randomly assigned 2369 HIV-1-positive, breast-feeding mothers with a CD4+ lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen, infant nevirapine, or no extended postnatal antiretroviral regimen (control group). All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine. We used the Kaplan-Meier method to estimate the cumulative risk of HIV-1 transmission or death by 28 weeks among infants who were HIV-1-negative 2 weeks after birth. Rates were compared with the use of the log-rank test. RESULTS: Among mother-infant pairs, 5.0% of infants were HIV-1-positive at 2 weeks of life. The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group (5.7%) than in either the maternal-regimen group (2.9%, P=0.009) or the infant-regimen group (1.7%, P<0.001). The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0% in the control group, 4.1% in the maternal-regimen group (P=0.02), and 2.6% in the infant-regimen group (P<0.001). The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen (6.2%) than among those in either the nevirapine group (2.6%) or the control group (2.3%). Among infants receiving nevirapine, 1.9% had a hypersensitivity reaction. CONCLUSIONS: The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding. (ClinicalTrials.gov number, NCT00164736.) |
Guillain-Barre syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data
Sejvar JJ , Kohl KS , Gidudu J , Amato A , Bakshi N , Baxter R , Burwen D , Cornblath DR , Cleerbout J , Edwards KM , Heininger U , Hughes R , Khuri-Bulos N , Korinthenberg R , Law BJ , Munro U , Maltezou HC , Nell P , Oleske J , Sparks R , Velentgas P , Vermeer P , Wiznitzer M . Vaccine 2010 29 (3) 599-612 Among the various events reported as adverse outcomes following immunizations, neurologic adverse events following immunization (AEFI) are among the most severe and the most difficult to assess. The multifaceted presentation of neurologic illness, the relative lack of familiarity of many clinicians with the approach to and diagnosis of neurologic disease, and the relative scarcity of trained neurologists in many parts of the world make neurologic AEFI some of the most challenging issues in clinical vaccinology. Further, the severity of central and peripheral nervous system events in individual patients often heightens the concern when such illnesses are associated with antecedent immunizations. The lack of a common definition of GBS and FS hinders comparability and uniform reporting of these adverse events. | Sections 2 Clinical case definitions: Guillain–Barré syndrome (GBS), 3 Guidelines for data collection, analysis, and presentation of GBS and FS as adverse events following immunization of this paper provide the case definitions and guidelines for data collection, analysis, and presentation that the Brighton Collaboration GBS Working Group (hereafter referred to as the Working Group) has developed for the standardized collection and assessment of information about GBS and FS. Widespread use of these definitions with their guidelines will improve data comparability and allow for a better understanding of these neurological events that are applicable in study settings with different availability of resources, in health care settings that differ by availability of and access to health care, and in different geographic regions. |
The association between intentional delay of vaccine administration and timely childhood vaccination coverage
Smith PJ , Humiston SG , Parnell T , Vannice KS , Salmon DA . Public Health Rep 2010 125 (4) 534-41 OBJECTIVES: We evaluated the association between intentional delay of vaccine administration and timely vaccination coverage. METHODS: We used data from 2,921 parents of 19- to 35-month-old children that included parents' reports of intentional delay of vaccine administration. Timely vaccination was defined as administration with > or = 4 doses of diphtheria, tetanus, and pertussis; > or = 3 doses of polio vaccine; > or = 1 dose of measles, mumps, and rubella vaccine; > or = 3 doses of Haemophilus influenzae type b vaccine; > or = 3 doses of hepatitis B vaccine; and > or = 1 dose of varicella vaccine by 19 months of age, as reported by vaccination providers. RESULTS: In all, 21.8% of parents reported intentionally delaying vaccinations for their children. Among parents who intentionally delayed, 44.8% did so because of concerns about vaccine safety or efficacy and 36.1% delayed because of an ill child. Children whose parents intentionally delayed were significantly less likely to receive all vaccines by 19 months of age than children whose parents did not delay (35.4% vs. 60.1%, p < 0.05). Parents who intentionally delayed were significantly more likely to have heard or read unfavorable information about vaccines than parents who did not intentionally delay (87.6% vs. 71.9%, p < 0.05). Compared with parents who intentionally delayed only because their child was ill, parents who intentionally delayed only because of vaccine safety or efficacy concerns were significantly more likely to seek additional information about their decision from the Internet (11.4% vs. 1.1%, p < 0.05), and significantly less likely to seek information from a doctor (73.9% vs. 93.9%, p < 0.05). CONCLUSIONS: Intentionally delayed vaccine doses are not uncommon. Children whose parents delay vaccinations may be at increased risk of not receiving all recommended vaccine doses by 19 months of age and are more vulnerable to vaccine-preventable diseases. Providers should consider strategies such as educational materials that address parents' vaccine safety and efficacy concerns to encourage timely vaccination. |
Alcohol-related injury visits: do we know the true prevalence in U.S. trauma centres?
MacLeod JB , Hungerford DW . Injury 2010 42 (9) 922-6 INTRODUCTION: Alcohol consumption is a significant risk factor for injuries. Further, level I trauma centres are mandated to screen and provide a brief intervention for identified problem drinkers. However, a valid population-based estimate of the magnitude of the problem is unknown. Therefore, the goal of this study is to evaluate the extent to which the present literature provides a valid estimate of the prevalence of alcohol-related visits to U.S. trauma centres. METHODS: A Medline search for all articles from 1966 to 2007 that might provide prevalence estimates of alcohol-related visits to U.S. trauma centres yielded 836 articles in English language journals. This review included only papers whose main or secondary goal was to estimate the prevalence of positive blood alcohol concentration (BAC) or acute intoxication. Both a crude aggregate estimate and sample size adjusted estimate were calculated from the included papers and the coverage and comparability of methods were evaluated. RESULTS: Of the 15 studies that met inclusion criteria, incidence estimates of alcohol-related visits ranged from 26.2% to 62.5% and yielded an aggregate, weighted estimate of 32.5%. Target population, capture rate, and threshold for a positive screening result varied considerably across studies. No study provided a comprehensive estimate, i.e., of all trauma patients hospitalised, treated and released, or who died. CONCLUSIONS: Although the incidence of alcohol-related visits to U.S. trauma centres appears very high perhaps higher than any other medical setting, the validity of our aggregate estimate is threatened by crucial methodological considerations. The lack of a methodologically valid prevalence estimate hinders efforts to devise appropriate policies for trauma centres and across medical settings. |
Formulation and stability of a novel artificial human sweat under conditions of storage and use
Harvey CJ , Lebouf RF , Stefaniak AB . Toxicol In Vitro 2010 24 (6) 1790-6 A limitation of most artificial sweat formulations used for in vitro assessment of chemical release from materials in contact with skin have little biological relevance to human sweat. The purposes of this paper are to provide guidance for preparation of a novel artificial sweat with chemical constituents at concentrations that match human sweat and to characterize chemical stability. The artificial sweat was characterized under conditions of use (with and without sebum at 36 degrees C) and storage (without sebum at -4, 4, and 23 degrees C) over 28 days by gas chromatography-mass spectroscopy, high-performance liquid chromatography, enzymatic assay kits, and ion-selective electrodes. Seven indicator constituents were tracked: sodium, chloride, glucose, lactic acid, urea, pantothenic acid, and alanine. With or without sebum at 36 degrees C, the sweat solvent was chemically stable for 14 days. Storage by refrigeration at 4 degrees C retained the chemical integrity of the solvent longest. Based on these results, the solvent should be used within 14 days of preparation. The artificial sweat model presented herein is most similar to human sweat and has applications as a dissolution solvent, donor solution in diffusion cells, or vehicle for patch testing. This sweat model may aid researchers in understanding potential release and percutaneous absorption of chemicals in contact with human skin surface liquids. |
Gold nanorod delivery of an ssRNA immune activator inhibits pandemic H1N1 influenza viral replication
Chakravarthy KV , Bonoiu AC , Davis WG , Ranjan P , Ding H , Hu R , Bowzard JB , Bergey EJ , Katz JM , Knight PR , Sambhara S , Prasad PN . Proc Natl Acad Sci U S A 2010 107 (22) 10172-7 The emergence of the pandemic 2009 H1N1 influenza virus has become a world-wide health concern. As drug resistance appears, a new generation of therapeutic strategies will be required. Here, we introduce a nanotechnology approach for the therapy of pan-demic and seasonal influenza virus infections. This approach uses gold nanorods (GNRs) to deliver an innate immune activator, producing a localized therapeutic response. We demonstrated the utility of a biocompatible gold nanorod, GNR-5'PPP-ssRNA nanoplex, as an antiviral strategy against type A influenza virus. In human respiratory bronchial epithelial cells, this nanoplex activated the retinoic acid-inducible gene I (RIG-I) pathogen recognition pathway, resulting in increased expression of IFN-beta and other IFN-stimulated genes (ISGs) (e.g., PKR, MDA5, IRF1, IRF7, and MX1). This increase in type I IFN and ISGs resulted in a decrease in the replication of H1N1 influenza viruses. These findings suggest that further evaluation of biocompatible nanoplexes as unique antivirals for treatment of seasonal and pandemic influenza viruses is warranted. |
Association between IL-1A single nucleotide polymorphisms and chronic beryllium disease and beryllium sensitization
McCanlies EC , Yucesoy B , Mnatsakanova A , Slaven JE , Andrew M , Frye BL , Schuler CR , Kreiss K , Weston A . J Occup Environ Med 2010 52 (7) 680-4 OBJECTIVE: To determine if single nucleotide polymorphisms (SNPs) in interleukin (IL) IL-1A, IL-1B, IL-1RN, IL-2, IL-9, and IL-9R were associated with chronic beryllium disease (CBD) and beryllium sensitization (BeS). METHODS: Forty SNPs in six IL genes were evaluated in 85 individuals with CBD, 61 individuals with BeS, and 730 individuals without BeS or CBD (nonsensitized) using a 5' nuclease polymerase chain reaction assay. Logistic regression was used to evaluate the association between IL SNPs, CBD, and BeS, adjusting for plant-site and HLA-DPB1 in additive, dominant, and recessive inheritance models. RESULTS: IL-1A-1142, IL-1A-3769, and IL-1A-4697 were significantly associated with CBD in both the additive and dominant models compared to individuals with BeS or the nonsensitized. CONCLUSIONS: These results indicate that genetic variations in the IL-1A gene may play a role in the development of CBD but not BeS. |
Development of an RNA extraction protocol for detection of waterborne viruses by reverse transcriptase quantitative PCR (RT-qPCR)
Jothikumar N , Sobsey MD , Cromeans TL . J Virol Methods 2010 169 (1) 8-12 RNA extraction from environmental samples yields frequently an RNA preparation containing inhibitors of molecular reactions. Commercial RNA extraction kits commonly permit extraction of only 0.1 - 0.2ml sample volume. An RNA extraction buffer (RNAX buffer) was formulated for the extraction of viral RNA from 4.0ml using a silica column based protocol. To evaluate the RNAX buffer based protocol, we used hepatitis A virus (HAV) and coxsackievirus B3 (CVB3) to monitor the RNA extraction efficiency from environmental samples. For evaluation of viral RNA recovery from water concentrates which were prepared from river and pond water by PEG concentration. Serial ten fold dilutions of two waterborne viruses were added to the water concentrates for detection for evaluation by quantitative detection. Quantitative recovery of HAV and CVB3 was determined by reverse transcriptase quantitative real-time PCR (RT-qPCR). The extracted RNA was compatible with RT-qPCR and sensitivity of detection of 0.8 PFU per reaction was found with RNAX buffer and the developed protocol. This level of sensitivity was obtained using viral RNA extracted from 4.0ml of an inoculated water sample concentrate. The RNAX buffer developed in this study could be applicable to the detection of other pathogens in water and food. |
Maternal and neonatal vitamin B12 deficiency detected through expanded newborn screening--United States, 2003-2007
Hinton CF , Ojodu JA , Fernhoff PM , Rasmussen SA , Scanlon KS , Hannon WH . J Pediatr 2010 157 (1) 162-3 The incidence of neonatal vitamin B12 (cobalamin) deficiency because of maternal deficiency was determined by surveying state newborn screening programs. Thirty-two infants with nutritional vitamin B12 deficiency were identified (0.88/100,000 newborns). Pregnant women should be assessed for their risk of inadequate intake/malabsorption of vitamin B12. |
Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System
Martin JA , Osterman MJ , Sutton PD . NCHS Data Brief 2010 (39) 1-8 The U.S. preterm birth rate (less than 37 weeks of gestation) rose by more than one-third from the early 1980s through 2006 (1). This rise has been a cause of great concern (2,3). Preterm infants are at increased risk of life-long disability and early death compared with infants born later in pregnancy (2,4). Many reasons, such as changes in maternal demographics and increases in multiple births, have been suggested for the growth in preterm births (5). Another factor cited is the heightened use of obstetric interventions such as induction of labor and cesarean delivery earlier in pregnancy (5,6,7). Although it is not possible to know whether an infant would be born preterm if labor was not induced or delivered by cesarean, studies suggest that increased use of these procedures before 37 completed weeks of gestation may have influenced the upswing in preterm birth rates (6,7). Preliminary 2007 and 2008 birth certificate data reveal a shift in the long upward trend in preterm births (8,9). This report describes this change. |
Agricultural tractor overturn deaths: assessment of trends and risk factors
Myers JR , Hendricks KJ . Am J Ind Med 2010 53 (7) 662-72 BACKGROUND: Tractor overturn deaths have been recognized as a public health concern for decades. Studies have reported on the hazards associated with tractor overturns, but none have reported on trends in tractor overturn fatality rates in the United States (US). METHODS: Tractor overturn fatality data from the Bureau of Labor Statistics Census of Fatal Occupational Injuries were used in Poisson regression models to: identify risk factors associated with overturn fatalities; examine trends in tractor overturn fatality rates between 1992 and 2007; and assess trends in overturn fatality rates for specific risk factors. RESULTS: Characteristics found to be associated with tractor overturn fatality rates were age, type of farm, region, and the victim's relationship to the farm (P < 0.0001). Older age groups, crop farms, farms in the Midwest and Northeast, and family workers all had higher fatal tractor overturn risks. Overall, tractor overturn fatality rates declined 28.5% between 1992 and 2007. Significant decreases in tractor overturn fatality rates were found for the Northeast and South regions, hired workers, crop farms, and in every age group except those less than 25 years of age. CONCLUSIONS: Tractor overturn fatality rates decreased between 1992 and 2007. These decreases were not consistent between different categories of the agricultural workforce or regions of the US. Changes in tractor overturn fatality rates may be partially explained by increases in the prevalence of ROPS on farm tractors in the US. ROPS promotion programs are needed to reduce tractor overturn fatalities, especially among those subpopulations at highest risk. |
Dopaminergic neurotoxicity following pulmonary exposure to manganese-containing welding fumes
Sriram K , Lin GX , Jefferson AM , Roberts JR , Chapman RS , Chen BT , Soukup JM , Ghio AJ , Antonini JM . Arch Toxicol 2010 84 (7) 521-40 The potential for development of Parkinson's disease (PD)-like neurological dysfunction following occupational exposure to aerosolized welding fumes (WF) is an area of emerging concern. Welding consumables contain a complex mixture of metals, including iron (Fe) and manganese (Mn), which are known to be neurotoxic. To determine whether WF exposure poses a neurological risk particularly to the dopaminergic system, we treated Sprague-Dawley rats with WF particulates generated from two different welding processes, gas metal arc-mild steel (GMA-MS; low Mn, less water-soluble) and manual metal arc-hard surfacing (MMA-HS; high Mn, more water-soluble) welding. Following repeated intratracheal instillations (0.5 mg/rat, 1/week x 7 weeks) of GMA-MS or MMA-HS, elemental analysis and various molecular indices of neurotoxicity were measured at 1, 4, 35 or 105 days after last exposure. MMA-HS exposure, in particular, led to increased deposition of Mn in striatum and midbrain. Both fumes also caused loss of tyrosine hydroxylase (TH) protein in the striatum (~20%) and midbrain (~30%) by 1 day post-exposure. While the loss of TH following GMA-MS was transient, a sustained loss (34%) was observed in the midbrain 105 days after cessation of MMA-HS exposure. In addition, both fumes caused persistent down-regulation of dopamine D2 receptor (Drd2; 30-40%) and vesicular monoamine transporter 2 (Vmat2; 30-55%) mRNAs in the midbrain. WF exposure also modulated factors associated with synaptic transmission, oxidative stress, neuroinflammation and gliosis. Collectively, our findings demonstrate that repeated exposure to Mn-containing WF can cause persistent molecular alterations in dopaminergic targets. Whether such perturbations will lead to PD-like neuropathological manifestations remains to be elucidated. |
Physical activity and optimal self-rated health of adults with and without diabetes
Tsai J , Ford ES , Li C , Zhao G , Balluz LS . BMC Public Health 2010 10 (1) 365 BACKGROUND: Regular physical activity can improve people's overall health and contribute to both primary and secondary prevention of many chronic diseases and conditions including diabetes. The aim of this study was to examine the association between levels of physical activity and optimal self-rated health (SRH) of U.S. adults with and without diabetes in all 50 states and territories of the Unites States. METHODS: We estimated the prevalence of optimal SRH by diabetes status of 430,912 adults aged 18 years and older who participated in the 2007 state-based survey of the Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using levels of physical activity as a predictor and status of optimal SRH as an outcome variable while controlling for sociodemographic and behavioral health risk factors. RESULTS: The prevalence of reporting optimal SRH was 53.3%, 52.2%, and 86.2% for adults with type 1 diabetes, type 2 diabetes, and without diabetes, respectively. Also in the aforementioned order, adults who reported being active had an increased likelihood of 81%, 32%, and 18% for reporting optimal SRH, when compared with adults who reported being inactive. CONCLUSIONS: Regular physical activity of adults, particularly adults with diabetes, is associated with optimal SRH. The findings of this study underscore the importance of advising and motivating adults with diabetes so that physical activity can be integrated into their lifestyle for diabetes care. Additionally, a population-based effort to promote physical activity in communities may benefit adults in general by improving their overall health and well-being. |
Provider attitudes toward HPV vaccine for males
Liddon N , Dunne E , Markowitz LA . J Adolesc Health 2010 47 (1) 1-2 Two prophylactic human papillomavirus (HPV) vaccines licensed by the U.S. Food and Drug Administration (FDA) have great potential to prevent HPV-associated diseases and cancers. In 2006, a quadrivalent vaccine that protects against four HPV types associated with most cases of genital warts and cervical cancers and in 2009 a bivalent vaccine that protects against two types associated with most cases of cervical cancer were licensed. The Advisory Committee on Immunization Practices (ACIP) recommends either vaccine for routine vaccination of 11- or 12-year-old female adolescents and catch-up vaccination of females through age 26 years. The quadrivalent HPV vaccine was recently licensed for use in males aged 9 through 26 years; ACIP did not recommend that the vaccine be used for routine use but that it may be given to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts. Although HPV vaccine for males is not routinely recommended, it can still be covered by the Vaccines for Children Program. | For any vaccine, implementation is affected by attitudes and acceptance of the general public, parents, and providers. Studies show that the most influential factor in vaccination decisions is provider recommendation [1], [2], [3]. Most previous research on attitudes and acceptability for HPV vaccine has focused on vaccination of females; there has been less research related to males. The study in this issue by Weiss et al [4] provides valuable insight about providers' attitudes toward vaccinating males. Although not generalizable to pediatricians and family physicians as a whole, it does provide information on those already stocking and providing vaccine to females and who may consider providing vaccine to males. |
Trends in perceived overweight status among overweight and nonoverweight adolescents
Foti K , Lowry R . Arch Pediatr Adolesc Med 2010 164 (7) 636-42 OBJECTIVE: To examine trends in perceived overweight among US adolescents, including trends in perceived overweight among overweight and nonoverweight adolescents overall and by sex and race/ethnicity. DESIGN: Trend analyses of serial cross-sectional data. SETTING: National Youth Risk Behavior Surveys conducted in 1999, 2001, 2003, 2005, and 2007. PARTICIPANTS: Nationally representative samples of US high school students in each survey year. MAIN OUTCOME MEASURES: All students with a body mass index at or higher than the 85th percentile were considered "overweight," while those with a body mass index lower than the 85th percentile were considered "nonoverweight." Students who perceived themselves as "slightly overweight" or "very overweight" were considered to perceive themselves as overweight. RESULTS: Among all students and among most subgroups, the prevalence of overweight increased from 1999 to 2007. The prevalence of perceived overweight did not change. Among nonoverweight students, the prevalence of perceived overweight decreased overall, among white males, and among white, black, and Hispanic females. Among overweight students, few trends in the prevalence of perceived overweight were detected; only among overweight black males did the prevalence of perceived overweight increase. CONCLUSIONS: Weight perception is an important predictor of diet and weight management behaviors. Decreases in the prevalence of perceived overweight among nonoverweight students have positive implications for reducing unhealthy weight control behaviors. Among overweight students, interventions are needed to increase their recognition of being overweight because those who do not perceive themselves as overweight are unlikely to engage in weight control practices. |
Unraveling the source of African American children's positively biased perceptions of peer acceptance
Dunkel SB , Kistner JA , David-Ferdon C . Soc Dev 2010 19 (3) 556-576 The present study investigated possible ethnic contributions to overly positive self-perceptions in middle childhood. The goals of this study were threefold. First, the present study sought to replicate the intriguing findings reported by Zakriski and Coie that African American children overestimate their acceptance, and European American children underestimate acceptance by other-ethnicity peers. Second, this study examined possible explanations for ethnic differences in the pattern of perceptual bias. Finally, this study extended prior research by examining ethnic differences in the accuracy of children's perceived peer acceptance. Archival data consisting of 826 children in third (N = 284), fourth (N = 241), and fifth grades (N = 301) were used in the present investigation; 237 of which were African American children, and 589 were European American children. Results of this study replicated the findings of Zakriski and Coie. Moreover, African Americans' overestimation and European Americans' underestimation of acceptance by other-ethnicity peers was found to be attributable to more positive views of self and others among African American children relative to European American children. Finally, children were found to be more accurate about judging their acceptance by peers of the same ethnicity than those of a different ethnicity. Possible explanations of what causes African American children to have more positive views of self and others than European American children are discussed. |
Disordered eating and unhealthy weight loss practices: which adolescents are at highest risk?
Haley CC , Hedberg K , Leman RF . J Adolesc Health 2010 47 (1) 102-5 Early diagnosis of unhealthy weight loss practices (UWLP) among adolescents improves treatment outcomes. Analysis of population-based school survey data in Oregon demonstrated that the 11.6% reporting UWLP were more likely to perceive themselves as overweight, depressed, and to have abused substances. Targeted screening of adolescents can help identify those with UWLP. |
Content Index (Achived Edition)
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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.
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