Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters
Bayliss EA , Bonds DE , Boyd CM , Davis MM , Finke B , Fox MH , Glasgow RE , Goodman RA , Heurtin-Roberts S , Lachenmayr S , Lind C , Madigan EA , Meyers DS , Mintz S , Nilsen WJ , Okun S , Ruiz S , Salive ME , Stange KC . Ann Fam Med 2014 12 (3) 260-9 PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS: Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION: Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life. |
Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA
Bauer UE , Briss PA , Goodman RA , Bowman BA . Lancet 2014 384 (9937) 45-52 With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health. |
IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions
Goodman RA , Boyd C , Tinetti ME , Von Kohorn I , Parekh AK , McGinnis JM . Ann Fam Med 2014 12 (3) 256-9 BACKGROUND: The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. PURPOSE: In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. RESULTS: Eleven principles to improve guidelines' attentiveness to the population with multiple chronic conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of multiple chronic conditions; and (3) principles intended to increase focus on patient-centered care. CONCLUSION: This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with multiple chronic conditions. The suggested principles are helping professional societies to improve guidelines' attentiveness to persons with multiple chronic conditions. |
Trends in HCV RNA testing among HCV antibody-positive persons in care, 2003-2010.
Spradling PR , Tong X , Rupp L , Moorman AC , Lu M , Teshale EH , Gordon SC , Vijayadeva V , Boscarino JA , Schmidt MA , Holmberg SD . Clin Infect Dis 2014 59 (7) 976-81 BACKGROUND: A test for hepatitis C virus (HCV) RNA is essential to identify persons with active, or current, HCV infection. We assessed trends in HCV RNA testing following a positive HCV antibody among persons in four large healthcare organizations. METHODS: Data collected from adults with ≥2 clinical encounters during 2003-2010 were analyzed to determine the frequency of, interval between, and factors associated with having an RNA test after a first positive HCV antibody test. RESULTS: From 2003-2010, 5,860 persons had a positive antibody test, of whom 3,570 (60.9%) had a follow-up RNA test. During the period, the annual frequency of persons with an eventual RNA test did not change significantly; however, the fraction of persons who had the follow-up RNA test within six months improved significantly, from 45% in 2003 to 57% in 2010 (p<0.001, for trend). Persons born from 1945-1965, men, and those with annual income <$30,000 (by census geocode) were less likely to have had a follow-up RNA test done within six months of a positive antibody test. CONCLUSIONS: Less than two-thirds of persons with a positive HCV antibody test had a follow-up RNA test. Rapid ascertainment of HCV infection status with reflex testing to RNA is critical to identify persons eligible for treatment. |
Rapid HIV testing at gay pride events to reach previously untested MSM: U.S., 2009-2010
Mdodo R , Thomas PE , Walker A , Chavez P , Ethridge S , Oraka E , Sutton MY . Public Health Rep 2014 129 (4) 328-34 We offered rapid HIV testing at social events frequented by young men who have sex with men (MSM), a group disproportionately affected by the HIV epidemic. We tested 1,312 MSM; of those MSM, 1,072 (81.7%) reported HIV testing history. Of those reporting HIV testing history, 550 (51.3%) were non-Hispanic black and 404 (37.7%) were aged <25 years. One hundred twenty-eight (11.9%) had never tested for HIV; 77 (7.2%) were preliminarily positive, with 15 (19.5%) being first-time testers. Factors associated with no previous HIV test included young age (13-24 years) (adjusted odds ratio [AOR] = 3.5, 95% confidence interval [CI] 1.9, 6.5) and non-Hispanic black (AOR=3.2, 95% CI 1.6, 6.4) or Hispanic (AOR=2.8, 95% CI 1.2, 6.3) race/ethnicity. HIV testing at Gay Pride events reaches young, previously untested MSM. This venue-based HIV testing approach at nonclinical sociocultural events is an additional strategy for HIV prevention goals to increase the number of people aware of their HIV infection with subsequent linkage to HIV care. |
Risk factors for invasive pneumococcal disease among children less than 5 Years of age in a high HIV-prevalence setting, South Africa, 2010 to 2012
von Mollendorf C , Cohen C , de Gouveia L , Naidoo N , Meiring S , Quan V , Lindani S , Moore DP , Reubenson G , Moshe M , Eley B , Hallbauer UM , Finlayson H , Madhi SA , Conklin L , Zell ER , Klugman KP , Whitney CG , von Gottberg A . Pediatr Infect Dis J 2014 34 (1) 27-34 INTRODUCTION: Invasive pneumococcal disease (IPD) causes significant disease burden, especially in developing countries, even in the era of pneumococcal conjugate vaccine (PCV) and maternal-to-child HIV transmission prevention programs. We evaluated factors that might increase IPD risk in young children in a high HIV prevalence setting. METHODS: We conducted a case-control study using IPD cases identified at 24 Group for Enteric, Respiratory and Meningeal disease Surveillance - South Africa (GERMS-SA) program sites (2010-2012). At least four controls were matched by age, HIV status and hospital to each case. Potential risk factors were evaluated using multivariable conditional logistic regression. RESULTS: In total 486 age-eligible cases were enrolled. Factors associated with IPD in HIV-uninfected children (237 cases, 928 controls) included: siblings <5 years (adjusted odds ratio [aOR]=1.68, 95% confidence interval [CI] 1.16-2.46), underlying medical conditions (aOR=1.99, CI 1.22-3.22), preceding upper respiratory tract infection (URTI) (aOR=1.79, CI 1.19-2.69), daycare attendance (aOR=1.58, CI 1.01-2.47), perinatal HIV exposure (aOR=1.62, CI 1.10-2.37), household car ownership (aOR=0.45, CI 0.25-0.83) and ≥2 PCV-7 doses (aOR=0.67, CI 0.46-0.99). Amongst HIV-infected children (124 cases, 394 controls), IPD-associated factors included malnutrition (aOR=2.68, CI 1.40-5.14), URTI (aOR=3.49, CI 1.73-7.03), tuberculosis in last 3 months (aOR=5.12, CI 1.69-15.50), and current antiretroviral treatment (ART) (aOR=0.13, CI 0.05-0.38). CONCLUSION: Previously-identified factors related to poverty, poor health, and intense exposure continue to be risk factors for IPD in children. Ensuring delivery of PCV and ART are important for improving disease prevention. |
The status of the National HIV Surveillance System, United States, 2013
Cohen SM , Gray KM , Ocfemia MC , Johnson AS , Hall HI . Public Health Rep 2014 129 (4) 335-41 The burden of HIV disease in the United States is monitored by using a comprehensive surveillance system. Data from this system are used at the federal, state, and local levels to plan, implement, and evaluate public health policies and programs. Implementation of HIV reporting has differed by area, and for the first time in early 2013, estimated data on diagnosed HIV infection were available from all 50 states, the District of Columbia, and six U.S. dependent areas. The newly available data for the entire U.S. as well as several other key changes to the surveillance system support the need to provide an updated summary of the status of the National HIV Surveillance System. |
Understanding the burden of tuberculosis among American Indians/Alaska Natives in the U.S.: a validation study
Podewils LJ , Alexy E , Driver SJ , Cheek JE , Holman RC , Haberling D , Brett M , McCray E , Redd JT . Public Health Rep 2014 129 (4) 351-60 OBJECTIVE: We validated cases of active tuberculosis (TB) recorded in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) and evaluated the completeness of TB case reporting from IHS facilities to state health departments. METHODS: We reviewed the medical records of American Indian/Alaska Native (AI/AN) patients at IHS health facilities who were classified as having active TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes from 2006 to 2009 for clinical and laboratory evidence of TB disease. Individuals were reclassified as having active TB disease; recent latent TB infection (LTBI); past positive tuberculin skin test (TST) only; or as having no evidence of TB, LTBI, or a past positive TST. We compared validated active TB cases with corresponding state records to determine if they were reported. RESULTS: The study included 596 patients with active TB as per ICD-9-CM codes. Based on chart review, 111 (18.6%) had active TB; 156 (26.2%) had LTBI; 104 (17.4%) had a past positive TST; and 221 (37.1%) had no evidence of TB disease, LTBI, or a past positive TST. Of the 111 confirmed cases of active TB, 89 (80.2%) resided in participating states; 81 of 89 (91.2%) were verified as reported TB cases. CONCLUSIONS: ICD-9-CM codes for active TB disease in the IHS NPIRS do not accurately reflect the burden of TB among AI/ANs. Most confirmed active TB cases in the IHS health system were reported to the state; the national TB surveillance system may accurately represent the burden of TB in the AI/AN population. |
Unraveling the mysteries of Middle East respiratory syndrome coronavirus
Watson JT , Hall AJ , Erdman DD , Swerdlow DL , Gerber SI . Emerg Infect Dis 2014 20 (6) 1054-6 Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel CoV known to cause severe acute respiratory illness in humans; ≈40% of confirmed cases have been fatal. Human-to-human transmission and multiple outbreaks of respiratory illness have been attributed to MERS-CoV, and severe respiratory illness caused by this virus continues to be identified. MERS-CoV was first reported in September 2012, and subsequent investigations documented illness onsets as early as April 2012 (1). As of February 23, 2014, the World Health Organization has reported 182 laboratory-confirmed cases of MERS-CoV infection, including 79 deaths, indicating an ongoing risk for transmission to humans in the Arabian Peninsula (2). The median age of reported case-patients is 52 years (range 2–94 years); most case-patients are male (3). Most index case-patients have at least 1 reported chronic comorbid condition (4) and have resided in, or recently traveled to, Jordan, Qatar, United Arab Emirates, Oman, Kuwait, or Saudi Arabia (3). Confirmed cases of MERS-CoV have been identified in travelers returning from France, Germany, Italy, United Kingdom, and Tunisia (3). Although some have speculated that a zoonotic reservoir of MERS-CoV exists, very little is known about the specific exposures that result in primary human cases. | MERS-CoV infection causes severe acute hypoxemic respiratory failure, extrapulmonary organ dysfunction, and high rates of death; however, the spectrum of illness and clinical course are not fully defined (5). Evidence suggests that MERS-CoV is capable of limited human-to-human transmission, which results in outbreaks in family and health care settings (5,6). The 182 reported cases include multiple distinct spatiotemporal clusters and 32 identified infections in health care workers (3). Modeling performed to assess the extent of human infection and the transmission potential of MERS-CoV (as of August 2013) estimated that most symptomatic case-patients had not been detected but that chains of transmission were not self-sustaining when infection control was implemented (7). Despite evidence of human-to-human transmission, the number of contacts infected by persons with confirmed infections appears to be limited; sustained transmission in the community has not been documented (3). The Hajj, the annual religious pilgrimage to Saudi Arabia, involved 1.37 million pilgrims from 188 countries in 2013 but resulted in no reports of confirmed cases in the weeks after the pilgrimage (3). |
Effect of rapid influenza diagnostic testing on antiviral treatment decisions for patients with influenza-like illness: southwestern U.S., May-December 2009
Suryaprasad A , Redd JT , Ricks PM , Podewils LJ , Brett M , Oski J , Minenna W , Armao F , Vize BJ , Cheek JE . Public Health Rep 2014 129 (4) 322-7 Rapid influenza diagnostic tests (RIDTs) had low test sensitivity for detecting 2009 pandemic influenza A (H1N1pdm09) infection, causing public health authorities to recommend that treatment decisions be based primarily upon risk for influenza complications. We used multivariate Poisson regression analysis to estimate the contribution of RIDT results and risk for H1N1pdm09 complications to receipt of early antiviral (AV) treatment among 290 people with influenza-like illness (ILI) who received an RIDT ≤48 hours after symptom onset from May to December 2009 at four southwestern U.S. facilities. RIDT results had a stronger association with receipt of early AVs (rate ratio [RR] = 3.3, 95% confidence interval [CI] 2.4, 4.6) than did the presence of risk factors for H1N1pdm09 complications (age <5 years or high-risk medical conditions) (RR=1.9, 95% CI 1.3, 2.7). Few at-risk people (28/126, 22%) who had a negative RIDT received early AVs, suggesting the need for sustained efforts by public health to influence clinician practices. |
An exploration of religion and spirituality among young, HIV-infected gay and bisexual men in the USA
Jeffries WLth , Okeke JO , Gelaude DJ , Torrone EA , Gasiorowicz M , Oster AM , McCree DH , Bertolli J . Cult Health Sex 2014 16 (9) 1-14 Although religion and spirituality can promote healthy behaviours and mental well-being, negative religious experiences may harm sexual minority men's health. Despite increasing vulnerability to HIV infection among young gay and bisexual men, few studies examine how religion and spirituality might affect them. To this end, we interviewed young gay and bisexual men who were diagnosed with HIV infection during January 2006-June 2009. Questionnaires assessed religious service attendance, disclosure of sexuality within religious communities, and beliefs about homosexuality being sinful. A subset described religious and spiritual experiences in qualitative interviews. We calculated the prevalence of religion- and spirituality-related factors and identified themes within qualitative interviews. Among men completing questionnaires, 66% currently attended religious services, 16% believed they could disclose their sexuality at church, and 37% believed homosexuality was sinful. Participants who completed qualitative interviews commonly discussed religious attendance and negative experiences within religious settings. They often expressed their spirituality through prayer, and some used it to cope with adverse experiences. These data suggest that religion and spirituality are notable factors that shape young, HIV-infected gay and bisexual men's social contexts. Programmes and interventions that constructively engage with religious institutions and are sensitive to spiritual beliefs may promote these men's health. |
Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis
Ahmed SM , Hall AJ , Robinson AE , Verhoef L , Premkumar P , Parashar UD , Koopmans M , Lopman BA . Lancet Infect Dis 2014 14 (8) 725-730 BACKGROUND: Despite substantial decreases in recent decades, acute gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute gastroenteritis worldwide. METHODS: We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute gastroenteritis. The primary outcome was prevalence of norovirus among all cases of gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models. FINDINGS: Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute gastroenteritis was 18% (95% CI 17-20). Norovirus prevalence tended to be higher in cases of acute gastroenteritis in community (24%, 18-30) and outpatient (20%, 16-24) settings compared with inpatient (17%, 15-19, p=0.066) settings. Prevalence was also higher in low-mortality developing (19%, 16-22) and developed countries (20%, 17-22) compared with high-mortality developing countries (14%, 11-16; p=0.058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence. INTERPRETATION: Norovirus is a key gastroenteritis pathogen associated with almost a fifth of all cases of acute gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered. FUNDING: The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG. |
HIV infection and risk, prevention, and testing behaviors among injecting drug users - National HIV Behavioral Surveillance System, 20 U.S. cities, 2009
Broz D , Wejnert C , Pham HT , DiNenno E , Heffelfinger JD , Cribbin M , Krishna N , Teshale EH , Paz-Bailey G . MMWR Surveill Summ 2014 63 Suppl 6 (6) 1-51 PROBLEM/CONDITION: At the end of 2009, an estimated 1,148,200 persons aged ≥13 years were living with human immunodeficiency virus (HIV) infection in the United States. Despite the recent decreases in HIV infection attributed to injection drug use, 8% of new HIV infections in 2010 occurred among injecting drug users (IDUs). REPORTING PERIOD: June-December 2009. DESCRIPTION OF SYSTEM: The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, IDUs, and heterosexual adults at increased risk for HIV infection. Data for NHBS are collected in rotating cycles. For the 2009 NHBS cycle, IDUs were recruited in 20 participating MSAs using respondent-driven sampling, a peer-referral sampling method. Participants were eligible if they were aged ≥18 years, lived in a participating MSA, were able to complete a behavioral survey in English or Spanish, and reported that they had injected drugs during the past 12 months. Consenting participants completed an interviewer-administered (face-to-face), anonymous standardized questionnaire about HIV-associated behaviors, and all participants were offered anonymous HIV testing. Analysis of 2009 NHBS data represents the first large assessment of HIV prevalence among IDUs in the United States in >10 years. RESULTS: This report summarizes two separate analyses using unweighted data from 10,200 eligible IDUs in 20 MSAs from the second collection cycle of NHBS in 2009. Both an HIV infection analysis and a behavioral analysis were conducted. Different denominators were used in each analysis because of the order and type of exclusion criteria applied. For the HIV infection analysis, of the 10,200 eligible participants, 10,090 had a valid HIV test result, of whom 906 (9%) tested positive for HIV (range: 2%-19% by MSA). When 509 participants who reported receiving a previous positive HIV test result were excluded from this analysis, 4% (397 of 9,581 participants) tested HIV-positive. For the behavioral analysis, because knowledge of HIV status might influence risk behaviors, 548 participants who reported a previous HIV-positive test result were excluded from the 10,200 eligible participants. All subsequent analyses were conducted for the remaining 9,652 participants. The most commonly injected drugs during the past 12 months among these participants were heroin (90%), speedball (heroin and cocaine combined) (58%), and cocaine or crack (49%). Large percentages of participants reported receptive sharing of syringes (35%); receptive sharing of other injection equipment, such as cookers, cotton, or water (58%); and receptive sharing of syringes to divide drugs (35%). Many participants reported having unprotected sex with opposite-sex partners during the past 12 months: 70% of men and 73% of women had unprotected vaginal sex, and 25% of men and 21% of women had unprotected anal sex. A combination of unsafe injection- and sex-related behaviors during the past 12 months was commonly reported; 41% of participants who reported unprotected vaginal sex with one or more opposite-sex partners, and 53% of participants who reported unprotected anal sex with one or more opposite-sex partners also reported receptive sharing of syringes. More women than men reported having sex in exchange for money or drugs (31% and 18%, respectively). Among men, 10% had oral or anal sex with one or more male partners during the past 12 months. Many participants (74%) reported noninjection drug use during the past 12 months, and 41% reported binge drinking during the past 30 days. A large percentage of participants (74%) had ever been tested for hepatitis C, 41% had received a hepatitis C virus infection diagnosis, and 29% had received a vaccination against hepatitis A virus, hepatitis B virus, or both. Most (88%) had been tested for HIV during their lifetime, and 49% had been tested during the past 12 months. Approximately half of participants received free HIV prevention materials during the past 12 months, including condoms (50%) and sterile syringes (44%) and other injection equipment (41%). One third of participants had been in an alcohol or a drug treatment program, and 21% had participated in an individual- or a group-level HIV behavioral intervention. INTERPRETATION: IDUs in the United States continue to engage in sexual and drug-use behaviors that increase their risk for HIV infection. The large percentage of participants in this study who reported engaging in both unprotected sex and receptive sharing of syringes supports the need for HIV prevention programs to address both injection and sex-related risk behaviors among IDUs. Although most participants had been tested for HIV infection previously, less than half had been tested in the past year as recommended by CDC. In addition, many participants had not been vaccinated against hepatitis A and B as recommended by CDC. Although all participants had injected drugs during the past year, only a small percentage had recently participated in an alcohol or a drug treatment program or in a behavioral intervention, suggesting an unmet need for drug treatment and HIV prevention services. PUBLIC HEALTH ACTION: To reduce the number of HIV infections among IDUs, additional efforts are needed to decrease the number of persons who engage in behaviors that increase their risk for HIV infection and to increase their access to HIV testing, alcohol and drug treatment, and other HIV prevention programs. The National HIV/AIDS Strategy for the United States delineates a coordinated response to reduce HIV incidence and HIV-related health disparities among IDUs and other disproportionately affected groups. CDC's high-impact HIV prevention approach provides an essential step toward achieving these goals by using combinations of scientifically proven, cost-effective, and scalable interventions among populations at greatest risk. NHBS data can be used to monitor progress toward the national strategy goals and to guide national and local planning efforts to maximize the impact of HIV prevention programs. |
Challenges of infectious diseases in the USA
Khabbaz RF , Moseley RR , Steiner RJ , Levitt AM , Bell BP . Lancet 2014 384 (9937) 53-63 In the USA, infectious diseases continue to exact a substantial toll on health and health-care resources. Endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of individuals and widen health disparities. Additional concerns include health-care-associated and foodborne infections-both of which have been targets of broad prevention efforts, with success in some areas, yet major challenges remain. Although substantial progress in reduction of the burden of vaccine-preventable diseases has been made, continued cases and outbreaks of these diseases persist, driven by various contributing factors. Worldwide, emerging and reemerging infections continue to challenge prevention and control strategies while the growing problem of antimicrobial resistance needs urgent action. An important priority for control of infectious disease is to ensure that scientific and technological advances in molecular diagnostics and bioinformatics are well integrated into public health. Broad and diverse partnerships across governments, health care, academia, and industry, and with the public, are essential to effectively reduce the burden of infectious diseases. |
Genetic diversity in Enterocytozoon bieneusi isolates from dogs and cats in China: host specificity and public health implications.
Karim MR , Dong H , Yu F , Jian F , Zhang L , Wang R , Zhang S , Rume FI , Ning C , Xiao L . J Clin Microbiol 2014 52 (9) 3297-302 To explore the genetic diversity, host specificity and zoonotic potential of Enterocytozoon bieneusi, feces from 348 stray and pet dogs, and 96 pet cats from different locations in China were examined by internal transcribed spacer (ITS) based PCR. E. bieneusi was detected in 15.5% of dogs including 20.5% of stray dogs and 11.7% of pet dogs, and in 11.5% of pet cats. Higher infection rates were recorded in the > 2 years and 1 to 2 years age groups in dogs and cats, respectively. All together, 24 genotypes, including 11 known and 13 new ones, were detected in 65 infected animals. In 54 positive dogs, 18 genotypes, nine known (PtEbIX, O, D, CM1, EbpA, Peru8, Type IV, EbpC and PigEBITS5) and nine new (CD1 to CD9), were found. In contrast, eight genotypes, four known (D, BEB6, I and PtEbIX) and four new (CC1 to CC4), were identified in 11 infected cats. The dominant genotype in dogs was PtEbIX (26/54). Phylogenetic analysis revealed that eight known genotypes (D, Peru8, Type IV, CM1, EbpC, PigEBITS5, O and EbpA) and seven new ones (CD1 to CD4 and CC2 to CC4) were the members of zoonotic group 1, whereas genotypes CD7, CD8 and CD9 together with PtEbIX belonged to the dog specific group, and genotypes CD6 and CC1 were placed in group 2 with BEB6 and I. Conversely, genotype CD5 clustered with CM4 without belonging to any previous groups. This study concludes that zoonotic genotypes are common in both animals along with host specific genotypes in dogs. |
Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines - United States, 2012
Paulozzi LJ , Mack KA , Hockenberry JM . MMWR Morb Mortal Wkly Rep 2014 63 (26) 563-8 Persons in the United States consume opioid pain relievers (OPR) at a greater rate than any other nation. They consume twice as much per capita as the second ranking nation, Canada. Overprescribing of opioid pain relievers can result in multiple adverse health outcomes, including fatal overdoses. Opioid pain relievers were involved in 16,917 overdose deaths in 2011; in 31% of these deaths, benzodiazepine sedatives were also cited as contributing causes (CDC WONDER, unpublished data, 2014). High rates of prescribing these controlled substances are important determinants of rates of fatal overdose and drug abuse. Overall state prescribing rates of OPR vary widely. Variation in prescribing rates for higher-risk opioid prescriptions (e.g., those for long-acting or extended-release [LA/ER] formulations) or those for high daily dosage have not been examined. LA/ER OPR are more prone to abuse, and high-dose formulations are more likely to result in overdoses, so they deserve special attention. Benzodiazepines are commonly prescribed in combination with OPR, even though this combination increases the risk for overdose. Interstate variation in prescribing rates for benzodiazepines has not been measured. |
Decline in drug overdose deaths after state policy changes - Florida, 2010-2012
Johnson H , Paulozzi L , Porucznik C , Mack K , Herter B . MMWR Morb Mortal Wkly Rep 2014 63 (26) 569-74 During 2003-2009, the number of deaths caused by drug overdose in Florida increased 61.0%, from 1,804 to 2,905, with especially large increases in deaths caused by the opioid pain reliever oxycodone and the benzodiazepine alprazolam. In response, Florida implemented various laws and enforcement actions as part of a comprehensive effort to reverse the trend. This report describes changes in overdose deaths for prescription and illicit drugs and changes in the prescribing of drugs frequently associated with these deaths in Florida after these policy changes. During 2010-2012, the number of drug overdose deaths decreased 16.7%, from 3,201 to 2,666, and the deaths per 100,000 persons decreased 17.7%, from 17.0 to 14.0. Death rates for prescription drugs overall decreased 23.2%, from 14.5 to 11.1 per 100,000 persons. The decline in the overdose deaths from oxycodone (52.1%) exceeded the decline for other opioid pain relievers, and the decline in deaths for alprazolam (35.6%) exceeded the decline for other benzodiazepines. Similar declines occurred in prescribing rates for these drugs during this period. The temporal association between the legislative and enforcement actions and the substantial declines in prescribing and overdose deaths, especially for drugs favored by pain clinics, suggests that the initiatives in Florida reduced prescription drug overdose fatalities. |
Decline in perfluorooctane sulfonate and perfluorooctanoate serum concentrations in an Australian population from 2002 to 2011
Toms LM , Thompson J , Rotander A , Hobson P , Calafat AM , Kato K , Ye X , Broomhall S , Harden F , Mueller JF . Environ Int 2014 71c 74-80 Some perfluoroalkyl and polyfluoroalkyl substances (PFASs) have become widespread pollutants detected in human and wildlife samples worldwide. The main objective of this study was to assess temporal trends of PFAS concentrations in human blood in Australia over the last decade (2002-2011), taking into consideration age and sex trends. Pooled human sera from 2002/03 (n=26); 2008/09 (n=24) and 2010/11 (n=24) from South East Queensland, Australia were obtained from de-identified surplus pathology samples and compared with samples collected previously from 2006/07 (n=84). A total of 9775 samples in 158 pools were available for an assessment of PFASs. Stratification criteria included sex and age: <16years (2002/03 only); 0-4 (2006/07, 2008/09, 2010/11); 5-15 (2006/07, 2008/09, 2010/11); 16-30; 31-45; 46-60; and >60years (all collection periods). Sera were analyzed using on-line solid-phase extraction coupled to high-performance liquid chromatography-isotope dilution-tandem mass spectrometry. Perfluorooctane sulfonate (PFOS) was detected in the highest concentrations ranging from 5.3-19.2ng/ml (2008/09) to 4.4-17.4ng/ml (2010/11). Perfluorooctanoate (PFOA) was detected in the next highest concentration ranging from 2.8-7.3ng/ml (2008/09) to 3.1-6.5ng/ml (2010/11). All other measured PFASs were detected at concentrations <1ng/ml with the exception of perfluorohexane sulfonate which ranged from 1.2-5.7ng/ml (08/09) and 1.4-5.4ng/ml (10/11). The mean concentrations of both PFOS and PFOA in the 2010/11 period compared to 2002/03 were lower for all adult age groups by 56%. For 5-15year olds, the decrease was 66% (PFOS) and 63% (PFOA) from 2002/03 to 2010/11. For 0-4year olds the decrease from 2006/07 (when data were first available for this age group) was 50% (PFOS) and 22% (PFOA). This study provides strong evidence for decreasing serum PFOS and PFOA concentrations in an Australian population from 2002 through 2011. Age trends were variable and concentrations were higher in males than in females. Global use has been in decline since around 2002 and hence primary exposure levels are expected to be decreasing. Further biomonitoring will allow assessment of PFAS exposures to confirm trends in exposure as primary and eventually secondary sources are depleted. |
State-based surveillance for selected hemoglobinopathies.
Hulihan MM , Feuchtbaum L , Jordan L , Kirby RS , Snyder A , Young W , Greene Y , Telfair J , Wang Y , Cramer W , Werner EM , Kenney K , Creary M , Grant AM . Genet Med 2014 17 (2) 125-30 PURPOSE: The lack of an ongoing surveillance system for hemoglobinopathies in the United States impedes the ability of public health organizations to identify individuals with these conditions, monitor their health-care utilization and clinical outcomes, and understand the effect these conditions have on the health-care system. This article describes the results of a pilot program that supported the development of the infrastructure and data collection methods for a state-based surveillance system for selected hemoglobinopathies. METHODS: The system was designed to identify and gather information on all people living with a hemoglobinopathy diagnosis (sickle cell diseases or thalassemias) in the participating states during 2004-2008. Novel, three-level case definitions were developed, and multiple data sets were used to collect information. RESULTS: In total, 31,144 individuals who had a hemoglobinopathy diagnosis during the study period were identified in California; 39,633 in Florida; 20,815 in Georgia; 12,680 in Michigan; 34,853 in New York, and 8,696 in North Carolina. CONCLUSION: This approach provides a possible model for the development of state-based hemoglobinopathy surveillance systems. |
The risk of misclassifying subjects within principal component based asset index
Sharker MY , Nasser M , Abedin J , Arnold BF , Luby SP . Emerg Themes Epidemiol 2014 11 6 The asset index is often used as a measure of socioeconomic status in empirical research as an explanatory variable or to control confounding. Principal component analysis (PCA) is frequently used to create the asset index. We conducted a simulation study to explore how accurately the principal component based asset index reflects the study subjects' actual poverty level, when the actual poverty level is generated by a simple factor analytic model. In the simulation study using the PC-based asset index, only 1% to 4% of subjects preserved their real position in a quintile scale of assets; between 44% to 82% of subjects were misclassified into the wrong asset quintile. If the PC-based asset index explained less than 30% of the total variance in the component variables, then we consistently observed more than 50% misclassification across quintiles of the index. The frequency of misclassification suggests that the PC-based asset index may not provide a valid measure of poverty level and should be used cautiously as a measure of socioeconomic status. |
Public health for the people: participatory infectious disease surveillance in the digital age
Wojcik OP , Brownstein JS , Chunara R , Johansson MA . Emerg Themes Epidemiol 2014 11 7 The 21(st) century has seen the rise of Internet-based participatory surveillance systems for infectious diseases. These systems capture voluntarily submitted symptom data from the general public and can aggregate and communicate that data in near real-time. We reviewed participatory surveillance systems currently running in 13 different countries. These systems have a growing evidence base showing a high degree of accuracy and increased sensitivity and timeliness relative to traditional healthcare-based systems. They have also proven useful for assessing risk factors, vaccine effectiveness, and patterns of healthcare utilization while being less expensive, more flexible, and more scalable than traditional systems. Nonetheless, they present important challenges including biases associated with the population that chooses to participate, difficulty in adjusting for confounders, and limited specificity because of reliance only on syndromic definitions of disease limits. Overall, participatory disease surveillance data provides unique disease information that is not available through traditional surveillance sources. |
Improving response to foodborne disease outbreaks in the United States: findings of the Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE), 2010-2012
Biggerstaff GK . J Public Health Manag Pract 2014 21 (4) E18-26 CONTEXT: Each year foodborne diseases (FBD) affect approximately 1 in 6 Americans, resulting in 128 000 hospitalizations and 3000 deaths. Decreasing resources impact the ability of public health officials to identify, respond to, and control FBD outbreaks. Geographically dispersed outbreaks necessitate multijurisdictional coordination across all levels of the public health system. Rapid response depends on rapid detection. OBJECTIVE: Targeted resources were provided to state and local health departments to improve completeness and timeliness of laboratory, epidemiology, and environmental health (EH) activities for FBD surveillance and outbreak response. DESIGN: Foodborne Disease Centers for Outbreak Response Enhancement (FoodCORE) centers, selected through competitive award, implemented work plans designed to make outbreak response more complete and faster in their jurisdiction. Performance metrics were developed and used to evaluate the impact and effectiveness of activities. PARTICIPANTS: Departments of Health in Connecticut, New York City, Ohio, South Carolina, Tennessee, Utah, and Wisconsin. RESULTS: From the first year (Y1) of the program in October 2010 to the end of the second year (Y2) in December 2012, the centers completed molecular subtyping for a higher proportion of Salmonella, Shiga toxin-producing Escherichia coli, and Listeria (SSL) isolates (86% vs 98%) and reduced the average time to complete testing from a median of 8 to 4 days. The centers attempted epidemiologic interviews with more SSL case-patients (93% vs 99%), and the average time to attempt interviews was reduced from a median of 4 to 2 days. During Y2, nearly 200 EH assessments were conducted. FoodCORE centers began documenting model practices such as streamlining and standardizing case-patient interviewing. CONCLUSION: Centers used targeted resources and process evaluation to implement and document practices that improve the completeness and timeliness of FBD surveillance and outbreak response activities in several public health settings. FoodCORE strategies and model practices could be replicated in other jurisdictions to improve FBD response. |
Molecular analysis of single oocyst of Eimeria by whole genome amplification (WGA) based nested PCR.
Wang Y , Tao G , Cui Y , Lv Q , Xie L , Li Y , Suo X , Qin Y , Xiao L , Liu X . Exp Parasitol 2014 144 96-9 PCR-based molecular tools are widely used for the identification and characterization of protozoa. Here we report the molecular analysis of Eimeria species using combined methods of whole genome amplification (WGA) and nested PCR. Single oocyst of Eimeria stiedai or E. media was directly used for random amplification of the genomic DNA with either primer extension preamplification (PEP) or multiple displacement amplification (MDA), and then the WGA product was used as template in nested PCR with species-specific primers for ITS-1, 18S rDNA and 23S rDNA of E. stiedai and E. media. WGA-based PCR was successful for the amplification of these genes from single oocyst. For the species identification of single oocyst isolated from mixed E. stiedai or E. media, the results from WGA-based PCR were exactly in accordance with those from morphological identification, suggesting the availability of this method in molecular analysis of eimerian parasites at the single oocyst level. WGA-based PCR method can also be applied for the identification and genetic characterization of other protists. |
Global health and the US Centers for Disease Control and Prevention
Schuchat A , Tappero J , Blandford J . Lancet 2014 384 (9937) 98-101 Why is an article about global health included in a special issue on health in the USA? About half the produce that Americans consume is cultivated in other countries, 60 million Americans travel or work outside the USA, and most patients with measles and tuberculosis in the USA acquired their infection elsewhere. Emerging diseases, globalisation of foods and medicines, the rise in antimicrobial resistance, and the ease with which pathogens can be manipulated for good or harm increase each nation's vulnerability and interdependence. | The Centers for Disease Control and Prevention (CDC) has engaged in global health for more than 60 years. Although tackling infectious disease threats has been a constant, the agency has also provided humanitarian assistance in natural disasters, refugee crises, and famines; improved child survival; and strengthened scientific measurement of health metrics. CDC's workforce includes more than 300 internationally deployed public health professionals in addition to around 1330 locally employed staff working in about 60 countries (figure ). CDC's global health strategy aims to: achieve optimum health effects; strengthen global health capacity; improve global health security; and strengthen the organisation's capacity.1 This report describes selected programmes that illustrate these goals. |
Drowsy driving and risk behaviors - 10 states and Puerto Rico, 2011-2012
Wheaton AG , Shults RA , Chapman DP , Ford ES , Croft JB . MMWR Morb Mortal Wkly Rep 2014 63 (26) 557-62 Findings in published reports have suggested that drowsy driving is a factor each year in as many as 7,500 fatal motor vehicle crashes (approximately 25%) in the United States. CDC previously reported that, in 2009-2010, 4.2% of adult respondents in 19 states and the District of Columbia reported having fallen asleep while driving at least once during the previous 30 days. Adults who reported usually sleeping ≤6 hours per day, snoring, or unintentionally falling asleep during the day were more likely to report falling asleep while driving compared with adults who did not report these sleep patterns. However, limited information has been published on the association between drowsy driving and other risk behaviors that might contribute to crash injuries or fatalities. Therefore, CDC analyzed responses to survey questions regarding drowsy driving among 92,102 respondents in 10 states and Puerto Rico to the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The results showed that 4.0% reported falling asleep while driving during the previous 30 days. In addition to known risk factors, drowsy driving was more prevalent among binge drinkers than non-binge drinkers or abstainers and also more prevalent among drivers who sometimes, seldom, or never wear seatbelts while driving or riding in a car, compared with those who always or almost always wear seatbelts. Drowsy driving did not vary significantly by self-reported smoking status. Interventions designed to reduce binge drinking and alcohol-impaired driving, to increase enforcement of seatbelt use, and to encourage adequate sleep and seeking treatment for sleep disorders might contribute to reductions in drowsy driving crashes and related injuries. |
Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update
Marschall J , Mermel LA , Fakih M , Hadaway L , Kallen A , O'Grady NP , Pettis AM , Rupp ME , Sandora T , Maragakis LL , Yokoe DS . Infect Control Hosp Epidemiol 2014 35 (7) 753-71 Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates. |
Influenza vaccination and treatment in children with neurologic disorders
Havers F , Fry A , Peacock G , Finelli L . Ther Adv Vaccines 2014 2 (4) 95-105 Influenza viruses cause substantial morbidity in children each year, especially among children with specific chronic conditions. In particular, neurologic disorders have emerged as a strong risk factor for influenza-related complications. Children with these disorders may be vulnerable due to diminished respiratory muscle strength, decreased muscle tone or impaired mobility, which can compromise pulmonary function and the ability to handle secretions. Although they represent a small fraction of the general pediatric population, children with neurologic disorders make up a disproportionately high number of those children who are hospitalized and die as a result of influenza-associated complications. Annual vaccination is the most effective way to prevent influenza and its complications, and is recommended for all children 6 months through 18 years of age, including children with neurologic disorders. Family members and those who work with these children in institutional, educational and daycare settings should also be vaccinated against influenza annually. However, there have been few studies of influenza vaccination specifically in this population. In addition, vaccine effectiveness may vary from year to year and vaccination will not prevent all infections. Early empiric antiviral treatment should be started promptly in these children if they present to healthcare providers with symptoms suspicious for influenza. This article reviews influenza epidemiology in children with neurologic disorders and what is known about vaccines and other methods of protecting this vulnerable population from influenza-related complications. |
Prevention of injury and violence in the USA
Haegerich TM , Dahlberg LL , Simon TR , Baldwin GT , Sleet DA , Greenspan AI , Degutis LC . Lancet 2014 384 (9937) 64-74 In the first three decades of life, more individuals in the USA die from injuries and violence than from any other cause. Millions more people survive and are left with physical, emotional, and financial problems. Injuries and violence are not accidents; they are preventable. Prevention has a strong scientific foundation, yet efforts are not fully implemented or integrated into clinical and community settings. In this Series paper, we review the burden of injuries and violence in the USA, note effective interventions, and discuss methods to bring interventions into practice. Alliances between the public health community and medical care organisations, health-care providers, states, and communities can reduce injuries and violence. We encourage partnerships between medical and public health communities to consistently frame injuries and violence as preventable, identify evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence. |
The epidemiology of falling-through-the-ice in Alaska, 1990-2010
Fleischer NL , Melstrom P , Yard E , Brubaker M , Thomas T . J Public Health (Oxf) 2014 36 (2) 235-42 BACKGROUND: Climate change has contributed to increasing temperatures, earlier snowmelts and thinning ice packs in the Arctic, where crossing frozen bodies of water is essential for transportation and subsistence living. In some Arctic communities, anecdotal reports indicate a growing belief that falling-through-the-ice (FTI) are increasing. The objective of this study was to describe the morbidity and mortality associated with unintentional FTIs in Alaska. METHODS: We searched newspaper reports to identify FTI events from 1990 to 2010. We also used data from a trauma registry, occupational health and law enforcement registries and vital statistics to supplement the newspaper reports. Morbidity and mortality rates were calculated for Alaska Native (AN) people and all Alaskans. RESULTS: During the 21-year period, we identified 307 events, affecting at least 449 people. Events ranged from no morbidity to fatalities of five people. More than half of the events involved transportation by snow machine. Mortality rates were markedly higher for AN people than that for all Alaskans. CONCLUSIONS: We provide a numeric estimate of the importance of FTI events in Alaska. FTIs may represent an adverse health outcome related to climate changes in the Arctic, and may be particularly critical for vulnerable populations such as AN people. |
Can an evidence-based fall prevention program be translated for use in culturally diverse communities?
Sleet DA , Baldwin GT . J Sport Health Sci 2014 3 (1) 32-33 Older adult falls remain a significant public health problem amenable to preventive interventions (CDC, 2009; CDC, 2011). Despite the progress made in identifying risk factors, developing efficacious health-related interventions, and promoting evidence-based programs in the community, much work remains before these strategies are broadly available and effectively used to reduce fall-related injuries (Noonan, Sleet, Stevens, 2011). Newton and Scott-Findlay (2007) point out that the translation of basic scientific knowledge into clinical studies, and from clinical studies to improvements in health services and public health practices, remain major obstacles to widespread adoption. | Donaldson and Finch (2013) showed the feasibility of applying implementation science to sports injury prevention and Li et al (2008) demonstrated how an exercise and balance program (Tai Chi) can successfully be translated into a community program. As important, Li and colleagues maintained program fidelity and adherence to their intervention, at least over the short term, to prevent older adult falls. Manson et al (2013) showed positive results taking a Tai Chi program to low-income older adults, concluding that “non-(Tai chi) culturally related ethnic groups did not experience a barrier to participation in an older low-socioeconomic population sample” (p270). However, the sample consisted of only 56 participants who were recruited into a 16-week program and no attempt was made to translate the findings to the wider multi-ethnic community through the use of existing stakeholders. |
CDC Grand Rounds: evidence-based injury prevention
Degutis LC , Sleet DA , Kohn M , Benjamin G , Cohen N , Iskander J . MMWR Morb Mortal Wkly Rep 2014 62 1048-50 Approximately 5.8 million persons die from injuries each year, accounting for 10% of all deaths worldwide. In the United States, 180,000 persons die each year from injuries, making the category the country's leading cause of death for those aged 1-44 years and the leading cause of years of potential life lost before age 65 years. Injuries also result in 2.8 million hospitalizations and 29 million emergency department visits each year in the United States. Motor vehicle crashes, falls, homicides, suicides, domestic violence, child maltreatment, and other forms of intentional and unintentional injury affect all strata of society, with widespread physical, mental, and reproductive health consequences. Injuries and violence affect not only individuals, but also families and communities, producing substantial economic and societal burdens related to health-care costs, work loss, and disruption of education. The estimated annual U.S. cost in medical expenses and lost productivity resulting from injuries is $355 billion. |
Motor vehicle injury prevention
Sleet DA , Viano DC , Dellinger A . Oxford Bibliographies, Public Health 2013 One hundred years after the first self-propelled vehicle was invented, the world’s first recorded traffic death occurred when Mary Ward was thrown from the passenger seat of her cousin’s steam-powered car and rolled underneath the vehicle traveling 3-4 mph in Ireland on August 31, 1869. The first traffic fatality in the United States reportedly occurred in New York City in 1899 when Henry H. Bliss stepped off a streetcar and was struck by a passing electric-powered taxicab at the corner of Central Park West and 74th Street. By 1900 the yearly traffic death toll in the United States was up to thirty-six, and by 1972 a staggering 54,000 people were killed in traffic, and 2 million maimed. In 2009, traffic injuries were the leading cause of death of Americans aged 10–14, 15–19, and 20–24. The annual cost of motor vehicle–related fatal and nonfatal injuries is $99 billion in medical expenses and lost productivity, which is nearly the equivalent of $500 for each licensed driver in the United States. Motor vehicle travel is the most common form of transportation in the United States, although pedestrians, motorcyclists, and bicyclists are also injured in traffic. The number of registered automobiles in the United States grew from 8,000 in 1900 to 250 million in 2010, yet deaths per 100 million vehicle miles traveled actually declined by 77 percent between 1966 and 2010. Advances in the safety of vehicles, improved roads, and changes in driver behavior have led to this improvement. The conceptualization of this approach was fostered by William Haddon Jr., who developed models for exploring countermeasures to reduce or prevent injuries involving elements in the causal sequence related to the host (driver and passenger), agent (vehicle), and environment (roads and highways). Still, in 2009, the United States lost 33,808 people in traffic crashes. The major risk factors include non-use of seat belts and child restraints, alcohol, speed, non-use of helmets, and distracted driving. According to Rumar (The role of perceptual and cognitive filters in observed behavior, in Human behavior and traffic safety, Edited by L. Evans and R. Schwing. New York: Plenum, 1985) only 3 percent of crashes are due solely to the roadway environment, 2 percent solely to vehicles, and 27 percent to the combination of road environment and drivers. Globally, 1.3 million people die each year from road traffic injuries, or about 3,000 each day. Around 90 percent of those deaths occur in low- and middle-income countries. By 2020, traffic-related injuries will be the third leading contributor to the global burden of disease and injury, up from the eighth leading cause in 2009. This article describes the science of motor vehicle injury prevention and control, and identifies resources on the history, development, and application of principles of injury control to reduce traffic injury. |
Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020
Raffo V , Bliss T , Shotten M , Sleet D , Blanchard C . Glob Health Promot 2013 20 20-36 This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them. |
Comparative genomic analysis and virulence differences in closely related salmonella enterica serotype heidelberg isolates from humans, retail meats, and animals.
Hoffmann M , Zhao S , Pettengill J , Luo Y , Monday SR , Abbott J , Ayers SL , Cinar HN , Muruvanda T , Li C , Allard MW , Whichard J , Meng J , Brown EW , McDermott PF . Genome Biol Evol 2014 6 (5) 1046-68 Salmonella enterica subsp. enterica serovar Heidelberg (S. Heidelberg) is one of the top serovars causing human salmonellosis. Recently, an antibiotic-resistant strain of this serovar was implicated in a large 2011 multistate outbreak resulting from consumption of contaminated ground turkey that involved 136 confirmed cases, with one death. In this study, we assessed the evolutionary diversity of 44 S. Heidelberg isolates using whole-genome sequencing (WGS) generated by the 454 GS FLX (Roche) platform. The isolates, including 30 with nearly indistinguishable (one band difference) Xbal pulsed-field gel electrophoresis patterns (JF6X01.0032, JF6X01.0058), were collected from various sources between 1982 and 2011 and included nine isolates associated with the 2011 outbreak. Additionally, we determined the complete sequence for the chromosome and three plasmids from a clinical isolate associated with the 2011 outbreak using the Pacific Biosciences (PacBio) system. Using single-nucleotide polymorphism (SNP) analyses, we were able to distinguish highly clonal isolates, including strains isolated at different times in the same year. The isolates from the recent 2011 outbreak clustered together with a mean SNP variation of only 17 SNPs. The S. Heidelberg isolates carried a variety of phages, such as prophage P22, P4, lambda-like prophage Gifsy-2, and the P2-like phage which carries the sopE1 gene, virulence genes including 62 pathogenicity, and 13 fimbrial markers and resistance plasmids of the incompatibility (Inc)I1, IncA/C, and IncHI2 groups. Twenty-one strains contained an IncX plasmid carrying a type IV secretion system. On the basis of the recent and historical isolates used in this study, our results demonstrated that, in addition to providing detailed genetic information for the isolates, WGS can identify SNP targets that can be utilized for differentiating highly clonal S. Heidelberg isolates. |
Advances in laboratory methods for detection and typing of norovirus.
Vinje J . J Clin Microbiol 2014 53 (2) 373-81 Human noroviruses are the leading cause of epidemic and sporadic gastroenteritis across all age groups. Although the disease is usually self-limiting, in the United States norovirus gastroenteritis causes an estimated 56,000-71,000 hospitalizations and 570-800 deaths each year. This minireview describes the latest data on laboratory methods (molecular, immunological) for norovirus detection including real-time reverse transcription-polymerase chain reaction (RT-qPCR), commercially available immunological assays, as well as the latest FDA-cleared multi enteric pathogens platforms. In addition, an overview is provided on the latest nomenclature and molecular epidemiology of human noroviruses. |
Multilocus sequence and microsatellite identification of intra-specific hybrids and ancestor-like donors among natural Ethiopian isolates of Leishmania donovani.
Gelanew T , Hailu A , Schonian G , Lewis MD , Miles MA , Yeo M . Int J Parasitol 2014 44 (10) 751-7 Protozoan parasites of the genus Leishmania (Kinetoplastida:Trypanosomatidae) cause widespread and devastating human diseases. Visceral leishmaniasis (VL) is endemic in Ethiopia where it has also been responsible for fatal epidemics. It is postulated that genetic exchange in Leishmania has implications for heterosis (hybrid vigour), spread of virulent strains, resistance to chemotherapeutics, and exploitation of different hosts and vectors. Here we analyse 11 natural Ethiopian Leishmania donovani isolates consisting of four putative hybrids, seven parent-like isolates and over 90 derived biological clones. We apply a novel combination of high resolution multilocus microsatellite typing (MLMT, five loci) and multilocus sequence typing (MLST, four loci) that together distinguish parent-like and hybrid L. donovani strains. Results indicate that the four isolates (and their associated biological clones) are genetic hybrids, not the results of mixed infections, each possessing heterozygous markers consistent with inheritance of divergent alleles from genetically distinct Ethiopian L. donovani lineages. The allelic profiles of the putative hybrids may have arisen from a single hybridisation event followed by inbreeding or gene conversion, or alternatively from two or more hybridisation events. Mitochondrial sequencing showed uniparental maxicircle inheritance for all of the hybrids, each possessing a single mitochondrial genotype. Fluorescence activated cell sorting analysis of DNA content demonstrated that all hybrids and their associated clones were diploid. Together the data imply that intra-specific genetic exchange is a recurrent feature of natural L. donovani populations, with substantial implications for the phyloepidemiology of Leishmania. |
Prophylaxis with a respiratory syncytial virus (RSV) anti-G protein monoclonal antibody shifts the adaptive immune response to RSV rA2-line19F infection from Th2 to Th1 in BALB/c mice
Boyoglu-Barnum S , Chirkova T , Todd SO , Barnum TR , Gaston KA , Jorquera P , Haynes LM , Tripp RA , Moore ML , Anderson LJ . J Virol 2014 88 (18) 10569-83 Respiratory syncytial virus (RSV) is the single most important cause of serious lower respiratory tract infections in young children, yet no highly effective treatment or vaccine is available. In the present study, we investigated the effect of prophylactic treatment with the intact and F(ab')2 forms of an anti-G protein monoclonal antibody (mAb), 131-2G, on the humoral and cellular adaptive immune response to RSV rA2-line19F (r19F) challenge in BALB/c mice. The F(ab')2 form of 131-2G does not decrease virus replication but intact 131-2G does. The serum specimens for antibodies and spleen cells for memory T cell responses to RSV antigens were analyzed at 30, 45, 75 and 95 p.i. with/without prior treatment with 131-2G. The ratios of Th2/Th1 antibody isotypes at each time p.i indicated that both forms of mAb 131-2G shifted the subclass response from a Th2 (IgG1 and IgG2b) to a Th1 (IgG2A) bias. The ratio of IgG1/IgG2A antibody titer was 3-fold to 10-fold higher for untreated than mAb treated mice. There was also some increase in IgG (22%+/-13 increase) and neutralization (32% increase) in antibodies with mAb 131-2G prophylaxis at 75 days p.i. Treatment with 131-2G significantly (p≤0.001) decreased the percent of IL-4 positive CD4 and CD8 in RSV stimulated spleen cells at all times p.i. while percent of IFN-gamma T cells significantly (p≤0.001) increased ≥75 days p.i. The shift from a Th2 to a Th1 biased T cell response in treated compared to untreated mice likely was directed by the much higher levels of T-box transcription factor (Tbet) (≥45% vs <10%) in CD4 and CD8 T cells and lower levels of Gata-3 (≤2% vs ≥6%) in CD4 T cells in peptide stimulated, day 75 p.i. spleen cells. These data show that the RSV G protein affects both humoral and cellular adaptive immune responses and induction of 131-2G-like antibodies might improve the safety and long term efficacy of an RSV vaccine. IMPORTANCE: The data in this report suggest that the RSV G protein not only contributes to disease but also dampens the host immune response to infection. Both effects of G likely contribute to difficulties in achieving an effective vaccine. The ability of mAb 131-2G to block these effects of G suggests that inducing antibodies similar to 131-2G should prevent disease and enhance the adaptive immune response with later RSV infection. The fact that 131-2G binds to the 13 aa region conserved among all strains and flanking sequences are conserved within Group A or within Group B strains, simplifies the task of developing a vaccine to induce 131-2G-like antibodies. If our findings in mice apply to humans, then including the 131-2G binding region of G in a vaccine should improve its safety and efficacy. |
Quantitation of ten flavor compounds in unburned tobacco products
Lisko JG , Stanfill SB , Watson CH . Anal Methods 2014 6 (13) 4698-4704 Most research on unburned tobacco has focused on the harmful chemicals associated with the tobacco itself. However, certain flavor additives in tobacco products can pose additional health risks. Flavors like camphor, coumarin, pulegone, eugenol, methyl salicylate, menthol and diphenyl ether have exhibited biological activity and/or toxicity in both lab animals and humans. This publication presents a new GC/MS method for the quantitation of ten flavor compounds (eucalyptol, camphor, menthol, pulegone, ethyl salicylate, methyl salicylate, cinnamaldehyde, eugenol, diphenyl ether and coumarin) in a variety of tobacco products, including smokeless products and cigar filler. Excellent linearity (0.997), accuracy (93.9-106.6%) and precision (CV, 0.5-3.0%) were achieved for all flavor analytes measured. A summary of the concentrations of these flavors in selected international smokeless tobacco (SLT) products including zarda, quiwam, gutkha, and khaini varieties from Southeast Asia and snuff, clove cigarette filler and flavored cigar filler from the United States is reported. High concentrations of eugenol (2110 g g-1), coumarin (439 g g-1), camphor (1060 g g-1) and diphenyl ether (4840 g g-1) were found in selected products. Accurate identification and quantitation of potentially hazardous flavor compounds is important because they can exist in relatively high levels in some tobacco products, including international SLT products. We outline a versatile method which can be used to quantitate flavor compounds in multiple types of tobacco products. |
Feasibility of a lateral flow test for neurocysticercosis using novel up-converting nanomaterials and a lightweight strip analyzer
Corstjens PL , de Dood CJ , Priest JW , Tanke HJ , Handali S . PLoS Negl Trop Dis 2014 8 (7) e2944 Neurocysticercosis is a frequent parasitic infection of the human brain, occurring in most of the world, and requires imaging of the brain to diagnose. To determine the burden of disease and to simplify diagnosis, a field-friendly rapid lateral flow (LF) based antibody screening test was developed. The assay utilizes novel nano-sized up-converting phosphor (UCP) reporter particles in combination with a portable lightweight analyzer and detects antibodies in serum samples reactive with bacterial-expressed recombinant (r) T24H, a marker for detecting neurocysticercosis cases. Three sequential flow steps allow enrichment of antibodies on the Test (T) line and consecutive binding of protein-A coated UCP reporter particles. Antibody binding was determined by measuring 550 nm emission after excitation of the UCP label with a 980 nm infrared (IR) diode. Clinical sensitivity and specificity of the assay to detect cases of human neurocysticercosis with 2 or more viable brain cysts were 96% and 98%, respectively, using a sample set comprised of sera from 63 confirmed cases and 170 healthy parasite-naive non-endemic controls. In conclusion: Proof-of-principle, of a rapid UCP-LF screening assay for neurocysticercosis was demonstrated. The assay utilized bacterial-expressed rT24H as a potential alternative for baculovirus-expressed rT24H. Performance of the UCP-LF assay was excellent, although further studies need to confirm that bacterial expressed antigen can entirely replace previously used baculovirus antigen. In addition, the increasing availability of commercial sources for UCP reporter materials as well as the accessibility of affordable semi-handheld scanners may allow UCP-based bioanalytical systems for point-of-care to evolve at an even faster pace. |
H7N9 and other pathogenic avian influenza viruses elicit a three-pronged transcriptomic signature that is reminiscent of 1918 influenza and associated with lethal outcome in mice
Morrison J , Josset L , Tchitchek N , Chang J , Belser JA , Swayne DE , Pantin-Jackwood MJ , Tumpey TM , Katze MG . J Virol 2014 88 (18) 10556-68 Modulating the host response is a promising approach to treating influenza, a virus whose pathogenesis is determined in part by the reaction it elicits within the host. Though the pathogenicity of emerging H7N9 influenza virus has been reported in several animal models, these studies have not included a detailed characterization of the host response following infection. To this end, we characterized the transcriptomic response of BALB/c mice infected with H7N9 (A/Anhui/01/2013) virus and compared it to the responses induced by H5N1 (A/Vietnam/1203/2004), H7N7 (A/Netherlands/219/2003) or pandemic 2009 H1N1 (A/Mexico/4482/2009) influenza viruses. We found that responses to the H7 subtype viruses were intermediate to those elicited by H5N1 and pdm09H1N1 early in infection, but that they evolved to resemble the H5N1 response as infection progressed. H5N1, H7N7 and H7N9 viruses were pathogenic in mice, and this pathogenicity correlated with increased transcription of cytokine response genes and decreased transcription of lipid metabolism and coagulation signaling genes. This three-pronged transcriptomic signature was observed in mice infected with pathogenic H1N1 strains such as the 1918 virus, indicating that it may be predictive of pathogenicity across multiple influenza strains. Finally, we used host transcriptomic profiling to computationally predict drugs that reverse the host response to H7N9 infection, and identified six FDA-approved drugs that could potentially be repurposed to treat H7N9 and other pathogenic influenza viruses. IMPORTANCE: Emerging avian influenza viruses are of global concern because the human population is immunologically naive to them. Current influenza drugs target viral molecules, but the high mutation rate of influenza viruses eventually leads to the development of antiviral resistance. As the host evolves far more slowly than the virus, and influenza pathogenesis is determined in part by the host response, targeting the host response is a promising approach to treating influenza. Here we characterize the host transcriptomic response to emerging H7N9 influenza virus and compare it with the responses to H7N7, H5N1 and pdm09H1N1. All three avian viruses were pathogenic in mice, and elicited a transcriptomic signature that also occurs in response to the legendary 1918 influenza virus. Our work identifies host responses that could be targeted to treat severe H7N9 influenza and identifies six FDA-approved drugs that could potentially be repurposed as H7N9 influenza therapeutics. |
Induction of stemlike cells with fibrogenic properties by carbon nanotubes and its role in fibrogenesis
Luanpitpong S , Wang L , Manke A , Martin KH , Ammer AG , Castranova V , Yang Y , Rojansakul Y . Nano Lett 2014 14 (6) 3110-6 We developed a three-dimensional fibroblastic nodule model for fibrogenicity testing of nanomaterials and investigated the role of fibroblast stemlike cells (FSCs) in the fibrogenic process. We showed that carbon nanotubes (CNTs) induced fibroblastic nodule formation in primary human lung fibroblast cultures resembling the fibroblastic foci in clinical fibrosis and promoted FSCs that are highly fibrogenic and a potential driving force of fibrogenesis. This study provides a predictive 3D model and mechanistic insight on CNT fibrogenesis. |
State-specific estimates of complete smoke-free home rules among postpartum women, 2010
Tong VT , Hutchings Y , Farr SL , D'Angelo D , Babb S . Prev Med 2014 67 24-7 BACKGROUND: Secondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules. METHODS: Data were analyzed from 26 states and New York City (n=37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics. RESULTS: Overall, 93.6% (95% CI: 93.1-94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), <20 years of age (87.1%), <$15,000 annual income (87.6%), <12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%). CONCLUSIONS: Prevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes. |
Urinary phthalate metabolite associations with biomarkers of inflammation and oxidative stress across pregnancy in Puerto Rico
Ferguson KK , Cantonwine DE , Rivera-Gonzalez LO , Loch-Caruso R , Mukherjee B , Anzalota Del Toro LV , Jimenez-Velez B , Calafat AM , Ye X , Alshawabkeh AN , Cordero JF , Meeker JD . Environ Sci Technol 2014 48 (12) 7018-25 Phthalate exposure during pregnancy has been linked to adverse birth outcomes such as preterm birth, and inflammation and oxidative stress may mediate these relationships. In a prospective cohort study of pregnant women recruited early in gestation in Northern Puerto Rico, we investigated the associations between urinary phthalate metabolites and biomarkers of inflammation, including C-reactive protein, IL-1beta, IL-6, IL-10, and TNF-alpha, and oxidative stress, including 8-hydroxydeoxyguanosine (OHdG) and 8-isoprostane. Inflammation biomarkers were measured in plasma twice during pregnancy (N = 215 measurements, N = 120 subjects), and oxidative stress biomarkers in urine were measured three times (N = 148 measurements, N = 54 subjects) per woman. In adjusted linear mixed models, metabolites of di-2-ethylhexyl phthalate (DEHP) were associated with increased IL-6 and IL-10 but relationships were generally not statistically significant. All phthalates were associated with increases in oxidative stress markers. Relationships with OHdG were significant for DEHP metabolites as well as mono-n-butyl phthalate (MBP) and monoiso-butyl phthalate (MiBP). For 8-isoprostane, associations with nearly all phthalates were statistically significant and the largest effect estimates were observed for MBP and MiBP (49-50% increase in 8-isoprostane with an interquartile range increase in metabolite concentration). These relationships suggest a possible mechanism for phthalate action that may be relevant to a number of adverse health outcomes. |
Neither folic acid supplementation nor pregnancy affects the distribution of folate forms in the red blood cells of women
Hartman BA , Fazili Z , Pfeiffer CM , O'Connor DL . J Nutr 2014 144 (9) 1364-9 It is not known whether folate metabolism is altered during pregnancy to support increased DNA and RNA biosynthesis. By using a state-of-the-art LC tandem mass spectrometry technique, the aim of this study was to investigate differences in RBC folate forms between pregnant and nonpregnant women and between nonpregnant women consuming different concentrations of supplemental folic acid. Forms of folate in RBCs were used to explore potential shifts in folate metabolism during early erythropoiesis. Total RBC folate and folate forms [tetrahydrofolate (THF); 5-methyltetrahydrofolate (5-methyl-THF); 4alpha-hydroxy-5-methyl-THF (an oxidation product of 5-methyl-THF); 5-formyl-THF; and 5,10-methenyl-THF] were measured in 4 groups of women (n = 26): pregnant women (PW) (30-36 wk of gestation) consuming 1 mg/d of folic acid, and nonpregnant women consuming 0 mg/d (NPW-0), 1 mg/d (NPW-1), and 5 mg/d (NPW-5) folic acid. Mean (+/- SD) RBC folate concentration of the NPW-0 group (890 +/- 530 nmol/L) was lower than the NPW-1 (1660 +/- 350 nmol/L) and NPW-5 (1980 +/- 570 nmol/L) groups as assessed by microbiologic assay (n = 26, P < 0.0022). No difference was found between the NPW-1 and NPW-5 groups. We detected 5-methyl-THF [limit of detection (LOD) = 0.06 nmol/L] in all groups and THF (LOD = 0.2 nmol/L) in most women regardless of methylenetetrahydrofolate reductase genotype. Most women consuming folic acid supplements had detectable concentrations of 5,10-methenyl-THF (LOD = 0.31 nmol/L). However, there was no difference in the relative distribution of 5-methyl-THF (83-84%), sum of non-methyl folates (0.6-3%), or individual non-methyl folate forms in RBCs across groups. We conclude that although folic acid supplementation in nonpregnant women increases RBC total folate and the concentration of individual folate forms, it does not alter the relative distribution of folate forms. Similarly, distribution of RBC folate forms did not differ between pregnant and nonpregnant women. This trial was registered at clinicaltrials.gov as NCT01741077. |
Pediatric inpatient hospital resource use for congenital heart defects
Simeone RM , Oster ME , Cassell CH , Armour BS , Gray DT , Honein MA . Birth Defects Res A Clin Mol Teratol 2014 100 (12) 934-43 BACKGROUND: Congenital heart defects (CHDs) occur in approximately 8 per 1000 live births. Improvements in detection and treatment have increased survival. Few national estimates of the healthcare costs for infants, children and adolescents with CHDs are available. METHODS: We estimated hospital costs for hospitalizations using pediatric (0-20 years) hospital discharge data from the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) for hospitalizations with CHD diagnoses. Estimates were up-weighted to be nationally representative. Mean costs were compared by demographic factors and presence of critical CHDs (CCHDs). RESULTS: Up-weighting of the KID generated an estimated 4,461,615 pediatric hospitalizations nationwide, excluding normal newborn births. The 163,980 (3.7%) pediatric hospitalizations with CHDs accounted for approximately $5.6 billion in hospital costs, representing 15.1% of costs for all pediatric hospitalizations in 2009. Approximately 17% of CHD hospitalizations had a CCHD, but it varied by age: approximately 14% of hospitalizations of infants, 30% of hospitalizations of patients aged 1 to 10 years, and 25% of hospitalizations of patients aged 11 to 20 years. Mean costs of CHD hospitalizations were higher in infancy ($36,601) than at older ages and were higher for hospitalizations with a CCHD diagnosis ($52,899). Hospitalizations with CCHDs accounted for 26.7% of all costs for CHD hospitalizations, with hypoplastic left heart syndrome, coarctation of the aorta, and tetralogy of Fallot having the highest total costs. CONCLUSION: Hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with CCHD diagnoses accounted for 27% of CHD hospital costs. |
Persistence of parent-reported ADHD symptoms from childhood through adolescence in a community sample
Holbrook JR , Cuffe SP , Cai B , Visser SN , Forthofer MS , Bottai M , Ortaglia A , McKeown RE . J Atten Disord 2014 20 (1) 11-20 OBJECTIVE: To examine ADHD symptom persistence and factors associated with elevated symptom counts in a diverse, longitudinal community-based sample. METHOD: Parents reported demographics and completed a diagnostic interview repeatedly over a 6-year period. At Time 1, 481 interviews were completed about children (5-13 years); all participants were invited to four annual follow-up interviews, and 379 (79%) completed at least one. Inattentive (IA) and hyperactive-impulsive (HI) symptom counts were modeled with logistic quantile regression, while accounting for study design complexities. RESULTS: The prevalence of seven IA symptoms remained stable from early childhood through late adolescence. The prevalence of eight HI symptoms decreased by more than half over time. After demographic adjustment, the upper quartile of HI symptom counts decreased with age (p < .01). High HI symptom counts persisted more among those with high IA symptom counts (p = .05). CONCLUSION: This study further characterizes and provides insights into ADHD symptom trajectory through adolescence. |
Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children's development
Stein A , Desmond C , Garbarino J , Van IJzendoorn MH , Barbarin O , Black MM , Stein AD , Hillis SD , Kalichman SC , Mercy JA , Bakermans-Kranenburg MJ , Rapa E , Saul JR , Dobrova-Krol NA , Richter LM . AIDS 2014 28 S261-s268 The immediate and short-term consequences of adult HIV for affected children are well documented. Little research has examined the long-term implications of childhood adversity stemming from caregiver HIV infection. Through overviews provided by experts in the field, together with an iterative process of consultation and refinement, we have extracted insights from the broader field of child development of relevance to predicting the long-term consequences to children affected by HIV and AIDS. We focus on what is known about the impact of adversities similar to those experienced by HIV-affected children, and for which there is longitudinal evidence. Cautioning that findings are not directly transferable across children or contexts, we examine findings from the study of parental death, divorce, poor parental mental health, institutionalization, undernutrition, and exposure to violence. Regardless of the type of adversity, the majority of children manifest resilience and do not experience any long-term negative consequences. However, a significant minority do and these children experience not one, but multiple problems, which frequently endure over time in the absence of support and opportunities for recovery. As a result, they are highly likely to suffer numerous and enduring impacts. These insights suggest a new strategic approach to interventions for children affected by HIV and AIDS, one that effectively combines a universal lattice of protection with intensive intervention targeted to selected children and families. |
Prevalence and characteristics of women at risk for an alcohol-exposed pregnancy (AEP) in the United States: estimates from the national survey of family growth
Cannon MJ , Guo J , Denny CH , Green PP , Miracle H , Sniezek JE , Floyd RL . Matern Child Health J 2014 19 (4) 776-82 Non-pregnant women can avoid alcohol-exposed pregnancies (AEPs) by modifying drinking and/or contraceptive practices. The purpose of this study was to estimate the number and characteristics of women in the United States who are at risk of AEPs. We analyzed data from in-person interviews obtained from a national probability sample (i.e., the National Survey of Family Growth) of reproductive-aged women conducted from January 2002 to March 2003. To be at risk of AEP, a woman had to have met the following criteria in the last month: (1) was drinking; (2) had vaginal intercourse with a man; and (3) did not use contraception. During a 1-month period, nearly 2 million U.S. women were at risk of an AEP (95 % confidence interval 1,760,079-2,288,104), including more than 600,000 who were binge drinking. Thus, 3.4 %, or 1 in 30, of all non-pregnant women were at risk of an AEP. Most demographic and behavioral characteristics were not clearly associated with AEP risk. However, pregnancy intention was strongly associated with AEP risk (prevalence ratio = 12.0, P < 0.001) because women often continued to drink even after they stopped using contraception. Nearly 2 million U.S. women are at AEP risk and therefore at risk of having children born with fetal alcohol spectrum disorders. For pregnant women and women intending a pregnancy, there is an urgent need for wider implementation of prevention programs and policy approaches that can reduce the risk for this serious public health problem. |
Micronutrient status in Jordan: 2002 and 2010
Serdula MK , Nichols EK , Aburto NJ , Masa'd H , Obaid B , Wirth J , Tarawneh M , Barham R , Hijawi B , Sullivan KM . Eur J Clin Nutr 2014 68 (10) 1124-8 BACKGROUND/OBJECTIVES: Two national surveys were conducted in Jordon in 2002 and 2010 to investigate the micronutrient status in women and children. To determine the prevalence of anemia, iron and folate deficiency among women and children in 2010 and compare with the prevalence of anemia and iron deficiency in 2002. SUBJECTS/METHODS: A nationally representative survey was conducted in 2002 (1023 women, 15-49 years of age; 1059 children, 12-59 months of age) and a second survey in 2010 (2035 women; 940 children). Venous blood samples were used to measure hemoglobin, ferritin and red blood cell folate (the latter on a subsample of 393 women). RESULTS: Among women in 2010, the prevalence of folate deficiency and insufficiency was 13.6% and 82.9%, respectively. Geometric mean serum ferritin was higher in 2010 compared with 2002 (21.3 ng/ml vs 18.3, P=0.01); there was no significant change in the prevalence of iron deficiency (35.1% vs 38.7%, P=0.17), iron deficiency anemia (19.1% vs 20.0%, P=0.61) or anemia (29.2% vs 29.3%, P=0.96). Among children, a significantly lower prevalence was observed in 2010 compared with 2002 for iron deficiency (13.7% vs 26.2% P<0.001) and iron deficiency anemia (4.8% vs 10.1%, P<0.001); a nonsignificant lower prevalence was observed for anemia (16.6% vs 20.2%, P=0.09). CONCLUSIONS: In 2010, approximately one of seven women was folate deficient and six out of seven were folate insufficient for the prevention of neural tube defects. Between 2002 and 2010, significant improvement was observed in the prevalence of iron deficiency in children, but not in women. |
The imbalance of sodium and potassium intake: implications for dietetic practice
Levings JL , Gunn JP . J Acad Nutr Diet 2014 114 (6) 838-41 Americans are consuming too much sodium and too little potassium. Decreasing sodium intake and increasing potassium intake can reduce the risk of high blood pressure, heart disease, and stroke, and can help control blood pressure. Registered dietitians (RD’s) may play a role in preventing disease by counseling clients about the importance of reducing sodium intake and increasing potassium intake. This paper discusses the impact of sodium and potassium intake on health and explains the role of the registered dietitian nutritionist (RDN) when counseling clients about reducing sodium intake and increasing potassium intake. |
A comparison of cytotoxicity and oxidative stress from welding fumes generated with a new nickel-, copper-based consumable versus mild and stainless steel-based welding in RAW 264.7 mouse macrophages
Badding MA , Fix NR , Antonini JM , Leonard SS . PLoS One 2014 9 (6) e101310 Welding processes that generate fumes containing toxic metals, such as hexavalent chromium (Cr(VI)), manganese (Mn), and nickel (Ni), have been implicated in lung injury, inflammation, and lung tumor promotion in animal models. While federal regulations have reduced permissible worker exposure limits to Cr(VI), this is not always practical considering that welders may work in confined spaces and exhaust ventilation may be ineffective. Thus, there has been a recent initiative to minimize the potentially hazardous components in welding materials by developing new consumables containing much less Cr(VI) and Mn. A new nickel (Ni) and copper (Cu)-based material (Ni-Cu WF) is being suggested as a safer alternative to stainless steel consumables; however, its adverse cellular effects have not been studied. This study compared the cytotoxic effects of the newly developed Ni-Cu WF with two well-characterized welding fumes, collected from gas metal arc welding using mild steel (GMA-MS) or stainless steel (GMA-SS) electrodes. RAW 264.7 mouse macrophages were exposed to the three welding fumes at two doses (50 microg/ml and 250 microg/ml) for up to 24 hours. Cell viability, reactive oxygen species (ROS) production, phagocytic function, and cytokine production were examined. The GMA-MS and GMA-SS samples were found to be more reactive in terms of ROS production compared to the Ni-Cu WF. However, the fumes from this new material were more cytotoxic, inducing cell death and mitochondrial dysfunction at a lower dose. Additionally, pre-treatment with Ni-Cu WF particles impaired the ability of cells to phagocytize E. coli, suggesting macrophage dysfunction. Thus, the toxic cellular responses to welding fumes are largely due to the metal composition. The results also suggest that reducing Cr(VI) and Mn in the generated fume by increasing the concentration of other metals (e.g., Ni, Cu) may not necessarily improve welder safety. |
Dermal exposure potential from textiles that contain silver nanoparticles
Stefaniak AB , Duling MG , Lawrence RB , Thomas TA , LeBouf RF , Wade EE , Abbas Virji M . Int J Occup Environ Health 2014 20 (3) 220-234 BACKGROUND: Factors that influence exposure to silver particles from the use of textiles are not well understood. OBJECTIVES: The aim of this study was to evaluate the influence of product treatment and physiological factors on silver release from two textiles. METHODS: Atomic and absorbance spectroscopy, electron microscopy, and dynamic light scattering (DLS) were applied to characterize the chemical and physical properties of the textiles and evaluate silver release in artificial sweat and saliva under varying physiological conditions. One textile had silver incorporated into fiber threads (masterbatch process) and the other had silver nanoparticles coated on fiber surfaces (finishing process). RESULTS: Several complementary and confirmatory analytical techniques (spectroscopy, microscopy, etc.) were required to properly assess silver release. Silver released into artificial sweat or saliva was primarily in ionic form. In a simulated "use" and laundering experiment, the total cumulative amount of silver ion released was greater for the finishing process textile (0.51+/-0.04%) than the masterbatch process textile (0.21+/-0.01%); P<0.01. CONCLUSIONS: We found that the process (masterbatch vs finishing) used to treat textile fibers was a more influential exposure factor than physiological properties of artificial sweat or saliva. |
The Patient Protection and Affordable Care Act: opportunities for prevention and public health
Shaw FE , Asomugha CN , Conway PH , Rein AS . Lancet 2014 384 (9937) 75-82 The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage-and the health benefits of insurance-to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population. |
Factors driving the adoption of quality improvement initiatives in local health departments: results from the 2010 Profile Study
Luo H , Sotnikov S , McLees A , Stokes S . J Public Health Manag Pract 2014 21 (2) 176-85 BACKGROUND: Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. OBJECTIVES: (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs' decision to implement QI initiatives. METHODS: In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs' QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration's Area Resource Files and the Association of State and Territorial Health Officials' 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. RESULTS: The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. CONCLUSION: According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed. |
Health security in 2014: building on preparedness knowledge for emerging health threats
Khan AS , Lurie N . Lancet 2014 384 (9937) 93-7 Ideas, information, and microbes are shared worldwide more easily than ever before. New infections, such as the novel influenza A H7N9 or Middle East respiratory syndrome coronavirus, pay little heed to political boundaries as they spread; nature pays little heed to destruction wrought by increasingly frequent natural disasters. Hospital-acquired infections are hard to prevent and contain, because the bacteria are developing resistance to the therapeutic advances of the 20th century. Indeed, threats come in ever-complicated combinations: a combined earthquake, tsunami, and radiation disaster; blackouts in skyscrapers that require new thinking about evacuations and medically fragile populations; or bombings that require as much psychological profiling as chemical profiling. Response requires up-to-date laboratories with genetic sequencing capabilities for infectious agents and rapid detection methods for chemical and radiological threats, nimble medical and epidemiological response units, and an alert and prepared workforce. | These complex and interconnected problems have spurred innovation across government to create interconnected solutions. Increasingly, the USA is building national capabilities to improve health security, which is defined as a state in which the nation and its people are prepared for, protected from, and resilient in the face of health threats.1 To ensure a nation's health security entails preventing, protecting, mitigating, responding to, and recovering from all hazards that adversely affect health, requiring strengthening health and response systems at the local, state, and national levels. These capabilities are being built to address a wide range of hazards so that a strong base of readiness for any threat is developed. |
Improving health in the USA: progress and challenges
Jaffe HW , Frieden TR . Lancet 2014 384 (9937) 3-5 The health of Americans continues to improve. Life expectancy at birth, 78·7 years (76·2 years for men and 81·0 years for women), has never been higher.1 Age-adjusted death rates for the four leading causes of death—heart disease, cancer, chronic lower respiratory diseases, and stroke—are all falling.1 Immunisation rates for young children are high, racial and ethnic disparities in childhood vaccinations have largely been eliminated, and most vaccine-preventable diseases of childhood are now at historically low levels.2, 3 Deaths from motor vehicle crashes are at their lowest levels since 1950, and teen pregnancies have fallen to their lowest rate in seven decades.4, 5 What's wrong with this picture? | Although increases in US health-care costs have recently slowed, health spending reached US$2·8 trillion in 2012, or $8915 per person, and accounted for 17·2% of gross domestic product.6 These expenditures exceed those of other high-income countries in Europe, Asia, and North America, but a recent report found US life expectancy and other health outcomes generally poorer than in other high-income countries.7 A fragmented health-care delivery system, physical and social environments, and individual risk behaviours all play a part. |
Monitoring health outcomes of assisted reproductive technology
Kissin DM , Jamieson DJ , Barfield WD . N Engl J Med 2014 371 (1) 91-3 During the past 35 years, assisted reproductive technology has been transformed from a miracle to a standard and common part of medical practice. Although this technology is believed to be safe and has resulted in more than 5 million infants born globally, rapid technological progress leading to treatment modifications makes it important to continually monitor the safety of assisted reproductive technology for the rapidly growing population of users of the technology and infants conceived with its use. | Although many countries have national registries to monitor the use and effectiveness of assisted reproductive technology, they are typically not designed to collect data beyond delivery. In the United States, the Centers for Disease Control and Prevention (CDC) maintains the National ART (Assisted Reproductive Technology) Surveillance System (NASS), which collects limited information about treatment outcome (live birth data are limited to plurality, infant sex, birth weight, and gestational age). Studying the long-term health outcomes of assisted reproductive technology is difficult owing to the relative infrequency of both the exposure to it and the outcomes of interest (e.g., birth defects, cancer, and developmental disorders) and to the sensitive nature of the fertility treatments. Our knowledge of the long-term effect of assisted reproductive technology on maternal and child health is thus quite limited.1 |
Consensus proposals for classification of the family Hepeviridae
Smith DB , Simmonds P , Jameel S , Emerson SU , Harrison TJ , Meng XJ , Okamoto H , Van der Poel WH , Purdy MA . J Gen Virol 2014 95 2223-2232 The family Hepeviridae consists of positive-stranded RNA viruses that infect a wide range of mammalian species, as well as chickens and trout. A subset of these viruses infects humans and can cause a self-limiting acute hepatitis that may become chronic in immunosuppressed individuals. Current published descriptions of the taxonomical divisions within the family Hepeviridae are contradictory in relation to the assignment of species and genotypes. Through analysis of existing sequence information, we propose a taxonomic scheme in which the family is divided into the genera Orthohepevirus (all mammalian and avian hepatitis E virus (HEV) isolates) and Piscihepevirus (cutthroat trout virus). Species within the genus Orthohepevirus are designated Orthohepevirus A (isolates from human, pig, wild boar, deer, mongoose, rabbit and camel), Orthohepevirus B (isolates from chicken), Orthohepevirus C (isolates from rat, greater bandicoot, Asian musk shrew, ferret and mink) and Orthohepevirus D (isolates from bat). Proposals are also made for the designation of genotypes within the human and rat HEVs. This hierarchical system is congruent with hepevirus phylogeny, and the three classification levels (genus, species and genotype) are consistent with, and reflect discontinuities in the ranges of pairwise distances between amino acid sequences. Adoption of this system would include the avoidance of host names in taxonomic identifiers and provide a logical framework for the assignment of novel variants. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
- Global Health
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Public Health Law
- Public Health Leadership and Management
- Reproductive Health
- Sciences, General
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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.
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 03, 2024
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