U.S. primary care physicians' diet-, physical activity-, and weight-related care of adult patients
Smith AW , Borowski LA , Liu B , Galuska DA , Signore C , Klabunde C , Huang TT , Krebs-Smith SM , Frank E , Pronk N , Ballard-Barbash R . Am J Prev Med 2011 41 (1) 33-42 BACKGROUND: Overweight and obesity are substantial problems in the U.S., but few national studies exist on primary care physicians' (PCPs') clinical practices regarding overweight and obesity. PURPOSE: To profile diet, physical activity, and weight control practice patterns of PCPs who treat adults. METHODS: A nationally representative survey of 1211 PCPs sampled from the American Medical Association's Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included PCPs' assessment, counseling, referral, and follow-up of diet, physical activity, and weight control in adult patients with and without chronic disease and PCPs' use of pharmacologic treatments and surgical referrals for overweight and obesity. RESULTS: The survey response rate was 64.5%. Half of PCPs (49%) reported recording BMI regularly. Fewer than 50% reported always providing specific guidance on diet, physical activity, or weight control. Regardless of patients' chronic disease status, <10% of PCPs always referred patients for further evaluation/management and <22% reported always systematically tracking patients over time concerning weight or weight-related behaviors. Overall, PCPs were more likely to counsel on physical activity than on diet or weight control (p's<0.05). More than 70% of PCPs reported ever using pharmacologic treatments to treat overweight and 86% had referred for obesity-related surgery. CONCLUSIONS: PCPs' assessment and behavioral management of overweight and obesity in adults is at a low level relative to the magnitude of the problem in the U.S. Further research is needed to understand barriers to providing care and to improve physician engagement in tracking and managing healthy lifestyles in U.S. adults. |
Pediatricians' and family physicians' weight-related care of children in the U.S.
Huang TT , Borowski LA , Liu B , Galuska DA , Ballard-Barbash R , Yanovski SZ , Olster DH , Atienza AA , Smith AW . Am J Prev Med 2011 41 (1) 24-32 BACKGROUND: Few national data exist to assess primary care physicians' (PCPs') clinical practices with regard to childhood obesity. PURPOSE: To survey pediatricians and family practice physicians regarding their assessment, counseling, and management of diet, physical activity, and weight status among pediatric patients in the primary care setting. METHODS: A nationally representative cross-sectional survey of pediatricians and family practice physicians sampled from the American Medical Association (AMA) Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included physicians' self-reported practice behaviors regarding assessments of pediatric patients' weight status, counseling of diet and physical activity, and referrals and follow-ups. RESULTS: Response rate excluding physicians listed as "no-contact" by the AMA was 73.7% among pediatricians and 66.9% among family physicians. Less than 50% of all PCPs assessed BMI percentiles regularly in children. Eighteen percent of all PCPs reported referring children for further evaluation or management. Fifty-eight percent of all PCPs reported never, rarely, or only sometimes tracking patients over time concerning weight or weight-related behaviors. Pediatricians were more likely than family physicians to assess weight status and provide behavioral counseling (p's<0.001). CONCLUSIONS: Active PCP participation in assessing or managing childhood obesity in the primary care setting appears low relative to the frequency of the problem in the U.S. Interventions to reduce the barriers to physician engagement in the assessment and management of healthy lifestyles are needed to prevent and control childhood obesity. |
Factors associated with asthma control among adults in five New England states, 2006-2007
Nguyen K , Zahran H , Iqbal S , Peng J , Boulay E . J Asthma 2011 48 (6) 581-8 BACKGROUND: Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown. OBJECTIVE: The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England. METHODS: Data from the 2006-2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as "well controlled," "not well controlled," or "very poorly controlled" according to the NAEPP guidelines. RESULTS: Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2-13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0-53.4), high school educated or less (OR = 2.8; 95% CI = 1.6-4.7), current smokers (OR = 2.5; 95% CI = 1.3-5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4-17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5-4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3-8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1-7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6-4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2-7.8) were significantly associated with poor asthma control. CONCLUSION: The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management. |
Association of foot symptoms with self-reported and performance-based measures of physical function: the Johnston County osteoarthritis project
Golightly YM , Hannan MT , Shi XA , Helmick CG , Renner JB , Jordan JM . Arthritis Care Res (Hoboken) 2011 63 (5) 654-9 OBJECTIVE: To examine associations of foot symptoms with self-reported and performance-based measures of physical function in a large, biracial, community-based sample of individuals ages ≥45 years. METHODS: Data from 2,589 Johnston County participants (evaluated in 1999-2004) were used in cross-sectional analyses. The presence of foot symptoms was defined as pain, aching, or stiffness of at least one foot on most days. Physical function was assessed by the total Stanford Health Assessment Questionnaire (HAQ) score (0, >0 but <1, and ≥1), timed 5 repeated chair stands (completion time <12 seconds, ≥12 seconds, and unable), and 8-foot walk time (<3.35 seconds and ≥3.35 seconds). Separate multivariable logistic regression models examined associations between foot symptoms and physical function measures, controlling for age, race, sex, body mass index, radiographic knee osteoarthritis, radiographic hip osteoarthritis, knee symptoms, hip symptoms, and depressive symptoms. Interaction terms between each of the 3 physical function measures and each demographic and clinical characteristic were examined. RESULTS: The prevalence of foot symptoms was 37%. Participants with foot symptoms were more likely than those without symptoms to have higher HAQ scores (adjusted odds ratio [OR] 1.79, 95% confidence interval [95% CI] 1.50-2.12). Among obese participants, those with foot symptoms had longer chair stand (adjusted OR 1.38, 95% CI 1.04-1.87) and 8-foot walk times (adjusted OR 1.61, 95% CI 1.21-2.15) than those without symptoms. CONCLUSION: Foot symptoms were independently and significantly associated with 2 of 3 measures of poorer physical function. Interventions for foot symptoms may be important for helping patients prevent or deal with an existing decline in physical function. |
Cardiac arrest patients in the emergency department-National Hospital Ambulatory Medical Care Survey, 2001-2007
Valderrama AL , Fang J , Merritt RK , Hong Y . Resuscitation 2011 82 (10) 1298-301 AIM OF THE STUDY: Few studies have focused on the full complement of cardiac arrest cases seen in hospital emergency departments (ED). The aims of our study were to describe cardiac arrest visits in the ED by using a nationally representative sample of U.S. adults. METHODS: ED data from the 2001-2007 National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed. Cardiac arrest visits were considered to be those with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 427.5 as the primary diagnosis. RESULTS AND CONCLUSIONS: From 2001 to 2007, adults in the U.S. made an estimated 600,729,000 ED visits. Of those, 1,001,000 (0.17%) had a primary diagnosis of cardiac arrest. The majority of patients with such visits were dead on arrival or died in the ED (74.0%). The mean age for cardiac arrest visits was 66.7 years (95% confidence interval [CI], 64.6-68.8 years). Women had a lower rate of cardiac arrest visits than men (age-adjusted odds ratio [AOR], 0.6; 95% CI, 0.5-0.8), and the privately insured (AOR, 0.4; 95% CI, 0.2-0.7) and those with government insurance (AOR, 0.5; 95% CI, 0.3-0.9) had a lower proportion of cardiac arrest ED visits than uninsured persons. In addition, increasing age was a significant predictor of cardiac arrest visits. Cardiac arrest visits did not vary significantly by race, geographic region, or metropolitan statistical area. ED visits classified as cardiac arrest represent 1 in 600 visits and these visits differ by age, sex, payment source, and arrival time at the ED. |
Changes in mortality among United States adults with chronic obstructive pulmonary disease in two national cohorts recruited during 1971 through 1975 and 1988 through 1994
Ford ES , Mannino DM , Zhao G , Li C , Croft JB . Chest 2011 141 (1) 101-110 BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major contributor to the global burden of disease. Our objective was to examine changes in the mortality rate among people with COPD in the United States. METHODS: We conducted prospective studies using data from 5185 participants of the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (baseline examination from 1971 through 1975; follow-up through 1992/1993) and 10954 participants of the NHANES III Linked Mortality Study (baseline examination from 1988 through 1994; follow-up through 2006). RESULTS: The age-adjusted rate (per 1,000 person-years) among participants with moderate or severe COPD (23.9 and 20.2) was about 2.5 to 3 times higher than the rate among participants with normal lung function (10.4 and 6.2) in NHANES I and NHANES III, respectively. Compared with NHANES I, the mortality rate among participants of NHANES III decreased by 15.8% for those with moderate or severe COPD, 25.2% for those with mild COPD, 35.9% for those with respiratory symptoms with normal lung function, 16.6% for those with restrictive impairment, and 40.1% for those with normal lung function. However, the decrease did not reach statistical significance among participants with moderate or severe COPD. The decreases in the mortality rate among men with moderate or severe COPD (-17.8%) or with restrictive impairment (-35.1%) exceeded the changes among women (+3%, -6.1%, respectively). CONCLUSIONS: The secular decline in the mortality rate in the United States benefitted people with COPD less than people with normal lung function. |
Chronic typhoid infection and the risk of biliary tract cancer and stones in Shanghai, China
Safaeian M , Gao YT , Sakoda LC , Quraishi SM , Rashid A , Wang BS , Chen J , Pruckler J , Mintz E , Hsing AW . Infect Agent Cancer 2011 6 6 Previous studies have shown a positive association between chronic typhoid carriage and biliary cancers. We compared serum Salmonella enterica serovar Typhi antibody titers between biliary tract cancer cases, biliary stone cases without evidence of cancer, and healthy subjects in a large population-based case-control study in Shanghai, China. Participants included 627 newly diagnosed primary biliary tract cancer patients; 1,037 biliary stone cases (774 gallbladder and 263 bile-duct) and 959 healthy subjects without a history of cancer, randomly selected from the Shanghai Resident Registry. Overall only 6/2,293 (0.26%) were Typhi positive. The prevalence of Typhi was 1/457 (0.22%), 4/977 (0.41%), and 1/859 (0.12%) among cancer cases, biliary-stone cases, and population controls, respectively. We did not find an association between Typhi and biliary cancer in Shanghai, due to the very low prevalence of chronic carriers in this population.The low seroprevalence of S. Typhi in Shanghai is unlikely to explain the high incidence of biliary cancers in this population. |
Older partner selection, sexual risk behaviour and unrecognised HIV infection among black and Latino men who have sex with men
Joseph HA , Marks G , Belcher L , Millett GA , Stueve A , Bingham TA , Lauby J . Sex Transm Infect 2011 87 (5) 442-7 OBJECTIVES: The authors examine whether young black and Latino men who have sex with men (MSM) who have older sex partners are more likely than those who do not have older sex partners to have unrecognised HIV infection. The authors examine whether the association stems from (1) increased sexual risk behaviour with male partners of any age, (2) heightened risk of being exposed to HIV infection by older partners or (3) a combination of these two factors. METHODS: The analytical sample consisted of 723 black and Latino MSM, aged 18-35 years, who were HIV negative or of unknown serostatus at study entry. Participants completed a self-administered questionnaire and were tested for HIV infection. Men who reported having a male sex partner who was at least 4 years older than themselves were compared with those who did not. Outcomes included unprotected receptive anal intercourse (URAI) with male partners of any age (past 3 months) and having unrecognised HIV infection. RESULTS: Men with older partners reported a higher prevalence of URAI (AOR=1.50, 95% CI 1.02 to 2.21). A second model found that men with older partners had increased odds of having unrecognised HIV infection (AOR=2.51, 95% CI 1.18 to 5.34) after controlling for the number of URAI partners of any age, which remained an independent predictor. CONCLUSIONS: Young black and Latino MSM who had older male sex partners were at increased risk of having unrecognised HIV infection. This heightened risk was associated with sexual risk behaviour with partners of any age as well as possible increased exposure to HIV infection from older partners. |
Protection from smallpox: beyond immune biomarkers
Karem KL , Reynolds MG . Future Virol 2011 6 (6) 709-719 Since the eradication of smallpox, immunological studies of smallpox vaccine (vaccinia virus) have provided great gains in understanding immunology as well as depecting smallpox vaccine-derived immune responses. Despite this wealth of knowledge, two confounding problems remain. First, that surviving smallpox provides an individual with lifelong protective immunity, whereas vaccination may not, and second, that specific molecular correlates of protection against smallpox remain vague. Historical literature on smallpox and contemporary studies of other human infections with orthopoxviruses, such as monkeypox, indicate that vaccination may lower disease risks, but it does not provide complete protection against infection in all individuals. Factors impacting protective immunity include longevity of immunologic memory post-vaccination, challenge dose and differences in the challenge viruses, as well as route of exposure. This article discusses historical information regarding smallpox attack rates during outbreaks and contemporary views on aspects of vaccines and naturally occurring orthopoxvirus outbreaks as related to vaccine-derived immunity. 2011 Future Medicine Ltd. |
Epidemiology of respiratory infections caused by atypical bacteria in two Kenyan refugee camps
Kim C , Nyoka R , Ahmed JA , Winchell JM , Mitchell SL , Kariuki Njenga M , Auko E , Burton W , Breiman RF , Eidex RB . J Immigr Minor Health 2011 14 (1) 140-5 Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella spp. are common causes of atypical pneumonia; however, data about these atypical pathogens are limited in the refugee setting. Paired nasopharyngeal and oropharyngeal specimens were collected from patients with respiratory illness presenting to healthcare centers in two refugee camps in Kenya. The specimens were tested for C. pneumoniae, M. pneumoniae, and Legionella spp. as well as eight respiratory viruses. Atypical pathogens were detected in 5.5% of the specimens of which 54% were co-infected with at least one of the eight viruses tested. Patients positive for atypical bacteria co-infected with virus were significantly more likely to have severe acute respiratory illness than patients infected with only atypical bacteria (P = 0.04). While the percentage of atypical pathogens identified was lower than expected, we found a significant relationship between atypical bacterial-viral co-infection and severity of disease in this refugee population. |
Phylogenetic analysis of eastern equine encephalitis virus isolates from Florida.
White GS , Pickett BE , Lefkowitz EJ , Johnson AG , Ottendorfer C , Stark LM , Unnasch TR . Am J Trop Med Hyg 2011 84 (5) 709-17 Florida has the highest degree of endemicity for eastern equine encephalitis virus (EEEV) of any state in the United States and is the only state with year-round transmission of EEEV. To further understand the viral population dynamics in Florida, the genome sequence of six EEEV isolates from central Florida were determined. These data were used to identify the most polymorphic regions of the EEEV genome from viruses isolated in Florida. The sequence of these polymorphic regions was then determined for 18 additional Florida isolates collected in four geographically distinct regions over a 20-year period. Phylogenetic analyses of these data suggested a rough temporal association of the Florida isolates, but no clustering by region or by source of the isolate. Some clustering of northeastern isolates with Florida isolates was seen, providing support for the hypothesis that Florida serves as a reservoir for the periodic introduction of EEEV into the northeastern United States. |
Bartonella seroprevalence in rural Thailand
Bhengsri S , Baggett HC , Peruski LF , Morway C , Bai Y , Fisk TL , Sitdhirasdr A , Maloney SA , Dowell SF , Kosoy M . Southeast Asian J Trop Med Public Health 2011 42 (3) 687-92 We estimated the prevalence of anti-Bartonella antibodies among febrile and non-febrile patients presenting to community hospitals in rural Thailand from February 2002 through March 2003. Single serum specimens were tested for IgG titers to four Bartonella species, B. henselae, B. quintana, B. elizabethae and B. vinsonii subsp vinsonii using an indirect immunofluorescent assay. A titer 21:256 was considered positive. Forty-two febrile patients (9.9%) and 19 non-febrile patients (19%) had positive serology titers to at least one Bartonella species. Age-standardized Bartonella seroprevalence differed significantly between febrile (10%) and non-febrile patients (18%, p=0.047), but did not differ by gender. Among all 521 patients, IgG titers 21:256 to B. henselae were found in 20 participants (3.8%), while 17 (3.3%) had seropositivity to B. quintana, 51 (9.8%) to B. elizabethae, and 19 (3.6%) to B. vinsonii subsp vinsonii. These results suggest exposure to Bartonella species is more common in rural Thailand than previously suspected. |
Evaluation of pot-chlorination of wells during a cholera outbreak, Bissau, Guinea-Bissau, 2008
Cavallaro EC , Harris JR , Goia MSda , Barrado JCdos S , Nóbrega AAda , Alvarenga Júnior ICde , Silva AP , Sobel J , Mintz E . J Water Health 2011 9 (2) 394-402 We evaluated the ability of UNICEF-designed pot-chlorinators to achieve recommended free residual chlorine (FRC) levels in well water in Bissau, Guinea-Bissau, during a cholera outbreak. Thirty wells were randomly selected from six neighbourhoods. Pot-chlorinators - perforated plastic bottles filled with gravel, sand and calcium hypochlorite granules - were placed in each well. FRC was measured before and 24, 48 and 72 h after placement and compared with World Health Organization (WHO)-recommended levels of ≥1 mg L-1 for well water during cholera outbreaks and 0.2-5 mg L-1 in non-outbreak settings. Presence of well covers, distance from wells to latrines, and rainfall were noted. Complete post-chlorination data were collected from 26 wells. At baseline, no wells had FRC >0.09 mg L-1. At 24, 48 and 72 h post-chlorination, 4 (15%), 1 (4%) and 0 wells had FRC ≥1 mg L-1 and 16 (62%), 4 (15%) and 1 (4%) wells had FRC between 0.2 and 5 mg L-1, respectively. Several families reported discontinuing household water chlorination after wells were treated with pot-chlorinators. Pot-chlorinators failed to achieve WHO-recommended FRC levels in well water during a cholera outbreak, and conveyed a false sense of security to local residents. Pot-chlorination should be discouraged and alternative approaches to well-water disinfection promoted. |
Racial/ethnic differences in US health behaviors: a decomposition analysis
Dubowitz T , Heron M , Basurto-Davila R , Bird CE , Lurie N , Escarce JJ . Am J Health Behav 2011 35 (3) 290-304 OBJECTIVE: To quantify contributions of individual sociodemographic factors, neighborhood socioeconomic status (NSES), and unmeasured factors to racial/ethnic differences in health behaviors for non-Hispanic (NH) whites, NH blacks, and Mexican Americans. METHODS: We used linear regression and Oaxaca decomposition analyses. RESULTS: Although individual characteristics and NSES contributed to racial/ethnic differences in health behaviors, differential responses by individual characteristics and NSES also played a significant role. CONCLUSIONS: There are racial/ethnic differences in the way that individual-level determinants and NSES affect health behaviors. Understanding the mechanisms for differential responses could inform community interventions and public health campaigns that target particular groups. |
Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up
Apondi R , Bunnell R , Ekwaru JP , Moore D , Bechange S , Khana K , King R , Campbell J , Tappero J , Mermin J . AIDS 2011 25 (10) 1317-27 BACKGROUND: Long-term impact of antiretroviral therapy (ART) on sexual HIV-transmission risk in Africa is unknown. We assessed sexual behavior changes and estimated HIV transmission from HIV-infected adults on ART in Uganda. METHODS: Between 2003 and 2007, we enrolled and followed ART-naive HIV-infected adults in a home-based AIDS program with annual counseling and testing for cohabitating partners, participant transmission risk-reduction plans, condom distribution and prevention support for cohabitating discordant couples. We assessed participants' HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent/no condom use with HIV-negative or unknown serostatus partners in previous 3 months. We compared rates using Poisson regression models, estimated transmission risk using established viral load-specific transmission estimates, and documented sero-conversion rates among HIV-discordant couples. RESULTS: Of 928 participants, 755 (81%) had 36 months data: 94 (10%) died and 79 (9%) missing data. Sexual activity increased from 28% (baseline) to 41% [36 months (P < 0.001)]. Of sexually active participants, 22% reported risky sex at baseline, 8% at 6 months (P < 0.001), and 14% at 36 months (P = 0.018). Median viral load among those reporting risky sex was 122 500 [interquartile range (IQR) 45 100-353 000] copies/ml pre-ART at baseline and undetectable at follow-up. One sero-conversion occurred among 62 cohabitating sero-discordant partners (0.5 sero-conversions/100 person-years). At 36 months, consistent condom use was 74% with discordant partners, 55% with unknown and 46% with concordant partners. Estimated HIV transmission risk reduced 91%, from 47.3 to 4.2/1000 person-years. CONCLUSIONS: Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa. |
Gender-responsive programming and HIV prevention for women: Centers for Disease Control and Prevention perspective
Koenig LJ , McCree DH . Womens Health Issues 2011 21 S241-2 There has been much progress in HIV prevention and treatment for women in the United States. From 2006 to 2009, there were decreases in the estimated rates of annual diagnoses of HIV infections, and of AIDS, among women (Centers for Disease Control and Prevention [CDC], 2011a). Nevertheless, challenges remain. In 2009, in the 40 states with confidential HIV reporting, an estimated 174,057 adolescent and adult women were living with HIV and 9,973 females aged 13 or older were newly diagnosed (CDC, 2011a). Along with supporting a wide range of prevention programs, the CDC collects critical HIV case surveillance data needed to monitor the epidemic. Information regarding age, race/ethnicity, transmission category, area of residence, and timing/stage of disease at diagnosis make it possible to target prevention and care services to the women for whom the burden of disease is greatest. Monitoring of heterosexual women and female injection drug users through recurring National HIV Behavioral Surveillance surveys allows for greater understanding of HIV testing and risk behaviors. | Surveillance data make clear the urgency of addressing health inequities as a prevention priority for women. In 2009, among women and girls, the HIV incidence rate for African Americans/Blacks (39.7) was more than 16 times the rate for Whites; for Hispanics, the rate (11.8) was more than 4 times the rate for Whites (Prejean et al, 2011). In line with the National HIV/AIDS Strategy, the CDC’s Division of HIV/AIDS Prevention (DHAP) encourages a tiered approach to prevention that prioritizes intensive interventions for HIV-positive and highest risk individuals, community-level and structural interventions in highly impacted communities, and fundamental awareness to create a supportive environment for addressing HIV-related disparities. Further, this approach recognizes the need for gender-responsive programming that involves addressing social determinants of health and reaching racial and ethnic minority women with culturally relevant messages and prevention options. |
Using electronic health information to risk-stratify rates of Clostridium difficile infection in US hospitals
Zilberberg MD , Tabak YP , Sievert DM , Derby KG , Johannes RS , Sun X , McDonald LC . Infect Control Hosp Epidemiol 2011 32 (7) 649-55 BACKGROUND: Expanding hospitalized patients' risk stratification for Clostridium difficile infection (CDI) is important for improving patient safety. We applied definitions for hospital-onset (HO) and community-onset (CO) CDI to electronic data from 85 hospitals between January 2007 and June 2008 to identify factors associated with higher HO CDI rates. METHODS: Nonrecurrent CDI cases were identified among adult (≥18-year-old) inpatients by a positive C. difficile toxin assay result more than 8 weeks after any previous positive result. Case categories included HO, CO-hospital associated (CO-HA), CO-indeterminate hospital association (CO-IN), and CO-non-hospital associated (CO-NHA). C. difficile testing intensity (CDTI) was defined as the total number of C. difficile tests performed, normalized to the number of patients with at least 1 C. difficile toxin test recorded. We calculated both the incidence density and the prevalence of CDI where appropriate. We fitted a multivariable Poisson model to identify factors associated with higher HO CDI rates. RESULTS: Among 1,351,156 unique patients with 2,022,213 admissions, 9,803 cases of CDI were identified; of these, 50.6% were HO, 17.4% were CO-HA, 9.0% were CO-IN, and 23.0% were CO-NHA. The incidence density of HO was 6.3 per 10,000 patient-days. The prevalence of CO CDI on admission was, per 10,000 admissions, 8.4 for CO-HA, 4.4 for CO-IN, and 11.1 for CO-NHA. Factors associated ([Formula: see text]) with higher HO CDI rates included older age, higher CO-NHA prevalence on admission, and increased CDTI. CONCLUSION: Electronic health information can be leveraged to risk-stratify HO CDI rates by patient age and CO-NHA prevalence on admission. Hospitals should optimize diagnostic testing to improve patient care and measured CDI rates. |
Faculty and resident physicians' attitudes, perceptions, and knowledge about antimicrobial use and resistance
Abbo L , Sinkowitz-Cochran R , Smith L , Ariza-Heredia E , Gomez-Marin O , Srinivasan A , Hooton TM . Infect Control Hosp Epidemiol 2011 32 (7) 714-8 We surveyed faculty and residents to assess attitudes, perceptions, and knowledge about antimicrobial use and resistance. Most respondents were concerned about resistance when prescribing antibiotics and agreed that antibiotics are overused, that inappropriate use is professionally unethical, and that others, but not themselves, overprescribe antibiotics. Antimicrobial stewardship programs should capitalize on these perceptions. |
Models of the impact of dengue vaccines: a review of current research and potential approaches
Johansson MA , Hombach J , Cummings DA . Vaccine 2011 29 (35) 5860-8 Vaccination reduces transmission of pathogens directly, by preventing individual infections, and indirectly, by reducing the probability of contact between infected individuals and susceptible ones. The potential combined impact of future dengue vaccines can be estimated using mathematical models of transmission. However, there is considerable uncertainty in the structure of models that accurately represent dengue transmission dynamics. Here, we review models that could be used to assess the impact of future dengue immunization programmes. We also review approaches that have been used to validate and parameterize models. A key parameter of all approaches is the basic reproduction number, R(0), which can be used to determine the critical vaccination fraction to eliminate transmission. We review several methods that have been used to estimate this quantity. Finally, we discuss the characteristics of dengue vaccines that must be estimated to accurately assess their potential impact on dengue virus transmission. |
Direct and indirect effects of rotavirus vaccination upon childhood hospitalizations in 3 US counties, 2006-2009
Payne DC , Staat MA , Edwards KM , Szilagyi PG , Weinberg GA , Hall CB , Chappell J , Curns AT , Wikswo M , Tate JE , Lopman BA , Parashar UD . Clin Infect Dis 2011 53 (3) 245-53 BACKGROUND: Routine rotavirus vaccination of US infants began in 2006. We conducted active, population-based surveillance for rotavirus gastroenteritis hospitalizations in 3 US counties to assess vaccine impact. METHODS: Children <36 months old hospitalized with diarrhea and/or vomiting were enrolled from January through June each year during the period 2006-2009 and tested for rotavirus. Age-stratified rates of hospitalization for rotavirus infection were compared with corresponding vaccination coverage among a control group of children with acute respiratory illness. To assess direct and indirect benefits, vaccination coverage rates in the control group were multiplied by vaccine effectiveness estimates to calculate expected reductions in the rate of hospitalization for rotavirus infection. Rotavirus serotypes were compared across years. RESULTS: Compared with 2006, a significant reduction in rates of hospitalization for rotavirus infection (P < .001) was observed in 2008 among all age groups. There was an 87% reduction in the 6-11-month-old age group (coverage, 77%), a 96% reduction in the 12-23-months-old age group (coverage, 46%), and a 92% reduction in the 24-35-month-old age group (coverage, 1%), which exceeded reductions expected on the basis of coverage and vaccine effectiveness estimates. Age-specific rate reductions were nearly equivalent to those expected on the basis of age-specific vaccine coverage in 2009. Predominant strains varied annually: G1P[8] (91%) in 2006; G1P[8] (45%) and G12P[8] (36%) in 2007; G1P[8] (89%) in 2008; and G3P[8] (43%), G2P[4] (34%), and G9P[8] (27%) in 2009. CONCLUSIONS: Rotavirus vaccination has dramatically decreased rates of hospitalization for rotavirus infection among children in these US counties. In 2008, reductions were prominent among both vaccine-eligible age groups and older, largely unvaccinated children; the latter likely resulted from indirect protection. Although rates among age groups eligible for vaccination remained low in 2009, indirect benefits disappeared. |
Adverse childhood experiences and sleep disturbances in adults
Chapman DP , Wheaton AG , Anda RF , Croft JB , Edwards VJ , Liu Y , Sturgis SL , Perry GS . Sleep Med 2011 12 (8) 773-9 BACKGROUND: Sleep disturbances are associated with an increased risk for many chronic diseases and unhealthy behaviors. A history of adverse childhood experiences (ACEs) is also associated with similar adult health outcomes. We studied the relationship between multiple ACEs and the likelihood of experiencing self-reported sleep disturbances in adulthood. METHODS: We used data from the adverse childhood experiences (ACE) study, a retrospective cohort study of 17,337 adult health maintenance organization members in California who completed a survey about eight ACEs, which included childhood abuse and growing up with various forms of household dysfunction. The self-reported sleep disturbances measured included ever having trouble falling or staying asleep and feeling tired after a good night's sleep. We used an integer count of the number of ACEs (the ACE score) to assess the cumulative impact of these experiences on the likelihood of self-reported sleep disturbances. RESULTS: Thirty-three percent of the cohort reported trouble falling or staying asleep, while 24% reported feeling tired after sleeping. All eight ACE categories were associated with an increased likelihood of self-reported sleep disturbances (p<0.05). Compared to persons with an ACE score of 0, those with an ACE score 5 were 2.1 (95% CI: 1.8-2.4) times more likely to report trouble falling or staying asleep and 2.0 (95% CI: 1.7-2.3) times more likely to report feeling tired even after a good night's sleep. The trend for increasing odds for both types of self-reported sleep disturbance with increasing ACE scores was statistically significant (p<0.0001). CONCLUSIONS: Adverse childhood experiences were associated with self-reported sleep disturbances in adulthood, and the ACE score had a graded relationship to these sleep disturbances. A history of ACEs should be obtained for patients with self-reported sleep disturbances to coordinate services that ameliorate the long-term effects of these events. |
Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh
Borse NN , Hyder AA , Streatfield PK , Arifeen SE , Bishai D . Arch Dis Child 2011 96 (7) 675-80 Recent mortality data indicate that approximately half a million people drown each year worldwide, with more than 97% of such deaths occurring in low-income and middle-income countries. The purpose of this study was to examine verbal autopsy data on the circumstances of childhood drowning in Matlab, Bangladesh. The study analysed 10 years (1996-2005) of data which reported 489 deaths in children under 5 years and recorded preimmersion, immersion and postimmersion events. The data summarised household characteristics, age, gender and time of drowning event. The study also examined traditional rescue methods performed on children who were removed from the water OR found drowning. Of 489 deaths, 57% were aged 1-2 years and had a drowning mortality rate of 521 per 100,000 children. Most drowning events occurred during the morning (68%), in ponds (69%), and while the mother was busy doing household chores (70%). Traditional rescue methods were attempted in 55% of children and the most frequently reported measure was to spin the child over head (35%). Only 3% of families tried to perform resuscitation. Verbal autopsy data for Matlab is a useful resource for childhood injury research in a low-income country. The study is one of the first to publish data on traditional rescue practices performed on drowning children in rural Bangladesh. The findings suggest that interventions should be designed using locally identified risk factors to reduce childhood drowning incidents. Community-based resuscitation techniques and emergency medical systems are needed to improve postimmersion recovery of the child. |
Efficient DNA extraction for HPV genotyping in formalin-fixed, paraffin-embedded tissues.
Steinau M , Patel SS , Unger ER . J Mol Diagn 2011 13 (4) 377-81 DNA from archived FFPE can be used for papillomavirus genotyping, but potential problems include paraffin as a physical barrier, DNA cross-linking, and PCR inhibitors. To address these complications, we combined a commercially available DNA isolation kit (Qiagen DNeasy) with a heat treatment and evaluated the resulting DNA with regards to HPV typing. DNA was extracted from 10-mum sections from 150 FFPE cancer samples. One protocol followed the manufacturer's recommendation, including paraffin removal by xylene and tissue lysis at 56 degrees C. A second section was directly incubated at 120 degrees C and subsequently lysed at 65 degrees C. After spin-column purification, both extracts were tested with a linear array HPV genotyping assay. Additionally, cellular DNA yield, HPV16 DNA copies, and PCR inhibitors were assessed by real-time qPCR assays. Inadequate linear array HPV genotyping assay results were significantly more frequent (P = 0.0003) in xylene-treated (29/150, 19.3%) than in heat-treated extracts (8/150, 5.3%). HPV detection also differed, with 94/150 (62.7%) and 110/150 (73.3%) positive results, respectively (P = 0.0026). The heat method also yielded more PCR-amplifiable cellular DNA (8.2-fold; P < 0.001) and HPV16 copies (6.5-fold; P = 0.009), although PCR inhibitors also had a greater effect (P = 0.035). Aggressive heat treatment demonstrated an advantage over traditional xylene purification protocols, resulting in higher DNA yields and increased sensitivity for HPV testing. |
Secondary cell wall polysaccharides from Bacillus cereus strains G9241, 03BB87 and 03BB102 causing fatal pneumonia share similar glycosyl structures with the polysaccharides from Bacillus anthracis
Forsberg LS , Choudhury B , Leoff C , Marston CK , Hoffmaster AR , Saile E , Quinn CP , Kannenberg EL , Carlson RW . Glycobiology 2011 21 (7) 934-48 Secondary cell wall polysaccharides (SCWPs) are important structural components of the Bacillus cell wall and contribute to the array of antigens presented by these organisms in both spore and vegetative forms. We previously found that antisera raised to Bacillus anthracis spore preparations cross-reacted with SCWPs isolated from several strains of pathogenic B. cereus, but did not react with other phylogenetically related but nonpathogenic Bacilli, suggesting that the SCWP from B. anthracis and pathogenic B. cereus strains share specific structural features. In this study, SCWPs from three strains of B. cereus causing severe or fatal pneumonia (G9241, 03BB87 and 03BB102) were isolated and subjected to structural analysis and their structures were compared to SCWPs from B. anthracis. Complete structural analysis was performed for the B. cereus G9241 SCWP using NMR spectroscopy, mass spectrometry and derivatization methods. The analyses show that SCWPs from B. cereus G9241 has a glycosyl backbone identical to that of B. anthracis SCWP, consisting of multiple trisaccharide repeats of: -->6)-alpha-d-GlcpNAc-(1 --> 4)-beta-d-ManpNAc-(1 --> 4)-beta-d-GlcpNAc-(1-->. Both the B. anthracis and pathogenic B. cereus SCWPs are highly substituted at all GlcNAc residues with alpha- and beta-Gal residues, however, only the SCWPs from B. cereus G9241 and 03BB87 carry an additional alpha-Gal substitution at O-3 of ManNAc residues, a feature lacking in the B. anthracis SCWPs. Both the B. anthracis and B. cereus SCWPs are pyruvylated, with an approximate molecular mass of approximately 12,000 Da. The implications of these findings regarding pathogenicity and cell wall structure are discussed. |
Serological diagnostics of hepatitis E virus infection
Khudyakov Y , Kamili S . Virus Res 2011 161 (1) 84-92 Development of accurate diagnostic assays for the detection of serological markers of hepatitis E virus (HEV) infection remains challenging. In the course of nearly 20 years after the discovery of HEV, significant progress has been made in characterizing the antigenic structure of HEV proteins, engineering highly immunoreactive diagnostic antigens, and devising efficient serological assays. However, many outstanding issues related to sensitivity and specificity of these assays in clinical and epidemiological settings remain to be resolved. Complexity of antigenic composition, viral genetic heterogeneity and varying epidemiological patterns of hepatitis E in different parts of the world present challenges to the refinement of HEV serological diagnostic assays. Development of antigens specially designed for the identification of serological markers specific to acute infection and of IgG anti-HEV specific to the convalescent phase of infection would greatly facilitate accurate identification of active, recent and past HEV infections. |
Spray-dried doxorubicin-albumin microparticulate systems for treatment of multidrug resistant melanomas
Jones AK , Bejugam NK , Nettey H , Addo R , D'Souza MJ . J Drug Target 2011 19 (6) 427-33 As multidrug resistance continues to be a problem in cancer treatment, controlled release delivery systems, such as microspheres, may aid to give a slower release of anticancer drugs into drug resistant tumor cells. In this study doxorubicin microspheres microencapsulated in an albumin matrix were prepared via the spray-drying method and characterized for particle size, content analysis, and release studies. They were then evaluated in vitro using drug resistant murine melanoma tumor cells for uptake and efflux studies. Spray-drying produced a dispersed powder with a mean particle size of 4.91 +/- 1.2 microm, 60% product yield, and encapsulation efficiency of 85% and a zeta potential range of 37 to -40 mV. Intracellular doxorubicin concentrations were higher in drug resistant tumor cells treated with microspheres as opposed to solution, and efflux of doxorubicin from the tumor cell was inhibited. Greater cytotoxic effects were seen in tumor cells treated with doxorubicin microspheres versus solution up to and after 3 days. In vivo pharmacokinetic studies conducted in male Sprague-Dawley rats, revealed a plasma-level time curve indicative of a two-compartment model, and showed prolonged half-life of doxorubicin, greater area under the plasma concentration time curve, and increased plasma concentrations of doxorubicin in rats at 8 and 24 h after administration of doxorubicin microspheres. |
Pilus backbone protein PitB of Streptococcus pneumoniae contains stabilizing intramolecular isopeptide bonds
Zahner D , Gandhi AR , Stuchlik O , Reed M , Pohl J , Stephens DS . Biochem Biophys Res Commun 2011 409 (3) 526-31 Streptococcus pneumoniae type 2 pili are recently identified fimbrial structures extending from the bacterial surface and formed by polymers of the structural protein PitB. Intramolecular isopeptide bonds are a characteristic of the related pilus backbone protein Spy0128 of group A streptococci. Based on the identification of conserved residues in PitB, we predicted two intramolecular isopeptide bonds in PitB. Using a combination of tandem mass spectrometry and Edman sequencing, we show that these bonds were formed between Lys(63)-Asn(214) and Lys(243)-Asn(372) in PitB. Mutant proteins lacking the intramolecular isopeptide bonds retained the proteolytic stability observed with the wild type protein. However, absence of these bonds substantially decreased the melting temperature of the PitB-derivatives, indicating a stabilizing function of these bonds in PitB of the pneumococcal type 2 pilus. |
Population-based biochemistry, immunologic and hematological reference values for adolescents and young adults in a rural population in Western Kenya
Zeh C , Amornkul PN , Inzaule S , Ondoa P , Oyaro B , Mwaengo DM , Vandenhoudt H , Gichangi A , Williamson J , Thomas T , Decock KM , Hart C , Nkengasong J , Laserson K . PLoS One 2011 6 (6) e21040 BACKGROUND: There is need for locally-derived age-specific clinical laboratory reference ranges of healthy Africans in sub-Saharan Africa. Reference values from North American and European populations are being used for African subjects despite previous studies showing significant differences. Our aim was to establish clinical laboratory reference values for African adolescents and young adults that can be used in clinical trials and for patient management. METHODS AND FINDINGS: A panel of 298, HIV-seronegative individuals aged 13-34 years was randomly selected from participants in two population-based cross-sectional surveys assessing HIV prevalence and other sexually transmitted infections in western Kenya. The adolescent (<18 years)-to-adults (≥18 years) ratio and the male-to-female ratio was 1:1. Median and 95% reference ranges were calculated for immunohematological and biochemistry values. Compared with U.S-derived reference ranges, we detected lower hemoglobin (HB), hematocrit (HCT), red blood cells (RBC), mean corpuscular volume (MCV), neutrophil, glucose, and blood urea nitrogen values but elevated eosinophil and total bilirubin values. Significant gender variation was observed in hematological parameters in addition to T-bilirubin and creatinine indices in all age groups, AST in the younger and neutrophil, platelet and CD4 indices among the older age group. Age variation was also observed, mainly in hematological parameters among males. Applying U.S. NIH Division of AIDS (DAIDS) toxicity grading to our results, 40% of otherwise healthy study participants were classified as having an abnormal laboratory parameter (grade 1-4) which would exclude them from participating in clinical trials. CONCLUSION: Hematological and biochemistry reference values from African population differ from those derived from a North American population, showing the need to develop region-specific reference values. Our data also show variations in hematological indices between adolescent and adult males which should be considered when developing reference ranges. This study provides the first locally-derived clinical laboratory reference ranges for adolescents and young adults in western Kenya. |
Inhibition of xanthine oxidase reduces oxidative stress and improves skeletal muscle function in response to electrically stimulated isometric contractions in aged mice
Ryan MJ , Jackson JR , Hao Y , Leonard SS , Alway SE . Free Radic Biol Med 2011 51 (1) 38-52 Oxidative stress is a putative factor responsible for reducing function and increasing apoptotic signaling in skeletal muscle with aging. This study examined the contribution and functional significance of the xanthine oxidase enzyme as a potential source of oxidant production in aged skeletal muscle during repetitive in situ electrically stimulated isometric contractions. Xanthine oxidase activity was inhibited in young adult and aged mice via a subcutaneously placed time-release (2.5mg/day) allopurinol pellet, 7days before the start of in situ electrically stimulated isometric contractions. Gastrocnemius muscles were electrically activated with 20 maximal contractions for 3 consecutive days. Xanthine oxidase activity was 65% greater in the gastrocnemius muscle of aged mice compared to young mice. Xanthine oxidase activity also increased after in situ electrically stimulated isometric contractions in muscles from both young (33%) and aged (28%) mice, relative to contralateral noncontracted muscles. Allopurinol attenuated the exercise-induced increase in oxidative stress, but it did not affect the elevated basal level of oxidative stress that was associated with aging. In addition, inhibition of xanthine oxidase activity decreased caspase-3 activity, but it had no effect on other markers of mitochondrial-associated apoptosis. Our results show that compared to control conditions, suppression of xanthine oxidase activity by allopurinol reduced xanthine oxidase activity, H(2)O(2) levels, lipid peroxidation, and caspase-3 activity; prevented the in situ electrically stimulated isometric contraction-induced loss of glutathione; prevented the increase in catalase and copper-zinc superoxide dismutase activities; and increased maximal isometric force in the plantar flexor muscles of aged mice after repetitive electrically evoked contractions. |
Characterization of the murine Th2 response to immunization with liposomal M2e influenza vaccine
Adler-Moore J , Munoz M , Kim H , Romero J , Tumpey T , Zeng H , Petro C , Ernst W , Kosina S , Jimenez G , Fujii G . Vaccine 2011 29 (27) 4460-8 While the current influenza vaccine strategy is dependent on eliciting neutralizing antibodies to the hemagglutinin (H or HA) surface glycoprotein, antigenic drifts and occasional antigenic shifts necessitate constant surveillance and annual updates to the vaccine components. The ectodomain of the matrix 2 (M2e) channel protein has been proposed as a universal vaccine candidate, although it has not yet been shown to elicit neutralizing antibodies. Utilizing a liposome-based vaccine technology, an M2e vaccine (L-M2e-HD/MPL) was tested and shown to stimulate the production of anti-M2e antibodies which precipitated with whole virus and inhibited viral cell lysis by multiple type A strains of influenza virus using a novel in vitro assay. The anti-M2e antibodies also conferred complete protection following passive transfer from L-M2e-HD/MPL vaccinated mice to naive mice challenged with H1N1 virus. Significantly higher levels of IL-4 compared to IFN-gamma were secreted by the splenocytes of L-M2e-HD/MPL vaccinated mice incubated with M2e. In addition, depletion of CD4 cells or CD4 cells plus CD8 cells from L-M2e-HD/MPL vaccinated mice using monoclonal antibodies markedly decreased the level of protection of the vaccine when compared to just CD8 depletion of L-M2e-HD/MPL vaccinated mice. These results suggest that the protective immune response elicited by this vaccine is mediated primarily by a Th2 mechanism. |
Clinical breakpoints for the echinocandins and Candida revisited: integration of molecular, clinical, and microbiological data to arrive at species-specific interpretive criteria
Pfaller MA , Diekema DJ , Andes D , Arendrup MC , Brown SD , Lockhart SR , Motyl M , Perlin DS . Drug Resist Updat 2011 14 (3) 164-176 The CLSI established clinical breakpoints (CBPs) for caspofungin (CSF), micafungin (MCF) and anidulafungin (ANF) versus Candida. The same CBP (susceptible (S): MIC≤2mcg/ml; non-S: MIC>2mcg/ml) was applied to all echinocandins and species. More data now allow reassessment of these CBPs. We examined cases of echinocandin failure where both MICs and fks mutations were assessed; wild type (WT) MICs and epidemiological cutoff values (ECVs) for a large Candida collection; molecular analysis of fks hotspots for Candida with known MICs; and pharmacokinetic and pharmacodynamic (PK/PD) data. We applied these findings to propose new species-specific CBPs for echinocandins and Candida. Of 18 candidiasis cases refractory to echinocandins and with fks mutations, 28% (CSF), 58% (ANF) and 66% (MCF) had MICs in the S category using CBP of ≤2mcg/ml, while 0-8% would be S using CBP of ≤0.25mcg/ml. WT MIC distributions revealed ECV ranges of 0.03-0.25mcg/ml for all major species except C. parapsilosis (1-4mcg/ml) and C. guilliermondii (4-16mcg/ml). Among Candida tested for fks mutations, only 15.7-45.1% of 51 mutants were detected using the CBP for NS of >2mcg/ml. In contrast, a cutoff of >0.25mcg/ml for C. albicans, C. tropicalis, C. krusei, and C. dubliniensis detected 85.6% (MCF) to 95.2% (CSF) of 21 mutant strains. Likewise, a cutoff of >0.12mcg/ml for ANF and CSF and of >0.06mcg/ml for MCF detected 93% (ANF) to 97% (CSF, MCF) of 30 mutant strains of C. glabrata. These data, combined with PK/PD considerations, support CBPs of ≤0.25mcg/ml (S), 0.5mcg/ml (I), ≥1 (R) for CSF/MCF/ANF and C. albicans, C. tropicalis and C. krusei and ≤2mcg/ml (S), 4mcg/ml (I), and ≥8mcg/ml (R) for these agents and C. parapsilosis. The CBPs for ANF and CSF and C. glabrata are ≤0.12mcg/ml (S), 0.25mcg/ml (I), and ≥0.5mcg/ml (R), whereas those for MCF are ≤0.06mcg/ml (S), 0.12mcg/ml (I), and ≥0.25mcg/ml (R). New, species-specific CBPs for Candida and the echinocandins are more sensitive to detect emerging resistance associated with fks mutations, and better able to predict risk for clinical failure. |
Relationship between pulmonary and systemic markers of exposure to multiple types of welding particulate matter
Erdely A , Salmen-Muniz R , Liston A , Hulderman T , Zeidler-Erdely PC , Antonini JM , Simeonova PP . Toxicology 2011 287 153-9 Welding results in a unique and complex occupational exposure. Recent epidemiological studies have shown an increased risk of cardiovascular disease following welding fume exposure. In this study, we compared the induction of pulmonary and systemic inflammation following exposure to multiple types of welding fumes. Mice were exposed to 340mcg of manual metal arc stainless steel (MMA-SS), gas metal arc-SS (GMA-SS) or GMA-mild steel (GMA-MS) by pharyngeal aspiration. Mice were sacrificed at 4 and 24h post-exposure to evaluate various parameters of pulmonary and systemic inflammation. Alterations in pulmonary gene expression by a custom designed TaqMan array showed minimal differences between the fumes at 4h. Conversely at 24h, gene expression changes were further increased by SS but not GMA-MS exposure. These findings were associated with the surrogate marker of systemic inflammation, liver acute phase gene induction. Interestingly, stress response genes in cardiovascular tissues were only increased following MMA-SS exposure. These effects were related to the initial level of pulmonary cytotoxicity, as measured by lactate dehydrogenase activity, which was greatest following MMA-SS exposure. In conclusion, varying types of welding fumes elicit quantitatively different systemic inflammatory and/or stress responses. |
Thyroxine and free thyroxine levels in workers occupationally exposed to inorganic lead
Bledsoe ML , Pinkerton LE , Silver S , Deddens JA , Biagini RE . Environ Health Insights 2011 5 55-61 BACKGROUND: The effects of lead exposure on thyroid function are unclear. METHODS: Serum thyroxine (T4) was evaluated among 137 lead-exposed workers and 83 non-exposed workers. Free thyroxine (FT4) was evaluated among a subset of these workers. Exposure metrics included blood lead level (BLL), which reflects recent exposure, zinc protoporphyrin (ZPP), a marker of intermediate-duration lead exposure, exposure duration, and estimated cumulative exposure. Multiple linear regression results were adjusted for age, race, and current smoking status. RESULTS: Mean BLLs were 38.9 mcg/dL in lead exposed workers and 2.1 mcg/dL in non-exposed workers. The adjusted mean T4 and FT4 concentrations among exposed and non-exposed workers were similar. While T4 was not significantly related to any of the exposure metrics, FT4 was inversely related to the logged values of both exposure duration and cumulative exposure, but not to ZPP or BLL. CONCLUSIONS: The findings suggest that FT4 levels may be related to long-term lead exposure. |
Occupational exposure to diisononyl phthalate (DiNP) in polyvinyl chloride processing operations
Hines CJ , Hopf NB , Deddens JA , Silva MJ , Calafat AM . Int Arch Occup Environ Health 2011 85 (3) 317-25 PURPOSE: Diisononyl phthalate (DiNP) is primarily used as a plasticizer in polyvinyl chloride (PVC) materials. While information is available on general population exposure to DiNP, occupational exposure data are lacking. We present DiNP metabolite urinary concentrations in PVC processing workers, estimate DiNP daily intake for these workers, and compare worker estimates to other populations. METHODS: We assessed DiNP exposure in participants from two companies that manufactured PVC materials, a PVC film manufacturer (n = 25) and a PVC custom compounder (n = 12). A mid-shift and end-shift urine sample was collected from each participant and analyzed for the DiNP metabolite mono(carboxy-isooctyl) phthalate (MCiOP). Mixed models were used to assess the effect on MCiOP concentrations of a worker being assigned to (1) a task using DiNP and (2) a shift where DiNP was used. A simple pharmacokinetic model was used to estimate DiNP daily intake from the MCiOP concentrations. RESULTS: Creatinine-adjusted MCiOP urinary concentrations ranged from 0.42-80 mcg/g in PVC film and from 1.11-13.4 mcg/g in PVC compounding. PVC film participants who worked on a task using DiNP (n = 7) had the highest MCiOP geometric mean (GM) end-shift concentration (25.2 mcg/g), followed by participants who worked on a shift where DiNP was used (n = 11) (17.7 mcg/g) as compared to participants with no task (2.92 mcg/g) or shift (2.08 mcg/g) exposure to DiNP. The GM end-shift MCiOP concentration in PVC compounding participants (4.80 mcg/g) was comparable to PVC film participants with no task or shift exposure to DiNP. Because no PVC compounding participants were assigned to tasks using DINP on the day sampled, DiNP exposure in this company may be underestimated. The highest DiNP intake estimate was 26 mcg/kg/day. CONCLUSION: Occupational exposure to DiNP associated with PVC film manufacturing tasks were substantially higher (sixfold to tenfold) than adult general population exposures; however, all daily intake estimates were less than 25% of current United States or European acceptable or tolerable daily intake estimates. Further characterization of DiNP occupational exposures in other industries is recommended. |
Parents: an under-realized resource for protecting working adolescents
Castillo DN . J Adolesc Health 2011 49 (1) 5-6 By the time they are seniors in high school, only 20% of high school students report never having a paid job [1]. Work provides teenagers with job skills and experiences to help them transition into adulthood; however, the work environment also has numerous injury and illness hazards [2]. Adolescents and young adults (age: 15–24 years) have approximately twice the rate of nonfatal occupational injuries as older workers [3]. The United States has set a goal of reducing the occupational injury incidence rate among adolescents aged 15–19 years by 10% by 2020, from the 2007 rate of 4.9 injuries per 100 full-time equivalent workers [4]. |
Antitrypanosomal therapy for chronic Chagas' disease
Bern C . N Engl J Med 2011 364 (26) 2527-34 A 42-year-old woman presents to her physician with a letter stating that after she made a recent blood donation, a serologic test of her donated blood was positive for Chagas' disease. The patient was born in El Salvador and moved to the United States when she was 18 years of age. Her three children are 8, 13, and 16 years of age. Her medical history is remarkable only for a cholecystectomy 2 years earlier; she reports no cardiac or gastrointestinal symptoms. Her physical examination is unremarkable. Electrocardiography (ECG) shows sinus rhythm at a rate of 72 beats per minute and a complete right bundle-branch block. An echocardiogram shows mild left ventricular segmental wall-motion abnormalities, but a normal ejection fraction and left ventricular diameter. The patient is referred to an infectious-disease consultant, who recommends antitrypanosomal therapy. |
Evaluation of a comprehensive refresher training program in malaria microscopy covering four districts of Uganda
Kiggundu M , Nsobya SL , Kamya MR , Filler S , Nasr S , Dorsey G , Yeka A . Am J Trop Med Hyg 2011 84 (5) 820-4 Microscopy remains the gold standard for malaria diagnosis. However, quality microscopy services are severely lacking in most African countries. To improve capacity for malaria microscopy in Uganda, a 3-day refresher training program was conducted in four districts. Training impact was measured through a written examination and evaluation of the quality of blood-slide preparation and accuracy of field microscopy. A total of 184 of 192 (96%) identified laboratory personnel participated in the training. Average test scores improved from 41% to 75% (P < 0.001). A total of 1,079 and 1,190 routinely made thick blood smears were collected before and after the training, respectively. Sensitivity improved from 84% to 95% (P < 0.001), and specificity improved from 87% to 97% (P < 0.001). The proportion of well-prepared blood smears improved from 6% to 75% (P < 0.001). Supplemental training can have a significant impact on the knowledge of staff, accuracy of microscopy, and quality of blood-slide preparation. |
Association between depression and inflammation--differences by race and sex: the META-Health Study
Morris AA , Zhao L , Ahmed Y , Stoyanova N , De Staercke C , Hooper WC , Gibbons G , Din-Dzietham R , Quyyumi A , Vaccarino V . Psychosom Med 2011 73 (6) 462-8 OBJECTIVE: To test whether the association between depression and inflammation differs by race and sex. Depressive symptoms have been associated with higher levels of C-reactive protein (CRP). However, few studies have examined this association in samples including a significant number of African Americans, or examined whether the association differs by race and sex. METHODS: Depressive symptoms and CRP were assessed in 512 African American and white participants, age 30 to 65 years, as part of the community-based Morehouse and Emory Team up to Eliminate Health Disparities (META-Health) Study. Depression was determined by responses to the Beck Depression Inventory II (BDI-II). Multivariable linear regression models were used to adjust for demographic and metabolic risk factors. RESULTS: African American men had higher total BDI-II scores than white men (p = .03), whereas there was no difference in women. There was a significant race-sex-depression interaction in predicting CRP levels (p = .02). White women with mild to severe depressive symptoms had higher levels of CRP compared with those with minimal to no depressive symptoms (p < .05). There were no differences in levels of CRP by severity of depressive symptoms in white men or African Americans of either sex. Higher BDI-II scores were related to higher CRP levels in white women after adjusting for age and level of education (beta = 0.227, p = .006). However, the association was eliminated after further adjustment for metabolic risk factors (beta = 0.077, p = .35). CONCLUSIONS: Although depressive symptoms are associated with inflammation, the association varies by race and sex. |
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