Sagittal abdominal diameter and visceral adiposity : correlates of Beta-cell function and dysglycemia in severely obese women
Gletsu-Miller N , Kahn HS , Gasevic D , Liang Z , Frediani JK , Torres WE , Ziegler TR , Phillips LS , Lin E . Obes Surg 2013 23 (7) 874-81 BACKGROUND: In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m(2)) with fasting normoglycemia (n = 40) or dysglycemia (impaired fasting glucose + diabetes; n = 20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia. METHODS: VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test. RESULTS: Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P < 0.001) and SAD (P = 0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, -0.32 and -0.34, both P < 0.05). In addition, SAD (beta = 0.41, P = 0.02) was found to be a better estimate of VAT volume than WC (beta = 0.32, P = 0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants. CONCLUSIONS: Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation. |
Improving molecular tools for global surveillance of measles virus.
Bankamp B , Byrd-Leotis LA , Lopareva EN , Woo GK , Liu C , Jee Y , Ahmed H , Lim WW , Ramamurty N , Mulders MN , Featherstone D , Bellini WJ , Rota PA . J Clin Virol 2013 58 (1) 176-82 BACKGROUND: The genetic characterization of wild-type measles viruses plays an important role in the description of viral transmission pathways and the verification of measles elimination. The 450 nucleotides that encode the carboxyl-terminus of the nucleoprotein (N-450) are routinely sequenced for genotype analysis. OBJECTIVES: The objectives of this study were to develop improved primers and controls for RT-PCR reactions used for genotyping of measles samples and to develop a method to provide a convenient, safe, and inexpensive means to distribute measles RNA for RT-PCR assays and practice panels. STUDY DESIGN: A newly designed, genetically defined synthetic RNA and RNA isolated from cells infected with currently circulating genotypes were used to compare the sensitivity of primer pairs in RT-PCR and nested PCR. FTA(R) cards loaded with lysates of measles infected cells were tested for their ability to preserve viral RNA and destroy virus infectivity. RESULTS: A new primer pair, MeV216/MeV214, was able to amplify N-450 from viruses representing 10 currently circulating genotypes and a genotype A vaccine strain and demonstrated 100-fold increased sensitivity compared to the previously used primer set. A nested PCR assay further increased the sensitivity of detection from patient samples. A synthetic positive control RNA was developed that produced PCR products that are distinguishable by size from PCR products amplified from clinical samples. FTA(R) cards completely inactivated measles virus and stabilized RNA for at least six months. CONCLUSIONS: These improved molecular tools will advance molecular characterization of circulating measles viruses globally and provide enhanced quality control measures. |
Rapid HIV self-testing: long in coming but opportunities beckon
Myers JE , El-Sadr WM , Zerbe A , Branson BM . AIDS 2013 27 (11) 1687-95 The recent approval by the United States Food and Drug Administration of a rapid HIV self-test marks a significant milestone in the evolution of HIV testing approaches. With nearly one in five people living with HIV in the United States still undiagnosed and an even higher proportion unaware of their infection globally, this decision reflects a new willingness to offer diverse options to get tested for HIV. Rapid self-testing offers several distinct opportunities to improve testing among those with undiagnosed HIV: to encourage testing among those who might not otherwise be tested, to increase the frequency of testing among persons at highest risk for new infection, and to facilitate mutual HIV testing with sex partners. To date, the path to regulatory approval has been long but instructive. The studies and clinical trials required for regulatory approval in the United States provide insight into the performance and potential implications of HIV self-tests as they become available for sale directly to consumers. Although some persistent reservations about self-testing for HIV remain, including the 'window period' of the current test kit, its cost, and its effectiveness for facilitating entry to medical care, others have been dispelled. Self-testing in resource-constrained settings is also promising, including self-testing of health professionals. At present, although the impact has yet to be determined, availability of this new option might offer potential opportunities to improve HIV diagnosis and facilitate both treatment and prevention. |
Risk factors for measles mortality among hospitalized Somali refugees displaced by famine, Kenya, 2011
Mahamud A , Burton A , Hassan M , Ahmed JA , Wagacha JB , Spiegel P , Haskew C , Eidex RB , Shetty S , Cookson S , Navarro-Colorado C , Goodson JL . Clin Infect Dis 2013 57 (8) e160-6 BACKGROUND: Measles among displaced, malnourished populations can result in a high case fatality ratio (CFR). In 2011, a large measles outbreak occurred in Dadaab, Kenya among refugees fleeing famine and conflict in Somalia. The aim of this study was to identify predictors of measles deaths among hospitalized patients during the outbreak. METHODS: A retrospective cohort study design was used to investigate measles mortality among hospitalized measles patients with a date of rash onset during June 6-September 10, 2011. Data were abstracted from medical records and a measles case was defined as an illness with fever, maculopapular rash, and either cough, coryza or conjunctivitis. Vaccination status was determined by patient or parental recall. Independent predictors of mortality were identified using logistic regression. RESULTS: Of 388 hospitalized measles patients, 188 (49%) were from hospital X, 70 (18%) from hospital Y, and 130 (34%) from hospital Z; median age was 22 years, 192 (50%) were 15-29 years of age, and 22 (6%) were vaccinated. The mean number of days from rash onset to hospitalization varied by hospital (hospital X=5, hospital Y=3, hospital Z=6 [p<0.0001]). Independent risk factors for measles mortality were neurological complications (OR=12.8, 95% CI =3.1-52.4), acute malnutrition (OR=7.6, 95% CI=1.3-44.3), and admission to hospital Z (OR=4.2, 95% CI=1.3-13.2). CONCLUSIONS: Among Somali refugees, in addition to timely vaccination at border crossing points, early detection and treatment of acute malnutrition, and proper management of measles cases may reduce measles mortality. |
The utility of stool cultures for diagnosing tuberculosis in people living with the human immunodeficiency virus
Oramasionwu GE , Heilig CM , Udomsantisuk N , Kimerling ME , Eng B , Nguyen HD , Thai S , Keo C , McCarthy KD , Varma JK , Cain KP . Int J Tuberc Lung Dis 2013 17 (8) 1023-8 BACKGROUND: Delayed diagnosis of tuberculosis (TB) increases mortality. OBJECTIVE: To evaluate whether stool culture improves the diagnosis of TB in people living with the human immunodeficiency virus (PLHIV). DESIGN: We analysed cross-sectional data of TB diagnosis in PLHIV in Cambodia, Thailand and Viet Nam. Logistic regression was used to assess the association between positive stool culture and TB, and to calculate the incremental yield of stool culture. RESULTS: A total of 1693 PLHIV were enrolled with a stool culture result. Of 228 PLHIV with culture-confirmed TB from any site, 101 (44%) had a positive stool culture; of these, 91 (90%) had pulmonary TB (PTB). After adjusting for confounding factors, a positive stool culture was associated with smear-negative (odds ratio [OR] 26, 95% confidence interval [CI] 12-58), moderately smear-positive (OR 60, 95%CI 23-159) and highly smear-positive (OR 179, 95%CI 59-546) PTB compared with no PTB. No statistically significant association existed with extra-pulmonary TB compared with no extra-pulmonary TB (OR 2, 95%CI 1-5). The incremental yield of one stool culture above two sputum cultures (5%, 95%CI 3-8) was comparable to an additional sputum culture (7%, 95%CI 4-11). CONCLUSION: Nearly half of the PLHIV with TB had a positive stool culture that was strongly associated with PTB. Stool cultures may be used to diagnose TB in PLHIV. |
Pathogenesis and transmission of avian influenza A (H7N9) virus in ferrets and mice
Belser JA , Gustin KM , Pearce MB , Maines TR , Zeng H , Pappas C , Sun X , Carney PJ , Villanueva JM , Stevens J , Katz JM , Tumpey TM . Nature 2013 501 (7468) 556-9 On 29 March 2013, the Chinese Center for Disease Control and Prevention confirmed the first reported case of human infection with an avian influenza A(H7N9) virus. The recent human infections with H7N9 virus, totalling over 130 cases with 39 fatalities to date, have been characterized by severe pulmonary disease and acute respiratory distress syndrome (ARDS). This is concerning because H7 viruses have typically been associated with ocular disease in humans, rather than severe respiratory disease. This recent outbreak underscores the need to better understand the pathogenesis and transmission of these viruses in mammals. Here we assess the ability of A/Anhui/1/2013 and A/Shanghai/1/2013 (H7N9) viruses, isolated from fatal human cases, to cause disease in mice and ferrets and to transmit to naive animals. Both H7N9 viruses replicated to higher titre in human airway epithelial cells and in the respiratory tract of ferrets compared to a seasonal H3N2 virus. Moreover, the H7N9 viruses showed greater infectivity and lethality in mice compared to genetically related H7N9 and H9N2 viruses. The H7N9 viruses were readily transmitted to naive ferrets through direct contact but, unlike the seasonal H3N2 virus, did not transmit readily by respiratory droplets. The lack of efficient respiratory droplet transmission was corroborated by low receptor-binding specificity for human-like alpha2,6-linked sialosides. Our results indicate that H7N9 viruses have the capacity for efficient replication in mammals and human airway cells and highlight the need for continued public health surveillance of this emerging virus. |
Performance of Cepheid (R) Xpert MTB/RIF (R) and TB-Biochip (R) MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis
Kurbatova EV , Kaminski DA , Erokhin VV , Volchenkov GV , Andreevskaya SN , Chernousova LN , Demikhova OV , Ershova JV , Kaunetis NV , Kuznetsova TA , Larionova EE , Smirnova TG , Somova TR , Vasilieva IA , Vorobieva AV , Zolkina SS , Cegielski JP . Eur J Clin Microbiol Infect Dis 2013 32 (6) 735-43 The purpose of this study was to assess the performance of Cepheid(R) Xpert MTB/RIF(R) ("Xpert") and TB-Biochip(R) MDR ("TB-Biochip"). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein-Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube(R) (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0-98.3 %] than direct (59.6 %, 95 % CI, 50.2-68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7-91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4-87.5 %); the specificity was 86.0 % (95 % CI, 78.9-91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5-99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8-99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0-99.5 %); the specificity was 78.1 % (95 % CI, 61.5-89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2-100 %) of RIF-R, 94.7 % (95 % CI, 76.7-99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4-99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1-94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods. |
Epidemiology of pyrazinamide-resistant tuberculosis in the United States, 1999-2009
Kurbatova EV , Cavanaugh JS , Dalton T , Click E , Cegielski JP . Clin Infect Dis 2013 57 (8) 1081-93 BACKGROUND: Pyrazinamide (PZA) is essential in tuberculosis (TB) treatment. We describe the prevalence, trends and predictors of PZA resistance in Mycobacterium tuberculosis complex (MTBC) in the U.S. METHODS: We analyzed culture-positive MTBC cases with reported drug susceptibility tests (DST) for PZA in 38 jurisdictions routinely testing for PZA susceptibility from 1999-2009. National TB Genotyping Service data for 2004-2009 were used to distinguish Mycobacterium tuberculosis from Mycobacterium bovis and determine phylogenetic lineage. RESULTS: Overall 2.7% (2,167/79,321) of MTBC cases had PZA resistance, increasing annually from 2.0% to 3.3% during 1999-2009 (P<0.001), largely due to an increase in PZA monoresistance. PZA-monoresistant MTBC (versus drug-susceptible) was associated with age 0-24 years (adjusted prevalence ratio [aPR]=1.50, 95% CI 1.31-1.71), Hispanic ethnicity (aPR=3.52, 2.96-4.18), HIV infection (aPR=1.43, 1.15-1.77), extrapulmonary disease (aPR=3.02, 2.60-3.52), and normal chest radiograph (aPR=1.88, 1.63-2.16), and inversely associated with Asian (aPR=0.59, 0.47-0.73) and Black (aPR=0.37, 0.29-0.49) race. Among multidrug-resistant (MDR) cases 38.0% were PZA-resistant; PZA resistance in MDR MTBC was associated with female sex (aPR=1.25, 1.08-1.46) and previous TB diagnosis (aPR=1.37, 1.16-1.62). Of 28,080 cases with genotyping data, 925 (3.3%) had PZA resistance; 465/925 (50.3%) were M. bovis. In non-MDR M. tuberculosis cases, PZA resistance was higher in the Indo-Oceanic than the East Asian lineage (2.2% versus 0.9%; respectively; aPR=2.26, 1.53-3.36), but in MDR cases it was lower in the Indo-Oceanic lineage (22.0% versus 43.4%, respectively; aPR=0.54, 0.32-0.90). CONCLUSIONS: Specific human and mycobacterial characteristics were associated with pyrazinamide-resistant MTBC, reflecting both specific subgroups of the population and phylogenetic lineages of the mycobacteria. |
Estimates of the timing of reductions in genital warts and high grade cervical intraepithelial neoplasia after onset of human papillomavirus (HPV) vaccination in the United States
Chesson HW , Ekwueme DU , Saraiya M , Dunne EF , Markowitz LE . Vaccine 2013 31 (37) 3899-905 BACKGROUND: The objective of this study was to estimate the number of years after onset of a quadrivalent HPV vaccination program before notable reductions in genital warts and cervical intraepithelial neoplasia (CIN) will occur in teenagers and young adults in the United States. METHODS: We applied a previously published model of HPV vaccination in the United States and focused on the timing of reductions in genital warts among both sexes and reductions in CIN 2/3 among females. Using different coverage scenarios, the lowest being consistent with current 3-dose coverage in the United States, we estimated the number of years before reductions of 10%, 25%, and 50% would be observed after onset of an HPV vaccination program for ages 12-26 years. RESULTS: The model suggested female-only HPV vaccination in the intermediate coverage scenario will result in a 10% reduction in genital warts within 2-4 years for females aged 15-19 years and a 10% reduction in CIN 2/3 among females aged 20-29 years within 7-11 years. Coverage had a major impact on when reductions would be observed. For example, in the higher coverage scenario a 25% reduction in CIN2/3 would be observed with 8 years compared with 15 years in the lower coverage scenario. CONCLUSIONS: Our model provides estimates of the potential timing and magnitude of the impact of HPV vaccination on genital warts and CIN 2/3 at the population level in the United States. Notable, population-level impacts of HPV vaccination on genital warts and CIN 2/3 can occur within a few years after onset of vaccination, particularly among younger age groups. Our results are generally consistent with early reports of declines in genital warts among youth. |
An evaluation of hepatitis B virus diagnostic methods and responses to antiretroviral therapy among HIV-infected women in Thailand
Peters PJ , McNicholl JM , Raengsakulrach B , Wasinrapee P , Mueanpai F , Ratanasuwan W , Intalapaporn P , Drobeniuc J , Ramachandran S , Thai H , Xia GL , Kamili S , Khudyakov Y , Weidle PJ , Teo CG , McConnell MS . J Int Assoc Provid AIDS Care 2013 12 (5) 349-53 Coinfection with HIV and hepatitis B virus (HBV) is common in resource-limited settings but is frequently not diagnosed. The authors retrospectively tested specimens for HBV in HIV-infected Thai women who had participated in an antiretroviral therapy (ART) clinical study. A substantial proportion (27 of 211; 13%) of HIV-infected women were HBV coinfected. Among HIV/HBV-coinfected women, the authors observed similar rates of antiretroviral-associated liver toxicity (despite nevirapine [NVP] use) and CD4 count reconstitution as observed in HIV-monoinfected women. Hepatitis B surface antigen (HBsAg) screening detected the majority (81%) of HBV coinfections, including all 5 HBV-coinfected women who did not suppress HBV despite 48 weeks of lamivudine (3TC)-containing ART and could be used to tailor ART for patients diagnosed with HBV coinfection in accordance with World Health Organization guidelines. Although HBsAg screening did not diagnose 5 occult HBV coinfections, these women achieved HBV suppression on 3TC-containing ART, suggesting that not detecting occult HBV coinfection would have limited clinical impact. |
Evolutionary dynamics of Vibrio cholerae O1 following a single-source introduction to Haiti
Katz LS , Petkau A , Beaulaurier J , Tyler S , Antonova ES , Turnsek MA , Guo Y , Wang S , Paxinos EE , Orata F , Gladney LM , Stroika S , Folster JP , Rowe L , Freeman MM , Knox N , Frace M , Boncy J , Graham M , Hammer BK , Boucher Y , Bashir A , Hanage WP , Van Domselaar G , Tarr CL . mBio 2013 4 (4) Prior to the epidemic that emerged in Haiti in October of 2010, cholera had not been documented in this country. After its introduction, a strain of Vibrio cholerae O1 spread rapidly throughout Haiti, where it caused over 600,000 cases of disease and >7,500 deaths in the first two years of the epidemic. We applied whole-genome sequencing to a temporal series of V. cholerae isolates from Haiti to gain insight into the mode and tempo of evolution in this isolated population of V. cholerae O1. Phylogenetic and Bayesian analyses supported the hypothesis that all isolates in the sample set diverged from a common ancestor within a time frame that is consistent with epidemiological observations. A pangenome analysis showed nearly homogeneous genomic content, with no evidence of gene acquisition among Haiti isolates. Nine nearly closed genomes assembled from continuous-long-read data showed evidence of genome rearrangements and supported the observation of no gene acquisition among isolates. Thus, intrinsic mutational processes can account for virtually all of the observed genetic polymorphism, with no demonstrable contribution from horizontal gene transfer (HGT). Consistent with this, the 12 Haiti isolates tested by laboratory HGT assays were severely impaired for transformation, although unlike previously characterized noncompetent V. cholerae isolates, each expressed hapR and possessed a functional quorum-sensing system. Continued monitoring of V. cholerae in Haiti will illuminate the processes influencing the origin and fate of genome variants, which will facilitate interpretation of genetic variation in future epidemics. IMPORTANCE Vibrio cholerae is the cause of substantial morbidity and mortality worldwide, with over three million cases of disease each year. An understanding of the mode and rate of evolutionary change is critical for proper interpretation of genome sequence data and attribution of outbreak sources. The Haiti epidemic provides an unprecedented opportunity to study an isolated, single-source outbreak of Vibrio cholerae O1 over an established time frame. By using multiple approaches to assay genetic variation, we found no evidence that the Haiti strain has acquired any genes by horizontal gene transfer, an observation that led us to discover that it is also poorly transformable. We have found no evidence that environmental strains have played a role in the evolution of the outbreak strain. |
Human infections with influenza A(H3N2) variant virus in the United States, 2011-2012
Epperson S , Jhung M , Richards S , Quinlisk P , Ball L , Moll M , Boulton R , Haddy L , Biggerstaff M , Brammer L , Trock S , Burns E , Gomez T , Wong KK , Katz J , Lindstrom S , Klimov A , Bresee JS , Jernigan DB , Cox N , Finelli L . Clin Infect Dis 2013 57 Suppl 1 S4-S11 BACKGROUND: During August 2011-April 2012, 13 human infections with influenza A(H3N2) variant (H3N2v) virus were identified in the United States; 8 occurred in the prior 2 years. This virus differs from previous variant influenza viruses in that it contains the matrix (M) gene from the Influenza A(H1N1)pdm09 pandemic influenza virus. METHODS: A case was defined as a person with laboratory-confirmed H3N2v virus infection. Cases and contacts were interviewed to determine exposure to swine and other animals and to assess potential person-to-person transmission. RESULTS: Median age of cases was 4 years, and 12 of 13 (92%) were children. Pig exposure was identified in 7 (54%) cases. Six of 7 cases with swine exposure (86%) touched pigs, and 1 (14%) was close to pigs without known direct contact. Six cases had no swine exposure, including 2 clusters of suspected person-to-person transmission. All cases had fever; 12 (92%) had respiratory symptoms, and 3 (23%) were hospitalized for influenza. All 13 cases recovered. CONCLUSIONS: H3N2v virus infections were identified at a high rate from August 2011 to April 2012, and cases without swine exposure were identified in influenza-like illness outbreaks, indicating that limited person-to-person transmission likely occurred. Variant influenza viruses rarely result in sustained person-to-person transmission; however, the potential for this H3N2v virus to transmit efficiently is of concern. With minimal preexisting immunity in children and the limited cross-protective effect from seasonal influenza vaccine, the majority of children are susceptible to infection with this novel influenza virus. |
Invasive pneumococcal disease among children with and without sickle cell disease in the United States, 1998-2009
Payne AB , Link-Gelles R , Azonobi I , Hooper WC , Beall BW , Jorgensen JH , Juni B , Moore M . Pediatr Infect Dis J 2013 32 (12) 1308-12 BACKGROUND: Children with sickle cell disease (SCD) are at increased risk of illness and death from invasive pneumococcal disease (IPD). The introduction in 2000 of the 7-valent pneumococcal conjugate vaccine (PCV7) and penicillin prophylaxis for children with SCD has greatly reduced the incidence of IPD in this population. However, a recent report suggested an increase in cases of IPD in children with SCD. METHODS: Using data from Active Bacterial Core Surveillance (ABCs), we analyzed trends in hospitalizations, mortality, and serotype among children with SCD compared with other children. We used neonatal screening data to estimate SCD population denominators for each ABCs site. RESULTS: From 1998-2009, 3,069 cases of IPD occurred among African-American children less than 18 years of age in the ABCs catchment area. Of these, 127 (4.1%) had SCD identified by medical chart review and 185 (6.0%) had one or more IPD risk factors, excluding SCD. Rates of IPD among children with SCD declined by 53% (1,118 versus 530 per 100,000) while the overall rates among African-American children declined by 74% (54 to 14 per 100,000). For all time periods, children with SCD and IPD were more likely to be hospitalized (84%-92% versus 31%-56%) and more likely to die (6%-17% versus 1%-2%) than children with no risk factors. CONCLUSIONS: While the rate of IPD in children with SCD has dropped dramatically since PCV7 introduction, the rate of IPD in children with SCD remains higher than that of the general population of African-American children, pointing to the need for more effective prevention efforts to prevent IPD in children with SCD. |
Assessing the role of prevention partnerships in STD prevention: a review of comprehensive STD prevention systems progress reports
Hogben M , Hood J , Collins D , McFarlane M . Sex Transm Infect 2013 89 (7) 590-4 Systematic analysis of STD programme data contributes to a national portrait of sexually transmitted disease (STD) prevention activities, including research and evaluation specifically designed to optimise programme efficiency and impact. We analysed the narrative of the 2009 annual progress reports of the US Comprehensive STD Prevention Systems cooperative agreement for 58 STD programmes, concentrating on programme characteristics and partnerships. Programmes described 516 unique partnerships with a median of seven organisations cited per STD programme. Non-profit organisations (including service providers) were most frequently cited. Higher gonorrhoea morbidity was associated with reporting more partnerships; budget problems were associated with reporting fewer. Challenges to engaging in partnerships included budget constraints, staff turnover and low interest. Data provide a source of information for judging progress in programme collaboration and for informing a sustained programme-focused research and evaluation agenda. |
Caveat emptor? Meta-analysis of studies comparing self-observed therapy and directly observed therapy for tuberculosis
Moonan PK , Weis SE . Clin Infect Dis 2013 57 (7) 1062-3 Pasipanodya and Gumbo compared self-administered therapy (SAT) with directly observed therapy (DOT) to determine the proportion of cases with microbiologic failure, relapse, and acquired drug resistance among a pooled cohort of 12 482 persons with tuberculosis from 10 independent studies [1]. The concept of DOT first emerged as a potential therapeutic alternative to resource-intensive hospitalization [2]. Shortly after the introduction of oral antibiotics and during a time when the prevalence of tuberculosis exceeded the availability of hospital beds, well-organized, provider-supervised ambulatory care became the only viable option [2, 3]. However, it was unclear if such therapy could achieve the same success rate as long-term hospitalization. Randomized trials from the late 1950s demonstrated similar patient outcomes to those of hospitalization [3, 4], and thus resources began to shift away from sanatorium-era approaches to clinic-based approaches that have since evolved into the accepted standard of practice for tuberculosis management with DOT. Today similar resource restrictions have forced tuberculosis programs to rethink this strategy and consider less resource-intensive alternative approaches. The polarizing debate and controversy about DOT efficacy is not new [5, 6] and Pasipanodya and Gumbo are not the first to use meta-analysis to seek evidence for consensus [7, 8]. | Unfortunately, this analytic approach suffers from some potential methodological problems. First, the strength and validity of any meta-analysis is determined by criteria used to select the available pooled cohort. There are practical impediments to conducting well-designed studies on DOT efficacy. The chief among these is an ethical issue. An essential component of human research protection in clinical trials is the participant’s ability to withdraw from a study at any time with no loss of privileges or rights. Unlike other illnesses evaluated by randomized trials, tuberculosis is a public health problem that affects others in the community through respiratory transmission. As a result, physicians and laboratories in many areas are legally required to report the identity of persons with tuberculosis to health authorities. To prevent tuberculosis transmission, persons with tuberculosis who are noncompliant with treatment can face loss of personal liberty. Randomization to a study treatment that, if not followed, can result in loss of liberty and legally mandated treatment or isolation by public health authorities is problematic. Moreover, the studies with a randomized design that did meet the authors’ selection criteria included patients who had to make heroic efforts to receive DOT by reporting to a clinic during working hours. There was no support or incentives for transportation, nor financial provisions made for the income loss due to missed work. This type of DOT may result in work absence and income loss, thus potentially creating financial hardship for any enrolled patient, especially in developing countries. Second, 6 of 10 studies used sputum smear microscopy for diagnosis and clinical follow-up and were not tested for drug-resistant tuberculosis by culture prior to randomization [9–14]. Therefore, persons with drug-resistant tuberculosis had an equal chance of assignment in each arm. As such, it would follow that poor treatment outcomes associated with drug-resistant tuberculosis (ie, increased acquired drug resistance, failure, relapse, and death) would bias the comparison to the null. Third, 3 of 10 studies included both new and retreatment cases prior to randomization [15–17]. In a similar way to drug-resistant tuberculosis, persons with previous tuberculosis treatment are at higher risk of poor outcome, including increased acquired drug resistance, default, failure, relapse, and death. Fourth, for 3 of 10 studies there was a strong potential for bias induction; that is, persons with known risk factors for noncompliance were selected nonrandomly to the DOT arm, and conversely persons without known risk factors were selected nonrandomly to the SAT arm or crossed over treatment arms during the study, thus biasing the potential outcomes to the null [12, 14, 16]. |
Development of a diagnosis disclosure model for perinatally HIV-infected children in Thailand
Boon-Yasidhi V , Chokephaibulkit K , McConnell MS , Vanprapar N , Leowsrisook P , Prasitsurbsai W , Durier Y , Klumthanom K , Patel A , Sukwicha W , Naiwatanakul T , Chotpitayasunond T . AIDS Care 2013 25 (6) 756-762 While disclosure of HIV status to perinatally HIV-infected children has become an increasingly important clinical issue, specific disclosure guidelines are lacking. We developed a pediatric HIV diagnosis disclosure model to support caretakers. All HIV-infected children greater than 7-years-old at two participating hospitals in Bangkok, Thailand, and their caretakers, were offered disclosure according to the 4-step protocol: (1) screening; (2) readiness assessment; (3) disclosure; and (4) follow-up. Disclosure occurred after agreement of both providers and caretakers. Among 438 children who were screened, 398 (89%) were eligible. Readiness assessment was completed for 353 (91%) of eligible children and 216 (61%) were determined ready. Disclosure was done for 186 children. The mean age at eligibility screening was 10.5 years (range: 6.8-15.8 years); the mean age at disclosure was 11.7 years (range: 7.6-17.7 years). The mean duration between eligibility screening and disclosure was 15.2 months. There were no significant negative behavioral or emotional outcomes reported in children following disclosure. This HIV diagnosis disclosure model was feasible to implement and had no negative outcomes. As the time for preparation process was over 1 year for most cases, the disclosure process can be initiated as early as age 7 to allowenough time for disclosure to be completed by the age of adolescence. 2013 Taylor and Francis. |
Disclosure, knowledge of partner status, and condom use among HIV-positive patients attending clinical care in Tanzania, Kenya, and Namibia
Bachanas P , Medley A , Pals S , Kidder D , Antelman G , Benech I , Deluca N , Nuwagaba-Biribonwoha H , Muhenje O , Cherutich P , Kariuki P , Katuta F , Bukuku M , PwP Study Group . AIDS Patient Care STDS 2013 27 (7) 425-35 We describe the frequency of and factors associated with disclosure, knowledge of partner's HIV status, and consistent condom use among 3538 HIV-positive patients attending eighteen HIV care and treatment clinics in Kenya, Namibia, and Tanzania. Overall, 42% of patients were male, and 64% were on antiretroviral treatment. The majority (80%) had disclosed their HIV status to their partners, 64% knew their partner's HIV status, and 77% reported consistent condom use. Of those who knew their partner's status, 18% reported their partner was HIV negative. Compared to men, women were significantly less likely to report disclosing their HIV status to their sex partner(s), to knowing their partner's HIV status, and to using condoms consistently with HIV-negative partners. Other factors negatively associated with consistent condom use include nondisclosure, alcohol use, reporting a casual sex partner, and desiring a pregnancy. Health care providers should target additional risk reduction counseling and support services to patients who report these characteristics. |
Sequence analyses of 2012 West Nile virus isolates from Texas fail to associate viral genetic factors with outbreak magnitude.
Duggal NK , D'Anton M , Xiang J , Seiferth R , Day J , Nasci R , Brault AC . Am J Trop Med Hyg 2013 89 (2) 205-210 In 2012, Texas experienced the largest outbreak of human West Nile encephalitis (WNE) since the introduction of West Nile virus (WNV) in 2002. Despite the large number of WNV infections, data indicated the rate of reported WNE among human cases was no higher than in previous years. To determine whether the increase in WNV human cases could have been caused by viral genetic changes, the complete genomes of 17 isolates made from mosquito pools in Dallas and Montgomery Counties in 2012 were sequenced. The 2012 Texas isolates were found to be composed of two distinct clades, both circulating in Dallas and Montgomery Counties despite a 5-fold higher disease incidence in the former. Although minor genetic differences existed between Dallas and Montgomery WNV populations, there was weak support for population subdivision or adaptive changes. On the basis of these data, alternative explanations for increased WNV disease incidence in 2012 are proposed. |
Transmissibility of variant influenza from swine to humans: a modeling approach
Wong KK , Gambhir M , Finelli L , Swerdlow DL , Ostroff S , Reed C . Clin Infect Dis 2013 57 Suppl 1 S16-22 BACKGROUND: Respiratory illness was reported among humans and swine at an agricultural fair in 2011; 3 human infections with an influenza A(H3N2) variant (H3N2v) virus were confirmed. Using epidemiologic investigation data, we sought to estimate H3N2v transmissibility from swine to humans. METHODS: We developed a model of H3N2v transmission among swine and humans and fit it to data from a cohort of 100 agricultural club members reporting swine contact to estimate transmissibility. A sensitivity analysis was performed varying H3N2v prevalence in the club cohort. Using the best-fit transmission probability, we simulated the number of swine-acquired infections among all fair attendees. RESULTS: We estimated the best-fit probability of swine-to-human H3N2v transmission per minute of swine contact. Applying this probability to 14 910 people with swine contact at the fair, we estimate that there were 80 (95% confidence interval [CI], 40-133) H3N2v infections among persons aged <20 years and 58 (95% CI, 29-96) H3N2v infections among person aged ≥20 years. CONCLUSIONS: Using early data from investigation of a new virus with unclear transmission properties, we estimated the transmissibility of H3N2v from swine to humans and the burden of H3N2v among fair attendees. Although the risk of H3N2v virus infection is small for fair attendees with minimal swine contact, large populations attend agricultural events each year, and human cases will likely occur when infected swine are present. |
West Nile virus outbreak in Phoenix, Arizona-2010: entomological observations and epidemiological correlations
Colborn JM , Smith KA , Townsend J , Damian D , Nasci RS , Mutebi JP . J Am Mosq Control Assoc 2013 29 (2) 123-132 In 2010, Arizona experienced an unusually early and severe outbreak of West Nile virus (WNV) centered in the southeast section of Maricopa County. Entomological data were collected before and during the outbreak, from May 25 through July 31, 2010, using the CO-baited light trap monitoring system maintained by Maricopa County Vector Control. In the outbreak area, the most abundant species in the Town of Gilbert and in the area covered by the Roosevelt Water Conservation District was Culex quinquefasciatus, constituting 75.1% and 71.8% of the total number of mosquitoes collected, respectively. Vector index (VI) profiles showed that the abundance of infected Cx. quinquefasciatus peaked prior to human cases, suggesting that this species was involved in the initiation of the outbreak. In contrast, the VI profiles for Cx. tarsalis were consistently low, suggesting limited involvement in initiating and sustaining transmission. Taken together, the higher abundance and the VI profiles strongly suggest that Cx. quinquefasciatus was the primary vector for this outbreak. The VI profiles consistently showed that the abundance of infected mosquitoes peaked 1 to 2 wk before the peaks of human cases, suggesting that VI could have successfully been utilized to predict the WNV outbreak in Maricopa County, AZ, in 2010. |
Molecular detection and identification of Bartonella species in rat fleas from northeastern Thailand
Billeter SA , Colton L , Sangmaneedet S , Suksawat F , Evans BP , Kosoy MY . Am J Trop Med Hyg 2013 89 (3) 462-5 The presence of Bartonella species in Xenopsylla cheopis fleas collected from Rattus spp. (R. exulans, R. norvegicus, and R. rattus) in Khon Kaen Province, Thailand was investigated. One hundred ninety-three fleas obtained from 62 rats, were screened by polymerase chain reaction using primers specific for the 16S-23S intergenic spacer region, and the presence of Bartonella DNA was confirmed by using the citrate synthase gene. Bartonella DNA was detected in 59.1% (114 of 193) of fleas examined. Sequencing demonstrated the presence of Bartonella spp. similar to B. elizabethae, B. rattimassiliensis, B. rochalimae, and B. tribocorum in the samples tested with a cutoff for sequence similarity ≥ 96% and 4 clustered together with the closest match with B. grahamii (95.5% identity). If X. cheopis proves to be a competent vector of these species, our results suggest that humans and animals residing in this area may be at risk for infection by several zoonotic Bartonella species. |
Gender disparity between cutaneous and non-cutaneous manifestations of Lyme borreliosis
Strle F , Wormser GP , Mead P , Dhaduvai K , Longo MV , Adenikinju O , Soman S , Tefera Y , Maraspin V , Lotric-Furlan S , Ogrinc K , Cimperman J , Ruzic-Sabljic E , Stupica D . PLoS One 2013 8 (5) e64110 Cutaneous manifestations of Lyme borreliosis in Europe include erythema migrans (EM) and acrodermatitis chronica atrophicans (ACA); the most common non-cutaneous manifestations are Lyme neuroborreliosis (LNB) and Lyme arthritis. The purpose of this study was to evaluate the gender distribution of patients with these clinical manifestations of Lyme borreliosis. Data on gender were obtained from the clinical records of patients with Lyme borreliosis aged ≥15 years who had been evaluated at the University Medical Center Ljubljana, Ljubljana, Slovenia. Among 10,539 patients diagnosed with EM, 6,245 (59.3%) were female and among 506 ACA patients 347 (68.6%) were female. In contrast, among the 60 patients with Lyme arthritis only 15 (25%) were female (p<0.0001 for the comparison of gender with EM or ACA) and among the 130 patients with LNB only 51 (39.2%) were females (p<0.0001 for the comparison of gender with EM or ACA). Although the proportion that was female in the LNB group was greater than that of patients with Lyme arthritis, this difference did not reach statistical significance (p = 0.10). Although older individuals are more likely to be female in the general Slovenian population, the age of patients with cutaneous versus non-cutaneous manifestations was not the explanation for the observed differences in gender. In conclusion, patients with cutaneous manifestations of Lyme borreliosis were predominantly female, whereas those with non-cutaneous manifestations were predominantly male. This provocative finding is unexplained but may have direct relevance to the pathogenesis of Lyme borreliosis. |
Pre-existing medical conditions associated with Vibrio vulnificus septicaemia
Menon MP , Yu PA , Iwamoto M , Painter J . Epidemiol Infect 2013 142 (4) 1-4 Vibrio vulnificus (Vv) can result in severe disease. Although pre-existing liver disease is a recognized risk factor for serious infection, the relative importance of other comorbidities has not been fully assessed. We analysed reports of Vv infections submitted to CDC from January 1988 to September 2006 in order to assess the role of pre-existing conditions contributing to severe outcomes. A total of 1212 patients with Vv infection were reported. Only patients with liver disease [adjusted odds ratio (aOR) 5.1)] were more likely to become septic when exposure was due to contaminated food. Patients with liver disease (aOR 4.1), a haematological disease (aOR 3.2), or malignancy (aOR 3.2) were more likely to become septic when infection was acquired via a non-foodborne exposure. As such, patients with these pre-existing medical conditions should be advised of the risk of life-threatening illness after eating undercooked contaminated seafood or exposing broken skin to warm seawater. |
Quality of piped and stored water in households with children under five years of age enrolled in the Mali site of the Global Enteric Multi-Center Study (GEMS)
Baker KK , Sow S , Kotloff KL , Nataro JP , Farag TH , Tamboura B , Doumbia M , Sanogo D , Diarra D , O'Reilly CE , Mintz E , Panchalingam S , Wu Y , Blackwelder WC , Levine MM . Am J Trop Med Hyg 2013 89 (2) 214-222 Water, sanitation, and hygiene information was collected during a matched case-control study of moderate and severe diarrhea (MSD) among 4,096 children < 5 years of age in Bamako, Mali. Primary use of piped water (conditional odds ratio [cOR] = 0.45; 0.34-0.62), continuous water access (cOR = 0.30; 0.20-0.43), fetching water daily (cOR = 0.77; 0.63-0.96), and breastfeeding (cOR = 0.65; 0.49-0.88) significantly reduced the likelihood of MSD. Fetching water in > 30 minutes (cOR = 2.56; 1.55-4.23) was associated with MSD. Piped tap water and courier-delivered water contained high (> 2 mg/L) concentrations of free residual chlorine and no detectable Escherichia coli. However, many households stored water overnight, resulting in inadequate free residual chlorine (< 0.2 mg/L) for preventing microbial contamination. Coliforms and E. coli were detected in 48% and 8% of stored household water samples, respectively. Although most of Bamako's population enjoys access to an improved water source, water quality is often compromised during household storage. |
An improved tool for household faeces management in rural Bangladeshi communities
Sultana R , Mondal UK , Rimi NA , Unicomb L , Winch PJ , Nahar N , Luby SP . Trop Med Int Health 2013 18 (7) 854-60 OBJECTIVE: To explore child defecation and faeces management practices in rural Bangladesh with the aim to redesign and pilot a tool to facilitate removal and disposal of faeces. METHODS: We conducted six group discussions, six short interviews and three observations of practices and designed the new tool. We piloted the new tool and elicited feedback through two in-depth interviews and two observations. RESULTS: Until three years of age, a child commonly defecates in the courtyard and occasionally inside the house. A heavy digging hoe was commonly used to remove child faeces. Mothers preferred a redesigned 'mini-hoe' and found it easier to use for removal and disposal of liquid faeces. CONCLUSIONS: Promoting modified local tools may contribute to improving environmental sanitation and health. |
The serial intervals of seasonal and pandemic influenza viruses in households in Bangkok, Thailand
Levy JW , Cowling BJ , Simmerman JM , Olsen SJ , Fang VJ , Suntarattiwong P , Jarman RG , Klick B , Chotipitayasunondh T . Am J Epidemiol 2013 177 (12) 1443-51 The serial interval (SI) of human influenza virus infections is often described by a single distribution. Understanding sources of variation in the SI could provide valuable information for understanding influenza transmission dynamics. Using data from a randomized household study of nonpharmaceutical interventions to prevent influenza transmission in Bangkok, Thailand, over 34 months between 2008 and 2011, we estimated the influence of influenza virus type/subtype and other characteristics of 251 pediatric index cases and their 315 infected household contacts on estimates of household SI. The mean SI for all households was 3.3 days. Relative to influenza A(H1N1)pdm09 (3.1 days), the SI for influenza B (3.7 days) was 22% longer (95% confidence interval: 4, 43), or about half a day. The SIs for influenza viruses A(H1N1) and A(H3N2) were similar to that for A(H1N1)pdm09. SIs were shortest for older index cases (age 11-14 years) and for younger infected household contacts (age ≤15 years). Greater time spent in proximity to the index child was associated with shorter SIs. Differences in the SI might reflect differences in incubation period, viral shedding, contact, or susceptibility. These findings could improve parameterization of mathematical models to better predict the impact of epidemic or pandemic influenza mitigation strategies. |
States Monitoring Assisted Reproductive Technology (SMART) Collaborative: data collection, linkage, dissemination, and use
Mneimneh AS , Boulet SL , Sunderam S , Zhang Y , Jamieson DJ , Crawford S , McKane P , Copeland G , Mersol-Barg M , Grigorescu V , Cohen B , Steele J , Sappenfield W , Diop H , Kirby RS , Kissin DM . J Womens Health (Larchmt) 2013 22 (7) 571-7 Assisted reproductive technology (ART) refers to fertility treatments in which both eggs and sperm are handled outside the body. The Centers for Disease Control and Prevention (CDC) oversees the National ART Surveillance System (NASS), which collects data on all ART procedures performed in the United States. The NASS, while a comprehensive source of data on ART patient demographics and clinical procedures, includes limited information on outcomes related to women's and children's health. To examine ART-related health outcomes, CDC and three states (Massachusetts, Florida, and Michigan) established the States Monitoring ART (SMART) Collaborative to evaluate maternal and perinatal outcomes of ART and improve state-based ART surveillance. To date, NASS data have been linked with states' vital records, disease registries, and hospital discharge data with a linkage rate of 90.2%. The probabilistic linkage methodology used in the SMART Collaborative has been validated and found to be both accurate and efficient. A wide breadth of applied research within the Collaborative is planned or ongoing, including examinations of the impact of insurance mandates on ART use as well as the relationships between ART and birth defects and cancer, among others. The SMART Collaborative is working to improve state-based ART surveillance by developing state surveillance plans, establishing partnerships, and conducting data analyses. The SMART Collaborative has been instrumental in creating linked datasets and strengthening epidemiologic and research capacity for improving maternal and infant health programs and evaluating the public health impact of ART. |
Laboratory testing and diagnostic coding for cytomegalovirus among privately insured infants in the United States: A retrospective study using administrative claims data
Leung J , Cannon MJ , Grosse SD , Bialek SR . BMC Pediatr 2013 13 (1) 90 BACKGROUND: Rates of laboratory testing and diagnostic practices for congenital CMV in the United States are unknown. We determined rates of CMV testing and diagnostic coding for CMV among insured infants in the United States using a national healthcare claims database. METHODS: We analyzed medical claims from 2011 Truven Health MarketScan Commercial databases for infants who were <=30 days of age. We used ICD-9-CM codes to identify infants with CMV and CMV-associated conditions. We computed frequencies of infants with CPT codes for CMV testing. RESULTS: A total of 368,266 infants met the study criteria. We identified 61 (0.02%) infants with a diagnostic code for CMV. Among the 368,266 infants, 229 (0.1%) infants had a code for CMV-specific testing, of which 43% had codes for CMV polymerase chain reaction (PCR) and/or CMV direct florescent antibody (DFA) testing, 44% for CMV serologic testing alone, and 13% for CMV serology and non-specific PCR and/or culture. Over 80% (187/229) with CMV testing had a code for >=1 CMV-associated conditions. Although infrequently coded for, CMV testing was more common among infants with a code for a condition possibly associated with CMV than infants without these conditions (0.14% (187/ 136,857) vs. 0.02% (42/231,409)). CONCLUSIONS: The low rates of CMV testing among infants with symptoms suggestive of congenital CMV infection and the substantial proportion of infants tested with only serologic assays instead of PCR or viral culture suggests gaps in awareness and knowledge of congenital CMV and its diagnosis among healthcare providers. Although claims databases presumably do not capture all diagnosed CMV cases or CMV-specific testing, healthcare claims are a potential source for surveillance and monitoring practices of CMV-specific testing and diagnostic coding for CMV among infants. |
Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition
See I , Iwamoto M , Allen-Bridson K , Horan T , Magill SS , Thompson ND . Infect Control Hosp Epidemiol 2013 34 (8) 769-76 OBJECTIVE: To assess challenges to implementation of a new National Healthcare Safety Network (NHSN) surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). DESIGN: Multicenter field test. SETTING: Selected locations of acute care hospitals participating in NHSN central line-associated bloodstream infection (CLABSI) surveillance. METHODS: Hospital staff augmented their CLABSI surveillance for 2 months to incorporate MBI-LCBI: a primary bloodstream infection due to a selected group of organisms in patients with either neutropenia or an allogeneic hematopoietic stem cell transplant with gastrointestinal graft-versus-host disease or diarrhea. Centers for Disease Control and Prevention (CDC) staff reviewed submitted data to verify whether CLABSIs met MBI-LCBI criteria and summarized the descriptive epidemiology of cases reported. RESULTS: Eight cancer, 2 pediatric, and 28 general acute care hospitals including 193 inpatient units (49% oncology/bone marrow transplant [BMT], 21% adult ward, 20% adult critical care, 6% pediatric, 4% step-down) conducted field testing. Among 906 positive blood cultures reviewed, 282 CLABSIs were identified. Of the 103 CLABSIs that also met MBI-LCBI criteria, 100 (97%) were reported from oncology/BMT locations. Agreement between hospital staff and CDC classification of reported CLABSIs as meeting the MBI-LCBI definition was high (90%; [Formula: see text]). Most MBI-LCBIs (91%) occurred in patients meeting neutropenia criteria. Some hospitals indicated that their laboratories' methods of reporting cell counts prevented application of neutropenia criteria; revised neutropenia criteria were created using data from field testing. CONCLUSIONS: Hospital staff applied the MBI-LCBI definition accurately. Field testing informed modifications for the January 2013 implementation of MBI-LCBI in the NHSN. |
Multiple contributory factors to the age distribution of disease cases: a modeling study in the context of influenza A(H3N2v)
Gambhir M , Swerdlow DL , Finelli L , Van Kerkhove MD , Biggerstaff M , Cauchemez S , Ferguson NM . Clin Infect Dis 2013 57 Suppl 1 S23-7 BACKGROUND: In late 2011 and early 2012, 13 cases of human influenza resulted from infection with a novel triple reassortant swine-origin influenza virus, influenza A (H3N2) variant. This variant was notable for its inclusion of the matrix gene from the 2009 influenza A(H1N1) pandemic virus. While most of these confirmed cases were among children, the transmission potential and likely age-dependent susceptibility to the virus was unknown. Preliminary serologic studies indicated that very young children have less protection than older children and adults. METHODS: We construct a mathematical transmission model of influenza transmission that allows for external zoonotic exposure to infection and show how exposure and susceptibility-related factors contribute to the observed case distribution. RESULTS AND CONCLUSIONS: Age-dependent susceptibility to infection strongly influences epidemic dynamics. The result is that the risk of an outbreak in a highly susceptible age group may be substantially higher than in an older age group with less susceptibility, but exposure-related factors must also be accounted for when interpreting case data. |
Pneumococcal bacteremia requiring hospitalization in rural Thailand: an update on incidence, clinical characteristics, serotype distribution, and antimicrobial susceptibility, 2005-2010
Rhodes J , Dejsirilert S , Maloney SA , Jorakate P , Kaewpan A , Salika P , Akarachotpong T , Prapasiri P , Naorat S , Areerat P , Ruayajin A , Sawanpanyalert P , Akarasewi P , Peruski LF Jr , Baggett HC . PLoS One 2013 8 (6) e66038 BACKGROUND: Streptococcus pneumoniae is an important cause of morbidity and mortality in Southeast Asia, but regional data is limited. Updated burden estimates are critical as pneumococcal conjugate vaccine (PCV) is highly effective, but not yet included in the Expanded Program on Immunization of Thailand or neighboring countries. METHODS: We implemented automated blood culture systems in two rural Thailand provinces as part of population-based surveillance for bacteremia. Blood cultures were collected from hospitalized patients as clinically indicated. RESULTS: From May 2005- March 2010, 196 cases of pneumococcal bacteremia were confirmed in hospitalized patients. Of these, 57% had clinical pneumonia, 20% required mechanical ventilation, and 23% (n = 46) died. Antibiotic use before blood culture was confirmed in 25% of those with blood culture. Annual incidence of hospitalized pneumococcal bacteremia was 3.6 per 100,000 person-years; rates were higher among children aged <5 years at 11.7 and adults ≥65 years at 14.2, and highest among infants <1 year at 33.8. The median monthly case count was higher during December-March compared to the rest of the year 6.0 vs. 1.0 (p<0.001). The most common serotypes were 23F (16%) and 14 (14%); 61% (74% in patients <5 years) were serotypes in the 10-valent PCV (PCV 10) and 82% (92% in <5 years) in PCV 13. All isolates were sensitive to penicillin, but non-susceptibility was high for co-trimoxazole (57%), erythromycin (30%), and clindamycin (20%). CONCLUSIONS: We demonstrated a high pneumococcal bacteremia burden, yet underestimated incidence because we captured only hospitalized cases, and because pre-culture antibiotics were frequently used. Our findings together with prior research indicate that PCV would likely have high serotype coverage in Thailand. These findings will complement ongoing cost effectiveness analyses and support vaccine policy evaluation in Thailand and the region. |
Impact of time to maternal interview on interview responses in the National Birth Defects Prevention Study
Tinker SC , Gibbs C , Strickland MJ , Devine OJ , Crider KS , Werler MM , Anderka MT , Reefhuis J . Am J Epidemiol 2013 177 (11) 1225-35 Prenatal exposures often are assessed using retrospective interviews. Time from exposure to interview may influence data accuracy. We investigated the association of time to interview (TTI) with aspects of interview responses in the National Birth Defects Prevention Study, a population-based case-control study of birth defects in 10 US states. Mothers completed a computer-assisted telephone interview 1.5-24 months after their estimated date of delivery. Proxy metrics for interview quality were whether certain exposures were reported, whether the start month of reported medication use or illness was reported, or whether responses were missing. Interaction by case status was assessed. Interviews were completed with 30,542 mothers (22,366 cases and 8,176 controls) who gave birth between 1997 and 2007. Mothers of cases were interviewed later than were mothers of controls (11.7 months vs. 9.5 months, respectively). In adjusted analyses, having a TTI that was greater than 6 months was associated with only a few aspects of interview responses (e.g., start month of pseudoephedrine use). Interaction by case-control status was observed for some exposures; mothers of controls had a greater reduction in interview quality with increased TTI in these instances (e.g., report of morning sickness, start month of acetaminophen use and ibuprofen use). The results suggest that TTI might impact interview responses; however, the impact may be minimal and specific to the type of exposure. |
Agreement between fixed-ratio and lower limit of normal spirometry interpretation protocols decreases with age: is there a need for a new GOLD standard?
Mikulski MA , Gerke AK , Lourens S , Czeczok T , Sprince NL , Laney AS , Fuortes LJ . J Occup Environ Med 2013 55 (7) 802-8 OBJECTIVES: To assess concordance between the fixed 70% ratio cutoff point with the fixed percent predicted values (Fixed-ratio) and the lower limit of normal (LLN) algorithms in interpreting spirometry results in an older population. METHODS: Spirometries were interpreted using Third National Health and Nutrition Examination Survey reference equations for 2319 workers. RESULTS: The Fixed-ratio algorithm characterized 34.5% (n = 801) results as abnormal, compared with 29.7% (n = 689) by the LLN. There were almost twice as many obstructive and mixed airways spirometries identified under the Fixed-ratio compared to LLN. Rates of restrictive pattern physiology were virtually the same under each algorithm. Overall agreement between the algorithms decreased with age from "almost perfect" for those younger than 60 years to "substantial" for those older than 80 years. CONCLUSIONS: This study found age-related discordance between two algorithms possibly related to the lack of reference equations and standards for individuals older than 80 years. |
Bacterial meningitis surveillance in the Eastern Mediterranean Region, 2005-2010: successes and challenges of a regional network
Teleb N , Pilishvili T , Van Beneden C , Ghoneim A , Amjad K , Mostafa A , Estighamati AR , Smeo MN , Barkia A , Elkhatib M , Mujaly A , Ashmony H , Jassim KA , Hajjeh RA . J Pediatr 2013 163 S25-31 OBJECTIVE: To describe epidemiology of bacterial meningitis in the World Health Organization Eastern Mediterranean Region countries and assist in introduction of new bacterial vaccines. STUDY DESIGN: A laboratory-based sentinel surveillance was established in 2004, and up to 10 countries joined the network until 2010. Personnel at participating hospitals and national public health laboratories received training in surveillance and laboratory methods and used standard clinical and laboratory-confirmed case definitions. RESULTS: Over 22 000 suspected cases of meningitis were reported among children ≤5 years old and >6600 among children >5 years old. In children ≤5 years old, 921 of 13 125 probable cases (7.0%) were culture-confirmed. The most commonly isolated pathogens were S pneumoniae (27% of confirmed cases), N meningitidis (22%), and H influenzae (10%). Among culture-confirmed case-patients with known outcome, case-fatality rate was 7.0% and 12.2% among children ≤5 years old and those >5 years old, respectively. Declining numbers of Haemophilus influenzae type b meningitis cases within 2 years post-Haemophilus influenzae type b conjugate vaccine introduction were observed in Pakistan. CONCLUSIONS: Bacterial meningitis continues to cause significant morbidity and mortality in the Eastern Mediterranean Region. Surveillance networks for bacterial meningitis ensure that all sites are using standardized methodologies. Surveillance data are useful to monitor impact of various interventions including vaccines, but maintaining data quality requires consistent reporting and regular technical support. |
Breast cancer molecular subtypes and survival in a hospital-based sample in Puerto Rico
Ortiz AP , Frias O , Perez J , Cabanillas F , Martinez L , Sanchez C , Capo-Ramos DE , Gonzalez-Keelan C , Mora E , Suarez E . Cancer Med 2013 2 (3) 343-350 Information on the impact of hormone receptor status subtypes in breast cancer (BC) prognosis is still limited for Hispanics. We aimed to evaluate the association of BC molecular subtypes and other clinical factors with survival in a hospital-based female population of BC cases in Puerto Rico. We analyzed 663 cases of invasive BC diagnosed between 2002 and 2005. Information on HER-2/neu (HER-2) overexpression, estrogen (ER), and progesterone (PR) receptor status and clinical characteristics were retrieved from hospitals cancer registries and record review. Survival probabilities by covariates of interest were described using the Kaplan-Meier estimators. Cox proportional hazards models were employed to assess factors associated with risk of BC death. Overall, 17.3% of BC cases were triple-negative (TN), 61.8% were Luminal-A, 13.3% were Luminal-B, and 7.5% were HER-2 overexpressed. In the multivariate Cox model, among patients with localized stage, women with TN BC had higher risk of death (adjusted hazard ratio [HR]: 2.57, 95% confidence interval [CI]: 1.29-5.12) as compared to those with Luminal-A status, after adjusting for age at diagnosis. In addition, among women with regional/distant stage at diagnosis, those with TN BC (HR: 5.48, 95% CI: 2.63-11.47) and those HER-2+, including HER-2 overexpressed and Luminal-B, (HR: 2.73, 95% CI:1.30-5.75) had a higher mortality. This is the most comprehensive epidemiological study to date on the impact of hormone receptor expression subtypes in BC survival in Puerto Rico. Consistent to results in other populations, the TN subtype and HER-2+ tumors were associated with decreased survival. |
Cervical cancer screening intervals, 2006 to 2009: moving beyond annual testing
Berkowitz Z , Saraiya M , Sawaya GF . JAMA Intern Med 2013 173 (10) 922-4 Clinical guidelines recommend that women 30 years and older with a negative test result for oncogenic human papillomavirus (HPV) and with a concurrent normal Papanicolaou test result (co-testing) not be tested again for at least 3 years.1 Previous studies, however, indicate that primary care providers continue to perform annual testing regardless of prior test results.2,3 Our objective was to examine clinicians' reported behaviors regarding cervical cancer screening intervals over a 4-year period after the endorsement of co-testing. |
Cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ: comparison of ICD-9 codes and pathology results--Kaiser Permanente, United States, 2000-2005
Surie D , Dunne EF , Naleway AL , Weinmann S , Klein NP , Baxter R , Hutchins K , Gee J , Markowitz L . Cancer Epidemiol Biomarkers Prev 2013 22 (6) 1129-32 BACKGROUND: Cervical intraepithelial neoplasia grade 3+ (CIN3+) and adenocarcinoma in situ incidence will be an important measure of HPV vaccine impact. Integrated healthcare delivery systems, such as Kaiser Permanente, could be used to monitor CIN3+ trends; however, limited evaluations of data from healthcare delivery systems for CIN3+ surveillance exist. METHODS: We compared CIN3+ diagnoses by ICD-9 code with CIN3+ diagnoses by pathology results among 121,211 females aged 11 to 30 years who were continuously enrolled from 2000 to 2005 in either Kaiser Permanente Northern California or Kaiser Permanente Northwest. We calculated sensitivity and positive predictive value of diagnosis by ICD-9 codes using pathology CIN3+ diagnosis as the gold standard. RESULTS: There were 1,090 women with at least one CIN3+ diagnosis by ICD-9 code 233.1 and 1,200 women with at least one CIN3+ diagnosis by pathology results. The sensitivity of the ICD-9 code for detecting a woman with at least one pathology diagnosis for CIN3+ was 62% (740/1,200); positive predictive value was 68% (740/1,090). Among women with at least one CIN3+ diagnosis by ICD-9 code, 679 (62%) had more than one visit with this code; whereas, among women with at least one CIN3+ diagnosis by pathology, 466 (39%) had more than one CIN3+ pathology result. CONCLUSIONS: ICD-9 codes may underestimate the number of women with at least one CIN3+ diagnosis. IMPACT: Pathology results, when available, may provide better estimates of CIN3+ incidence. |
Changes among US cancer survivors: comparing demographic, diagnostic, and health care findings from the 1992 and 2010 National Health Interview Surveys
Buchanan ND , King JB , Rodriguez JL , White A , Trivers KF , Forsythe LP , Kent EE , Rowland JH , Sabatino SA . ISRN Oncol 2013 2013 238017 BACKGROUND: Differences in healthcare and cancer treatment for cancer survivors in the United States (US) have not been routinely examined in nationally representative samples or studied before and after important Institute of Medicine (IOM) recommendations calling for higher quality care provision and attention to comprehensive cancer care for cancer survivors. METHODS: To assess differences between survivor characteristics in 1992 and 2010, we conducted descriptive analyses of 1992 and 2010 National Health Interview Survey (NHIS) data. Our study sample consisted of 1018 self-reported cancer survivors from the 1992 NHIS and 1718 self-reported cancer survivors from the 2010 NHIS who completed the Cancer Control (CCS) and Cancer Epidemiology (CES) Supplements. RESULTS: The prevalence of reported survivors increased from 1992 to 2010 (4.2% versus 6.3%). From 1992 to 2010, there was an increase in long-term cancer survivors and a drop in multiple malignancies, and surgery remained the most widely used treatment. Significantly fewer survivors (<10 years after diagnosis) were denied insurance coverage. Survivors continue to report low participation in counseling or support groups. CONCLUSIONS: As the prevalence of cancer survivors continues to grow, monitoring differences in survivor characteristics can be useful in evaluating the effects of policy recommendations and the quality of clinical care. |
Cost analysis of an integrated vaccine-preventable disease surveillance system in Costa Rica
Toscano CM , Vijayaraghavan M , Salazar-Bolanos HM , Bolanos-Acuna HM , Ruiz-Gonzalez AI , Barrantes-Solis T , Fernandez-Vargas I , Panero MS , de Oliveira LH , Hyde TB . Vaccine 2013 31 Suppl 3 C88-93 INTRODUCTION: Following World Health Organization recommendations set forth in the Global Framework for Immunization Monitoring and Surveillance, Costa Rica in 2009 became the first country to implement integrated vaccine-preventable disease (iVPD) surveillance, with support from the U.S. Centers for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO). As surveillance for diseases prevented by new vaccines is integrated into existing surveillance systems, these systems could cost more than routine surveillance for VPDs targeted by the Expanded Program on Immunization. OBJECTIVES: We estimate the costs associated with establishing and subsequently operating the iVPD surveillance system at a pilot site in Costa Rica. METHODS: We retrospectively collected data on costs incurred by the institutions supporting iVPD surveillance during the preparatory (January 2007 through August 2009) and implementation (September 2009 through August 2010) phases of the iVPD surveillance project in Costa Rica. These data were used to estimate costs for personnel, meetings, infrastructure, office equipment and supplies, transportation, and laboratory facilities. Costs incurred by each of the collaborating institutions were also estimated. RESULTS: During the preparatory phase, the estimated total cost was 128,000 U.S. dollars (US$), including 64% for personnel costs. The preparatory phase was supported by CDC and PAHO. The estimated cost for 1 year of implementation was US$ 420,000, including 58% for personnel costs, 28% for laboratory costs, and 14% for meeting, infrastructure, office, and transportation costs combined. The national reference laboratory and the PAHO Costa Rica office incurred 64% of total costs, and other local institutions supporting iVPD surveillance incurred the remaining 36%. CONCLUSIONS: Countries planning to implement iVPD surveillance will require adequate investments in human resources, laboratories, data management, reporting, and investigation. Our findings will be valuable for decision makers and donors planning and implementing similar strategies in other countries. |
Critical issues in implementing a national integrated all-vaccine preventable disease surveillance system
Hyde TB , Andrus JK , Dietz VJ . Vaccine 2013 31 Suppl 3 C94-8 In 2007, the World Health Organization published the Global Framework for Immunization Monitoring and Surveillance (GFIMS) outlining measures to enhance national surveillance for vaccine preventable diseases (VPDs). The GFIMS emphasized that VPD surveillance should be integrated and placed in a 'unified framework' building upon the strengths of existing surveillance systems to prevent duplication of activities common to all surveillance systems and to minimize human resource and supply expenditures. Unfortunately, there was little experience in actually developing integrated VPD surveillance. We describe the process of developing operational guidance for ministries of health to implement such an integrated surveillance system for multiple VPDs. |
Current landscape and new paradigms of proficiency testing and external quality assessment for molecular genetics.
Kalman LV , Lubin IM , Barker S , du Sart D , Elles R , Grody WW , Pazzagli M , Richards S , Schrijver I , Zehnbauer B . Arch Pathol Lab Med 2013 137 (7) 983-988 CONTEXT: Participation in proficiency testing (PT) or external quality assessment (EQA) programs allows the assessment and comparison of test performance among different clinical laboratories and technologies. In addition to the approximately 2300 tests for individual genetic disorders, recent advances in technology have enabled the development of clinical tests that quickly and economically analyze the entire human genome. New PT/EQA approaches are needed to ensure the continued quality of these complex tests. OBJECTIVES: To review the availability and scope of PT/EQA for molecular genetic testing for inherited conditions in Europe, Australasia, and the United States; to evaluate the successes and demonstrated value of available PT/EQA programs; and to examine the challenges to the provision of comprehensive PT/EQA posed by new laboratory practices and methodologies. DATA SOURCES: The available literature on this topic was reviewed and supplemented with personal experiences of several PT/EQA providers. CONCLUSIONS: Proficiency testing/EQA schemes are available for common genetic disorders tested in many clinical laboratories but are not available for most genetic tests offered by only one or a few laboratories. Provision of broad, method-based PT schemes, such as DNA sequencing, would allow assessment of many tests for which formal PT is not currently available. Participation in PT/EQA improves the quality of testing by identifying inaccuracies that laboratories can trace to errors in their testing processes. Areas of research and development to ensure that PT/EQA programs can meet the needs of new and evolving genetic tests and technologies are identified and discussed. |
Development of a genomic DNA reference material panel for myotonic dystrophy type 1 (DM1) genetic testing.
Kalman L , Tarleton J , Hitch M , Hegde M , Hjelm N , Berry-Kravis E , Zhou L , Hilbert JE , Luebbe EA , Moxley RT 3rd , Toji L . J Mol Diagn 2013 15 (4) 518-25 Myotonic dystrophy type 1 (DM1) is caused by expansion of a CTG triplet repeat in the 3' untranslated region of the DMPK gene that encodes a serine-threonine kinase. Patients with larger repeats tend to have a more severe phenotype. Clinical laboratories require reference and quality control materials for DM1 diagnostic and carrier genetic testing. Well-characterized reference materials are not available. To address this need, the Centers for Disease Control and Prevention-based Genetic Testing Reference Material Coordination Program, in collaboration with members of the genetic testing community, the National Registry of Myotonic Dystrophy and Facioscapulohumeral Muscular Dystrophy Patients and Family Members, and the Coriell Cell Repositories, has established and characterized cell lines from patients with DM1 to create a reference material panel. The CTG repeats in genomic DNA samples from 10 DM1 cell lines were characterized in three clinical genetic testing laboratories using PCR and Southern blot analysis. DMPK alleles in the samples cover four of five DM1 clinical categories: normal (5 to 34 repeats), mild (50 to 100 repeats), classical (101 to 1000 repeats), and congenital (>1000 repeats). We did not identify or establish Coriell cell lines in the premutation range (35 to 49 repeats). These samples are publicly available for quality control, proficiency testing, test development, and research and should help improve the accuracy of DM1 testing. |
One year survey of human rotavirus strains suggests the emergence of genotype G12 in Cameroon.
Ndze VN , Papp H , Achidi EA , Gonsu KH , Laszlo B , Farkas S , Kisfali P , Melegh B , Esona MD , Bowen MD , Banyai K , Gentsch JR , Odama AM . J Med Virol 2013 85 (8) 1485-90 In this study the emergence of rotavirus A genotype G12 in children <5 years of age is reported from Cameroon during 2010/2011. A total of 135 human stool samples were P and G genotyped by reverse transcriptase PCR. Six different rotavirus VP7 genotypes were detected, including G1, G2, G3, G8, G9, and G12 in combinations with P[4], P[6] and P[8] VP4 genotypes. Genotype G12 predominated in combination with P[8] (54.1%) and P[6] (10.4%) genotypes followed by G1P[6] (8.2%), G3P[6] (6.7%), G2P[4] (5.9%), G8P[6] (3.7%), G2P[6] (0.7%), G3P[8] (0.7%), and G9P[8] (0.7%). Genotype P[6] strains in combination with various G-types represented a substantial proportion (N = 44, 32.6%) of the genotyped strains. Partially typed strains included G12P[NT] (2.2%); G3P[NT] (0.7%); G(NT)P[6] (1.5%); and G(NT)P[8] (0.7%). Mixed infections were found in five specimens (3.7%) in several combinations including G1 + G12P[6], G2 + G3P[6] + P[8], G3 + G8P[6], G3 + G12P[6] + P[8], and G12P[6] + P[8]. The approximately 10% relative frequency of G12P[6] strains detected in this study suggests that this strain is emerging in Cameroon and should be monitored carefully as rotavirus vaccine is implemented in this country, as it shares neither G- nor P-type specificity with strains in the RotaTeq(R) and Rotarix(R) vaccines. These findings are consistent with other recent reports of the global spread and increasing epidemiologic importance of G12 and P[6] strains. |
The microRNA-200 family targets multiple non-small cell lung cancer prognostic markers in H1299 cells and BEAS-2B cells.
Pacurari M , Addison JB , Bondalapati N , Wan YW , Luo D , Qian Y , Castranova V , Ivanov AV , Guo NL . Int J Oncol 2013 43 (2) 548-60 Lung cancer remains the leading cause of cancer-related mortality for both men and women. Tumor recurrence and metastasis is the major cause of lung cancer treatment failure and death. The microRNA200 (miR-200) family is a powerful regulator of the epithelial-mesenchymal transition (EMT) process, which is essential in tumor metastasis. Nevertheless, miR-200 family target genes that promote metastasis in non-small cell lung cancer (NSCLC) remain largely unknown. Here, we sought to investigate whether the microRNA-200 family regulates our previously identified NSCLC prognostic marker genes associated with metastasis, as potential molecular targets. Novel miRNA targets were predicted using bioinformatics tools based on correlation analyses of miRNA and mRNA expression in 57 squamous cell lung cancer tumor samples. The predicted target genes were validated with quantitative RT-PCR assays and western blot analysis following re-expression of miR-200a, -200b and -200c in the metastatic NSCLC H1299 cell line. The results show that restoring miR-200a or miR-200c in H1299 cells induces downregulation of DLC1, ATRX and HFE. Reinforced miR-200b expression results in downregulation of DLC1, HNRNPA3 and HFE. Additionally, miR-200 family downregulates HNRNPR3, HFE and ATRX in BEAS-2B immortalized lung epithelial cells in quantitative RT-PCR and western blot assays. The miR-200 family and these potential targets are functionally involved in canonical pathways of immune response, molecular mechanisms of cancer, metastasis signaling, cell-cell communication, proliferation and DNA repair in Ingenuity pathway analysis (IPA). These results indicate that re-expression of miR-200 downregulates our previously identified NSCLC prognostic biomarkers in metastatic NSCLC cells. These results provide new insights into miR-200 regulation in lung cancer metastasis and consequent clinical outcome, and may provide a potential basis for innovative therapeutic approaches for the treatment of this deadly disease. |
What we are watching-five top global infectious disease threats, 2012: a perspective from CDC's Global Disease Detection Operations Center
Christian KA , Ijaz K , Dowell SF , Chow CC , Chitale RA , Bresee JS , Mintz E , Pallansch MA , Wassilak S , McCray E , Arthur RR . Emerg Health Threats J 2013 6 20632 Disease outbreaks of international public health importance continue to occur regularly; detecting and tracking significant new public health threats in countries that cannot or might not report such events to the global health community is a challenge. The Centers for Disease Control and Prevention's (CDC) Global Disease Detection (GDD) Operations Center, established in early 2007, monitors infectious and non-infectious public health events to identify new or unexplained global public health threats and better position CDC to respond, if public health assistance is requested or required. At any one time, the GDD Operations Center actively monitors approximately 30-40 such public health threats; here we provide our perspective on five of the top global infectious disease threats that we were watching in 2012: 1 avian influenza A (H5N1), 2 cholera, 3 wild poliovirus, 4 enterovirus-71, and 5 extensively drug-resistant tuberculosis. |
Health professionals in Syria
Garfield R . Lancet 2013 382 (9888) 205-6 The US Centers for Disease Control and Prevention, UNICEF, and WHO, with support from the Office of Foreign Disaster Control, trained 50 staff from Syrian and Jordanian ministries of health and other organisations working in and around Syria in May, 2013, in Jordan. A third of Syria's 21 million people are now displaced from their homes.1 Most of the north of Syria is rebel-held territory and local administration is no longer directed by the national administration. | Patients have flooded into several hospitals in neighbouring countries, where Islamic charities are subsidising care. Some 850 camps are known to the Syrian Government, which attempts to supply them with essential goods. People living in these camps are vulnerable. The nascent network of opposition-led health services is neither supplied nor organised enough to respond to the needs. In some areas where both government and opposition are absent, local non-governmental organisations have formed to provide protection and care. Their main concern is a near dearth of medicines in these areas. |
Trends in modifiable lifestyle-related risk factors following diagnosis in breast cancer survivors
Zhao G , Li C , Okoro CA , Li J , Wen XJ , White A , Balluz LS . J Cancer Surviv 2013 7 (4) 563-9 PURPOSE: Evidence suggests that high-risk lifestyle behaviors exacerbate the health of cancer survivors and increase cancer mortality. This study examined the prevalence of lifestyle-related risk factors among female breast cancer survivors by duration of survivorship in the United States. METHODS: We analyzed data from 7,443 women aged ≥18 years who participated in the 2009 Behavioral Risk Factor Surveillance System and reported having ever-diagnosed breast cancer. Adjusted prevalence with 95 % confidence interval for lifestyle-related risk factors (including current smoking, excessive alcohol drinking, obesity, engaging in physical activity ≥150 min/week, and consuming fruits and vegetables ≥5 times/day) was estimated using log-linear regression while controlling for confounders. RESULTS: Overall, the prevalence estimates for lifestyle-related risk factors were 10.2 % for current smoking, 6.8 % for excessive alcohol drinking, 24.7 % for obesity, 53.8 % for engaging in physical activity ≥150 min/week, and 33.9 % for consuming fruits and vegetables ≥5 times/day among female breast cancer survivors. After adjustment for covariates, with increasing years of survivorship, a linearly increasing trend was observed for current smoking (P = 0.038), and quadratic trends were observed for excessive alcohol drinking (P < 0.001) and obesity (P = 0.048). The adjusted prevalence estimates for engaging in physical activity ≥150 min/week and consuming fruits and vegetables ≥5 times/day did not vary significantly by duration of survivorship. CONCLUSION: Continuing efforts on counseling and encouraging breast cancer survivors to adopt healthy lifestyles are needed to improve their health. IMPLICATIONS FOR CANCER SURVIVORS: Understanding the trends of modifiable lifestyle-related risk factors among breast cancer survivors with varying duration of survivorship may assist health care providers to provide appropriate counseling for breast cancer patients to improve their health. Clinical and public health intervention programs should seek to maximize the number of recommended healthy behaviors especially in those women who are at high risk for failing to comply with the healthy lifestyle guidelines. |
Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007
Tempalski B , Pouget ER , Cleland CM , Brady JE , Cooper HL , Hall HI , Lansky A , West BS , Friedman SR . PLoS One 2013 8 (6) e64789 BACKGROUND: People who inject drugs (PWID) have increased risk of morbidity and mortality. We update and present estimates and trends of the prevalence of current PWID and PWID subpopulations in 96 US metropolitan statistical areas (MSAs) for 1992-2007. Current estimates of PWID and PWID subpopulations will help target services and help to understand long-term health trends among PWID populations. METHODOLOGY: We calculated the number of PWID in the US annually from 1992-2007 and apportioned estimates to MSAs using multiplier methods. We used four types of data indicating drug injection to allocate national annual totals to MSAs, creating four distinct series of component estimates of PWID in each MSA and year. The four component estimates are averaged to create the best estimate of PWID for each MSA and year. We estimated PWID prevalence rates for three subpopulations defined by gender, age, and race/ethnicity. We evaluated trends using multi-level polynomial models. RESULTS: PWID per 10,000 persons aged 15-64 years varied across MSAs from 31 to 345 in 1992 (median 104.4) to 34 to 324 in 2007 (median 91.5). Trend analysis indicates that this rate declined during the early period and then was relatively stable in 2002-2007. Overall prevalence rates for non-Hispanic black PWID increased in 2005 as compared to other racial/ethnic groups. Hispanic prevalence, in contrast, declined across time. Importantly, results show a worrisome trend in young PWID prevalence since HAART was initiated - the mean prevalence was 90 to 100 per 10,000 youth in 1992-1996, but increased to >120 PWID per 10,000 youth in 2006-2007. CONCLUSIONS: Overall, PWID rates remained constant since 2002, but increased for two subpopulations: non-Hispanic black PWID and young PWID. Estimates of PWID are important for planning and evaluating public health programs to reduce harm among PWID and for understanding related trends in social and health outcomes. |
Shared decision making in prostate-specific antigen testing with men older than 70 years
Li J , Berkowitz Z , Richards TB , Richardson LC . J Am Board Fam Med 2013 26 (4) 401-8 BACKGROUND: Little is known about how shared decision making (SDM) is being carried out between older men and their health care providers. Our study aimed to describe the use of SDM key elements and assess their associations with prostate-specific antigen (PSA) testing among older men. METHODS: We conducted descriptive and logistic regression modeling analyses using the 2005 and 2010 National Health Interview Survey data. RESULTS: Age-specific prevalence of PSA testing was similar in 2005 and 2010. In 2010, 44.1% of men aged ≥70 years had PSA testing. Only 27.2% (95% confidence interval, 22.2-32.9) of them reported having discussions about both advantages and disadvantages of testing. Multiple regression analyses showed that PSA-based screening was positively associated with discussions of advantages only (P < .001) and with discussions of both advantages and disadvantages (P < .001) compared with no discussion. Discussion of scientific uncertainties was not associated with PSA testing. CONCLUSIONS: Efforts are needed to increase physicians' awareness of and adherence to PSA-based screening recommendations. Given that discussions of both advantages and disadvantages increased the uptake of PSA testing and discussion of scientific uncertainties has no effect, additional research about the nature, context, and extent of SDM and about patients' knowledge, values, and preferences regarding PSA-based screening is warranted. |
Sisters Empowered, Sisters Aware: three strategies to recruit African American women for HIV testing
Gaiter JL , Johnson WD , Taylor E , Thadiparthi S , Duncan-Alexander T , Lemon C , Turner A , Hickman D , Brown D , Aponte E , Kimbrough L , Prather C . AIDS Educ Prev 2013 25 (3) 190-202 African American women account for 66% of new HIV infections among U.S. women, and many are not aware of their status. The authors compared three strategies (targeted outreach, alternate venues, and social networks) to recruit African American women for HIV testing in Houston, New York City, Baltimore, and Dayton. A quasi-experimental design (N = 4,942) was used to compare HIV-positivity rates and to identify risk factors for previously undiagnosed infection. A total of 2.1% of the women were newly diagnosed with HIV. The proportion newly identified as HIV-positive did not differ significantly among the three strategies (2.4% for social networks, 1.7% for both targeted outreach and alternate venues). However, the social networks strategy recruited women with greater risk behaviors and other characteristics associated with newly identified HIV infection and thus may be effective at reaching some high-risk women before they become infected. A combination of recruitment strategies may be warranted to reach various subgroups of African American women at risk for HIV. |
Using electronic surveys to gather information on physician practices during a response to a local epidemic-Rhode Island, 2011
Minniear TD , McIntosh EB , Alexander N , Weidle PJ , Fulton J . Ann Epidemiol 2013 23 (8) 521-3 BACKGROUND: Electronic invitations may improve physician response rates to participate in internet surveys administered by public health agencies. METHODS: Following an increase in reported HIV/syphilis co-infection diagnoses among men-who-have-sex-with-men in Rhode Island, we invited the state's 700 adult primary care and emergency medicine physicians via e-mail to participate in an online, multiple choice survey covering their knowledge, attitudes, and practices regarding sexually transmitted diseases and HIV testing and prevention. Survey invitations were released in three waves over 28 days, triggered by declining daily response rates. RESULTS: Among 53% (n = 372) who agreed to participate, 68% (n = 252) completed all questions. Response was higher among internal medicine physicians than either family medicine or emergency medicine physicians (63% vs. 20% and 19%, respectively; P<0.0001). Daily response rates were highest in the first 48 hours after sending a reminder e-mail. CONCLUSION: This approach supported the Rhode Island Department of Health in rapidly gathering useful physician practice information during an outbreak. Internet-based survey tools coupled with increased prevalence of mobile communication devices and social media could greatly decrease the time and cost of shoe-leather epidemiology. |
Multi-level barriers to obtaining mammograms for women with mobility limitations: post workshop evaluation
Suzuki R , Krahn G , Small E , Peterson-Besse J . Am J Health Behav 2013 37 (5) 711-718 OBJECTIVES: To assess the barriers and facilitators to mammogram use in middle aged women with mobility limitations who had completed an educational workshop, Promoting Access to Health Service (PATHS), on clinical preventive services. METHODS: Women aged 40 to 64 with mobility impairments who reported not receiving a mammogram in the last 2 years were randomly assigned to a PATHS workshop and received follow-up monthly phone call interviews over 6 months. RESULTS: Individual (eg, comorbidities, family responsibilities), interpersonal (eg, unclear provider communication, negative history), and environmental (eg, healthcare availability, insurance coverage, finances) factors were identified as unsolved barriers and potential facilitators (eg, reminders, physical proximity), to obtaining a mammogram. CONCLUSIONS: A multi-level intervention approach is required to promote mammogram use by women with disabilities. |
Project POWER: adapting an evidence-based HIV/STI prevention intervention for incarcerated women
Fasula AM , Fogel CI , Gelaude D , Carry M , Gaiter J , Parker S . AIDS Educ Prev 2013 25 (3) 203-15 Incarcerated women are a critical population for targeted HIV/STI prevention programming; however, there is a dearth of evidence-based, gender specific behavioral interventions for this population. Systematically adapting existing evidence-based interventions (EBIs) can help fill this gap. We illustrate the adaptation of the HIV/STI prevention EBI, Project Safe, for use among incarcerated women and delivery in prisons. Project POWER, the final adapted intervention, was developed using formative research with prison staff and administration, incarcerated and previously incarcerated women, and input of community advisory boards. Intervention delivery adaptations included: shorter, more frequent intervention sessions; booster sessions prior to and just after release; facilitator experience in prisons and counseling; and new videos. Intervention content adaptations addressed issues of empowerment, substance use, gender and power inequity in relationships, interpersonal violence, mental health, reentry, and social support. This illustration of the adaption process provides information to inform additional efforts to adapt EBIs for this underserved population. |
Exploration of awareness, knowledge, and perceptions of traumatic brain injury among american youth athletes and their parents
Bloodgood B , Inokuchi D , Shawver W , Olson K , Hoffman R , Cohen E , Sarmiento K , Muthuswamy K . J Adolesc Health 2013 53 (1) 34-9 PURPOSE: Although much effort is underway by the Centers for Disease Control and Prevention (CDC) and other organizations to highlight the seriousness of traumatic brain injury, including concussions, among young athletes, little is known about how these athletes and their parents view this injury and how much they know about it. METHODS: Online surveys were conducted with youth who participate in sports (n = 252) and with the parents of youth who participate in sports (n = 300) to explore the ways in which these audiences view concussion and messaging related to concussion. RESULTS: More than four out of five youth and parents reported that they had heard about concussions, although awareness was significantly higher for some subgroups, including parents of children 10-13 years old, and parents who reported using the Internet several times daily. Youth ages 13-15 years were significantly more likely to strongly agree that concussions are a "critical issue," as compared with youth ages 16-18 years. Among parents, significantly more mothers than fathers agreed that concussions are a critical issue. More than half of youth participants strongly disagreed that their friends would think they were "dumb for caring about concussions," with girls significantly more likely to strongly disagree than boys. When parents were asked to identify organizations they would trust as a reliable source of information for concussions, the most frequently cited organization was the CDC. CONCLUSIONS: Results of this study demonstrate a high level of awareness about concussion among youth athletes and parents of youth athletes. However, important distinctions among subgroups of both youth and parents-such as by race/ethnicity, age, sex, and Internet use-suggest directions for future communication and research efforts. |
Identifying information needs among children and teens living with haemophilia
Simmons GM , Frick N , Wang A , Miller ME , Fragueiro D . Haemophilia 2013 20 (1) 1-8 Transitioning from one life stage to the next can be difficult, but for those living with a chronic condition, it can be even more challenging. Children and adolescents with haemophilia need help to manage transitions while dealing with the complications of their disorder. The National Haemophilia Foundation (NHF), headquartered in New York City, has an extensive information centre on bleeding disorders, but it was not clear how much material existed on the topic of transition. The objectives of this project were to (i) assess the availability of literature about transition for children and adolescents living with haemophilia, (ii) determine which transition issues were the most relevant and (iii) develop and test information products that would address those transition issues. An inventory of NHF's resources and an environmental scan over the Internet was performed. Focus groups were conducted to determine messaging. Video prototypes containing messages were created, tested by focus groups and revised. The literature search yielded limited information available on transition for children and adolescents with haemophilia. Results of the formative research indicated that adolescents wanted more information on sports participation and disclosure of their condition (e.g. to peers, teachers, coaches, health care providers). Video was found to be the preferred delivery format. Children and adolescents living with haemophilia need information to help them transition through life. As a result of this study, two educational products were produced, but several more are recommended to guide these individuals in making healthy transitions into adulthood. |
A double dose of fear: a theory-based content analysis of news articles surrounding the 2006 cough syrup contamination crisis in Panama
Turner MM , Boudewyns V , Kirby-Straker R , Telfer J . Risk Manage 2013 15 (2) 79-99 This study applied the extended parallel process model (EPPM) to evaluate the crisis messages employed by the mainstream media and the government during the 2006 diethylene glycol (DEG) poisoning crisis in Panama. Messages were content analyzed for its use of tenets of the EPPM. Overall, the findings reveal that the news coverage clearly emphasized the threat of DEC poisoning over the efficacy of avoiding being poisoned. In addition, quantitative analyses showed that the information provided by Ministry of Health of Panama (MINSA) and the local news outlets were widely divergent. These data indicate that the majority (82 per cent) of MINSA press releases included a balance of both threat and efficacy elements, compared with only 29 per cent of Panama newspapers. Panama newspapers tended to emphasize threat alone. |
Targeted versus universal decolonization to prevent ICU infection
Huang SS , Septimus E , Kleinman K , Moody J , Hickok J , Avery TR , Lankiewicz J , Gombosev A , Terpstra L , Hartford F , Hayden MK , Jernigan JA , Weinstein RA , Fraser VJ , Haffenreffer K , Cui E , Kaganov RE , Lolans K , Perlin JB , Platt R . N Engl J Med 2013 368 (24) 2255-65 BACKGROUND: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital. RESULTS: A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine. CONCLUSIONS: In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. |
Exserohilum infections associated with contaminated steroid injections: a clinicopathologic review of 40 cases
Ritter JM , Muehlenbachs A , Blau DM , Paddock CD , Shieh WJ , Drew CP , Batten BC , Bartlett JH , Metcalfe MG , Pham CD , Lockhart SR , Patel M , Liu L , Jones TL , Greer PW , Montague JL , White E , Rollin DC , Seales C , Stewart D , Deming MV , Brandt ME , Zaki SR . Am J Pathol 2013 183 (3) 881-92 September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. |
Characterization of Cannabis sativa allergens
Nayak AP , Green BJ , Sussman G , Berlin N , Lata H , Chandra S , Elsohly MA , Hettick JM , Beezhold DH . Ann Allergy Asthma Immunol 2013 111 (1) 32-37 e4 BACKGROUND: Allergic sensitization to Cannabis sativa is rarely reported, but the increasing consumption of marijuana has resulted in an increase in the number of individuals who become sensitized. To date, little is known about the causal allergens associated with C sativa. OBJECTIVE: To characterize marijuana allergens in different components of the C sativa plant using serum IgE from marijuana sensitized patients. METHODS: Serum samples from 23 patients with a positive skin prick test result to a crude C sativa extract were evaluated. IgE reactivity was variable between patients and C sativa extracts. IgE reactivity to C sativa proteins in Western blots was heterogeneous and ranged from 10 to 70 kDa. Putative allergens derived from 2-dimensional gels were identified. RESULTS: Prominent IgE reactive bands included a 23-kDa oxygen-evolving enhancer protein 2 and a 50-kDa protein identified to be the photosynthetic enzyme ribulose-1,5-bisphosphate carboxylase/oxygenase. Additional proteins were identified in the proteomic analysis, including those from adenosine triphosphate synthase, glyceraldehyde-3-phosphate dehydrogenase, phosphoglycerate kinase, and luminal binding protein (heat shock protein 70), suggesting these proteins are potential allergens. Deglycosylation studies helped refine protein allergen identification and demonstrated significant IgE antibodies against plant oligosaccharides that could help explain cross-reactivity. CONCLUSION: Identification and characterization of allergens from C sativa may be helpful in further understanding allergic sensitization to this plant species. |
Trends in compliance with two-dose influenza vaccine recommendations among children aged 6 months through 8 years
Pabst LJ , Chaves SS , Weinbaum C . Vaccine 2013 31 (31) 3116-20 Children aged <9 years may require two doses of influenza vaccine to achieve an adequate immune response to protect against the disease. We analyzed data for >2 million children in each influenza season from 2007 to 2012 from eight Immunization Information System Sentinel Sites to assess trends in two-dose compliance. Compliance was calculated by influenza season, age group, and influenza vaccination history. Two-dose compliance increased from 49% to 60% among 6-23 month olds from 2007 to 2012; no increase was observed for 2-4 or 5-8 year olds. In each season, compliance was 3-12 times higher among 6-23 month olds compared to older children and was two times higher among influenza vaccine naive children compared to previously vaccinated children. Improved messaging for providers and parents about the importance of the two-dose recommendation, about which children are eligible for two doses, and provider access to complete influenza vaccination histories for all children are needed. |
TRIVAC decision-support model for evaluating the cost-effectiveness of Haemophilus influenzae type b, pneumococcal and rotavirus vaccination
Clark A , Jauregui B , Griffiths U , Janusz CB , Bolanos-Sierra B , Hajjeh R , Andrus JK , Sanderson C . Vaccine 2013 31 Suppl 3 C19-29 The TRIVAC decision support model has been used widely in Latin America and other regions to help national teams evaluate the cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine, pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV). We describe the structure and functioning of this model, and identify the parameters with the greatest influence on the results. The TRIVAC model is a spreadsheet software program that calculates incremental cost-effectiveness ratios (ICERs) and other indicators for three childhood vaccines (Hib, PCV and RV) utilising parameters such as demography, disease burden, vaccine costs, vaccine coverage, vaccine efficacy, health service utilisation and costs. There is a good deal of uncertainty about the local values of many of the parameters that have most influence on the cost-effectiveness of these new vaccines. Cost-effectiveness models can be used to explore the implications of different values of these parameters. However, for such models to be seen as relevant and helpful by decision-makers, they need to be transparent, flexible, easy to use, and embedded in a process which is owned and led by national teams. In this paper the key drivers of cost-effectiveness in the model are identified by one-way sensitivity analyses, run for each vaccine in 147 countries. The data used are mainly from standard international sources and the published literature. The primary indicator was the discounted cost per Disability Adjusted Life-Year (DALY) averted, from a government perspective, over a 20-year period (2013-2032). For all three vaccines, the ICER was most sensitive to changes in relative coverage (the coverage of the children who would have become diseased or, more importantly, died if the population had not been vaccinated, as a % of overall national coverage) and the herd effect multiplier. Other influential parameters for all three vaccines were: the incidence and case fatality of disease, the baseline trend in disease mortality in the absence of vaccination, vaccine efficacy, vaccine price and the % decline in vaccine price per year. Important vaccine-specific parameters included the cost of Hib meningitis sequelae, PCV serotype coverage and the rotavirus gastro-enteritis (RVGE) admission rate. While vaccine efficacy, herd effects, disease mortality and vaccine price are commonly cited as important drivers of cost-effectiveness, this analysis highlights the potentially important influence of relative coverage, a parameter rarely considered in models of vaccine impact and cost-effectiveness. |
U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination
Griffin MR , Zhu Y , Moore MR , Whitney CG , Grijalva CG . N Engl J Med 2013 369 (2) 155-163 BACKGROUND: The introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into the U.S. childhood immunization schedule in 2000 has substantially reduced the incidence of vaccine-serotype invasive pneumococcal disease in young children and in unvaccinated older children and adults. By 2004, hospitalizations associated with pneumonia from any cause had also declined markedly among young children. Because of concerns about increases in disease caused by nonvaccine serotypes, we wanted to determine whether the reduction in pneumonia-related hospitalizations among young children had been sustained through 2009 and whether such hospitalizations in older age groups had also declined. METHODS: We estimated annual rates of hospitalization for pneumonia from any cause using the Nationwide Inpatient Sample database. The reason for hospitalization was classified as pneumonia if pneumonia was the first listed diagnosis or if it was listed after a first diagnosis of sepsis, meningitis, or empyema. Average annual rates of pneumonia-related hospitalizations from 1997 through 1999 (before the introduction of PCV7) and from 2007 through 2009 (well after its introduction) were used to estimate annual declines in hospitalizations due to pneumonia. RESULTS: The annual rate of hospitalization for pneumonia among children younger than 2 years of age declined by 551.1 per 100,000 children (95% confidence interval [CI], 445.1 to 657.1), which translates to 47,000 fewer hospitalizations annually than expected on the basis of the rates before PCV7 was introduced. The rate for adults 85 years of age or older declined by 1300.8 per 100,000 (95% CI, 984.0 to 1617.6), which translates to 73,000 fewer hospitalizations annually. For the three age groups of 18 to 39 years, 65 to 74 years, and 75 to 84 years, the annual rate of hospitalization for pneumonia declined by 8.4 per 100,000 (95% CI, 0.6 to 16.2), 85.3 per 100,000 (95% CI, 7.0 to 163.6), and 359.8 per 100,000 (95% CI, 199.6 to 520.0), respectively. Overall, we estimated an age-adjusted annual reduction of 54.8 per 100,000 (95% CI, 41.0 to 68.5), or 168,000 fewer hospitalizations for pneumonia annually. CONCLUSIONS: Declines in hospitalizations for childhood pneumonia were sustained during the decade after the introduction of PCV7. Substantial reductions in hospitalizations for pneumonia among adults were also observed. |
Meningococcal vaccines: current issues and future strategies
Cohn AC , Harrison LH . Drugs 2013 73 (11) 1147-55 Since the introduction of the first meningococcal conjugate vaccines in 1999, remarkable progress has been made in reducing the morbidity and mortality caused by meningococcal disease. Currently, varying meningococcal conjugate vaccines provide protection against serogroups A, C, Y, and W meningococcal disease. A large impact has been seen after vaccine introduction, particularly in the UK after vaccinating all 1-17 year olds. The introduction of serogroup A conjugate vaccine in the meningitis belt has the potential to control epidemics of disease that disproportionately affect this area of the world. Issues remain that require continued vigilance with disease surveillance and frequent reassessment of vaccine strategies. These issues include duration of protection, potential increases in non-vaccine serogroups, and vaccine safety and potential interference with other routine vaccines. Serogroup B meningococcal vaccines are protein-based vaccines, with the first approved in early 2013. Understanding the potential impact of serogroup B vaccines is critical to developing future meningococcal vaccination strategies. |
Mortality and neurodevelopmental outcomes of acute bacterial meningitis in children aged <5 years in Pakistan
Khowaja AR , Mohiuddin S , Cohen AL , Khalid A , Mehmood U , Naqvi F , Asad N , Pardhan K , Mulholland K , Hajjeh R , Zaidi AK , Shafqat S . J Pediatr 2013 163 S86-S91 e1 OBJECTIVE: Significant neurodevelopmental sequelae are known to occur after acute bacterial meningitis (ABM). This study determined the burden of such sequelae in Pakistani children aged <5 years to guide policies for Haemophilus influenzae type b (Hib) and pneumococcal vaccination. STUDY DESIGN: Cases of ABM were recruited from hospital-based surveillance and assigned to 1 of 3 etiologic groups (Hib, Streptococcus pneumoniae, or unknown etiology). Two age-matched controls were recruited for each case. Six months after enrollment, each case underwent neurologic history and examination, neurodevelopmental evaluation, and neurophysiological hearing test. Controls were assessed in parallel. RESULTS: Of 188 cases, 64 (34%) died. Mortality among subgroups were 7 (27%), 14 (28%), and 43 (39%) for Hib, Streptococcus pneumoniae, and unknown etiology, respectively. Eighty cases and 160 controls completed the assessments. Sequelae among cases included developmental delay (37%), motor deficit (31%), hearing impairment (18.5%), epilepsy (14%), and vision impairment (14%). Sequelae were higher after pneumococcal meningitis (19, 73%) compared with Hib meningitis (8, 53%). Compared with controls, cases were at significantly higher risk for all sequelae (P < .0001). CONCLUSIONS: ABM causes a substantial long-term burden of poor neurodevelopmental outcomes. Hib and pneumococcal vaccines are very effective interventions to prevent meningitis and its disabling sequelae. |
Mortality rates and cause-of-death patterns in a vaccinated population
McCarthy NL , Weintraub E , Vellozzi C , Duffy J , Gee J , Donahue JG , Jackson ML , Lee GM , Glanz J , Baxter R , Lugg MM , Naleway A , Omer SB , Nakasato C , Vazquez-Benitez G , Destefano F . Am J Prev Med 2013 45 (1) 91-7 BACKGROUND: Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines. PURPOSE: Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD). METHODS: Analyses were conducted in 2012. Mortality rates were calculated at 0-1 day, 0-7 days, 0-30 days, and 0-60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data. RESULTS: Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0-1-day to the 0-60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems. CONCLUSIONS: VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar. |
Progress towards demonstrating the impact of Haemophilus influenzae Type b conjugate vaccines globally
Hajjeh R , Mulholland K , Schuchat A , Santosham M . J Pediatr 2013 163 S1-3 Prior to the introduction of vaccines, Haemophilus influenzae type b (Hib) was the most common cause of bacterial meningitis and an important cause of severe pneumonia in children <5 years of age. Hib conjugate vaccines were introduced in developed countries during the early 1990s, resulting in a virtual elimination of Hib disease.1 However, the introduction of Hib vaccine in developing countries was delayed significantly due to multiple barriers, with major obstacles being the lack of local data on disease burden and the lack of awareness of the potential impact of the vaccine. In 2002, a group of scientific experts and public health officials gathered in Arizona, US, to discuss the epidemiology and control of Hib disease and recommended a multifaceted approach to overcome barriers for Hib vaccine introduction.2 In 2005, the GAVI Alliance funded the Hib Initiative, a consortium of public and private institutions (Johns Hopkins School of Public Health, the World Health Organization [WHO], the London School for Hygiene and Tropical Medicine, and the US Centers for Diseases Control and Prevention) to assist countries eligible for GAVI funding in making evidence-based decisions regarding the introduction of Hib vaccines into national immunizations programs. The Hib Initiative adopted a strategy based on improved communications, coordination with key partners at country, regional, and global levels, and supporting selected research studies to address gaps in Hib knowledge, particularly studies that could provide evidence and capacity to sustain vaccine programs beyond the period of GAVI support. Fortunately, significant progress in introduction of Hib vaccines has occurred over the last few years with all GAVI countries, having either introduced the vaccine already or are expected to introduce in 2013.3 | There frequently is tension in implementation programs regarding the appropriate role for research. The Hib Initiative focused on critical issues and geographic locations where scientific gaps remained and where strengthened capacity and systems could bridge to long term impacts. A decade after the Arizona meeting, the proceedings of which were reported in The Journal of Pediatrics, many scientific gaps have been filled, but a few questions still need to be answered.2 This Supplement features a number of projects that were supported by the Hib Initiative and that provide valuable lessons for meningitis and pneumonia control and accelerate uptake of new and underutilized vaccines. |
Effectiveness of Haemophilus influenzae type b conjugate vaccine on radiologically-confirmed pneumonia in young children in Pakistan
Khowaja AR , Mohiuddin S , Cohen AL , Mirza W , Nadeem N , Zuberi T , Salam B , Mubarak F , Rizvi B , Husen Y , Pardhan K , Khan KM , Raza SJ , Zuberi HK , Mustafa S , Sheikh SH , Nizamani A , Lohana H , Mulholland K , Zell E , Hajjeh R , Bosan A , Zaidi AK . J Pediatr 2013 163 S79-S85 e1 OBJECTIVE: The effectiveness of Haemophilus influenzae type b (Hib) vaccine in preventing severe pneumonia in Asian children has been questioned, and many large Asian countries yet to introduce Hib conjugate vaccine in immunization programs. The primary objective of this study was to assess Hib conjugate vaccine effectiveness (VE) on radiologically-confirmed pneumonia in children born after introduction of Hib conjugate vaccine in Pakistan. STUDY DESIGN: A matched case-control study enrolled cases of radiologically-confirmed pneumonia in several hospitals serving low-income populations during 2009-2011. Cases were matched by age and season with 3 hospital and 5 neighborhood controls. Pneumonia was diagnosed using standardized World Health Organization criteria for chest radiograph interpretation. Matched OR were estimated for VE. RESULTS: A total of 1027 children with radiologically-confirmed pneumonia were enrolled; 975 cases, 2925 hospital controls, and 4875 neighborhood controls were analyzed. The coverage for 3 doses of diphtheria-tetanus-pertussis-hepatitis B-Hib conjugate vaccine was 13.7%, 18%, and 22.7% in cases, hospital controls and neighborhood controls, respectively. Estimated Hib VE for radiologically-confirmed pneumonia was 62% with 3 doses of vaccine using hospital controls and 70% using neighborhood controls. CONCLUSIONS: Hib conjugate vaccine prevented a significant fraction of radiologically-confirmed pneumonia in children in Pakistan. Maximizing impact on child survival needs improved immunization coverage. |
Effectiveness of the 7-valent pneumococcal conjugate vaccine against vaccine-type invasive disease among children in Uruguay: An evaluation using existing data
Picon T , Alonso L , Garcia Gabarrot G , Speranza N , Casas M , Arrieta F , Camou T , Rosa R , Helena De Oliveira L , Verani JR . Vaccine 2013 31 Suppl 3 C109-13 The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine immunization program in Uruguay in March 2008 with a 2-dose primary series (given at 2 and 4 months) plus a booster (at 12 months) and a catch-up campaign (two doses given at 15 and 17 months). We used a case-control methodology and existing laboratory surveillance and immunization registry data from Uruguay to evaluate PCV7 effectiveness against vaccine-type invasive pneumococcal disease (VT-IPD). Cases of VT-IPD (with pneumococcus obtained from a normally sterile site) were identified through the National Reference Laboratory. Age- and neighborhood-matched controls were obtained through a national immunization registry in which all children are enrolled at birth regardless of vaccine receipt; all eligible controls were included. Immunization status of cases and controls was assessed through the immunization registry, and conditional logistic regression was used to calculate PCV7 effectiveness. Between April 2008 and February 2010, 44 cases of VT-IPD among children<5 years were identified; 43 (98%) of those children were located in the registry. Among located case patients, 7 (16.3%) were age-eligible to have received at least one dose of PCV7. A total of 637 matched controls were included. Vaccine effectiveness was 91.3% (95% CI: 46.4, 98.6) for ≥1 PCV7 doses and 94.8% (95% CI: 43.1, 99.5) for ≥2 PCV7 doses. Using existing data we demonstrated high effectiveness of PCV7 against VT-IPD in Uruguay-a middle-income country using a 2-dose primary series plus a booster dose and a limited catch-up campaign. These data also highlight the utility of surveillance and high-quality immunization registries for evaluating the effectiveness of vaccines. |
Haemophilus influenzae type b disease among children in rural Mozambique: impact of vaccine introduction
Sigauque B , Vubil D , Sozinho A , Quinto L , Morais L , Sacoor C , Carvalho MG , Verani JR , Alonso PL , Roca A . J Pediatr 2013 163 S19-24 OBJECTIVE: Haemophilus influenzae type b (Hib) conjugate vaccine has dramatically reduced invasive Hib disease worldwide. Yet, data on protection against pneumonia and among children with HIV are limited. We evaluated the impact of Hib conjugate vaccine introduction in 2009 in a rural, high-HIV prevalence area in Mozambique. STUDY DESIGN: From 2006-2011, we conducted hospital-based surveillance for invasive Hib disease and clinical pneumonia (classified as severe and very severe) among children <5 years of age. Incidences calculated using population denominators were compared between baseline (2006-2008) and post-Hib conjugate vaccine (2010-2011) periods. Surveillance data for radiologically-confirmed pneumonia among children <2 years of age in 2011 were compared with baseline data from 2004-2006. RESULTS: Among 50 cases of invasive Hib disease, 5 occurred after Hib conjugate vaccine introduction; 1 case-patient was age-eligible for Hib conjugate vaccine (and had received 3 doses). Four post-Hib conjugate vaccine case-patients (including Hib conjugate vaccine failure) had HIV. Among children <1 and <5 years of age, significant reductions occurred in rates of invasive Hib disease (91% and 85%, respectively) and very severe pneumonia (29% and 34%, respectively). Radiologically-confirmed pneumonia incidence fell significantly (33%) in children <2 years of age. Severe pneumonia incidence did not decline. CONCLUSIONS: We demonstrate important reductions in invasive disease and pneumonia following Hib conjugate vaccine introduction in a high-HIV area. Continued surveillance is needed to monitor long-term Hib conjugate vaccine effects, particularly among children with HIV. |
Impact and cost-effectiveness of Haemophilus influenzae type b conjugate vaccination in India
Clark AD , Griffiths UK , Abbas SS , Rao KD , Privor-Dumm L , Hajjeh R , Johnson H , Sanderson C , Santosham M . J Pediatr 2013 163 S60-72 OBJECTIVE: To estimate the potential health impact and cost-effectiveness of nationwide Haemophilus influenzae type b (Hib) vaccination in India. STUDY DESIGN: A decision support model was used, bringing together estimates of demography, epidemiology, Hib vaccine effectiveness, Hib vaccine costs, and health care costs. Scenarios favorable and unfavorable to the vaccine were evaluated. State-level analyses indicate where the vaccine might have the greatest impact and value. RESULTS: Between 2012 and 2031, Hib conjugate vaccination is estimated to prevent over 200 000 child deaths (approximately 1% of deaths in children <5 years of age) in India at an incremental cost of US$127 million per year. From a government perspective, state-level cost-effectiveness ranged from US$192 to US$1033 per discounted disability adjusted life years averted. With the inclusion of household health care costs, cost-effectiveness ranged from US$155-US$939 per discounted disability adjusted life year averted. These values are below the World Health Organization thresholds for cost effectiveness of public health interventions. CONCLUSIONS: Hib conjugate vaccination is a cost-effective intervention in all States of India. This conclusion does not alter with plausible changes in key parameters. Although investment in Hib conjugate vaccination would significantly increase the cost of the Universal Immunization Program, about 15% of the incremental cost would be offset by health care cost savings. Efforts should be made to expedite the nationwide introduction of Hib conjugate vaccination in India. |
Impact of Haemophilus influenzae Type b conjugate vaccine in Mongolia: prospective population-based surveillance, 2002-2010
Scott S , Altanseseg D , Sodbayer D , Nymadawa P , Bulgan D , Mendsaikhan J , Watt JP , Slack MP , Carvalho MG , Hajjeh R , Edmond KM . J Pediatr 2013 163 S8-S11 OBJECTIVES: Bacterial meningitis is associated with high mortality and long-term complications. This study assessed the impact of Haemophilus influenzae type b (Hib) conjugate vaccine on childhood bacterial meningitis in Ulaanbaatar, Mongolia. STUDY DESIGN: Prospective, active, population-based surveillance for suspected meningitis in children aged 2-59 months was conducted (February 2002-January 2011) in 6 hospitals. Clinical data, blood, and cerebrospinal fluid were collected. The impact of Hib conjugate vaccine was assessed by comparing Hib and all cause meningitis data in the 3 years preceding pentavalent conjugate vaccine implementation (2002-2004) with 3 years postimplementation (2008-2010). RESULTS: Five hundred eleven cases of suspected meningitis were identified from 2002-2011. Pentavalent conjugate vaccine coverage in December 2005 in Ulaanbaatar city was 97%. The proportion of suspected cases confirmed as Hib meningitis decreased from 25% (50/201) in the prevaccination era to 2% (4/193) in the postvaccination era (P < .0001). The annual incidence of Hib decreased from 28 cases per 100 000 children in 2002-2005 to 2 per 100 000 in 2008-2010 (P < .0001). CONCLUSIONS: This article demonstrates the marked impact of Hib conjugate vaccine introduction on meningitis in Mongolia. It is important to sustain this surveillance system to monitor the long-term impact of Hib conjugate vaccine, as well as other interventions such as pneumococcal and meningococcal vaccines. |
Impact of introduction of the Haemophilus influenzae type b conjugate vaccine into childhood immunization on meningitis in Bangladeshi infants
Sultana NK , Saha SK , Al-Emran HM , Modak JK , Sharker MA , El-Arifeen S , Cohen AL , Baqui AH , Luby SP . J Pediatr 2013 163 S73-8 OBJECTIVES: Some Asian countries have been reluctant to adopt Haemophilus influenzae type b (Hib) conjugate vaccination because of uncertainty over disease burden. We assessed the impact of introduction of Hib conjugate vaccine into the Expanded Program on Immunization in Bangladesh on purulent and laboratory-confirmed H influenzae meningitis. STUDY DESIGN: Within a well-defined catchment area around 2 surveillance hospitals in Dhaka, Bangladesh, we compared the incidence of Hib meningitis confirmed by culture, latex agglutination, and polymerase chain reaction assay among infants 1 year before and 1 year after introduction of Hib conjugate vaccine. We adjusted the incidence rate for the proportion of children who sought care at the surveillance hospitals. RESULTS: Among infants, the incidence of confirmed Hib meningitis decreased from 92-16 cases per 100 000 within 1 year of vaccine introduction (vaccine preventable incidence = 76; 95% CI 18, 135 per 100 000). The incidence of purulent meningitis decreased from 1659-1159 per 100 000 (vaccine preventable incidence = 500; 95% CI: 203, 799 per 100 000). During the same time period, there was no significant difference in the incidence of meningitis due to Streptococcus pneumoniae. CONCLUSIONS: Introduction of conjugate Hib conjugate vaccine into Bangladesh Expanded Program on Immunization markedly reduced the burden of Hib and purulent meningitis. |
Community diarrhea incidence before and after rotavirus vaccine introduction in Nicaragua
Becker-Dreps S , Melendez M , Liu L , Enrique Zambrana L , Paniagua M , Weber DJ , Hudgens MG , Caceres M , Kallestall C , Morgan DR , Espinoza F , Pena R . Am J Trop Med Hyg 2013 89 (2) 246-50 We estimated the incidence of watery diarrhea in the community before and after introduction of the pentavalent rotavirus vaccine in Leon, Nicaragua. A random sample of households was selected before and after rotavirus vaccine introduction. All children < 5 years of age in selected households were eligible for inclusion. Children were followed every 2 weeks for watery diarrhea episodes. The incidence rate was estimated as numbers of episodes per 100 child-years of exposure time. A mixed effects Poisson regression model was fit to compare incidence rates in the pre-vaccine and vaccine periods. The pre-vaccine cohort (N = 726) experienced 36 episodes per 100 child-years, and the vaccine cohort (N = 826) experienced 25 episodes per 100 child-years. The adjusted incidence rate ratio was 0.60 (95% confidence interval [CI] 0.40, 0.91) during the vaccine period versus the pre-vaccine period, indicating a lower incidence of watery diarrhea in the community during the vaccine period. |
Prospective cost-benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking
O'Connor AC , Kennedy ED , Loomis RJ , Haque SN , Layton CM , Williams WW , Amoozegar JB , Braun FM , Honeycutt AA , Weinbaum C . Vaccine 2013 31 (31) 3179-86 In the United States recording accurate vaccine lot numbers in immunization records is required by the National Childhood Vaccine Injury Act and is necessary for public health surveillance and implementation of vaccine product recalls. However, this information is often missing or inaccurate in records. The Food and Drug Administration (FDA) requires a linear barcode of the National Drug Code (NDC) on vaccine product labels as a medication verification measure, but lot number and expiration date must still be recorded by hand. Beginning in 2011, FDA permitted manufacturers to replace linear barcodes with two-dimensional (2D) barcodes on unit-of-use product labels. A 2D barcode can contain the NDC, expiration date, and lot number in a symbol small enough to fit on a unit-of-use label. All three data elements could be scanned into a patient record. To assess 2D barcodes' potential impacts, a mixed-methods approach of time-motion data analysis, interview and survey data collection, and cost-benefit analysis was employed. Analysis of a time-motion study conducted at 33 practices suggests scanning 2D-barcoded vaccines could reduce immunization documentation time by 36-39s per dose. Data from an internet survey of primary care providers and local health officials indicate that 60% of pediatric practices, 54% of family medicine practices, and 39% of health departments would use the 2D barcode, with more indicating they would do so if they used electronic health records. Inclusive of manufacturer and immunization provider costs and benefits, we forecast lower-bound net benefits to be $310-334 million between 2011 and 2023 with a benefit-to-cost ratio of 3.1:1-3.2:1. Although we were unable to monetize benefits for expected improved immunization coverage, surveillance, or reduced medication errors, based on our findings, we expect that using 2D barcodes will lower vaccine documentation costs, facilitate data capture, and enhance immunization data quality. |
Accumulating Evidence and Research Organization (AERO) model: a new tool for representing, analyzing, and planning a translational research program
Hey SP , Heilig CM , Weijer C . Trials 2013 14 159 BACKGROUND: Maximizing efficiency in drug development is important for drug developers, policymakers, and human subjects. Limited funds and the ethical imperative of risk minimization demand that researchers maximize the knowledge gained per patient-subject enrolled. Yet, despite a common perception that the current system of drug development is beset by inefficiencies, there remain few approaches for systematically representing, analyzing, and communicating the efficiency and coordination of the research enterprise. In this paper, we present the first steps toward developing such an approach: a graph-theoretic tool for representing the Accumulating Evidence and Research Organization (AERO) across a translational trajectory. METHODS: This initial version of the AERO model focuses on elucidating two dimensions of robustness: (1) the consistency of results among studies with an identical or similar outcome metric; and (2) the concordance of results among studies with qualitatively different outcome metrics. The visual structure of the model is a directed acyclic graph, designed to capture these two dimensions of robustness and their relationship to three basic questions that underlie the planning of a translational research program: What is the accumulating state of total evidence? What has been the translational trajectory? What studies should be done next? RESULTS: We demonstrate the utility of the AERO model with an application to a case study involving the antibacterial agent, moxifloxacin, for the treatment of drug-susceptible tuberculosis. We then consider some possible elaborations for the AERO model and propose a number of ways in which the tool could be used to enhance the planning, reporting, and analysis of clinical trials. CONCLUSION: The AERO model provides an immediate visual representation of the number of studies done at any stage of research, depicting both the robustness of evidence and the relationship of each study to the larger translational trajectory. In so doing, it makes some of the invisible or inchoate properties of the research system explicit - helping to elucidate judgments about the accumulating state of evidence and supporting decision-making for future research. |
Precipitating circumstances of suicide among youth aged 10-17 years by sex: data from the national violent death reporting system, 16 States, 2005-2008
Karch DL , Logan J , McDaniel DD , Floyd CF , Vagi KJ . J Adolesc Health 2013 53 S51-3 We examined the circumstances that precipitated suicide among 1,046 youth aged 10-17 years in 16 U.S. states from 2005 to 2008. The majority of deaths were among male subjects (75.2%), non-Hispanic whites (69.3%), those aged 16-17 years (58.1%), those who died by hanging/strangulation/suffocation (50.2%) and those who died in a house or an apartment (82.5%). Relationship problems, recent crises, mental health problems, and intimate partner and school problems were the most common precipitating factors and many differed by sex. School problems were reported for 25% of decedents, of which 30.3% were a drop in grades and 12.4% were bullying related. Prevention strategies directed toward relationship-building, problem-solving, and increasing access to treatment may be beneficial for this population. |
All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010
Shults RA , West BA , Rudd RA , Helmkamp JC . Pediatrics 2013 132 (2) 282-9 OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)-related nonfatal injuries among riders aged ≤15 years treated in hospital emergency departments (EDs) in the United States during 2001-2010. METHODS: National Electronic Injury Surveillance System-All Injury Program data for 2001-2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001-2010, an estimated 361 161 ATV riders aged ≤15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100 000 children in 2004 and then declined to 42 per 100 000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100 000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 48% of hospitalizations. CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children's use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs. |
Bullying and suicide: a public health approach
Hertz MF , Donato I , Wright J . J Adolesc Health 2013 53 S1-3 Several recent studies have found an association between bullying and depression [1] or bullying and suicide-related behaviors [2], and one study found evidence consistent with a causal link, at least for girls [3,4]. These studies, in conjunction with extensive media coverage of the deaths by suicide of several young people who were victims of bullying, led the Centers for Disease Control and Prevention (CDC) to convene an expert panel focusing on the relationship between bullying involvement and suicide-related behaviors. The purpose of the panel, held in September 2010, was to synthesize the latest research about the relationship between youth involvement in bullying (youth who bully, youth who are bullied, and those who bully and are bullied) and suicide-related behaviors (attempts, fatalities, and risk factors associated with suicide, such as depression). Experts on the topics of bullying and suicide presented their research about the relationship between these two behaviors; their work is contained in this supplement. The panel and this special issue provide clarity around the complicated issues of bullying and suicide among youth. Three key themes emerged: (1) bullying among youth is a significant public health problem; it is prevalent and frequently has detrimental effects; (2) there is a strong association between bullying and suicide-related behaviors, but this relationship is often mediated by other factors, including depression and delinquency; and (3) there are public health strategies that can be applied to the prevention of bullying and suicide. |
Biological networks for predicting chemical hepatocarcinogenicity using gene expression data from treated mice and relevance across human and rat species.
Thomas R , Thomas RS , Auerbach SS , Portier CJ . PLoS One 2013 8 (5) e63308 BACKGROUND: Several groups have employed genomic data from subchronic chemical toxicity studies in rodents (90 days) to derive gene-centric predictors of chronic toxicity and carcinogenicity. Genes are annotated to belong to biological processes or molecular pathways that are mechanistically well understood and are described in public databases. OBJECTIVES: To develop a molecular pathway-based prediction model of long term hepatocarcinogenicity using 90-day gene expression data and to evaluate the performance of this model with respect to both intra-species, dose-dependent and cross-species predictions. METHODS: Genome-wide hepatic mRNA expression was retrospectively measured in B6C3F1 mice following subchronic exposure to twenty-six (26) chemicals (10 were positive, 2 equivocal and 14 negative for liver tumors) previously studied by the US National Toxicology Program. Using these data, a pathway-based predictor model for long-term liver cancer risk was derived using random forests. The prediction model was independently validated on test sets associated with liver cancer risk obtained from mice, rats and humans. RESULTS: Using 5-fold cross validation, the developed prediction model had reasonable predictive performance with the area under receiver-operator curve (AUC) equal to 0.66. The developed prediction model was then used to extrapolate the results to data associated with rat and human liver cancer. The extrapolated model worked well for both extrapolated species (AUC value of 0.74 for rats and 0.91 for humans). The prediction models implied a balanced interplay between all pathway responses leading to carcinogenicity predictions. CONCLUSIONS: Pathway-based prediction models estimated from sub-chronic data hold promise for predicting long-term carcinogenicity and also for its ability to extrapolate results across multiple species. |
Optimization of Multiple Pathogen Detection Using the TaqMan Array Card: Application for a Population-Based Study of Neonatal Infection.
Diaz MH , Waller JL , Napoliello RA , Islam MS , Wolff BJ , Burken DJ , Holden RL , Srinivasan V , Arvay M , McGee L , Oberste MS , Whitney CG , Schrag SJ , Winchell JM , Saha SK . PLoS One 2013 8 (6) e66183 Identification of etiology remains a significant challenge in the diagnosis of infectious diseases, particularly in resource-poor settings. Viral, bacterial, and fungal pathogens, as well as parasites, play a role for many syndromes, and optimizing a single diagnostic system to detect a range of pathogens is challenging. The TaqMan Array Card (TAC) is a multiple-pathogen detection method that has previously been identified as a valuable technique for determining etiology of infections and holds promise for expanded use in clinical microbiology laboratories and surveillance studies. We selected TAC for use in the Aetiology of Neonatal Infection in South Asia (ANISA) study for identifying etiologies of severe disease in neonates in Bangladesh, India, and Pakistan. Here we report optimization of TAC to improve pathogen detection and overcome technical challenges associated with use of this technology in a large-scale surveillance study. Specifically, we increased the number of assay replicates, implemented a more robust RT-qPCR enzyme formulation, and adopted a more efficient method for extraction of total nucleic acid from blood specimens. We also report the development and analytical validation of ten new assays for use in the ANISA study. Based on these data, we revised the study-specific TACs for detection of 22 pathogens in NP/OP swabs and 12 pathogens in blood specimens as well as two control reactions (internal positive control and human nucleic acid control) for each specimen type. The cumulative improvements realized through these optimization studies will benefit ANISA and perhaps other studies utilizing multiple-pathogen detection approaches. These lessons may also contribute to the expansion of TAC technology to the clinical setting. |
Isolation of a novel orthobunyavirus (Brazoran virus) with a 1.7 kb S segment that encodes a unique nucleocapsid protein possessing two putative functional domains.
Lanciotti RS , Kosoy OI , Bosco-Lauth AM , Pohl J , Stuchlik O , Reed M , Lambert AJ . Virology 2013 444 55-63 In July, 2012 three isolations were made from mosquitoes collected in Brazoria, Orange and Montgomery counties, Texas, USA. Data from immunofluorescence testing suggested that these isolates are members of the genus Orthobunyavirus. Expanded analyses confirmed that these isolates comprise three independent isolations of the same virus; a novel orthobunyavirus. The genetic organization of the M and L segments of this virus is similar to that of other orthobunyaviruses. However, the S segment ( approximately 1.7kb) is nearly twice the length of known orthobunyavirus S segments, encoding a significantly larger nucleocapsid, N ( approximately 50kDa) and putative non-structural NSs ( approximately 20kDa) proteins in a novel strategy by which the NSs ORF precedes the N ORF. The N protein appears to consist of two functional domains; an amino portion that possesses motifs similar to other orthobunyavirus N proteins and a carboxyl portion that possesses a glutamine-rich domain with no known homologue among Bunyaviridae. |
Use of rapid HIV assays as supplemental tests in specimens with repeatedly reactive screening immunoassay results not confirmed by HIV-1 Western blot
Wesolowski LG , Delaney KP , Meyer WA 3rd , Blatt AJ , Bennett B , Chavez P , Granade TC , Owen M . J Clin Virol 2013 58 (1) 240-4 BACKGROUND: An alternate HIV testing algorithm has been proposed which includes a fourth-generation immunoassay followed by an HIV-1/HIV-2 antibody differentiation supplemental test for reactive specimens and a nucleic acid test (NAT) for specimens with discordant results. OBJECTIVE: To evaluate the performance of five rapid tests (Alere Clearview, Bio-Rad Multispot, OraSure OraQuick, MedMira Reveal, and Trinity Biotech Unigold) as the supplemental antibody assay in the algorithm. STUDY DESIGN: A total of 3273 serum and plasma specimens that were third-generation immunoassay repeatedly reactive and Western blot (WB) negative or indeterminate were tested with rapid tests and NAT. Specimens were classified by NAT: (1) HIV-1 infected (NAT-reactive; n=184, 5.6%), (2) HIV-status unknown (NAT nonreactive; n=3078, 94.2%) or by Multispot, (3) HIV-2 positive (n=5), and (4) HIV-1 and HIV-2 positive (n=6). Excluding HIV-2 positive specimens, we calculated the proportion of reactive rapid tests among specimens with reactive and nonreactive NAT. RESULTS: The proportion of infected specimens with reactive rapid test results and negative or indeterminate WB ranged from 30.4% (56) to 47.8% (88) depending on the rapid test. From 1% to 2% of NAT-negative specimens had reactive rapid test results. CONCLUSIONS: In these diagnostically challenging specimens, all rapid tests identified infections that were missed by the Western blot, but only Multispot could differentiate HIV-1 from HIV-2. Regardless of which rapid test is used as a supplemental test in the alternative algorithm, false-positive algorithm results (i.e., reactive screening and rapid test in uninfected person) may occur, which will need to be resolved during the baseline medical evaluation. |
A high-throughput LC-MS/MS method suitable for population biomonitoring measures five serum folate vitamers and one oxidation product
Fazili Z , Whitehead RD Jr , Paladugula N , Pfeiffer CM . Anal Bioanal Chem 2013 405 (13) 4549-60 Small specimen volume and high sample throughput are key features needed for routine methods used for population biomonitoring. We modified our routine eight-probe solid phase extraction (SPE) LC-MS/MS method for the measurement of five folate vitamers [5-methyltetrahydrofolate (5-methylTHF), folic acid (FA), plus three minor forms: THF, 5-formylTHF, 5,10-methenylTHF] and one oxidation product of 5-methylTHF (MeFox) to require less serum volume (150 muL instead of 275 muL) by using 96-well SPE plates with 50 mg instead of 100 mg phenyl sorbent and to provide faster throughput by using a 96-probe SPE system. Total imprecision (10 days, two replicates/day) for three serum quality control pools was 2.8-3.6% for 5-methylTHF (19.5-51.1 nmol/L), 6.6-8.7% for FA (0.72-11.4 nmol/L), and ≤11.4% for the minor folate forms (<1-5 nmol/L). The mean (+/-SE) recoveries of folates spiked into serum (3 days, four levels, two replicates/level) were: 5-methylTHF, 99.4 +/- 3.6%; FA, 100 +/- 1.8%; minor folates, 91.7-108%. SPE extraction efficiencies were ≥85%, except for THF (78%). Limits of detection were ≤0.3 nmol/L. The new method correlated well with our routine method [n = 150, r = 0.99 for 5-methylTHF, FA, and total folate (tFOL, sum of folate forms)] and produced slightly higher tFOL (5.6%) and 5-methylTHF (7.3%) concentrations, likely due to the faster 96-probe SPE process (1 vs. 5 h), resulting in improved SPE efficiency and recovery compared to the eight-probe SPE method. With this improved LC-MS/MS method, 96 samples can be processed in ~2 h, and all relevant folate forms can be accurately measured using a small serum volume. |
Interlaboratory agreement of pulsed-field gel electrophoresis identification of Leptospira serovars
Mende K , Galloway RL , Becker SJ , Beckius ML , Murray CK , Hospenthal DR . Am J Trop Med Hyg 2013 89 (2) 380-4 Leptospirosis may be caused by > 250 Leptospira serovars. Serovar classification is a complex task that most laboratories cannot perform. We assessed the interlaboratory reproducibility of a pulsed-field gel electrophoresis (PFGE) identification technique developed by the Centers for Disease Control and Prevention (CDC). Blinded exchange of 93 Leptospiraceae strains occurred between San Antonio Military Medical Center (SAMMC) and the CDC. PFGE was performed and gel images were analyzed and compared with patterns present in each laboratory's database (CDC database: > 800 strain patterns; SAMMC database: > 300 strain patterns). Overall, 93.7% (74 of 79) of strains present in each receiving laboratory's database were correctly identified. Five isolates were misidentified, and two isolates did not match serovar PFGE patterns in the receiving laboratory's database. Patterns for these seven isolates were identical between laboratories; four serovars represented misidentified reference strains. The PFGE methodology studied showed excellent interlaboratory reproducibility, enabling standardization and data sharing between laboratories. |
Analytical detection of influenza A(H3N2)v and other A variant viruses from the USA by rapid influenza diagnostic tests
Balish A , Garten R , Klimov A , Villanueva J . Influenza Other Respir Viruses 2013 7 (4) 491-6 BACKGROUND: The performance of rapid influenza diagnostic tests (RIDTs) that detect influenza viral nucleoprotein (NP) antigen has been reported to be variable. Recent human infections with variant influenza A viruses that are circulating in pigs prompted the investigation of the analytical reactivity of RIDTs with these variant viruses. OBJECTIVES: To determine analytical reactivity of seven FDA-cleared RIDTs with influenza A variant viruses in comparison with the reactivity with recently circulating seasonal influenza A viruses. METHODS: Tenfold serial dilutions of cell culture-grown seasonal and variant influenza A viruses were prepared and tested in duplicate with seven RIDTs. RESULTS: All RIDTs evaluated in this study detected the seasonal influenza A(H3N2) virus, although detection limits varied among assays. All but one examined RIDT identified the influenza A(H1N1)pdm09 virus. However, only four of seven RIDTs detected all influenza A(H3N2)v, A(H1N2)v, and A(H1N1)v viruses. Reduced sensitivity of RIDTs to variant influenza viruses may be due to amino acid differences between the NP proteins of seasonal viruses and the NP proteins from viruses circulating in pigs. CONCLUSIONS: Clinicians should be aware of the limitations of RIDTs to detect influenza A variant viruses. Specimens from patients with influenza-like illness in whom H3N2v is suspected should be sent to public health laboratories for additional diagnostic testing. |
Comparison of high-resolution and tandem mass spectrometry for the analysis of nerve agent metabolites in urine
Hamelin EI , Bragg W , Shaner RL , Swaim LL , Johnson RC . Rapid Commun Mass Spectrom 2013 27 (15) 1697-704 RATIONALE: Although use is prohibited, concerns remain for human exposure to nerve agents during decommissioning, research, and warfare. High-resolution mass spectrometry (HRMS) was compared to tandem mass spectrometry (MS/MS) analysis for the quantitation of five urinary metabolites specific to VX, Russian VX, soman, sarin and cyclosarin nerve agents. The HRMS method was further evaluated for qualitative screening of metabolites not included in the test panel. METHODS: Nerve agent metabolites were extracted from urine using solid-phase extraction, separated using hydrophilic interaction chromatography and analyzed using both tandem and high-resolution mass spectrometry. MS/MS results were obtained using selected reaction monitoring with unit resolution; HRMS results were obtained using a mass extraction window of 10 ppm at a mass resolution of 50 000. The benchtop Orbitrap HRMS instrument was operated in full scan mode, to measure the presence of unexpected nerve agent metabolites. RESULTS: The assessment of two quality control samples demonstrated high accuracy (99.5-104%) and high precision (2-9%) for both HRMS and MS/MS. Sensitivity, as described by the limit of detection, was overlapping for both detectors (0.2-0.7 ng/mL). Additionally, the HRMS method positively confirmed the presence of a nerve agent metabolite, not included in the test panel, using the accurate mass and relative retention time. CONCLUSIONS: The precision, accuracy, and sensitivity were comparable between the current MS/MS method and this newly developed HRMS analysis for five nerve agent metabolites. HRMS showed additional capabilities beyond the current method by confirming the presence of a metabolite not included in the test panel. |
Computer-automated silica aerosol generator and animal inhalation exposure system
McKinney W , Chen B , Schwegler-Berry D , Frazer DG . Inhal Toxicol 2013 25 (7) 363-72 Inhalation exposure systems are necessary tools for determining the dose response relationship of inhaled toxicants under a variety of exposure conditions. The objective of this study was to develop an automated computer controlled system to expose small laboratory animals to precise concentrations of uniformly dispersed airborne silica particles. An acoustical aerosol generator was developed which was capable of re-suspending particles from bulk powder. The aerosolized silica output from the generator was introduced into the throat of a venturi tube. The turbulent high-velocity air stream within the venturi tube increased the dispersion of the re-suspended powder. That aerosol was then used to expose small laboratory animals to constant aerosol concentrations, up to 20 mg/m(3), for durations lasting up to 8 h. Particle distribution and morphology of the silica aerosol delivered to the exposure chamber were characterized to verify that a fully dispersed and respirable aerosol was being produced. The inhalation exposure system utilized a combination of airflow controllers, particle monitors, data acquisition devices and custom software with automatic feedback control to achieve constant and repeatable exposure environments. The automatic control algorithm was capable of maintaining median aerosol concentrations to within +/-0.2 mg/m(3) of a user selected target concentration during exposures lasting from 2 to 8 h. The system was able to reach 95% of the desired target value in <10 min during the beginning phase of an exposure. This exposure system provided a highly automated tool for conducting inhalation toxicology studies involving silica particles. |
A cough aerosol simulator for the study of disease transmission by human cough-generated aerosols
Lindsley WG , Reynolds JS , Szalajda JV , Noti JD , Beezhold DH . Aerosol Sci Technol 2013 47 (8) 937-944 Aerosol particles expelled during human coughs are a potential pathway for infectious disease transmission. However, the importance of airborne transmission is unclear for many diseases. To better understand the role of cough aerosol particles in the spread of disease and the efficacy of different types of protective measures, we constructed a cough aerosol simulator that produces a human-like cough in a controlled environment. The simulated cough has a 4.2 l volume and is based on coughs recorded from influenza patients. In one configuration, the simulator produces a cough aerosol containing particles from 0.1 to 100 micrometer in diameter with a volume median diameter (VMD) of 8.5 micrometer and a geometric standard deviation (GSD) of 2.9. In a second configuration, the cough aerosol has a size range of 0.1–30 micrometer, a VMD of 3.4 micrometer, and a GSD of 2.3. The total aerosol volume expelled during each cough is 68 microlitre. By generating a controlled and reproducible artificial cough, the simulator allows us to test different ventilation, disinfection, and personal protection scenarios. The system can be used with live pathogens, including influenza virus, which allows isolation precautions used in the healthcare field to be tested without risk of exposure for workers or patients. The information gained from tests with the simulator will help to better understand the transmission of infectious diseases, develop improved techniques for infection control, and improve safety for healthcare workers and patients. |
Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients
Ko JY , Dietz PM , Conrey EJ , Rodgers LE , Shellhaas C , Farr SL , Robbins CL . J Womens Health (Larchmt) 2013 22 (8) 681-6 BACKGROUND: Most women with histories of gestational diabetes mellitus do not receive a postpartum screening test for type 2 diabetes, even though they are at increased risk. The objective of this study was to identify factors associated with high rates of postpartum glucose screening. METHODS: This cross-sectional analysis assessed characteristics associated with postpartum diabetes screening for patients with gestational diabetes mellitus (GDM)-affected pregnancies self-reported by randomly sampled licensed obstetricians/gynecologists (OBs/GYNs) in Ohio in 2010. RESULTS: Responses were received from 306 OBs/GYNs (56.5% response rate), among whom 69.9% reported frequently (always/most of the time) screening women with GDM-affected pregnancies for abnormal glucose tolerance at the postpartum visit. Compared to infrequent screeners, OBs/GYNs who frequently screen for postpartum glucose tolerance were statistically (p<0.05) more likely to have a clinical protocol addressing postpartum testing (67.2% vs. 26.7%), an electronic reminder system for providers (10.8% vs. 2.2%) and provide reminders to patients (16.4% vs. 4.4%). Frequent screeners were more likely to use recommended fasting blood glucose or 2-hour oral glucose tolerance test (61.8% vs. 34.6%, p<0.001) than infrequent screeners. CONCLUSIONS: Strategies associated with higher postpartum glucose screening for GDM patients included clinical protocols for postpartum testing, electronic medical records to alert providers of the need for testing, and reminders to patients. |
Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994-2009
Ghaji N , Boulet SL , Tepper N , Hooper WC . Am J Obstet Gynecol 2013 209 (5) 433 e1-8 OBJECTIVES: To evaluate national trends in the rate of pregnancy-related hospitalizations with venous thromboembolism (VTE) between 1994 and 2009 and estimate the prevalence of co-morbid conditions among these hospitalizations. STUDY DESIGN: An estimated 64,413,973 pregnancy-related hospitalizations among women 15-44 years of age were identified in the 1994-2009 Nationwide Inpatient Sample. Trends in VTE-associated pregnancy hospitalizations were evaluated using variance-weighted least squares regression. Chi-square tests were used to assess changes in prevalence of demographics and co-morbid conditions, and multivariable logistic regression was used to evaluate the likelihood of VTE during the study period after adjusting for co-morbid conditions. Antepartum, delivery, and postpartum hospitalizations were evaluated separately and reported using 4-year increments. RESULTS: From 1994-2009, there was a 14% increase in the rate of overall VTE-associated pregnancy hospitalizations while antepartum and postpartum hospitalizations with VTE increased by 17% and 47% respectively. Between 1994-1997 and 2006-2009, the prevalence of hypertension and obesity doubled among all VTE-associated pregnancy hospitalizations; significant increases in diabetes and heart disease were also noted. A temporal increase in the likelihood of a VTE diagnosis in pregnancy was observed for antepartum hospitalizations during 2006-2009 when compared with 1994-1997 (aOR 1.62, 95% CI 1.48-1.78). CONCLUSIONS: There has been an upward trend in VTE-associated pregnancy hospitalizations from 1994-2009 with concomitant increases in co-morbid conditions. Clinicians should have a heightened awareness of the risk of VTE among pregnant women particularly among those with co-morbid conditions, and have a low threshold for evaluation in women with symptoms or signs of VTE. |
Tubal factor infertility and perinatal risk after assisted reproductive technology
Kawwass JF , Crawford S , Kissin DM , Session DR , Boulet S , Jamieson DJ . Obstet Gynecol 2013 121 (6) 1263-71 OBJECTIVE: To assess trends of tubal factor infertility and to evaluate risk of miscarriage and delivery of preterm or low birth weight (LBW) neonates among women with tubal factor infertility using assisted reproductive technology (ART). METHODS: We assessed trends of tubal factor infertility among all fresh and frozen, donor, and nondonor ART cycles performed annually in the United States between 2000 and 2010 (N=1,418,774) using the National ART Surveillance System. The data set was then limited to fresh, nondonor in vitro fertilization cycles resulting in pregnancy to compare perinatal outcomes for cycles associated with tubal compared with male factor infertility. We performed bivariate and multivariable analyses controlling for maternal characteristics and calculated adjusted risk ratios (RRs) and 95% confidence intervals (CI). RESULTS: The percentage of ART cycles associated with tubal factor infertility diagnoses decreased from 2000 to 2010 (26.02-14.81%). Compared with male factor infertility, tubal factor portended an increased risk of miscarriage (14.0% compared with 12.7%, adjusted RR 1.08, 95% CI 1.04-1.12); risk was increased for both early and late miscarriage. Singleton neonates born to women with tubal factor infertility had an increased risk of preterm birth (15.8% compared with 11.6%, adjusted RR 1.27, 95% CI 1.20-1.34) and LBW (10.9% compared with 8.5%, adjusted RR 1.28, 95% CI 1.20-1.36). Significant increases in risk persisted for early and late preterm delivery and very low and moderately LBW delivery. A significantly elevated risk was also detected for twin, but not triplet, pregnancies. CONCLUSION: Tubal factor infertility, which is decreasing in prevalence in the United States, is associated with an increased risk of miscarriage, preterm birth, and LBW delivery as compared with couples with male factor infertility using ART. LEVEL OF EVIDENCE: : II. |
Effectiveness of intermittent preventive treatment with sulfadoxine-pyrimethamine in pregnancy on maternal and infant birth outcomes in Machinga District, Malawi
Gutman J , Mwandama D , Wiegand RE , Ali D , Mathanga DP , Skarbinski J . J Infect Dis 2013 208 (6) 907-16 BACKGROUND: Malaria in pregnancy (MIP) is associated with low birth weight (LBW) and increased perinatal mortality, especially among primigravidae. Despite increasing prevalence of malaria parasite resistance to sulfadoxine-pyrimethamine (SP), SP continues to be recommended for intermittent preventive treatment in pregnancy (IPTp). METHODS: HIV-uninfected women were enrolled upon delivery. Data on number of SP doses received during pregnancy were recorded. The primary outcome was placental infection demonstrated by histology. Secondary outcomes included malaria parasitemia (peripheral, placental, cord-blood) at delivery, and composite birth outcome (small for gestational age, preterm delivery, or LBW). RESULTS: Of 703 women enrolled, 22% received <2 SP doses. Receipt of ≥2 SP doses had no impact on histologically-confirmed placental infection. IPTp-SP was associated with a dose-dependent protective effect on composite birth outcome in primigravidae; adjusted prevalence ratio 0.50 (95% CI 0.30-0.82), 0.30 (95% CI 0.19-0.48), and 0.18 (95% CI 0.05-0.61) for 1, 2, and 3+ doses compared to 0 doses, respectively. CONCLUSIONS: IPTp-SP did not reduce placental infection, but was associated with improved birth outcomes. Few women received no SP, so the true effect of IPTp-SP may be underestimated. Malawian pregnant women should continue to receive IPTp-SP, but alternative strategies and antimalarials for preventing MIP should be investigated. |
Enrollment in early intervention programs among infants born late preterm, early term, and term
Shapiro-Mendoza C , Kotelchuck M , Barfield W , Davin CA , Diop H , Silver M , Manning SE . Pediatrics 2013 132 (1) e61-9 OBJECTIVE: To compare the prevalence of and characteristics associated with early intervention (EI) program enrollment among infants born late preterm (34-36 weeks' gestation), early term (37-38 weeks' gestation), and term (39-41 weeks' gestation). METHODS: A Massachusetts cohort of 554 974 singleton infants born during 1998 through 2005 and survived the neonatal period was followed until the third birthday of each infant. Data came from the Pregnancy to Early Life Longitudinal Data System that linked birth certificates, birth hospital discharge reports, death certificates, and EI program enrollment records. We calculated prevalence and adjusted risk ratios to compare differences and understand associations. RESULTS: The prevalence of EI program enrollment increased with each decreasing week of gestation before 41 weeks (late preterm [23.5%], early term [14.9%], and term [11.9%]. In adjusted analyses, the strongest predictors of EI enrollment (adjusted risk ratio ≥1.20) for all gestational age groups were male gender, having a congenital anomaly, and having mothers who were ≥40 years old, nonhigh school graduates, and recipients of public insurance. CONCLUSIONS: Infants born late preterm and early term have higher prevalence of EI program services enrollment than infants born at term, and may benefit from more frequent monitoring for developmental delays or disabilities. |
An epidemiologic investigation of potential risk factors for Nodding Syndrome in Kitgum District, Uganda
Foltz JL , Makumbi I , Sejvar JJ , Malimbo M , Ndyomugyenyi R , Atai-Omoruto AD , Alexander LN , Abang B , Melstrom P , Kakooza AM , Olara D , Downing RG , Nutman TB , Dowell SF , Lwamafa DK . PLoS One 2013 8 (6) e66419 INTRODUCTION: Nodding Syndrome (NS), an unexplained illness characterized by spells of head bobbing, has been reported in Sudan and Tanzania, perhaps as early as 1962. Hypothesized causes include sorghum consumption, measles, and onchocerciasis infection. In 2009, a couple thousand cases were reportedly in Northern Uganda. METHODS: In December 2009, we identified cases in Kitgum District. The case definition included persons who were previously developmentally normal who had nodding. Cases, further defined as 5- to 15-years-old with an additional neurological deficit, were matched to village controls to assess risk factors and test biological specimens. Logistic regression models were used to evaluate associations. RESULTS: Surveillance identified 224 cases; most (95%) were 5-15-years-old (range = 2-27). Cases were reported in Uganda since 1997. The overall prevalence was 12 cases per 1,000 (range by parish = 0.6-46). The case-control investigation (n = 49 case/village control pairs) showed no association between NS and previously reported measles; sorghum was consumed by most subjects. Positive onchocerciasis serology [age-adjusted odds ratio (AOR1) = 14.4 (2.7, 78.3)], exposure to munitions [AOR1 = 13.9 (1.4, 135.3)], and consumption of crushed roots [AOR1 = 5.4 (1.3, 22.1)] were more likely in cases. Vitamin B6 deficiency was present in the majority of cases (84%) and controls (75%). CONCLUSION: NS appears to be increasing in Uganda since 2000 with 2009 parish prevalence as high as 46 cases per 1,000 5- to 15-year old children. Our results found no supporting evidence for many proposed NS risk factors, revealed association with onchocerciasis, which for the first time was examined with serologic testing, and raised nutritional deficiencies and toxic exposures as possible etiologies. |
Improved newborn hearing screening follow-up results in more infants identified
Alam S , Gaffney M , Eichwald J . J Public Health Manag Pract 2013 20 (2) 220-3 Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed. |
Electronic media and beverage intake among United States high school students-2010
Demissie Z , Lowry R , Eaton DK , Park S , Kann L . J Nutr Educ Behav 2013 45 (6) 756-60 OBJECTIVE: To describe electronic media exposure and its associations with beverage intake among United States high school students. METHODS: School-based survey data from a nationally representative sample of 9th- through 12th-grade students from the National Youth Physical Activity and Nutrition Study were analyzed using chi-square and multivariate logistic analyses. RESULTS: On an average school day, 23.5% of students used a computer or played video/computer games ≥ 3 h/d, 28.3% watched television (TV) ≥ 3 h/d, 79.9% had ≥ 3 TVs in the home, 70.2% had a TV in their bedroom, and 41.0% most of the time or always had a TV on while eating dinner at home. Students with high media exposure were more likely to drink sugar-sweetened beverages ≥ 3 times per day and less likely to drink water ≥ 3 times per day and drink ≥ 2 glasses of milk per day. CONCLUSIONS AND IMPLICATIONS: Efforts to reduce sugar-sweetened beverage intake among adolescents may include limiting exposure to electronic media. |
Head-and-face shape variations of U.S. civilian workers.
Zhuang Z , Shu C , Xi P , Bergman M , Joseph M . Appl Ergon 2013 44 (5) 775-84 The objective of this study was to quantify head-and-face shape variations of U.S. civilian workers using modern methods of shape analysis. The purpose of this study was based on previously highlighted changes in U.S. civilian worker head-and-face shape over the last few decades - touting the need for new and better fitting respirators - as well as the study's usefulness in designing more effective personal protective equipment (PPE) - specifically in the field of respirator design. The raw scan three-dimensional (3D) data for 1169 subjects were parameterized using geometry processing techniques. This process allowed the individual scans to be put in correspondence with each other in such a way that statistical shape analysis could be performed on a dense set of 3D points. This process also cleaned up the original scan data such that the noise was reduced and holes were filled in. The next step, statistical analysis of the variability of the head-and-face shape in the 3D database, was conducted using Principal Component Analysis (PCA) techniques. Through these analyses, it was shown that the space of the head-and-face shape was spanned by a small number of basis vectors. Less than 50 components explained more than 90% of the variability. Furthermore, the main mode of variations could be visualized through animating the shape changes along the PCA axes with computer software in executable form for Windows XP. The results from this study in turn could feed back into respirator design to achieve safer, more efficient product style and sizing. Future study is needed to determine the overall utility of the point cloud-based approach for the quantification of facial morphology variation and its relationship to respirator performance. |
Shiftwork and sickness absence among police officers: the BCOPS Study
Fekedulegn D , Burchfiel CM , Hartley TA , Andrew ME , Charles LE , Tinney-Zara CA , Violanti JM . Chronobiol Int 2013 30 (7) 930-41 Shiftwork, regarded as a significant occupational stressor, has become increasingly prevalent across a wide range of occupations. The adverse health outcomes associated with shiftwork are well documented. Shiftwork is an integral part of law enforcement, a high-stress occupation with elevated risks of chronic disease and mortality. Sickness absence is an important source of productivity loss and may also serve as an indirect measure of workers' morbidity. Prior studies of shiftwork and sickness absenteeism have yielded varying results and the association has not been examined specifically among police officers. The objective of this study was to compare the incidence rate of sick leave (any, ≥3 consecutive days) among day-, afternoon-, and night-shift workers in a cohort of police officers and also examine the role of lifestyle factors as potential moderators of the association. Participants (N = 464) from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examined between 2004 and 2009 were used. Daily work history records that included the shift schedule, number of hours worked, and occurrence of sick leave were available for up to 15 yrs starting in 1994 to the date of the BCOPS study examination for each officer. Poisson regression analysis for ungrouped data was used to estimate incidence rates (IRs) of sick leave by shift, and comparison of IRs across shifts were made by computing incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Sick leave occurred at a higher rate on the night shift (4.37 per 10 000 person-hours) compared with either day (1.55 per 10 000 person-hours) or afternoon (1.96 per 10 000 person-hours) shifts. The association between shiftwork and sickness absence depended on body mass index (BMI). For overweight individuals (BMI ≥ 25 kg/m(2)), the covariate-adjusted incidence rate of sick leave (≥1 day) was twice as large for night-shift officers compared with those working on the day (IRR = 2.29, 95% CI: 1.69-3.10) or afternoon (IRR = 1.74, 95% CI: 1.29-2.34) shift. The IR of three or more consecutive days of sick leave was 1.7 times larger for those working on night shift (IRR = 1.65, 95% CI: 1.17-2.31) and 1.5 times larger for those working on afternoon shift (IRR = 1.50, 95% CI: 1.08-2.08) compared with day shiftworkers. For subjects with normal BMI (<25 kg/m(2)), the incidence rates of sick leave did not differ significantly across shifts. In conclusion, shiftwork is independently associated with sickness absence, with officers who work the night shift having elevated incidence of sick leave. In addition, overweight officers who work the night shift may be at additional risk for sickness absence. |
Workplace psychosocial factors associated with work-related injury absence: a study from a nationally representative sample of Korean workers
Lu ML , Nakata A , Park JB , Swanson NG . Int J Behav Med 2013 21 (1) 42-52 BACKGROUND: Little is known about the association between psychosocial factors and injury absence in the workplace. PURPOSE: This study aims to assess the association of comprehensive workplace psychosocial factors with work-related injury absence among Korean workers. METHODS: The data (n = 7,856) were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample (n = 10,043) of the Korean working population. The survey instrument contained questions about hours of work, physical risk factors, work organization, and the effect of work on health/injury. Work-related injury absence was indicated by a dichotomous variable with at least 1 day absence during the preceding 12 months. Logistic regression models were used to calculate odds ratio and confidence interval (CI). Incremental adjustments for sociodemographic, health behavior, and occupational confounding variables were employed in the models. RESULTS: The overall 1-year prevalence of work-related injury absence in this study was 1.37 % (95 % CI, 1.11-1.63 %). Those who experienced violence at work (adjusted odds ratio (aOR), 7.05 (95 % CI, 2.69-18.5)), threat of violence at work (aOR, 4.25 (95 % CI, 1.32-13.64)), low job autonomy (aOR, 1.79 (95 % CI, 1.17-2.74)), and high job strain (aOR, 2.38 (95 % CI, 1.29-4.42) had an increased risk of injury absence, compared with their respective counterparts (p < 0.05). Among all job types, skilled workers in Korea were at a near fourfold risk of work absence due to occupational injuries, compared with managers in low-risk jobs. CONCLUSION: Workplace violence and increased job strain were two key workplace psychosocial factors associated with work-related injury absence. |
Occupation held at the time of asthma symptom development
Knoeller GE , Mazurek JM , Storey E . Am J Ind Med 2013 56 (10) 1165-73 BACKGROUND: Examining occupations other than those held when asthma symptoms first developed may not correctly identify occupations with higher risk of asthma onset. METHODS: To determine the occupation held when individuals first developed asthma symptoms, we examined 2010 National Health Interview Survey data for working adults with current asthma. RESULTS: Overall 37.1% of working adults with current asthma developed asthma while employed. Of these, the highest proportions of individuals identified office and administrative support (13.3%), sales and related (9.4%), and management (8.5%) as the occupation held when asthma first developed; 37.8% had a different current occupation than at asthma onset, and estimates of a change in occupation were highest for those who developed asthma while working in business and financial operations (49.3%), sales and related (48.6%), and healthcare support (43.8%) occupations. CONCLUSION: Future population-based studies should further examine associations between asthma and occupation held at time of asthma onset. |
Occupational lung disease: from case reports to prevention
Kreiss K . Chest 2013 143 (6) 1529-31 Flock worker’s lung disease presents a useful paradigm for identifying new occupational causes of lung disease. It is an unusual interstitial lung disease characterized by lymphocytic bronchiolitis and peribronchiolitis in workers exposed to flock fibers in manufacturing velvet-like fabrics, fuzzy greeting cards and wall papers, and automotive gaskets and glove box surfaces. Flock is made by cutting short synthetic fibers from bundles of parallel monofilaments of nylon or other polymers for application to adhesive-coated substrates. Unlike respirable mineral fibers such as asbestos, synthetic flock is visible, as illustrated in its typical applications. Since 1975, published case reports have raised suspicion of a respiratory hazard associated with various synthetic fibers, including polyester, nylon, and acrylic dust.1-3 With regard to synthetic flock, early reports in 1974 and 1981 of workplace evaluations by National Institute of Occupational Safety and Health (NIOSH) investigators attributed respiratory symptoms among workers to irritant properties of nonrespirable flock fibers on the upper airways but did not pursue the possibility of lung disease associated with flock work.4,5 Systematic workplace investigation of lung disease in workers that flock with synthetic fibers awaited the recognition of case clusters of interstitial disease in small workforces, first in Kingston, Ontario, Canada, and then in Rhode Island, as detailed in the background of the follow-up study by Turcotte et al6 published in this issue of CHEST (see page 1642). Subsequently, additional cases or subclinical morbidity have been found in relation to nylon flock in two Massachusetts plants, to polyethylene flock in Spain, to polypropylene flock in Turkey, and to rayon flock in Kansas.6 |
The prevalence of selected potentially hazardous workplace exposures in the US: findings from the 2010 National Health Interview Survey
Calvert GM , Luckhaupt SE , Sussell A , Dahlhamer JM , Ward BW . Am J Ind Med 2013 56 (6) 635-46 OBJECTIVE: Assess the national prevalence of current workplace exposure to potential skin hazards, secondhand smoke (SHS), and outdoor work among various industry and occupation groups. Also, assess the national prevalence of chronic workplace exposure to vapors, gas, dust, and fumes (VGDF) among these groups. METHODS: Data were obtained from the 2010 National Health Interview Survey (NHIS). NHIS is a multistage probability sample survey of the civilian non-institutionalized population of the US. Prevalence rates and their variances were calculated using SUDAAN to account for the complex NHIS sample design. RESULTS: The data for 2010 were available for 17,524 adults who worked in the 12 months that preceded interview. The highest prevalence rates of hazardous workplace exposures were typically in agriculture, mining, and construction. The prevalence rate of frequent handling of or skin contact with chemicals, and of non-smokers frequently exposed to SHS at work was highest in mining and construction. Outdoor work was most common in agriculture (85%), construction (73%), and mining (65%). Finally, frequent occupational exposure to VGDF was most common among mining (67%), agriculture (53%), and construction workers (51%). CONCLUSION: We identified industries and occupations with the highest prevalence of potentially hazardous workplace exposures, and provided targets for investigation and intervention activities. |
A prospective study of carpal tunnel syndrome: workplace and individual risk factors
Burt S , Deddens JA , Crombie K , Jin Y , Wurzelbacher S , Ramsey J . Occup Environ Med 2013 70 (8) 568-74 OBJECTIVES: To quantify the risk for carpal tunnel syndrome (CTS) from workplace physical factors, particularly hand activity level and forceful exertion, while taking into account individual factors including age, gender, body mass index (BMI), and pre-existing medical conditions. METHODS: Three healthcare and manufacturing workplaces were selected for inclusion on the basis of range of exposure to hand activity level and forceful exertion represented by their jobs. Each study participant's job tasks were observed and evaluated onsite and videotaped for further analysis, including frequency and duration of exertion and postural deviation. Individual health assessment entailed electrodiagnostic testing of median and ulnar nerves, physical examination and questionnaires at baseline with annual follow-up for 2 years. RESULTS: The incidence of dominant hand CTS during the study was 5.11 per 100 person-years (29 cases). Adjusted HRs for dominant hand CTS were as follows: working with forceful exertion ≥20% but <60% of the time: 2.83 (1.18, 6.79) and ≥60% of the time vs <20%: 19.57 (5.96, 64.24), BMI ≥30 kg/m2 (obesity): 3.19 (1.28, 7.98). The American Conference for Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for hand activity level also predicted CTS, HR=1.40 (1.11, 1.78) for each unit increase in the TLV ratio, controlling for obesity and job strain. CONCLUSIONS: Workplace and individual risk factors both contribute to the risk for CTS. Time spent in forceful exertion can be a greater risk for CTS than obesity if the job exposure is high. Preventive workplace efforts should target forceful exertions. |
Protecting nanotechnology workers while Waiting for Godot
Murashov V , Howard J . J Occup Environ Hyg 2013 10 (8) D111-D115 On October 31, 2012, the Canadian Standards Association adopted an International Standards Organization (ISO) Technical Report on the occupational safety and health of nanotechnology as a national voluntary standard.( Citation1 ) What role can this and other international standards play in ensuring safety and health of workers in the United States? In this commentary, we argue that international standards can play an important role in protecting the health and safety of U.S. workers exposed to nanomaterials until national regulatory standards are considered and adopted. |
Effectiveness of taxicab security equipment in reducing driver homicide rates
Menendez CK , Amandus HE , Damadi P , Wu N , Konda S , Hendricks SA . Am J Prev Med 2013 45 (1) 1-8 BACKGROUND: Taxicab drivers historically have had one of the highest work-related homicide rates of any occupation. In 2010 the taxicab driver homicide rate was 7.4 per 100,000 drivers, compared to the overall rate of 0.37 per 100,000 workers. PURPOSE: Evaluate the effectiveness of taxicab security cameras and partitions on citywide taxicab driver homicide rates. METHODS: Taxicab driver homicide rates were compared in 26 major cities in the U.S. licensing taxicabs with security cameras (n=8); bullet-resistant partitions (n=7); and cities where taxicabs were not equipped with either security cameras or partitions (n=11). News clippings of taxicab driver homicides and the number of licensed taxicabs by city were used to construct taxicab driver homicide rates spanning 15 years (1996-2010). Generalized estimating equations were constructed to model the Poisson-distributed homicide rates on city-specific safety equipment installation status, controlling for city homicide rate and the concurrent decline of homicide rates over time. Data were analyzed in 2012. RESULTS: Cities with cameras experienced a threefold reduction in taxicab driver homicides compared with control cities (RR=0.27; 95% CI=0.12, 0.61; p=0.002). There was no difference in homicide rates for cities with partitions compared with control cities (RR=1.15; 95% CI=0.80, 1.64; p=0.575). CONCLUSIONS: Municipal ordinances and company policies mandating security cameras appear to be highly effective in reducing taxicab driver deaths due to workplace violence. |
Evaluation of alternate category structures for the Strain Index: an empirical analysis
Meyers AR , Gerr Fc , Fethke NB . Hum Factors 2013 56 (1) 131-42 OBJECTIVE: The purpose of this study was to develop alternative Strain Index risk classification categories. BACKGROUND: Strain Index scores are usually categorized into four Strain Index risk categories. The original risk categories were developed in the meat-packing industry and may not be fully applicable to other industries. METHOD: Daily Strain Index scores were estimated among 276 manufacturing workers participating in a cohort study of occupational risk factors for hand arm musculoskeletal symptoms. Each score was categorized using the original method and a new method based on quartiles of Strain Index score values among symptomatic participants. Models examining associations between original Strain Index risk categories and incident hand arm symptoms were compared to models examining associations between the alternative Strain Index risk categories and incident hand arm symptoms. RESULTS: Compared to the respective referent categories, a twofold or greater increase in the risk of incident hand arm symptoms was observed for the highest original Strain Index risk category (HR = 2.06, 95% CI = [1.08-3.92]) and for the second highest alternate Strain Index risk exposure category (HR = 2.21, 95% CI = [1.26-3.85]). Although significant associations between Strain Index risk category and incident hand arm symptoms were observed for both Strain Index categorization methods, model fit statistics favored the alternate approach. CONCLUSION: Results from this study suggests that the Strain Index risk category structure may need to be tailored to specific populations. APPLICATION: If verified, results from this study provide a better way to identify hazardous manufacturing jobs and target them for exposure reduction. |
Exposure assessment at 30 000 Feet: challenges and future directions
Grajewski B , Pinkerton LE . Ann Occup Hyg 2013 57 (6) 692-4 Few studies of cancer mortality and incidence among flight crew have included a detailed assessment of both occupational exposures and lifestyle factors that may influence the risk of cancer. In this issue, Kojo et al. [Kojo K, Helminen M, Pukkala E et al. (2013) Risk factors for skin cancer among Finnish airline cabin crew. Ann Occup Hyg. doi:10.1093/annhyg/mes106] evaluated the relative contributions of ultraviolet and cosmic radiation to the incidence of skin cancer in Finnish flight attendants. This is a useful contribution, yet the reason flight crew members have an increased risk of skin cancer compared with the general population remains unclear. Good policy decisions for flight crew will depend on continued and emerging effective collaborations to increase study power and improve exposure assessment in future flight crew health studies. Improving the assessment of occupational exposures and non-occupational factors will cost additional time and effort, which are well spent if the role of exposures can be clarified in larger studies. |
Advancing workplace health protection and promotion for an aging workforce
Loeppke RR , Schill AL , Chosewood LC , Grosch JW , Allweiss P , Burton WN , Barnes-Farrell JL , Goetzel RZ , Heinen L , Hudson TW , Hymel P , Merchant J , Edington DW , Konicki DL , Larson PW . J Occup Environ Med 2013 55 (5) 500-6 OBJECTIVE: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide recommendations for best practices to maximize contributions by aging workers. METHODS: Workgroups reviewed literature and case studies to develop consensus statements and recommendations for a national approach to issues related to older workers. RESULTS: Consensus statements and actions steps were identified for each of the Summit goals and call-to-action statements were developed. CONCLUSIONS: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed. Workers will benefit from improved health and performance; employers will realize a more engaged and productive workforce; and the nation will gain a vital, competitive workforce. |
Characteristics and magnitude of acute pesticide-related illnesses and injuries associated with pyrethrin and pyrethroid exposures-11 states, 2000-2008
Hudson NL , Kasner EJ , Beckman J , Mehler L , Schwartz A , Higgins S , Bonnar-Prado J , Lackovic M , Mulay P , Mitchell Y , Larios L , Walker R , Waltz J , Moraga-McHaley S , Roisman R , Calvert GM . Am J Ind Med 2013 57 (1) 15-30 BACKGROUND: Excluding disinfectants, pyrethrins and pyrethroids are the pesticides used most commonly in and around homes. Respiratory effects and paresthesia are among the concerns about pyrethrin/pyrethroid exposures. METHODS: Acute pesticide-related illness/injury cases were identified from the Sentinel Event Notification System for Occupational Risks-Pesticides Program and the California Department of Pesticide Regulation from 2000-2008. Characteristics and incidence rates were determined for acute pyrethrin/pyrethroid-related illness/injury cases. Logistic regression analyses were performed to determine odds of respiratory and dermal symptoms in persons with illness/injury following pyrethrin/pyrethroid exposure compared to persons with illness/injury following exposure to other pesticides. RESULTS: A total of 4,974 cases of acute pyrethrin/pyrethroid-related illness were identified. Incidence rates increased over time, reaching 8 cases/million population in 2008. The majority of cases were low severity (85%) and 34% were work-related. Respiratory effects were the most common symptoms reported (48%). Risk of acute respiratory effects were significantly elevated among persons exposed only to pyrethrins (adjusted odds ratio [aOR] 1.79; 95% confidence interval [95% CI]: 1.49-2.16), only to pyrethroids (aOR 1.99 95% CI: 1.77-2.24), to a mixture of pyrethroids (aOR 2.36; 95% CI: 1.99-2.81) or to a mixture containing both pyrethrins and pyrethroids (aOR 2.99; 95% CI: 2.33-3.84) compared to those with illness arising from exposure to other pesticides. The most common factors contributing to pyrethrin/pyrethroid-related illness included exposure from spills/splashes, improper storage, and failure to evacuate during pesticide application. CONCLUSIONS: The magnitude of acute pyrethrin/pyrethroid-related illness/injury is relatively low but is increasing. As such, additional measures to prevent them are needed. |
Cohort mortality study of garment industry workers exposed to formaldehyde: update and internal comparisons
Meyers AR , Pinkerton LE , Hein MJ . Am J Ind Med 2013 56 (9) 1027-39 BACKGROUND: To further evaluate the association between formaldehyde and leukemia, we extended follow-up through 2008 for a cohort mortality study of 11,043 US formaldehyde-exposed garment workers. METHODS: We computed standardized mortality ratios and standardized rate ratios stratified by year of first exposure, exposure duration, and time since first exposure. Associations between exposure duration and rates of leukemia and myeloid leukemia were further examined using Poisson regression models. RESULTS: Compared to the US population, myeloid leukemia mortality was elevated but overall leukemia mortality was not. In internal analyses, overall leukemia mortality increased with increasing exposure duration and this trend was statistically significant. CONCLUSIONS: We continue to see limited evidence of an association between formaldehyde and leukemia. However, the extended follow-up did not strengthen previously observed associations. In addition to continued epidemiologic research, we recommend further research to evaluate the biological plausibility of a causal relation between formaldehyde and leukemia. |
Comparative microscopic study of human and rat lungs after overexposure to welding fume
Antonini JM , Roberts JR , Schwegler-Berry D , Mercer RR . Ann Occup Hyg 2013 57 (9) 1167-79 Welding is a common industrial process used to join metals and generates complex aerosols of potentially hazardous metal fumes and gases. Most long-time welders experience some type of respiratory disorder during their time of employment. The use of animal models and the ability to control the welding fume exposure in toxicology studies have been helpful in developing a better understanding of how welding fumes affect health. There are no studies that have performed a side-by-side comparison of the pulmonary responses from an animal toxicology welding fume study with the lung responses associated with chronic exposure to welding fume by a career welder. In this study, post-mortem lung tissue was donated from a long-time welder with a well-characterized work background and a history of extensive welding fume exposure. To simulate a long-term welding exposure in an animal model, Sprague-Dawley rats were treated once a week for 28 weeks by intratracheal instillation with 2mg of a stainless steel, hard-surfacing welding fume. Lung tissues from the welder and the welding fume-treated rats were examined by light and electron microscopy. Pathological analysis of lung tissue collected from the welder demonstrated inflammatory cell influx and significant pulmonary injury. The poor and deteriorating lung condition observed in the welder examined in this study was likely due to exposure to very high levels of potentially toxic metal fumes and gases for a significant number of years due to work in confined spaces. The lung toxicity profile for the rats treated with welding fume was similar. For tissue samples from both the welder and treated rats, welding particle accumulations deposited and persisted in lung structures and were easily visualized using light microscopic techniques. Agglomerates of deposited welding particles mostly were observed within lung cells, particularly alveolar macrophages. Analysis of individual particles within the agglomerates showed that these particles were metal complexes with iron, chromium, and nickel being the most common metals present. In conclusion, long-term exposure to specific welding fume can lead to serious chronic lung disease characterized by significant particle deposition and persistence as demonstrated in both a human case study and rat model. Not only were the lung responses similar in the human and rat lungs, as evidenced by inflammatory cell influx and pulmonary disease, but the composition of individual welding particles and agglomerations in situ was comparable. |
Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?
Coggon D , Ntani G , Palmer KT , Felli VE , Harari R , Barrero LH , Felknor SA , Gimeno D , Cattrell A , Serra C , Bonzini M , Solidaki E , Merisalu E , Habib RR , Sadeghian F , Masood Kadir M , Warnakulasuriya SS , Matsudaira K , Nyantumbu B , Sim MR , Harcombe H , Cox K , Marziale MH , Sarquis LM , Harari F , Freire R , Harari N , Monroy MV , Quintana LA , Rojas M , Salazar Vega EJ , Harris EC , Vargas-Prada S , Martinez JM , Delclos G , Benavides FG , Carugno M , Ferrario MM , Pesatori AC , Chatzi L , Bitsios P , Kogevinas M , Oha K , Sirk T , Sadeghian A , Peiris-John RJ , Sathiakumar N , Wickremasinghe AR , Yoshimura N , Kelsall HL , Hoe VC , Urquhart DM , Derrett S , McBride D , Herbison P , Gray A . Pain 2013 154 (6) 856-63 To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed. |
Real-time diesel particulate monitor for underground mines
Noll J , Janisko S , Mischler SE . Anal Methods 2013 5 (12) 2954-2963 The standard method for determining diesel particulate matter (DPM) exposures in underground metal/nonmetal mines provides the average exposure concentration for an entire working shift, and several weeks might pass before results are obtained. The main problem with this approach is that it only indicates that an overexposure has occurred rather than providing the ability to prevent an overexposure or detect its cause. Conversely, real-time measurement would provide miners with timely information to allow engineering controls to be deployed immediately and to identify the major factors contributing to any overexposures. Toward this purpose, the National Institute for Occupational Safety and Health (NIOSH) developed a laser extinction method to measure real-time elemental carbon (EC) concentrations (EC is a DPM surrogate). To employ this method, NIOSH developed a person-wearable instrument that was commercialized in 2011. This paper evaluates this commercial instrument, including the calibration curve, limit of detection, accuracy, and potential interferences. The instrument was found to meet the NIOSH accuracy criteria and to be capable of measuring DPM concentrations at levels observed in underground mines. In addition, it was found that a submicron size selector was necessary to avoid interference from mine dust and that cigarette smoke can be an interference when sampling in enclosed cabs. |
Time-lapse analysis of methane quantity in the Mary Lee group of coal seams using filter-based multiple-point geostatistical simulation
Karacan OC , Olea RA . Math Geosci 2013 1-24 Coal seam degasification and its success are important for controlling methane, and thus for the health and safety of coal miners. During the course of degasification, properties of coal seams change. Thus, the changes in coal reservoir conditions and in-place gas content as well as methane emission potential into mines should be evaluated by examining time-dependent changes and the presence of major heterogeneities and geological discontinuities in the field. In this work, time-lapsed reservoir and fluid storage properties of the New Castle coal seam, Mary Lee/Blue Creek seam, and Jagger seam of Black Warrior Basin, Alabama, were determined from gas and water production history matching and production forecasting of vertical degasification wellbores. These properties were combined with isotherm and other important data to compute gas-in-place (GIP) and its change with time at borehole locations. Time-lapsed training images (TIs) of GIP and GIP difference corresponding to each coal and date were generated by using these point-wise data and Voronoi decomposition on the TI grid, which included faults as discontinuities for expansion of Voronoi regions. Filter-based multiple-point geostatistical simulations, which were preferred in this study due to anisotropies and discontinuities in the area, were used to predict time-lapsed GIP distributions within the study area. Performed simulations were used for mapping spatial time-lapsed methane quantities as well as their uncertainties within the study area. | The systematic approach presented in this paper is the first time in literature that history matching, TIs of GIPs and filter simulations are used for degasification performance evaluation and for assessing GIP for mining safety. Results from this study showed that using production history matching of coalbed methane wells to determine time-lapsed reservoir data could be used to compute spatial GIP and representative GIP TIs generated through Voronoi decomposition. Furthermore, performing filter simulations using point-wise data and TIs could be used to predict methane quantity in coal seams subjected to degasification. During the course of the study, it was shown that the material balance of gas produced by wellbores and the GIP reductions in coal seams predicted using filter simulations compared very well, showing the success of filter simulations for continuous variables in this case study. Quantitative results from filter simulations of GIP within the studied area briefly showed that GIP was reduced from an initial ∼73 Bcf (median) to ∼46 Bcf (2011), representing a 37 % decrease and varying spatially through degasification. It is forecasted that there will be an additional 2 Bcf reduction in methane quantity between 2011 and 2015. This study and presented results showed that the applied methodology and utilized techniques can be used to map GIP and its change within coal seams after degasification, which can further be used for ventilation design for methane control in coal mines. |
Lung-function impairment among US underground coal miners, 2005 to 2009: geographic patterns and association with coal workers' pneumoconiosis
Wang ML , Beeckman-Wagner LA , Wolfe AL , Syamlal G , Petsonk EL . J Occup Environ Med 2013 55 (7) 846-50 OBJECTIVE: To investigate contemporary geographic distributions of lung-function impairment and radiographic evidence of coal workers' pneumoconiosis (CWP) and their associations. METHODS: From 2005 to 2009, 6373 underground coal miners completed a health survey, including spirometry testing and chest radiography. Coal workers' pneumoconiosis and progressive massive fibrosis were determined by NIOSH B readers, using the International Labour Office classification. Prevalences of CWP and spirometry less than lower normal limits were mapped by county, and their association assessed. RESULTS: The prevalences of abnormal spirometry results and CWP were 13.1% and 4.0%, respectively. Counties with elevated prevalences for both the outcomes were located in contiguous areas of southeastern Kentucky, western Virginia, southern West Virginia, and eastern Pennsylvania. Prevalence of abnormal spirometry results increases with increasing category of simple CWP and progressive massive fibrosis. CONCLUSIONS: Abnormal spirometry in coal miners is associated with CWP; these two health outcomes have similar geographic distributions. |
Deposition uniformity of coal dust on filters and its effect on the accuracy of FTIR analyses for silica
Miller AL , Drake PL , Murphy NC , Cauda EG , LeBouf RF , Markevicius G . Aerosol Sci Technol 2013 47 (7) 724-733 Miners are exposed to silica-bearing dust which can lead to silicosis, a potentially fatal lung disease. Currently, airborne silica is measured by collecting filter samples and sending them to a laboratory for analysis. Since this may take weeks, a field method is needed to inform decisions aimed at reducing exposures. This study investigates a field-portable Fourier transform infrared (FTIR) method for end-of-shift (EOS) measurement of silica on filter samples. Since themethod entails localized analyses, spatial uniformity of dust deposition can affect accuracy and repeatability. The study, therefore, assesses the influence of radial deposition uniformity on the accuracy of the method. Using laboratory-generated Minusil and coal dusts and three different types of sampling systems, multiple sets of filter samples were prepared. All samples were collected in pairs to create parallel sets for training and validation. Silica was measured by FTIR at nine locations across the face of each filter and the data analyzed using a multiple regression analysis technique that compared various models for predicting silica mass on the filters using different numbers of "analysis shots." It was shown that deposition uniformity is independent of particle type (kaolin vs. silica), which suggests the role of aerodynamic separation is negligible. Results also reflected the correlation between the location and number of shots versus the predictive accuracy of the models. The coefficient of variation (CV) for the models when predicting mass of validation samples was 4%-51% depending on the number of points analyzed and the type of sampler used, which affected the uniformity of radial deposition on the filters. It was shown that using a single shot at the center of the filter yielded predictivity adequate for a field method, (93% return, CV approximately 15%) for samples collected with 3-piece cassettes. |
The current status of laboratory diagnosis of Angiostrongylus cantonensis infections in humans using serologic and molecular methods.
Wilkins PP , Qvarnstrom Y , Whelen AC , Saucier C , da Silva AJ , Eamsobhana P . Hawaii J Med Public Health 2013 2 55-57 Laboratory diagnosis of angiostrongyliasis relies on serological techniques, since definitive diagnosis is insensitive. Modern antibody detection methods focus on antibodies to the 29 and 31 kDa proteins of the parasite. Antigen detection may ultimately prove to be more reliable than antibody detection but no method has been adopted for clinical diagnostic use. Diagnosis using PCR amplification of DNA sequences specific to Angiostrongylus cantonensis have been developed but have not yet been validated for clinical use. Diagnostic tests have not been developed commercially and in the United States tests developed experimentally by non-commercial laboratories have to be approved by the Food and Drug Administration before they can be sold to other laboratories for diagnostic purposes. |
The silent threat: asymptomatic parasitemia and malaria transmission
Lindblade KA , Steinhardt L , Samuels A , Kachur SP , Slutsker L . Expert Rev Anti Infect Ther 2013 11 (6) 623-39 Scale-up of malaria control interventions has resulted in a substantial decline in global malaria morbidity and mortality. Despite this achievement, there is evidence that current interventions alone will not lead to malaria elimination in most malaria-endemic areas and additional strategies need to be considered. Use of antimalarial drugs to target the reservoir of malaria infection is an option to reduce the transmission of malaria between humans and mosquito vectors. However, a large proportion of human malaria infections are asymptomatic, requiring treatment that is not triggered by care-seeking for clinical illness. This article reviews the evidence that asymptomatic malaria infection plays an important role in malaria transmission and that interventions to target this parasite reservoir may be needed to achieve malaria elimination in both low- and high-transmission areas. |
Exchange transfusion for severe malaria: evidence base and literature review
Tan KR , Wiegand RE , Arguin PM . Clin Infect Dis 2013 57 (7) 923-8 BACKGROUND: Exchange transfusion (ET) has biologic plausibility an adjunct to antimalarial drugs in treating severe malaria and has been used for decades despite limited evidence of its efficacy in improving survival. We examined the efficacy of ET as an adjunct treatment for severe malaria using US surveillance data and reviewed the literature to update recommendations. METHODS: Patients with severe malaria reported to the US national malaria surveillance system from 1985-2010 were matched, and survival outcomes were compared between patients receiving and not receiving ET. The literature review used search terms 'severe malaria' and "exchange transfusion." Case reports and series, observational and case-control studies, and meta-analysis were included. RESULTS: 101 patients receiving ET were matched to 314 patients not receiving ET. There was no statistically significant association between ET and survival outcome (odds ratio 0.84, 95% confidence interval 0.44-1.60). We found 87 articles, mostly case reports or series showing successful use of ET; likely reporting bias. There were 12 comparative studies, most retrospective cohort, underpowered with no significant differences in survival. A previously published meta-analysis of 8 comparative studies found no significant survival differences. Adverse events were rarely reported but included acute respiratory distress syndrome, ventricular fibrillation, and hypotension. CONCLUSIONS: Despite rapid parasite clearance times resulting from ET, there is no evidence for efficacy of ET as adjunctive therapy in severe malaria . Adjunct ET cannot be recommended. When rapidly acting antimalarials, specifically artemisinins, become more widely available, the biologic plausibility argument for ET will become less relevant. |
Immunodiagnosis of CNS parasitic infections
Wilkins PP . Handb Clin Neurol 2013 114 23-36 The nature of many parasitic infections of the central nervous system (CNS) requires immunodiagnosis to confirm presumptive diagnoses. The CNS is the primary site of parasite infection for some parasitic organisms and for others, neurological infection occurs only in immunocompromised hosts. Still other parasites cause ectopic infections of the CNS and occur very rarely. This review concentrates on laboratory diagnosis of diseases that are caused by parasites with a primary predilection for the CNS. Emphasis is placed on laboratory diagnostic methods that are used and suitable for clinical diagnosis, rather than a comprehensive review of all the experimental methods that have been reported in the literature. Immunodiagnosis is not appropriate for the diagnosis of all parasitic infections of the CNS; in those cases, alternative diagnostic methods are presented, but not discussed in detail. In some instances potential new antigens or methods are presented, particularly if adoption of these methods is expected in the near future. |
Infections with free-living amebae
Visvesvara GS . Handb Clin Neurol 2013 114 153-68 Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri are mitochondria-bearing, free-living eukaryotic amebae that have been known to cause infections of the central nervous system (CNS) of humans and other animals. Several species of Acanthamoeba belonging to several different genotypes cause an insidious and chronic disease, granulomatous amebic encephalitis (GAE), principally in immunocompromised hosts including persons infected with HIV/AIDS. Acanthamoeba spp., belonging to mostly group 2, also cause infection of the human cornea, Acanthamoeba keratitis. Balamuthia mandrillaris causes GAE in both immunocompromised and immunocompetent hosts mostly in the very young or very old individuals. Both Acanthamoeba spp. and B. mandrillaris also cause a disseminated disease including the lungs, skin, kidneys, and uterus. Naegleria fowleri, on the other hand, causes an acute and fulminating, necrotizing infection of the CNS called primary amebic meningoencephalitis (PAM) in children and young adults with a history of recent exposure to warm fresh water. Additionally, another free-living ameba Sappinia pedata, previously described as S. diploidea, also has caused a single case of amebic meningoencephalitis. In this review the biology of these amebae, clinical manifestations, molecular and immunological diagnosis, and epidemiological features associated with GAE and PAM are discussed. |
Chagas disease in Latin American immigrants with dilated cardiomyopathy in New York City
Kapelusznik L , Varela D , Montgomery SP , Shah AN , Steurer FJ , Rubinstein D , Caplivski D , Pinney SP , Turker D , Factor SH . Clin Infect Dis 2013 57 (1) e7 Chagas disease-associated cardiomyopathy is clinically similar to other causes of cardiomyopathy and, therefore, the diagnosis can be easily overlooked. We found a 13% point prevalence of Chagas disease in a sample of New York City immigrants with dilated cardiomyopathy. |
Clinical and immunological aspects of post-kala-azar dermal leishmaniasis in Bangladesh
Islam S , Kenah E , Bhuiyan MA , Rahman KM , Goodhew B , Ghalib CM , Zahid MM , Ozaki M , Rahman MW , Haque R , Luby SP , Maguire JH , Martin D , Bern C . Am J Trop Med Hyg 2013 89 (2) 345-53 We conducted active surveillance for kala-azar and post-kala-azar dermal leishmaniasis (PKDL) in a population of 24,814 individuals. Between 2002 and 2010, 1,002 kala-azar and 185 PKDL cases occurred. Median PKDL patient age was 12 years; 9% had no antecedent kala-azar. Cases per 10,000 person-years peaked at 90 for kala-azar (2005) and 28 for PKDL (2007). Cumulative PKDL incidence among kala-azar patients was 17% by 5 years. Kala-azar patients younger than 15 years were more likely than older patients to develop PKDL; no other risk factors were identified. The most common lesions were hypopigmented macules. Of 98 untreated PKDL patients, 48 (49%) patients had resolution, with median time of 19 months. Kala-azar patients showed elevated interferon-gamma (IFNgamma), tumor necrosis factor-alpha (TNFalpha), and interleukin 10 (IL-10). Matrix metalloproteinase 9 (MMP9) and MMP9/tissue inhibitors of matrix metalloproteinases ratio were significantly higher in PKDL patients than in other groups. PKDL is frequent in Bangladesh and poses a challenge to the current visceral leishmaniasis elimination initiative in the Indian subcontinent. |
Detection of rat lungworm in intermediate, definitive, and paratenic hosts obtained from environmental sources
Qvarnstrom Y , Bishop HS , da Silva AJ . Hawaii J Med Public Health 2013 2 63-69 Angiostrongylus cantonensis is the most common parasite causing human eosinophilic meningitis worldwide. The geographical distribution of this disease has changed dramatically in the last few decades. Various methods have been used to detect A. cantonensis in host animals around the world. A survey of mollusks collected on the island of Hawai'i in 2005 using PCR showed an infection rate of 24-78% depending on the mollusk species. In this study, samples from intermediate, definitive, and paratenic hosts were analyzed to further determine the presence of A. cantonensis in the United States. All samples were from Hawai'i, except for the apple snails (Pomacea maculata) that were collected in New Orleans, Louisiana. Angiostrongylus cantonensis was detected in the majority of species examined, including the apple snails from New Orleans and flatworms (planarians) from Hawai'i. Among the mollusks examined, the semi-slug Parmarion martensi had the highest parasite load, with an average larval burden of 445 larvae in 25 mg of tissue, as estimated by real-time PCR. In contrast, slime excreted from these highly infected mollusks contained no or very little A. cantonensis DNA. Analysis of definitive hosts (Rattus spp.) showed discrepancies between morphological and PCR-based identification; 54% of the rats were positive based on morphology, while 100% of tissue samples from these animals were positive by real-time PCR. This indicates that necropsies of rodents could underestimate the infection rates in definitive hosts of A. cantonensis. |
Drug library screening against metronidazole-sensitive and metronidazole-resistant Trichomonas vaginalis isolates
Goodhew EB , Secor WE . Sex Transm Infect 2013 89 (6) 479-84 OBJECTIVES: Metronidazole and tinidazole are effective treatments for most patients with trichomoniasis but not for individuals who are infected with very resistant strains of Trichomonas vaginalis or persons with hypersensitivity to the 5-nitroimidazole drugs. Thus, there is a need for additional oral therapies to treat trichomoniasis. METHODS: We screened the US Drug Collection Library against metronidazole-susceptible and resistant strains of T vaginalis. Activity was measured by incubating parasites and drugs for 48 h in the presence of tritiated thymidine. Growth inhibition was determined by the reduction of incorporated radioactivity by compounds at 20 mcM in comparison to media control. Drugs that showed good initial activity were further tested to calculate IC50 values. Drugs with the most promise were tested together with metronidazole to see if there was any combinatorial effect. RESULTS: Of the 1040 drugs in the library, 83 (8%) reduced growth of a metronidazole-susceptible T vaginalis strain by at least 20%. Of these, IC50 values were calculated for 27 compounds and 8 drugs were evaluated in combination with metronidazole. Disulfiram and nithiamide were non-5-nitroimidazole drugs that showed the best activity against parasites when used alone. Albendazole and coenzyme B12 were the most promising compounds to boost the efficacy of metronidazole. CONCLUSIONS: No one drug was as effective as any of the 5-nitroimidazole compounds. However, disulfiram and nithiamide may be useful to treat individuals with hypersensitivity to 5-nitroimidazole drugs and albendazole and coenzyme B12 may be helpful in combination with metronidazole or tinidazole for treatment of persons with highly resistant T vaginalis infections. |
Behaviors related to physical activity and nutrition among U.S. high school students
Brener ND , Eaton DK , Kann LK , McManus TS , Lee SM , Scanlon KS , Fulton JE , O'Toole TP . J Adolesc Health 2013 53 (4) 539-46 PURPOSE: National data related to physical activity (PA) and nutrition among adolescents are needed to help develop effective obesity prevention programs. The 2010 National Youth Physical Activity and Nutrition Study (NYPANS) was conducted to provide nationally representative data on behaviors and behavioral correlates related to healthy eating and PA. METHODS: NYPANS used a three-stage cluster sample design to obtain data representative of public- and private-school students in grades 9 through 12 in the United States (n=11,429). Students completed an anonymous, self-administered questionnaire in their classrooms during a regular class period. Trained data collectors directly measured the students' height and weight at school using a standard protocol. RESULTS: Analyses revealed that 19.0% of students were obese and 17.8% were overweight. Students participated in a range of physical activities during the 12 months before the survey; prevalence ranged from 5.0% for ice hockey to 83.9% for walking. In addition, 52.5% of students enjoyed the physical education classes they took at school. During the 7 days before the survey, 74.8% of students ate at least one meal or snack from a fast food restaurant, with black students more likely than white and Hispanic students to have done so. Forty-one percent of students always or most of the time have a TV on while eating dinner at home. CONCLUSIONS: These and other NYPANS results can be used to develop obesity prevention programs that address specific behaviors and behavioral correlates, and target subgroups in which behaviors and behavioral correlates related to obesity are most prevalent. |
Putting program evaluation to work: a framework for creating actionable knowledge for suicide prevention practice
Wilkins N , Thigpen S , Lockman J , Mackin J , Madden M , Perkins T , Schut J , Van Regenmorter C , Williams L , Donovan J . Transl Behav Med 2013 3 (2) 149-161 The economic and human cost of suicidal behavior to individuals, families, communities, and society makes suicide a serious public health concern, both in the US and around the world. As research and evaluation continue to identify strategies that have the potential to reduce or ultimately prevent suicidal behavior, the need for translating these findings into practice grows. The development of actionable knowledge is an emerging process for translating important research and evaluation findings into action to benefit practice settings. In an effort to apply evaluation findings to strengthen suicide prevention practice, the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) supported the development of three actionable knowledge products that make key findings and lessons learned from youth suicide prevention program evaluations accessible and useable for action. This paper describes the actionable knowledge framework (adapted from the knowledge transfer literature), the three products that resulted, and recommendations for further research into this emerging method for translating research and evaluation findings and bridging the knowledge-action gap. (2012 Society of Behavioral Medicine.) |
The effect of performance indicator category on estimates of intervention effectiveness
Rowe AK . Int J Qual Health Care 2013 25 (3) 331-9 BACKGROUND: A challenge for systematic reviews on improving health worker performance is that included studies often use different performance indicators, and the validity of comparing interventions with different indicators is unclear. One potential solution is to adjust comparisons by indicator category, with categories based on steps of the case-management process that can be easily recognized (assessment of symptoms, treatment etc.) and that might require different levels of effort to bring about improvements. However, this approach would only be useful if intervention effect sizes varied by indicator category. To explore this approach, studies were analyzed that evaluated the Integrated Management of Childhood Illness (IMCI) strategy. METHODS: Performance indicators were grouped into four categories: patient assessment, diagnosis, treatment and counseling. An effect size of IMCI was calculated for each indicator. Linear regression modeling was used to test for differences among the mean effect sizes of the indicator categories. RESULTS: Six studies were included, with data from 3136 ill child consultations. Mean effect sizes for 63 assessment indicators, 12 diagnosis indicators, 31 treatment indicators and 34 counseling indicators were 50.9 percentage-points (%-points), 44.7, 36.5 and 46.6%-points, respectively. After adjusting for baseline indicator value, compared with the assessment mean effect size, the diagnosis mean was 7.3%-points lower (P = 0.23), the treatment mean was 15.2%-points lower (P = 0.0004) and the counseling mean was 12.9%-points lower (P = 0.0027). CONCLUSION: Adjusting the results of systematic reviews for indicator category and baseline indicator value might be useful for improving the validity of intervention comparisons. |
Effectiveness of a brief parent-directed teen driver safety intervention (checkpoints) delivered by driver education instructors
Zakrajsek JS , Shope JT , Greenspan AI , Wang J , Bingham CR , Simons-Morton BG . J Adolesc Health 2013 53 (1) 27-33 BACKGROUND: The Checkpoints program (Checkpoints) uses a Parent-Teen Driving Agreement (PTDA) to help parents monitor teens' driving, and has shown efficacy in increasing parental restrictions on teens' driving and decreasing teens' risky driving. In previous trials, research staff administered Checkpoints. This study examined the effectiveness of Checkpoints when delivered by driver educators. It was hypothesized that Checkpoints would result in more PTDA use, greater PTDA limits on higher risk driving situations, and less high-risk driving. METHODS: Eight trained driving instructors were randomly assigned to intervention or control groups in a group randomized trial. Instructors enrolled 148 parent-teen dyads (intervention = 99, control = 49); 35% of those eligible. Intervention parents joined teens for a 30-minute Checkpoints session during driver education. The session included a video, persuasive messages, discussion, and PTDA initiation. Teens completed four surveys: baseline, licensure, and 3- and 6-months post-licensure. RESULTS: Intervention teens were more likely to report that they used a PTDA (OR= 15.92, p = .004) and had restrictions on driving with teen passengers (OR = 8.52, p = .009), on weekend nights (OR = 8.71, p = .021), on high-speed roads (OR = 3.56, p = .02), and in bad weather (b = .51, p = .05) during the first six months of licensure. There were no differences in offenses or crashes at six months, but intervention teens reported less high-risk driving (p = .04). CONCLUSIONS: Although challenges remain to encourage greater parent participation, Checkpoints conducted by driver education instructors resulted in more use of PTDAs, greater restrictions on high-risk driving, and less high-risk driving. Including Checkpoints in driver education parent meetings/classes has potential to enhance teen driver safety. |
Knowledge and barriers related to reporting of acute transfusion reactions among healthcare workers in Namibia
Basavaraju SV , Lohrke B , Pitman JP , Pathak SR , Meza BP , Shiraishi RW , Wilkinson R , Bock N , Mataranyika M , Lowrance DW . Transfus Med 2013 23 (5) 367-9 In sub-Saharan Africa, only South Africa has had a long-standing national haemovigilance system to monitor acute transfusion reactions (ATR) (Nel and Heyns, 2000). To improve monitoring, recognition and reporting of ATR more countries in the region have implemented or are considering national haemovigilance systems (Dahourou et al., 2012). In Namibia, The Blood Transfusion Service of Namibia (NAMBTS) is the only organisation authorised to collect, process and distribute blood and blood components for transfusion. Since 2006, NAMBTS has invested heavily in the development of guidelines and training for doctors and nurses in the appropriate clinical use of blood. Coupled with this focus on appropriate use, in 2008 NAMBTS launched a national haemovigilance system with a standardised reporting tool backed by clinical and laboratory investigations of all reported ATR. Under this system, healthcare workers (HCW) in Namibia who order or perform transfusions (primarily physicians and nurses) are responsible for voluntary reporting of ATR to NAMBTS by phone or via a paper-based system. Reportable ATR include allergic, acute haemolytic, febrile non-haemolytic reactions, sepsis due to bacterial contamination of the donor unit, transfusion-associated acute lung injury, transfusion-associated circulatory overload and transfusion-associated dyspnoea. |
An analysis of root cause identification and continuous quality improvement in public health H1N1 after-action reports
Singleton CM , Debastiani S , Rose D , Kahn EB . J Public Health Manag Pract 2013 20 (2) 197-204 OBJECTIVE: To identify the extent to which the Homeland Security Exercise and Evaluation Program's (HSEEP) After Action Report/Improvement Plan (AAR/IP) template was followed by public health entities and facilitated the identification of detailed corrective actions and continuous improvement. DESIGN: Data were drawn from the US H1N1 Public Health Emergency Response (PHER) federal grant awardees (n = 62). After action report/improvement plan text was examined to identify the presence of AAR/IP HSEEP elements and characterized as "minimally complete," "partially complete," or "complete." Corrective actions (CA) and recommendations within the IP focusing on performance deficits were coded as specific, measurable, and time-bound, and whether they were associated with a problem that met root cause criteria and whether the CA/recommendation was intended to address or fix the root cause. MAIN OUTCOME MEASURES: A total of 2619 CA/recommendations were identified. More than half (n = 1480, 57%) addressed root causes. Corrective actions/recommendations associated with complete AARs more frequently addressed root cause (58% vs 51%, chi = 9.1, P < 0.003) and were more specific (34% vs 23%, chi = 32.3, P < 0.0001), measurable (30% vs 18%, chi = 37.9, P < 0.0001), and time-bound (38% vs 15%, chi = 115.5, P < 0.0001) than partially complete AARs. The same pattern was not observed with completeness of IPs. Corrective actions and recommendations were similarly specific and measurable. Recommendations significantly addressed root cause more than CAs. CONCLUSIONS: Our analysis indicates a possible lack of awardee distinction between CA and recommendations in AARs. As HSEEP adapts to align with the 2011 National Preparedness Goal and National Preparedness System, future HSEEP documents should emphasize the importance of root cause analysis as a required element within AAR documents and templates in the exercise and real incident environment, as well as the need for specific and measurable CAs. |
Biobanking, consent, and certificates of confidentiality: does the ANPRM muddy the water?
Williams BA , Wolf LE . J Law Med Ethics 2013 41 (2) 440-453 In its Advanced Notice of Proposed Rule Making (ANPRM), the U.S. Department of Health and Human Services proposed substantial changes to how biospecimen research is treated under the regulations governing human subjects research. Currently, much of this research can be conducted without consent because it may not be considered "human subjects" research, is considered exempt, or consent may be waived. Responding to criticisms that scientific changes have made biospecimen research riskier than contemplated when the Common Rule was last amended, the ANPRM proposes to require written consent for biospecimen research, even if they have been stripped of identifiers or initially collected for a non-research purpose. The ANPRM's recognition of these risks is consistent with relatively recent NIH recommendations that research projects involving genetics, genomics, or biospecimen repositories should consider getting a Certificate of Confidentiality to provide additional protections to participants where breach of confidentiality is typically the primary risk. Ironically, the ANPRM proposals may make it more difficult to provide these protections. Our paper explores the implications of the conflicting requirements of the Certificate and the ANPRM proposals and makes recommendations for achieving the dual goals of appropriate consent and adequate confidentiality protections. |
The state of US health, 1990-2010: burden of diseases, injuries, and risk factors
Murray CJ , Abraham J , Ali MK , Alvarado M , Atkinson C , Baddour LM , Bartels DH , Benjamin EJ , Bhalla K , Birbeck G , Bolliger I , Burstein R , Carnahan E , Chen H , Chou D , Chugh SS , Cohen A , Colson KE , Cooper LT , Couser W , Criqui MH , Dabhadkar KC , Dahodwala N , Danaei G , Dellavalle RP , Des Jarlais DC , Dicker D , Ding EL , Dorsey ER , Duber H , Ebel BE , Engell RE , Ezzati M , Felson DT , Finucane MM , Flaxman S , Flaxman AD , Fleming T , Forouzanfar MH , Freedman G , Freeman MK , Gabriel SE , Gakidou E , Gillum RF , Gonzalez-Medina D , Gosselin R , Grant B , Gutierrez HR , Hagan H , Havmoeller R , Hoffman H , Jacobsen KH , James SL , Jasrasaria R , Jayaraman S , Johns N , Kassebaum N , Khatibzadeh S , Knowlton LM , Lan Q , Leasher JL , Lim S , Lin JK , Lipshultz SE , London S , Lozano R , Lu Y , Macintyre MF , Mallinger L , McDermott MM , Meltzer M , Mensah GA , Michaud C , Miller TR , Mock C , Moffitt TE , Mokdad AA , Mokdad AH , Moran AE , Mozaffarian D , Murphy T , Naghavi M , Narayan KM , Nelson RG , Olives C , Omer SB , Ortblad K , Ostro B , Pelizzari PM , Phillips D , Pope CA , Raju M , Ranganathan D , Razavi H , Ritz B , Rivara FP , Roberts T , Sacco RL , Salomon JA , Sampson U , Sanman E , Sapkota A , Schwebel DC , Shahraz S , Shibuya K , Shivakoti R , Silberberg D , Singh GM , Singh D , Singh JA , Sleet DA , Steenland K , Tavakkoli M , Taylor JA , Thurston GD , Towbin JA , Vavilala MS , Vos T , Wagner GR , Weinstock MA , Weisskopf MG , Wilkinson JD , Wulf S , Zabetian A , Lopez AD . JAMA 2013 310 (6) 591-608 IMPORTANCE: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. |
What do policy makers need to know? Lessons from the decision to add pneumococcal conjugate and rotavirus vaccines to the US immunization program
Whitney CG , Parashar UD . Vaccine 2013 31 Suppl 3 C6-7 The decisions to introduce pneumococcal conjugate and rotavirus vaccines into the US immunization programs were good ones. The vaccines have performed even better than expected, markedly reducing disease not only among young children who received them but also among unvaccinated persons in the community [1], [2]. But when the US Centers for Disease Control and Prevention (CDC) first considered whether to recommend routine use of these vaccines, several pieces of information – such as data on disease burden and vaccine efficacy, safety, and cost-effectiveness – had to be gathered before the decision to use these vaccines became clear. | First, policy makers had to determine the need. Do pneumococci and rotavirus cause enough hospitalizations and deaths in the US to warrant vaccinating every child? In the US, as in most parts of the world that use Haemophilus influenzae type b vaccine, pneumococcus was the most common cause of severe pneumonia and bacterial meningitis in young children [3]. Likewise, rotavirus was the most common cause of diarrhea requiring hospitalization [4]. While sub-populations at greater risk of both severe pneumococcal and rotavirus disease were identified (e.g., premature infants), targeting vaccination to these groups would miss the vast majority of cases and thus universal vaccination was the best option. |
PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation
Seem DL , Lee I , Umscheid CA , Kuehnert MJ . Public Health Rep 2013 128 (4) 247-343 This guideline supersedes the 1994 U.S. Public Health Service (PHS) Guidelines for Preventing Transmission of Human Immunodeficiency Virus through Transplantation of Human Tissue and Organs, hereafter referred to as the 1994 PHS guidelines.1 The most significant changes are: | Expanding the guideline to include hepatitis B virus (HBV) and hepatitis C virus (HCV), in addition to human immunodeficiency virus (HIV); | Using factors known to be associated with an increased likelihood of recent HIV, HBV, or HCV infection to identify potential donors who may be at increased risk for transmitting infection; and | Limiting the focus to organs and blood vessel conduits recovered for organ transplantation because the Food and Drug Administration (FDA) implemented more comprehensive regulations for human cell and tissue products.2 | As with the 1994 PHS guidelines, the recommendations relate to adult and pediatric donors who are living or deceased, as well as transplant candidates and recipients. This guideline is not intended to assess infectious risks beyond HIV, HBV, and HCV. |
Capitated payments to primary care providers and the delivery of patient education
Pearson WS , King DE , Richards C . J Am Board Fam Med 2013 26 (4) 350-5 INTRODUCTION: Patient education is a critical component of the patient-centered medical home and is a powerful and effective tool in chronic disease management. However, little is known about the effect of practice payment on rates of patient education during office encounters. METHODS: For this study we took data from the 2009 National Ambulatory Medical Care Survey. This was a cross-sectional analysis of patient visits to primary care providers to determine whether practice payment in the form of capitated payments is associated within patient education being included more frequently during office visits compared with other payment methods. RESULTS: In a sample size of 9863 visits in which capitation status was available and the provider was the patient's primary care provider, the weighted percentages of visits including patient education were measured as a percentages of education (95% confidence intervals): <25% capitation, 42.7% (38.3-47.3); 26% to 50% capitation, 37.6% (23.5-54.2); 51% to 75% capitation, 38.4% (28.1-49.8); >75% capitation, 74.0% (52.2-88.1). In an adjusted logistic model controlling for new patients (yes/no), number of chronic conditions, number of medications managed, number of previous visits within the year, and age and sex of the patients, the odds of receiving education were reported as odds ratios (95% confidence intervals): <25% capitation, 1.00 (1.00-1.00); 26% to 50% capitation, 0.77 (0.38-1.58); 51% to 75% capitation, 0.81 (0.53-1.25); and >75% capitation, 3.38 (1.23-9.30). CONCLUSIONS: Patients are more likely to receive education if their primary care providers receive primarily capitated payment. This association is generally important for health policymakers constructing payment strategies for patient populations who would most benefit from interventions that incorporate or depend on patient education, such as populations requiring management of chronic diseases. |
Trends in health-related quality of life among adolescents in the United States, 2001-2010
Cui W , Zack MM . Prev Chronic Dis 2013 10 E111 Health-related quality of life (HRQOL) measures are often used to track changes in population health, mostly among adults. Prompted by the recent US recession, we assessed trends in adolescent HRQOL by using cross-sectional data from the 2001-2010 National Health and Nutrition Examination Survey. Adolescents' self-rated health and reported mental health declined significantly, especially among those in low-income families, but their physical health and activity limitation did not change. Because these HRQOL declines occurred at the end of the decade and especially among adolescents from low-income families, we conclude that these declines are consistent with recession effects and warrant further study. |
Age-related eye diseases and visual impairment among U.S. adults
Chou CF , Cotch MF , Vitale S , Zhang X , Klein R , Friedman DS , Klein BE , Saaddine JB . Am J Prev Med 2013 45 (1) 29-35 BACKGROUND: Visual impairment is a common health-related disability in the U.S. The association between clinical measurements of age-related eye diseases and visual impairment in data from a national survey has not been reported. PURPOSE: To examine common eye conditions and other correlates associated with visual impairment in the U.S. METHODS: Data from the 2005-2008 National Health and Nutrition Examination Survey of 5222 Americans aged ≥40 years were analyzed in 2012 for visual impairment (presenting distance visual acuity worse than 20/40 in the better-seeing eye), and visual impairment not due to refractive error (distance visual acuity worse than 20/40 after refraction). Diabetic retinopathy (DR) and age-related macular degeneration (AMD) were assessed from retinal fundus images; glaucoma was assessed from two successive frequency-doubling tests and a cup-to-disc ratio measurement. RESULTS: Prevalence of visual impairment and of visual impairment not due to refractive error was 7.5% (95% CI=6.9%, 8.1%) and 2.0% (1.7%, 2.3%), respectively. The prevalence of visual impairment not due to refractive error was significantly higher among people with AMD (2.2%) compared to those without AMD (0.8%), or with DR (3.5%) compared to those without DR (1.2%). Independent predictive factors of visual impairment not due to refractive error were AMD (OR=4.52, 95% CI=2.50, 8.17); increasing age (OR=1.09 per year, 95% CI=1.06, 1.13); and less than a high school education (OR=2.99, 95% CI=1.18, 7.55). CONCLUSIONS: Visual impairment is a public health problem in the U.S. Visual impairment in two thirds of adults could be eliminated with refractive correction. Screening of the older population may identify adults at increased risk of visual impairment due to eye diseases. |
Perceived weight, not obesity, increases risk for major depression among adolescents
Roberts RE , Duong HT . J Psychiatr Res 2013 47 (8) 1110-7 This study examined the association between major depression, obesity and body image among adolescents. METHODS: Participants were 4175 youths 11-17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity. |
Effect of meditation on endothelial function in black Americans with metabolic syndrome: a randomized trial
Vaccarino V , Kondwani KA , Kelley ME , Murrah NV , Boyd L , Ahmed Y , Meng YX , Gibbons GH , Hooper WC , De Staercke C , Quyyumi AA . Psychosom Med 2013 75 (6) 591-9 OBJECTIVES: Psychological stress may play a role in metabolic syndrome. A consequence of metabolic syndrome is endothelial dysfunction, which is also influenced by psychological stress. We sought to compare the effect of consciously resting meditation (CRM), a sound based meditation, with a control intervention of health education (HE) on endothelial function in the setting of metabolic syndrome. METHODS: Sixty-eight black Americans with metabolic syndrome risk factors (age, 30-65 years) were randomized to either CRM (n = 33) or HE (n = 35); interventions were matched for frequency and duration of sessions and lasted 12 months. Endothelial function was assessed by brachial artery flow-mediated dilation at baseline and at 6 and 12 months. Arterial elasticity, metabolic risk factors, and psychosocial and behavioral variables were secondary end points. RESULTS: Although flow-mediated dilation improved in the CRM group for 12 months, this increase was not significantly higher than that in the HE group (p = .51 for the interaction between group and time). Non-endothelium-dependent dilation and arterial elasticity did not change in either group. Most metabolic syndrome risk factors showed beneficial trends in the CRM group only. A risk factor score counting the number of metabolic syndrome components decreased in the CRM group only (p = .049 for the interaction between treatment group and time). CONCLUSIONS: Among black Americans with metabolic syndrome risk factors, CRM, did not improve endothelial function significantly more than a control intervention of HE. CRM resulted in favorable trends in metabolic syndrome risk factors, which were examined as secondary outcomes. |
The geometric increase in meta-analyses from China in the genomic era.
Ioannidis JPA , Chang CQ , Lam TK , Schully SD , Khoury MJ . PLoS One 2013 8 (6) e65602 Meta-analyses are increasingly popular. It is unknown whether this popularity is driven by specific countries and specific meta-analyses types. PubMed was used to identify meta-analyses since 1995 (last update 9/1/2012) and catalogue their types and country of origin. We focused more on meta-analyses from China (the current top producer of meta-analyses) versus the USA (top producer until recently). The annual number of meta-analyses from China increased 40-fold between 2003 and 2011 versus 2.4-fold for the USA. The growth of Chinese meta-analyses was driven by genetics (110-fold increase in 2011 versus 2003). The HuGE Navigator identified 612 meta-analyses of genetic association studies published in 2012 from China versus only 109 from the USA. We compared in-depth 50 genetic association meta-analyses from China versus 50 from USA in 2012. Meta-analyses from China almost always used only literature-based data (92%), and focused on one or two genes (94%) and variants (78%) identified with candidate gene approaches (88%), while many USA meta-analyses used genome-wide approaches and raw data. Both groups usually concluded favorably for the presence of genetic associations (80% versus 74%), but nominal significance (P<0.05) typically sufficed in the China group. Meta-analyses from China typically neglected genome-wide data, and often included candidate gene studies published in Chinese-language journals. Overall, there is an impressive rise of meta-analyses from China, particularly on genetic associations. Since most claimed candidate gene associations are likely false-positives, there is an urgent global need to incorporate genome-wide data and state-of-the art statistical inferences to avoid a flood of false-positive genetic meta-analyses. |
An empirical comparison of low-dose extrapolation from points of departure (PoD) compared to extrapolations based upon methods that account for model uncertainty
Wheeler MW , Bailer AJ . Regul Toxicol Pharmacol 2013 67 (1) 75-82 Experiments with relatively high doses are often used to predict risks at appreciably lower doses.A point of departure (PoD) can be calculated as the dose associated with a specified moderate response level that is often in the range of experimental doses considered. A linear extrapolation to lower doses often follows.An alternative to the PoD method is to develop a model that accounts for the model uncertainty in the dose-response relationship and to use this model to estimate the risk at low doses.Two such approaches that account for model uncertainty are model averaging (MA) and semi-parametric methods.We use these methods, along with the PoD approach in the context of a large animal (40,000+ animal) bioassay that exhibited sub-linearity. When models are fit to high dose data and risks at low doses are predicted, the methods that account for model uncertainty produce dose estimates associated with an excess risk that are closer to the observed risk than the PoD linearization.This comparison provides empirical support to accompany previous simulation studies that suggest methods that incorporate model uncertainty provide viable, and arguably preferred, alternatives to linear extrapolation from a PoD. |
Reactions of adult smokers and former smokers to current US warning labels
O'Hegarty M , Pederson LL , Asman KJ , Malarcher AM , Kruger J . Am J Health Behav 2013 37 (5) 654-659 OBJECTIVE: To assess current and former smokers' reactions to US warning labels as a baseline for comparison to new labels. METHODS: The mail-in Consumer- Styles survey was sent to a representative sample of US adult consumers in 2010 (N = 10,328). RESULTS: Among current smokers, 51.5% (95% CI: 47.5-55.5) reported that they had 'never/rarely' seen or looked closely at the labels in the past 30 days. Current smokers (91.1%) reported that warning labels never stopped them from having a cigarette (95% CI: 89.1- 93.1) and that the labels had no effect on their likelihood of quitting (75.5%; 95% CI: 71.6-79.4). CONCLUSIONS: Current warning labels do not make smokers think about the risks of smoking or have an effect on their likelihood of forgoing cigarettes or quitting. |
Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement
Hasin DS , Aharonovich E , O'Leary A , Greenstein E , Pavlicova M , Arunajadai S , Waxman R , Wainberg M , Helzer J , Johnston B . Addiction 2013 108 (7) 1230-40 AIMS: In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients. DESIGN: Parallel random assignment to control (n = 88), MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients. SETTING: Large urban HIV primary care clinic. PARTICIPANTS: Patients consuming ≥4 drinks at least once in prior 30 days. MEASUREMENTS: Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days. FINDINGS: End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model chi(2) , d.f. = 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control; P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant. CONCLUSIONS: For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement. |
Knowledge, attitudes, and practices of veterinary facility owners regarding rabies preexposure prophylaxis-West Virginia, 2011
Taylor TK , Radcliffe RA , Bixler D . J Am Vet Med Assoc 2013 243 (1) 63-7 OBJECTIVE: To assess the knowledge, attitudes, and practices regarding rabies preexposure prophylaxis among veterinary facility owners in West Virginia and to compare facilities in counties where raccoon rabies virus variant (RRVV) is or is not enzootic. DESIGN: Cross-sectional telephone survey. SAMPLE: 124 owners of facilities licensed by the West Virginia Board of Veterinary Medicine. PROCEDURES: In 2011, an owner of each licensed facility in West Virginia was contacted by telephone to complete a questionnaire regarding practice demographics, knowledge of rabies epidemiology, and preexposure prophylaxis policies. Data from facilities in counties where RRVV is enzootic were compared with data from facilities in counties where RRVV is not enzootic. Prevalence ratios and 95% confidence intervals were calculated to quantify the strength of associations. RESULTS: Owners of 124 of the 162 (77%) veterinary facilities participated in the survey. West Virginia veterinarians were knowledgeable of rabies epidemiology in the state. Respondents agreed that veterinarians (122/124 [98%]) and technicians and assistants (111/124 [90%]) should receive preexposure prophylaxis. Fifty-six (45%) respondents required that veterinarians receive preexposure prophylaxis, whereas 19 (15%) respondents required that technicians and assistants receive preexposure prophylaxis. A preexposure prophylaxis policy was in effect at 20 of 64 (31%) facilities in counties where RRVV is enzootic and 6 of 60 (10%) facilities in counties where RRVV is not enzootic. Concerns related to cost of preexposure prophylaxis were reported. CONCLUSIONS AND CLINICAL RELEVANCE: Except for veterinarians, veterinary staff in West Virginia did not commonly receive preexposure prophylaxis or regular assessments of serum rabies virus neutralizing antibody titers. All veterinary practices are encouraged to consider revising or implementing a preexposure prophylaxis policy based on the Advisory Committee on Immunization Practices' recommendations. |
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