Obesity prevention: the impact of local health departments
Chen ZA , Roy K , Gotway Crawford CA . Health Serv Res 2012 48 603-27 OBJECTIVE: To examine the association between bodyweight status and provision of population-based prevention services. DATA SOURCES: The National Association of City and County Health Officials 2005 Profile survey data, linked with two cross-sections of the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2004 and 2005. STUDY DESIGN: Multilevel logistic regressions were used to examine the association between provision of obesity-prevention services and the change in risk of being obese or morbidly obese among BRFSS respondents. The estimation sample was stratified by sex. Low-income samples were also examined. Falsification tests were used to determine whether there is counterevidence. PRINCIPAL FINDINGS: Provision of population-based obesity-prevention services within the jurisdiction of local health departments and specifically those provided by the local health departments are associated with reduced risks of obesity and morbid obesity from 2004 to 2005. The magnitude of the association appears to be stronger among low-income populations and among women. Results of the falsification tests provide additional support of the main findings. CONCLUSIONS: Population-based obesity-prevention services may be useful in containing the obesity epidemic. |
Seasonality, timing, and climate drivers of influenza activity worldwide
Azziz-Baumgartner E , Dao C , Nasreen S , Bhuiyan MU , Mah EMuneer S , Al Mamun A , Sharker MA , Zaman RU , Cheng PY , Klimov AI , Widdowson MA , Uyeki T , Luby SP , Mounts A , Bresee J . J Infect Dis 2012 206 (6) 838-46 BACKGROUND: Although, influenza is a vaccine-preventable disease which annually causes substantial disease burden, data on virus activity in tropical countries are limited. We analyzed publicly available influenza data to better understand the global circulation of influenza viruses. METHOD: We reviewed open-source laboratory-confirmed influenza surveillance data. For each country we abstracted data on the percent of samples testing positive for influenza each epidemiologic week from the annual number of samples testing positive for influenza. The start of influenza season was defined as the first week when the proportion of samples that tested positive remained above the annual mean. We assessed the relationship between percent of samples testing positive and average monthly temperature using regression models. FINDINGS: We identified data on laboratory-confirmed influenza virus infection from 85 countries. More than one influenza epidemic period per year was more common in tropical countries (41%) than temperate countries (15%). Year-round activity (i.e., influenza virus identified each week having ≥10 specimens submitted) occurred in 3 (7%) of 43 temperate, one (17%) of six subtropical, and 11 (37%) of 30 tropical countries with available data (p=0.006). Percent positivity was associated with low temperature (p=0.001). INTERPRETATION: Annual influenza epidemics occur in consistent temporal patterns depending upon climate. |
Use of intravenous peramivir for treatment of severe influenza A(H1N1)pdm09
Louie JK , Yang S , Yen C , Acosta M , Schechter R , Uyeki TM . PLoS One 2012 7 (6) e40261 Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety. |
A low-effort clinic-wide intervention improves attendance for HIV primary care
Gardner L , Marks G , Craw J , Wilson T , Drainoni ML , Moore R , Mugavero M , Rodriguez A , Bradley-Springer L , Holman S , Keruly J , Sullivan M , Skolnik P , Malitz F , Metsch L , Raper J , Giordano T . Clin Infect Dis 2012 55 (8) 1124-34 BACKGROUND: Retention in care for HIV-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the CDC/HRSA Retention in Care project. METHODS: Six HIV-specialty clinics participated in a cross-sectionally sampled pre-post evaluation of brochures, posters and messages that conveyed the importance of regular clinic attendance. 10,018 patients in 2008-2009 (pre-intervention period) and 11,039 patients in 2009-2010 (intervention period) were followed for clinic attendance. Outcome variables were the percentage of patients who kept two consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, re-engaging and active patients, HIV RNA viral load, CD4+ cell count, age, gender, race/ethnicity, risk group, number of scheduled visits and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation methods. RESULTS: Clinic attendance for primary care was significantly higher in the intervention vs. pre-intervention year. Overall relative improvement was 7.0% for keeping two consecutive visits and 3.0% for the mean proportion of all visits kept (p<0.0001). Larger relative improvement for both outcomes was observed for new or re-engaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or re-engaging patients was consistent across the six clinics, and less consistent across clinics for active patients. CONCLUSION: Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or re-engaging patients, young patients, and those with elevated viral loads. |
The future of HIV prevention in the United States
Mermin J , Fenton KA . JAMA 2012 308 (4) 347-8 In the United States, 1.1 million people live with human immunodeficiency virus (HIV), a 60% increase from 15 years ago. The increasing number of people who can potentially transmit HIV makes prevention more difficult. Yet federal domestic HIV prevention funding, after adjustment for inflation, has not increased since 1991, necessitating a different approach to HIV prevention. | The CDC's new strategy, “High Impact Prevention,” involves prioritizing and implementing the optimal combination of cost-effective, scalable interventions based on current science.1 This strategy focuses on the goal of the National HIV/AIDS Strategy (NHAS) of reducing the current annual HIV incidence of about 50 000 infections by 25% in 5 years. If the NHAS goals are realized, it is possible that an estimated 163 000 infections could be prevented along with a corresponding potential projected savings of $48 billion in health expenditures by 2020.2 |
Biomedical and social dimensions of HIV prevention
Aral SO , Blanchard J . Am J Public Health 2012 102 (9) e9; author reply e9-10 The recent article by Kippax and Stephenson argues that increasing bio medicalization distorts prevention efforts. All prevention requires that people change their social practices and such changes can only be effectively sustained if they are supported by broader social transformation. Developing effective HIV prevention requires that the field move beyond the distinction between biomedical and social dimensions of HIV. Effective prevention requires that biomedical technologies, behavioral strategies, and social structures are not treated as separate entities. We agree. (Am J Public Health. Published online ahead of print July 19, 2012: e1. doi:10.2105/AJPH.2012.300886). |
Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora
Millett GA , Jeffries WL4th , Peterson JL , Malebranche DJ , Lane T , Flores SA , Fenton KA , Wilson PA , Steiner R , Heilig CM . Lancet 2012 380 (9839) 411-23 Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8.5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources. |
Concurrent influenza virus infection and tuberculosis in patients hospitalized with respiratory illness in Thailand
Roth S , Whitehead S , Thamthitiwat S , Chittaganpitch M , Maloney SA , Baggett HC , Olsen SJ . Influenza Other Respir Viruses 2012 7 (3) 244-8 Thailand, where influenza viruses circulate year-round, is one of 22 WHO-designated high-burden countries for tuberculosis (TB). Surveillance for hospitalized respiratory illness between 2003 and 2011 revealed 23 (<1% of 7180 tested) with concurrent influenza and TB. Only two persons were previously known to have TB suggesting that acute respiratory illness may bring patients to medical attention and lead to TB diagnosis. Influenza/TB was not associated with higher disease severity or mortality. |
Vertebrate hosts of Aedes aegypti and Aedes mediovittatus (Diptera: Culicidae) in rural Puerto Rico
Barrera R , Bingham AM , Hassan HK , Amador M , Mackay AJ , Unnasch TR . J Med Entomol 2012 49 (4) 917-921 The distribution of Aedes (Stegomyia) aegypti (L.), the main vector of dengue viruses (DENV) worldwide, overlaps with Aedes (Gymnometopa) mediovittatus (Coquillett), the Caribbean treehole mosquito, in urban, suburban, and rural areas. Ae. mediovittatus is a competent vector of DENV with high rates of vertical DENV transmission in the laboratory. This study determined whether Ae. mediovittatus feeds on humans and compared its feeding patterns with co-occurring Ae. aegypti in two rural communities of Puerto Rico. Adult mosquitoes were captured for three consecutive days every week from July 2009 to May 2010 using BG-Sentinel traps with skin lures that were placed in the front yard of houses in both communities. Three methods were used to identify the 756 bloodmeals obtained in this study: a multiplex polymerase chain reaction (PCR) for humans and dogs targeting cytochrome b; a PCR targeting the 16S rRNA; and a nested PCR targeting cytochrome b. Ae. mediovittatus fed mostly on humans (45-52%) and dogs (28-32%) but also on cats, cows, horses, rats, pigs, goats, sheep, and chickens. Ae. aegypti fed mostly on humans (76-79%) and dogs (18-21%) but also on cats, horses, and chickens. Our results indicate that Ae. mediovittatus may have a relatively high rate of vector-human contact, which might facilitate virus transmission or harborage in rural areas of Puerto Rico. |
Prevalence and diversity of Bartonella spp. in bats in Peru
Bai Y , Recuenco S , Gilbert AT , Osikowicz LM , Gomez J , Rupprecht C , Kosoy MY . Am J Trop Med Hyg 2012 87 (3) 518-23 Bartonella infections were investigated in bats in the Amazon part of Peru. A total of 112 bats belonging to 19 species were surveyed. Bartonella bacteria were cultured from 24.1% of the bats (27/112). Infection rates ranged from 0% to 100% per bat species. Phylogenetic analyses of gltA of the Bartonella isolates revealed 21 genetic variants clustering into 13 divergent phylogroups. Some Bartonella strains were shared by bats of multiple species, and bats of some species were infected with multiple Bartonella strains, showing no evident specific Bartonella sp.-bat relationships. Rarely found in other bat species, the Bartonella strains of phylogroups I and III discovered from the common vampire bats (Desmodus rotundus) were more specific to the host bat species, suggesting some level of host specificity. |
Detection of persistent West Nile virus RNA in experimentally and naturally infected avian hosts
Wheeler SS , Langevin SA , Brault AC , Woods L , Carroll BD , Reisen WK . Am J Trop Med Hyg 2012 87 (3) 559-64 To determine whether West Nile virus (WNV) persistent infection in avian hosts may potentially serve as an overwintering mechanism, house sparrows and house finches experimentally and naturally infected with several strains of WNV and two naturally infected western scrub jays were held in mosquito-proof outdoor aviaries from during 2007-March 2008. Overall, 94% (n = 36) of house sparrows, 100% (n = 14) of house finches and 2 western scrub jays remained WNV antibody positive. When combined by species, 37% of the house sparrows, 50% of the house finches, and 2 western scrub jays were WNV RNA positive at necropsy, up to 36 weeks post-infection. Infectious WNV was not detected. Our study supports the hypothesis that some avian hosts support the long-term persistence of WNV RNA, but it remains unresolved whether these infections relapse to restart an avian-arthropod transmission cycle and thereby serve as an overwintering mechanism for WNV. |
Stem cell and benzene-induced malignancy and hematotoxicity
Wang L , He X , Bi Y , Ma Q . Chem Res Toxicol 2012 25 (7) 1303-15 The biological effect of benzene on the hematopoietic system has been known for over a century. The rapid advancement in understanding the biology of hematopoietic stem cells (HSCs) and cancer stem cells (CSCs) in recent years has renewed interest in investigating the role of stem cells in benzene-induced malignancy and bone marrow depression. The interplay between benzene and stem cells is complex involving the stem cell, progenitor, and HSC niche compartments of the bone marrow. In this prospect, benzene metabolites formed through metabolism in the liver and bone marrow cause damage in hematopoietic cells via multiple mechanisms that, in addition to traditionally recognized chromosomal aberration and covalent binding, incorporate oxidative stress, alteration of gene expression, apoptosis, error-prone DNA repair, epigenetic regulation, and disruption of tumor surveillance. However, benzene-exposed individuals exhibit variable susceptibility to benzene effect that arises, in part, from genetic variations in benzene metabolism, DNA repair, genomic stability, and immune function. These new studies of benzene leukemogenesis and hematotoxicity are expected to provide insights into how environmental and occupational chemicals affect stem cells to cause cancer and toxicity, which impact the risk assessment, permissible level, and therapy of benzene exposure. |
Factors associated with serum polybrominated diphenyl ether (PBDE) levels among school-age children in the CHAMACOS cohort
Bradman A , Castorina R , Sjodin A , Fenster L , Jones RS , Harley KG , Chevrier J , Holland NT , Eskenazi B . Environ Sci Technol 2012 46 (13) 7373-81 Polybrominated diphenyl ethers (PBDEs) are a class of flame retardants historically used in textiles, furniture, and electronic products. Recent studies have documented widespread PBDE exposure to humans, with higher levels measured in children than adults. We analyzed 10 tri- to hepta-BDE congener levels in blood collected from 7-year old Mexican-American children living in an agriculture community in California (n = 272). The most frequently detected PBDE congeners in child serum were BDE-47, -99, -100, and -153, all of which were measured in >99% of the children. We used multiple linear regression models to examine associations between child total PBDE levels (ng/g lipid) and determinants of exposure. Factors positively associated with higher PBDE levels in the children were total PBDE levels in maternal serum during pregnancy, duration of exclusive breastfeeding, and having no safe places to play in their neighborhood. Child BMI was inversely associated with serum PBDE levels (regression p-values <0.05). Our findings confirm that exposure to the penta-BDE mixture is ongoing, and that Mexican-American children living in California may be experiencing higher PBDE exposure from their environment compared to children sampled from the general U.S. population. Additional research is needed to assess the health impacts of these exposures. |
The influence of physicochemical properties on the internal dose of trihalomethanes in humans following a controlled showering exposure
Silva LK , Backer LC , Ashley DL , Gordon SM , Brinkman MC , Nuckols JR , Wilkes CR , Blount BC . J Expo Sci Environ Epidemiol 2012 23 (1) 39-45 Although disinfection of domestic water supply is crucial for protecting public health from waterborne diseases, this process forms potentially harmful by-products, such as trihalomethanes (THMs). We evaluated the influence of physicochemical properties of four THMs (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) on the internal dose after showering. One hundred volunteers showered for 10 min in a controlled setting with fixed water flow, air flow, and temperature. We measured THMs in shower water, shower air, bathroom air, and blood samples collected at various time intervals. The geometric mean (GM) for total THM concentration in shower water was 96.2 mcg/l. The GM of total THM in air increased from 5.8 mcg/m(3) pre shower to 351 mcg/m(3) during showering. Similarly, the GM of total-blood THM concentration increased from 16.5 ng/l pre shower to 299 ng/l at 10 min post shower. THM levels were significantly correlated between different matrices (e.g. dibromochloromethane levels) in water and air (r=0.941); blood and water (r=0.845); and blood and air (r=0.831). The slopes of best-fit lines for THM levels in water vs air and blood vs air increased with increasing partition coefficient of water/air and blood/air. The slope of the correlation plot of THM levels in water vs air decreased in a linear (r=0.995) fashion with increasing Henry's law constant. The physicochemical properties (volatility, partition coefficients, and Henry's law constant) are useful parameters for predicting THM movement between matrices and understanding THM exposure during showering. (Journal of Exposure Science and Environmental Epidemiology advance online publication, 25 July 2012; doi:10.1038/jes.2012.80.) |
Assessment of airborne Asteraceae pollen in Brisbane, Australia
Green BJ , Simpson RW , Dettmann ME . Aerobiologia (Bologna) 2012 28 (2) 295-301 In the southern hemisphere, the airborne prevalence and seasonal distribution of Asteraceae pollen are poorly characterized. In this study, we assessed the longitudinal distribution of Asteraceae pollen using an historic aerobiological dataset. The influence of weather parameters on pollen derived from Asteraceae species was additionally explored. Asteraceae pollen was collected using a static Burkard 7-day spore trap during a 5-year (June 1994-May 1999) aerometric surveillance program in Brisbane, Australia. Two discrete seasonal intervals were identified each sampling year. The first interval (September and October) consisted of small quantities of unidentifiable Asteraceae pollen. The second interval (March and April) was characterized by the highest concentrations of Asteraceae pollen that were predominantly derived from Baccharis halimifolia. Associations between daily Asteraceae pollen concentrations and temperature were observed during each sampling year. The results of the study demonstrated that pollen derived from B. halimifolia, an invasive weed species introduced in the late nineteenth century, continue to be in the environment of Brisbane. Given the public health burden associated with personal Asteraceae pollen exposure in other geographic locations, future Australian-based clinical studies should characterize the contribution of Asteraceae pollen, in particular B. halimifolia, to allergic sensitization and respiratory morbidity. |
Assessment of environmental cockroach allergen exposure
Chew GL . Curr Allergy Asthma Rep 2012 12 (5) 456-64 In the past, cockroach allergen exposure assessment mainly focused on settled dust in homes in low-income urban cities in the United States. That choice was not wrong; without measureable levels of cockroach allergen, it is difficult to show associations with any home characteristics, much less with health outcomes (e.g., allergy, asthma). However, recent studies in other suburban areas, schools, and other countries have elucidated the importance of cockroach allergen in these environments too. In addition, characterizing the underlying factors that give rise to cockroach allergen exposure (or protect against it) can lead to more targeted public health interventions. This review discusses different approaches to sampling indoor environments, interprets recent asthma and allergy studies, compares cockroach allergen levels from past studies with those of recent studies, and describes strategies for decreasing exposures. |
Trends in hospitalization for community-associated methicillin-resistant Staphylococcus aureus in New York City, 1997-2006: data from New York State's statewide planning and research cooperative system
Farr AM , Aden B , Weiss D , Nash D , Marx MA . Infect Control Hosp Epidemiol 2012 33 (7) 725-31 OBJECTIVE: To describe trends in hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in New York City over 10 years and to explore the demographics and comorbidities of patients hospitalized with CA-MRSA infections. DESIGN: Retrospective analysis of hospital discharges from New York State's Statewide Planning and Research Cooperative System database from 1997 to 2006. PATIENTS: All patients greater than 1 year of age admitted to New York hospitals with diagnosis codes indicating MRSA who met the criteria for CA-MRSA on the basis of admission information and comorbidities. METHODS: We determined hospitalization rates and compared demographics and comorbidities of patients hospitalized with CA-MRSA versus those hospitalized with all other non-MRSA diagnoses by multivariable logistic regression. RESULTS: Of 18,226 hospitalizations with an MRSA diagnosis over 10 years, 3,579 (20%) were classified as community-associated. The CA-MRSA hospitalization rate increased from 1.47 to 10.65 per 100,000 people overall from 1997 to 2006. Relative to non-MRSA hospitalizations, men, children, Bronx and Manhattan residents, the homeless, patients with human immunodeficiency virus (HIV) infection, and persons with diabetes had higher adjusted odds of CA-MRSA hospitalization. CONCLUSIONS: The CA-MRSA hospitalization rate appeared to increase between 1997 and 2006 in New York City, with residents of the Bronx and Manhattan, men, and persons with HIV infection or diabetes at increased odds of hospitalization with CA-MRSA. Further studies are needed to explore how changes in MRSA incidence, access to care, and other factors may have impacted these rates. |
Monitoring hand hygiene via human observers: how should we be sampling?
Fries J , Segre AM , Thomas G , Herman T , Ellingson K , Polgreen PM . Infect Control Hosp Epidemiol 2012 33 (7) 689-95 OBJECTIVE: To explore how hand hygiene observer scheduling influences the number of events and unique individuals observed. DESIGN: We deployed a mobile sensor network to capture detailed movement data for 6 categories of healthcare workers over a 2-week period. SETTING: University of Iowa Hospital and Clinic medical intensive care unit (ICU). METHODS: We recorded 33,721 time-stamped healthcare worker entries to and exits from patient rooms and considered each entry or exit to be an opportunity for hand hygiene. Architectural drawings were used to derive 4 optimal line-of-sight placements for observers. We ran simulations for different observer movement schedules, all with a budget of 1 hour of total observation time. We considered observation times of 1-15, 15-30, 30, and 60 minutes per station. We stochastically generated healthcare worker hand hygiene compliance on the basis of all data and recorded the total unit compliance as it would be reported by each simulated observer. RESULTS: Considering a 60-minute total observation period, aggregate simulated observers captured 1.7% of the average total number of opportunities per day at best and 0.5% at worst. The 1-15-minute schedule captures, on average, 16% fewer events than does the 60-minute (ie, static) schedule, but it samples 17% more unique individuals. The 1-15-minute schedule also provides the best estimator of compliance for the duration of the shift, with a mean standard deviation of 17%, compared with 23% for the 60-minute schedule. CONCLUSIONS: Our results show that observations are sensitive to different observers' schedules and suggest the importance of using data-driven approaches to schedule hand hygiene audits. |
No evidence of mumps transmission during air travel, United States, November 1, 2006-October 31, 2010
Nelson KR , Marienau KJ , Barskey AE , Schembri C . Travel Med Infect Dis 2012 10 (4) 165-71 Since November 2006, flight-related mumps contact investigations were conducted in the United States only for flights ≥5 h long after an investigation showed minimal risk of mumps transmission on flights <5 h. Because the transmission risk on longer flights had not been evaluated, we investigated whether there was evidence to support the guidelines. We examined data from mumps contact investigations that were initiated by the US Centers for Disease Control and Prevention (CDC) from November 2006 to October 2010. We also cross-referenced passenger-contact data with data on mumps cases in the National Notifiable Diseases Surveillance System (NNDSS). Twenty-seven cases met inclusion criteria. Of 246 passengers identified as contacts, 166 (67%) were distributed to a US health department for contact tracing. Outcomes were reported for 21 (13%) of those 166 passengers. No secondary cases of mumps among passenger contacts were reported or identified by cross-referencing NNDSS data. The findings suggested that in-flight risk of mumps transmission is not high. Furthermore, these investigations have low yield, are resource intensive, there is no post-exposure prophylaxis, and mumps transmission has not been eliminated in the United States. Therefore, CDC discontinued conducting flight-related mumps contact investigations in May 2011. |
A functional public health surveillance system
Kass-Hout TA , Gallagher K , Foldy S , Buehler JW . Am J Public Health 2012 102 (9) e1-2; author reply e2 Lenert and Sundwall identify opportunities and challenges of the Meaningful Use (MUse) incentive programs that advance standardized electronic reporting to health departments at a time when there is limited funding to upgrade systems. We concur that cloud-based Platform as a Service (PaaS) is a possible remedy. However, we disagree with their conclusion that "the security risks inherent in BioSense 2.0's public cloud implementation may make this effort better suited to a demonstration project than a national level biodefense system." (Am J Public Health. Published online ahead of print July 19, 2012: e1. doi:10.2105/AJPH.2012.300800). |
Client characteristics and gender-specific correlates of testing HIV positive: a comparison of standalone center versus mobile outreach HIV testing and counseling in Botswana
Hood JE , MacKellar D , Spaulding A , Nelson R , Mosiakgabo B , Sikwa B , Puso I , Raats J , Loeto P , Alwano MG , Monyatsi B . AIDS Behav 2012 16 (7) 1902-16 Using data from Botswana's largest HIV testing and counseling (HTC) provider, Tebelopele, we evaluate populations served and gender-specific correlates of testing HIV-positive among clients of two programs: standalone centers and outreach testing. Client records from January to June 2007 (n = 47,890) were evaluated by HTC program and gender. Bivariate and multivariate analyses were performed to identify demographic, testing, and risk-behavior variables associated with testing HIV-positive. Compared to outreach testing, standalone centers served proportionally more clients who were young, well-educated, unmarried, and HIV-infected; outreach testing reached an older, less-educated population. Age, educational attainment, marital status, couples testing, testing because of illness or discordant relationship, and nonuse of condoms (among young clients only) were consistently associated with testing HIV-positive, by HTC program and gender. Our evaluation suggests that Tebelopele standalone and outreach HTC programs serve different populations, and identifies strategies to reduce HIV infection risk and to improve uptake of HTC by HIV-infected, undiagnosed Batswana. |
Public awareness and use of direct-to-consumer personal genomic tests from four state population-based surveys, and implications for clinical and public health practice.
Kolor K , Duquette D , Zlot A , Foland J , Anderson B , Giles R , Wrathall J , Khoury MJ . Genet Med 2012 14 (10) 860-7 PURPOSE: Direct-to-consumer personal genomic tests are widely available, but population-based data are limited on awareness and use of these tests among the general public in the United States. METHODS: We assessed awareness and use of direct-to-consumer personal genomic tests in Connecticut, Michigan, Oregon, and Utah using the 2009 Behavioral Risk Factor Surveillance System and compared the state results to the 2008 national HealthStyles survey results. RESULTS: Awareness was the highest in Oregon (29.1%) and the lowest in Michigan (15.8%). Factors associated with awareness across all states and nationally were higher education, higher income, and increasing age, except among those 75 years or older. Less than 1% of respondents had used the tests, with about one-half to three-quarters of those sharing the results with a health-care provider. CONCLUSIONS: Awareness of direct-to-consumer genetic tests is greater in this study as compared with a related study conducted in 2006, whereas use is similarly low in both studies. The few respondents who reported using the tests often reported sharing their results with their health-care provider, indicating an important opportunity for health-care providers to offer patient education regarding these tests. Public health agencies have important roles in surveillance, education, and policy development on direct-to-consumer genomic tests. (Genet Med advance online publication 19 July 2012.) |
Relaxation of adaptive evolution during the HIV-1 infection owing to reduction of CD4+ T cell counts.
Leal E , Casseb J , Hendry M , Busch MP , Diaz RS . PLoS One 2012 7 (6) e39776 BACKGROUND: The first stages of HIV-1 infection are essential to establish the diversity of virus population within host. It has been suggested that adaptation to host cells and antibody evasion are the leading forces driving HIV evolution at the initial stages of AIDS infection. In order to gain more insights on adaptive HIV-1 evolution, the genetic diversity was evaluated during the infection time in individuals contaminated by the same viral source in an epidemic cluster. Multiple sequences of V3 loop region of the HIV-1 were serially sampled from four individuals: comprising a single blood donor, two blood recipients, and another sexually infected by one of the blood recipients. The diversity of the viral population within each host was analyzed independently in distinct time points during HIV-1 infection. RESULTS: Phylogenetic analysis identified multiple HIV-1 variants transmitted through blood transfusion but the establishing of new infections was initiated by a limited number of viruses. Positive selection (d(N)/d(S)>1) was detected in the viruses within each host in all time points. In the intra-host viruses of the blood donor and of one blood recipient, X4 variants appeared respectively in 1993 and 1989. In both patients X4 variants never reached high frequencies during infection time. The recipient, who X4 variants appeared, developed AIDS but kept narrow and constant immune response against HIV-1 during the infection time. CONCLUSION: Slowing rates of adaptive evolution and increasing diversity in HIV-1 are consequences of the CD4+ T cells depletion. The dynamic of R5 to X4 shift is not associated with the initial amplitude of humoral immune response or intensity of positive selection. |
Results from a large-scale epidemiologic look-back investigation of improperly reprocessed endoscopy equipment
Holodniy M , Oda G , Schirmer PL , Lucero CA , Khudyakov YE , Xia G , Lin Y , Valdiserri R , Duncan WE , Davey VJ , Cross GM . Infect Control Hosp Epidemiol 2012 33 (7) 649-56 OBJECTIVE: To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission. DESIGN: Retrospective cohort study. SETTING: Four Veterans Affairs medical centers (VAMCs). PATIENTS: Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009. METHODS: Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness. RESULTS: Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%. CONCLUSIONS: Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown. |
Trends in Candida central line-associated bloodstream infections among NICUs, 1999-2009
Chitnis AS , Magill SS , Edwards JR , Chiller TM , Fridkin SK , Lessa FC . Pediatrics 2012 130 (1) e46-52 OBJECTIVES: To assess trends in incidence of Candida spp. central line-associated bloodstream infections (CLABSIs) in US NICUs, 1999-2009. METHODS: Data from NICUs participating in the National Nosocomial Infections Surveillance (1999-2004) and National Healthcare Safety Network (2006-2009) were analyzed. Overall and birth weight-specific incidence rates of Candida spp. CLABSIs per 1000 central line-days were calculated. Trends in incidence were assessed by using Poisson regression, and trends in proportion of CLABSIs identified as Candida albicans were assessed by using weighted-linear regression. RESULTS: Overall, 398 NICUs reported 1407 Candida spp. CLABSIs (706 due to C albicans) among 1400 neonates. Of the 1400 neonates, 963 (69%) were ≤1000 g at the time of birth, and 182 (13%) died. From 1999 to 2009, the overall incidence decreased significantly for CLABSIs due to Candida spp. (0.92 vs 0.2), C albicans (0.53 vs 0.09), and non-albicans Candida spp. (0.39 vs 0.1). Birth weight-specific incidence significantly decreased across all birth weight categories for C albicans. For CLABSIs due to non-albicans Candida spp., significant decreases were detected among all birth weight categories, except among neonates 1501 to 2500 g. The proportion of Candida spp. CLABSIs due to C albicans did not significantly change over time, remaining at approximately 50%. CONCLUSIONS: Incidence of Candida spp. CLABSIs decreased substantially among NICU patients, regardless of birth weight. Decreases in incidence across all birth weight categories, and not only among neonates ≤1000 g in whom antifungal prophylaxis may be more common, suggest that multiple factors contributed to the declining incidence. |
Serogroup A meningococcal conjugate vaccination in Burkina Faso: analysis of national surveillance data
Novak RT , Kambou JL , Diomande FV , Tarbangdo TF , Ouedraogo-Traore R , Sangare L , Lingani C , Martin SW , Hatcher C , Mayer LW , Laforce FM , Avokey F , Djingarey MH , Messonnier NE , Tiendrebeogo SR , Clark TA . Lancet Infect Dis 2012 12 (10) 757-64 BACKGROUND: An affordable, highly immunogenic Neisseria meningitidis serogroup A meningococcal conjugate vaccine (PsA-TT) was licensed for use in sub-Saharan Africa in 2009. In 2010, Burkina Faso became the first country to implement a national prevention campaign, vaccinating 11.4 million people aged 1-29 years. We analysed national surveillance data around PsA-TT introduction to investigate the early effect of the vaccine on meningitis incidence and epidemics. METHODS: We examined national population-based meningitis surveillance data from Burkina Faso using two sources, one with cases and deaths aggregated at the district level from 1997 to 2011, and the other enhanced with results of cerebrospinal fluid examination and laboratory testing from 2007 to 2011. We compared mortality rates and incidence of suspected meningitis, probable meningococcal meningitis by age, and serogroup-specific meningococcal disease before and during the first year after PsA-TT implementation. We assessed the risk of meningitis disease and death between years. FINDINGS: During the 14 year period before PsA-TT introduction, Burkina Faso had 148 603 cases of suspected meningitis with 17 965 deaths, and 174 district-level epidemics. After vaccine introduction, there was a 71% decline in risk of meningitis (hazard ratio 0.29, 95% CI 0.28-0.30, p<0.0001) and a 64% decline in risk of fatal meningitis (0.36, 0.33-0.40, p<0.0001). We identified a statistically significant decline in risk of probable meningococcal meningitis across the age group targeted for vaccination (62%, cumulative incidence ratio [CIR] 0.38, 95% CI 0.31-0.45, p<0.0001), and among children aged less than 1 year (54%, 0.46, 0.24-0.86, p=0.02) and people aged 30 years and older (55%, 0.45, 0.22-0.91, p=0.003) who were ineligible for vaccination. No cases of serogroup A meningococcal meningitis occurred among vaccinated individuals, and epidemics were eliminated. The incidence of laboratory-confirmed serogroup A N meningitidis dropped significantly to 0.01 per 100,000 individuals per year, representing a 99.8% reduction in the risk of meningococcal A meningitis (CIR 0.002, 95% CI 0.0004-0.02, p<0.0001). INTERPRETATION: Early evidence suggests the conjugate vaccine has substantially reduced the rate of meningitis in people in the target age group, and in the general population because of high coverage and herd immunity. These data suggest that fully implementing the PsA-TT vaccine could end epidemic meningitis of serogroup A in sub-Saharan Africa. FUNDING: None. |
Frequency of alternative immunization schedule use in a metropolitan area
Robison SG , Groom H , Young C . Pediatrics 2012 130 (1) 32-8 OBJECTIVES: Recent studies have described an increase in parental hesitancy regarding vaccines as well as increases in parental adoption of vaccine schedules that delay or limit receipt of recommended vaccines. This study quantifies potential prevalence and trends in alternative schedule compliance by measuring consistent shot-limiting in a metropolitan area of Oregon. METHODS: Retrospective cohort analysis using the Oregon ALERT Immunization Information System to track children born between 2003 and 2009 in the Portland metropolitan area. Joinpoint regression was used to analyze prevalence trends in consistent shot-limiting during that time period. The 2007-2009 Haemophilus influenzae type b vaccine shortage and increased availability of combination vaccines were also examined for their effects on shot-limiting rates. RESULTS: A total of 4502 of 97,711 (4.6%) children met the definition of consistent shot-limiters. The proportion of consistent shot-limiters in the population increased from 2.5% to 9.5% between 2006 and 2009. Compared with those with no or episodic limiting, consistent shot-limiters by 9 months of age had fewer injections (6.4 vs 10.4) but more visits when immunizations were administered (4.2 vs 3.3). However, only a small minority of shot-limiters closely adhered to published alternative schedules. CONCLUSIONS: The percentage of children consistently receiving 2 or fewer vaccine injections per visit between birth and age 9 months increased threefold within a 2-year period, suggesting an increase in acceptance of non-Advisory Committee on Immunization Practices vaccine schedules in this geographic area. |
Health-related quality of life in the CDC Human Anthrax Vaccine Adsorbed Clinical Trial
Stewart B , Rose CE , Tokars JI , Martin SW , Keitel WA , Keyserling HL , Babcock J , Parker SD , Jacobson RM , Poland GA , McNeil MM . Vaccine 2012 30 (40) 5875-9 BACKGROUND: After the Department of Defense implemented a mandatory anthrax vaccination program in 1998 concerns were raised about potential long-term safety effects of the current anthrax vaccine. The CDC multicenter, randomized, double-blind, placebo-controlled Anthrax Vaccine Adsorbed (AVA) Human Clinical Trial to evaluate route change and dose reduction collected data on participants' quality of life. Our objective is to assess the association between receipt of AVA and changes in health-related quality of life, as measured by the SF-36 health survey (Medical Outcomes Trust, Boston, MA), over 42 months after vaccination. METHODS: 1562 trial participants completed SF-36v2 health surveys at 0, 12, 18, 30 and 42 months. Physical and mental summary scores were obtained from the survey results. We used Generalized Estimating Equations (GEE) analyses to assess the association between physical and mental score difference from baseline and seven study groups receiving either AVA at each dose, saline placebo at each dose, or a reduced AVA schedule substituting saline placebo for some doses. RESULTS: Overall, mean physical and mental scores tended to decrease after baseline. However, we found no evidence that the score difference from baseline changed significantly differently between the seven study groups. CONCLUSIONS: These results do not favor an association between receipt of AVA and an altered health-related quality of life over a 42-month period. |
Assessing the interest to participate in a dengue vaccine efficacy trial among residents of Puerto Rico
Guerra CL , Rodriguez-Acosta R , Soto-Gomez E , Zielinski-Gutierrez E , Pena-Orellana M , Santiago L , Rivera R , Cruz RR , Ramirez V , Tomashek K , Dayan G . Hum Vaccin Immunother 2012 8 (7) 905-15 Dengue, endemic in Puerto Rico, is a major public health problem. Vaccines are thought the best means to prevent dengue because vector control alone has been largely ineffective. We implemented qualitative studies in 2006 and 2010 to determine the acceptability of conducting placebo-controlled dengue vaccine efficacy trials in Puerto Rican children. Key informant interviews and focus groups with parents and children were conducted in municipalities with high dengue incidence. We used structured open-ended questions to determine motivators and attitudes regarding vaccine trial participation. Knowledge about dengue risk and prevention, and knowledge, attitudes, and beliefs regarding vaccines and vaccine trials were assessed. Using grounded theory, we conducted content analysis and established categories and sub-categories of participant responses. All participants were knowledgeable about dengue prevention and perceived children as most affected age groups. Participants were aware of vaccines benefits and they thought a vaccine could prevent dengue. However, most would not allow their children to participate in a placebo-controlled vaccine trial. Barriers included lack of trust in new vaccines and vaccine trial procedures; fear of developing dengue or side effects from the vaccine and lack of information about candidate dengue vaccines. Participants thought information, including results of previous trials might overcome barriers to participation. Motivators for participation were altruism, protection from dengue, free medical attention, and compensation for transportation and participation. Parents would consider children participation if accurate vaccine trial information is provided. |
Mental health survey among landmine survivors in Siem Reap province, Cambodia
Cardozo BL , Blanton C , Zalewski T , Tor S , McDonald L , Lavelle J , Brooks R , Anderson M , Mollica R . Med Confl Surviv 2012 28 (2) 161-181 Many survivors of the Khmer Rouge period in Cambodia and the subsequent war with Vietnam have now returned to Cambodia. In this two-stage household cluster survey in Siem Reap Province in Cambodia, we explored the mental health consequences on 166 landmine injury survivors selected from 1000 household in 50 clusters and an oversample of all landmine survivors. We found a prevalence of anxiety of 62% for all respondents, 74% for depression, and 34% for post-traumatic stress disorder (PTSD). These prevalences were statistically significantly higher than among the adult population who had not been injured by landmines. These data underscore the importance of providing mental health care services for the people in Siem Reap Province in Cambodia who have been injured by landmines. |
A naturally occurring mutation within the probe-binding region compromises a molecular-based West Nile virus surveillance assay for mosquito pools (Diptera: Culicidae).
Brault AC , Fang Y , Dannen M , Anishchenko M , Reisen WK . J Med Entomol 2012 49 (4) 939-941 A naturally occurring mutation was detected within the probe binding region targeting the envelope gene sequence of West Nile virus used in real-time polymerase chain reaction assays to test mosquito pools and other samples. A single C->T transition 6nt from the 5' end of the 16 mer in the envelope gene probe-binding region at genomic position 1,194 reduced assay sensitivity. The mutation first was detected in 2009 and persisted at a low prevalence into 2011. The mutation caused a 0.4% false negative error rate during 2011. These data emphasized the importance of confirmational testing and redundancy in surveillance systems relying on highly specific nucleic acid detection platforms. |
Localization and structural analysis of a conserved pyruvylated epitope in Bacillus anthracis secondary cell wall polysaccharides and characterization of the galactose-deficient wall polysaccharide from avirulent B. anthracis CDC 684
Forsberg LS , Abshire TG , Friedlander A , Quinn CP , Kannenberg EL , Carlson RW . Glycobiology 2012 22 (8) 1103-17 Bacillus anthracis CDC 684 is a naturally occurring, avirulent variant and close relative of the highly pathogenic B. anthracis Vollum. Bacillus anthracis CDC 684 contains both virulence plasmids, pXO1 and pXO2, yet is non-pathogenic in animal models, prompting closer scrutiny of the molecular basis of attenuation. We structurally characterized the secondary cell wall polysaccharide (SCWP) of B. anthracis CDC 684 (Ba684) using chemical and NMR spectroscopy analysis. The SCWP consists of a HexNAc trisaccharide backbone having identical structure as that of B. anthracis Pasteur, Sterne and Ames, -->4)-beta-d-ManpNAc-(1 --> 4)-beta-d-GlcpNAc-(1 --> 6)-alpha-d-GlcpNAc-(1-->. Remarkably, although the backbone is fully polymerized, the SCWP is the devoid of all galactosyl side residues, a feature which normally comprises 50% of the glycosyl residues on the highly galactosylated SCWPs from pathogenic strains. This observation highlights the role of defective wall assembly in virulence and indicates that polymerization occurs independently of galactose side residue attachment. Of particular interest, the polymerized Ba684 backbone retains the substoichiometric pyruvate acetal, O-acetate and amino group modifications found on SCWPs from normal B. anthracis strains, and immunofluorescence analysis confirms that SCWP expression coincides with the ability to bind the surface layer homology (SLH) domain containing S-layer protein extractable antigen-1. Pyruvate was previously demonstrated as part of a conserved epitope, mediating SLH-domain protein attachment to the underlying peptidoglycan layer. We find that a single repeating unit, located at the distal (non-reducing) end of the Ba684 SCWP, is structurally modified and that this modification is present in identical manner in the SCWPs of normal B. anthracis strains. These polysaccharides terminate in the sequence: (S)-4,6-O-(1-carboxyethylidene)-beta-d-ManpNAc-(1 --> 4)-[3-O-acetyl]-beta-d-GlcpNAc-(1 --> 6)-alpha-d-GlcpNH(2)-(1-->. |
Manipulation of immunodominant dengue virus E protein epitopes reduces potential antibody-dependent enhancement
Hughes HR , Crill WD , Chang GJ . Virol J 2012 9 (1) 115 BACKGROUND: Dengue viruses (DENV) are the most important arboviruses of humans and cause significant disease. Infection with DENV elicits antibody responses to the envelope glycoprotein, predominantly against immunodominant, cross-reactive, weakly-neutralizing epitopes. These weakly-neutralizing antibodies are implicated in enhancing infection via Fcgamma receptor bearing cells and can lead to increased viral loads that are associated with severe disease. Here we describe results from the development and testing of cross-reactivity reduced DENV-2 DNA vaccine candidates that contain substitutions in immunodominant B cell epitopes of the fusion peptide and domain III of the envelope protein. RESULTS: Cross-reactivity reduced and wild-type vaccine candidates were similarly immunogenic in outbred mice and elicited high levels of neutralizing antibody, however mice immunized with cross-reactivity reduced vaccines produced significantly reduced levels of immunodominant cross-reactive antibodies. Sera from mice immunized with wild-type, fusion peptide-, or domain III- substitution containing vaccines enhanced heterologous DENV infection in vitro, unlike sera from mice immunized with a vaccine containing a combination of both fusion peptide and domain III substitutions. Passive transfer of immune sera from mice immunized with fusion peptide and domain III substitutions also reduced the development of severe DENV disease in AG129 mice when compared to mice receiving wild type immune sera. CONCLUSIONS: Reducing cross-reactivity in the envelope glycoprotein of DENV may be an approach to improve the quality of the anti-DENV immune response. |
Monotonic bayesian semiparametric benchmark dose analysis
Wheeler M , Bailer AJ . Risk Anal 2012 32 (7) 1207-18 Quantitative risk assessment proceeds by first estimating a dose-response model and then inverting this model to estimate the dose that corresponds to some prespecified level of response. The parametric form of the dose-response model often plays a large role in determining this dose. Consequently, the choice of the proper model is a major source of uncertainty when estimating such endpoints. While methods exist that attempt to incorporate the uncertainty by forming an estimate based upon all models considered, such methods may fail when the true model is on the edge of the space of models considered and cannot be formed from a weighted sum of constituent models. We propose a semiparametric model for dose-response data as well as deriving a dose estimate associated with a particular response. In this model formulation, the only restriction on the model form is that it is monotonic. We use this model to estimate the dose-response curve from a long-term cancer bioassay, as well as compare this to methods currently used to account for model uncertainty. A small simulation study is conducted showing that the method is superior to model averaging when estimating exposure that arises from a quantal-linear dose-response mechanism, and is similar to these methods when investigating nonlinear dose-response patterns. |
Field application of the Nanoparticle Emission Assessment Technique (NEAT): task-based air monitoring during the processing of engineered nanomaterials (ENM) at four facilities
Methner M , Beaucham C , Crawford C , Hodson L , Geraci C . J Occup Environ Hyg 2012 9 (9) 543-55 In early 2006, the National Institute for Occupational Safety and Health created a field research team whose mission is to visit a variety of facilities engaged in the production, handling, or use of engineered nanomaterials (ENMs) and to conduct initial emission and exposure assessments to identify candidate sites for further study. To conduct the assessments, the team developed the Nanoparticle Emission Assessment Technique (NEAT), which has been used at numerous facilities to sample multiple engineered nanomaterials. Data collected at four facilities, which volunteered to serve as test sites, indicate that specific tasks can release ENMs to the workplace atmosphere and that traditional controls such as ventilation can be used to limit exposure. Metrics such as particle number concentration (adjusted for background), airborne mass concentration, and qualitative transmission electron microscopy were used to determine the presence, nature, and magnitude of emissions and whether engineered nanomaterials migrated to the workers' breathing zone. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a PDF file containing information on facilities, a description of processes/tasks, existing controls, and sampling strategy, and a PDF file containing TEM images according to facility and task.]. |
Biochemical, serological, and virulence characterization of clinical and oyster Vibrio parahaemolyticus isolates
Jones JL , Ludeke CH , Bowers JC , Garrett N , Fischer M , Parsons MB , Bopp CA , Depaola A . J Clin Microbiol 2012 50 (7) 2343-52 In this study, 77 clinical and 67 oyster Vibrio parahaemolyticus isolates from North America were examined for biochemical profiles, serotype, and the presence of potential virulence factors (tdh, trh, and type III secretion system [T3SS] genes). All isolates were positive for oxidase, indole, and glucose fermentation, consistent with previous reports. The isolates represented 35 different serotypes, 9 of which were shared by clinical and oyster isolates. Serotypes associated with pandemic strains (O1:KUT, O1:K25, O3:K6, and O4:K68) were observed for clinical isolates, and 7 (9%) oyster isolates belonged to serotype O1:KUT. Of the clinical isolates, 27% were negative for tdh and trh, while 45% contained both genes. Oyster isolates were preferentially selected for the presence of tdh and/or trh; 34% contained both genes, 42% had trh but not tdh, and 3% had tdh but not trh. All but 1 isolate (143/144) had at least three of the four T3SS1 genes examined. The isolates lacking both tdh and trh contained no T3SS2alpha or T3SS2beta genes. All clinical isolates positive for tdh and negative for trh possessed all T3SS2alpha genes, and all isolates negative for tdh and positive for trh possessed all T3SS2beta genes. The two oyster isolates containing tdh but not trh possessed all but the vopB2 gene of T3SS2alpha, as reported previously. In contrast to the findings of previous studies, all strains examined that were positive for both tdh and trh also carried T3SS2beta genes. This report identifies the serotype as the most distinguishing feature between clinical and oyster isolates. Our findings raise concerns about the reliability of the tdh, trh, and T3SS genes as virulence markers and highlight the need for more-detailed pathogenicity investigations of V. parahaemolyticus. |
Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006
Creanga AA , Berg CJ , Syverson C , Seed K , Bruce FC , Callaghan WM . Obstet Gynecol 2012 120 261-8 OBJECTIVE: To compare trends in and causes of pregnancy-related mortality by race, ethnicity, and nativity from 1993 to 2006. METHODS: We used data from the Pregnancy Mortality Surveillance System. For each race, ethnicity, and nativity group, we calculated pregnancy-related mortality ratios and assessed causes of pregnancy-related death and the time between the end of pregnancy and death. RESULTS: Race, ethnicity, and nativity-related minority women contributed 40.7% of all U.S. live births but 61.8% of the 7,487 pregnancy-related deaths during 1993-2006. Pregnancy-related mortality ratios were 9.1 and 7.5 deaths per 100,000 live births among U.S.- and foreign-born white women, respectively, and slightly higher at 9.6 and 11.6 deaths per 100,000 live births for U.S.- and foreign-born Hispanic women, respectively. Relative to U.S.-born white women, age-standardized pregnancy-related mortality ratios were 5.2 and 3.6 times higher among U.S.- and foreign-born black women, respectively. However, causes and timing of death within 42 days postpartum were similar for U.S.-born white and black women with cardiovascular disease, cardiomyopathy, and other pre-existing medical conditions emerging as chief contributors to mortality. Hypertensive disorders, hemorrhage, and embolism were the most important causes of pregnancy-related death for all other groups of women. CONCLUSION: Except for foreign-born white women, all other race, ethnicity, and nativity groups were at higher risk of dying from pregnancy-related causes than U.S.-born white women after adjusting for age differences. Integration of quality-of-care aspects into hospital- and state-based maternal death reviews may help identify race, ethnicity, and nativity-specific factors for pregnancy-related mortality. LEVEL OF EVIDENCE: III. |
Intended and unintended births in the United States: 1982-2010
Mosher WD , Jones J , Abma JC . Natl Health Stat Report 2012 55 (55) 1-28 OBJECTIVES: This report shows trends since 1982 in whether a woman wanted to get pregnant just before the pregnancy occurred. This is the most direct measure available of the extent to which women are able (or unable) to choose to have the number of births they want, when they want them. In this report, this is called the "standard measure of unintended pregnancy." METHODS: The data used in this report are primarily from the 2006-2010 National Survey of Family Growth (NSFG), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. The 2006-2010 NSFG included in-person interviews with 12,279 women aged 15-44. Some data in the trend analyses are taken from NSFG surveys conducted in 1982, 1988, 1995, and 2002. RESULTS: About 37% of births in the United States were unintended at the time of conception. The overall proportion unintended has not declined significantly since 1982. The proportion unintended did decline significantly between 1982 and 2006-2010 among births to married, non-Hispanic white women. Large differences exist between groups in the percentage of births that are unintended. For example, unmarried women, black women, and women with less education or income are still much more likely to experience unintended births compared with married, white, college-educated, and high-income women. This report also describes some alternative measures of unintended births that give researchers an opportunity to study this topic in new ways. |
Association between maternal age and birth defects of unknown etiology - United States, 1997-2007
Gill SK , Broussard C , Devine O , Green RF , Rasmussen SA , Reefhuis J . Birth Defects Res A Clin Mol Teratol 2012 94 (12) 1010-8 BACKGROUND: Birth defects affect 3% of babies born, and are one of the leading causes of infant mortality. Both younger and older maternal age may pose increased risks for certain birth defects. This study assessed the relationship between maternal age at the estimated delivery date and the risk for birth defects. METHODS: Data were obtained from the National Birth Defects Prevention Study, a population-based case-control study including mothers across 10 states. Maternal age was stratified into six categories: <20, 20 to 24, 25 to 29, 30 to 34, 35 to 39, and ≥40 years, and also analyzed as a continuous variable. Logistic regression models adjusted formaternal race/ethnicity, education, body mass index (BMI), folic acid use, smoking, gravidity, and parental age difference were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: For maternal age <20 years, associations with total anomalous pulmonary venous return (aOR, 2.3; 95% CI, 1.3-4.0), amniotic band sequence (aOR, 2.4; 95% CI, 1.5-3.8), and gastroschisis (aOR, 6.1; 95% CI, 4.8-8.0) were observed. For the ≥40 year age group, associations with several cardiac defects, esophageal atresia (aOR, 2.9; 95% CI, 1.7-4.9), hypospadias (aOR, 2.0; 95% CI, 1.4-3.0), and craniosynostosis (aOR, 1.6; 95% CI, 1.1-2.4) were observed. Results using maternal age as a continuous variable were consistent with those that used categorized maternal age. CONCLUSION: Elucidating risk factors specific to women ateither extreme of maternal age may offer prevention opportunities. All women should be made aware of prevention opportunities, such as folic acid supplementation, to reduce the occurrence of birth defects. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Associations between three characteristics of parent-youth relationships, youth substance use, and dating attitudes
Tharp AT , Noonan RK . Health Promot Pract 2012 13 (4) 515-23 Various dimensions of parenting have been associated with youth risk behaviors, such as substance use and dating violence. These associations have spawned many prevention strategies that focus on parenting. However, it is unclear which characteristics of parent-youth relationships, and thus, which parent-focused prevention strategies, may be most influential in youth risk behaviors and, thus, which should be targeted in prevention. Using responses from the YouthStyles 2007 survey (N = 1,357), this study identified three youth-reported parent-youth relationship characteristics: communication about risk behaviors, closeness/respect, and rules/monitoring. The authors examined the associations among these characteristics and youths' demographics, attitudes supporting controlling dating relationships, and use of alcohol, marijuana, and tobacco. Results suggested risk behavior communication was more frequently reported by girls and was more frequent among older youth. Closeness/respect and rules/monitoring were more frequent among younger youth. Regressions suggested communication about risk behaviors was not a predictor of attitudes supporting controlling dating relationships but was a significant predictor of substance use, closeness/respect and rules/monitoring predicted substance nonuse and attitudes unsupportive of controlling dating relationships. The findings suggest that parental communication alone may not be sufficient to influence youth risk taking, but that parental monitoring and the establishment of respectful, close relationships with children may be important elements of parent-focused health promotion efforts. |
Summary of an NIH workshop to identify research needs to improve the monitoring of iodine status in the United States and to inform the DRI
Swanson CA , Zimmermann MB , Skeaff S , Pearce EN , Dwyer JT , Trumbo PR , Zehaluk C , Andrews KW , Carriquiry A , Caldwell KL , Egan SK , Long SE , Bailey RL , Sullivan KM , Holden JM , Betz JM , Phinney KW , Brooks SP , Johnson CL , Haggans CJ . J Nutr 2012 142 (6) 1175S-85S The Office of Dietary Supplements (ODS) at the NIH sponsored a workshop on May 12-13, 2011, to bring together representatives from various NIH institutes and centers as a first step in developing an NIH iodine research initiative. The workshop also provided an opportunity to identify research needs that would inform the dietary reference intakes for iodine, which were last revised in 2001. Iodine is required throughout the life cycle, but pregnant women and infants are the populations most at risk of deficiency, because iodine is required for normal brain development and growth. The CDC monitors iodine status of the population on a regular basis, but the status of the most vulnerable populations remains uncertain. The NIH funds very little investigator-initiated research relevant to iodine and human nutrition, but the ODS has worked for several years with a number of other U.S. government agencies to develop many of the resources needed to conduct iodine research of high quality (e.g., validated analytical methods and reference materials for multiple types of samples). Iodine experts, scientists from several U.S. government agencies, and NIH representatives met for 2 d to identify iodine research needs appropriate to the NIH mission. |
Use of lipid-based nutrient supplements by HIV-infected Malawian women during lactation has no effect on infant growth from 0 to 24 weeks
Flax VL , Bentley ME , Chasela CS , Kayira D , Hudgens MG , Knight RJ , Soko A , Jamieson DJ , van der Horst CM , Adair LS . J Nutr 2012 142 (7) 1350-6 The Breastfeeding, Antiretrovirals, and Nutrition Study evaluated the effect of daily consumption of lipid-based nutrient supplements (LNS) by 2121 lactating, HIV-infected mothers on the growth of their exclusively breast-fed, HIV-uninfected infants from 0 to 24 wk. The study had a 2 x 3 factorial design. Malawian mothers with CD4(+) ≥250 cells/mm(3), hemoglobin ≥70 g/L, and BMI ≥17 kg/m(2) were randomized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs, and mother-infant pairs were assigned to maternal antiretroviral drugs (ARV), infant ARV, or no ARV. Sex-stratified, longitudinal, random effects models were used to estimate the effect of the 6 study arms on infant weight, length, and BMI. Logistic regression models were used to calculate the odds of growth faltering [decline in weight-for-age Z-score (WAZ) or length-for-age Z-score (LAZ) >0.67] using the control arm as the reference. Although some differences between study arms emerged with increasing infant age in boys, there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models. At the ages where differences were observed, the effects on weight and BMI were quite small (≤200 g and ≤0.4 kg/m(2)) and unlikely to be of clinical importance. Overall, 21 and 34% of infants faltered in WAZ and LAZ, respectively. Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm. These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth. |
Respiratory disease among flavoring-exposed workers in food and flavoring manufacture
Kreiss K . Clin Pulm Med 2012 19 (4) 165-173 Fixed airways obstruction was found in workers producing microwave popcorn in relation to inhaling synthetic butter flavoring volatiles in 2000. Since then, an industry-wide hazard of clinical bronchiolitis obliterans was found in other microwave-popcorn plants, in flavoring manufacture, and in diacetyl (2,3-butanedione) manufacture. Recently, workers in 1 food production and 1 flavoring manufacturing facility have had excesses of spirometric restrictive abnormalities. Evidence of flavoring-related excessive declines in forced expiratory volume in 1 second (FEV1) suggests that restriction in the latter flavoring plant is work-related. However, the pathologic and physiological correlates of restriction in flavoring-exposed workers remain uninvestigated. Diacetyl vapor causes respiratory epithelial necrosis in rodents, compatible with the pathologic mechanism for constrictive bronchiolitis, but exposures in flavoring manufacturing are more diverse than diacetyl. The diacetyl substitute, 2,3-pentanedione, has comparable toxicity to diacetyl, and other members of the alpha-diketone family have not been evaluated for respiratory toxicity. With the increasing spectrum of flavoring-related lung diseases and chemical exposures, pulmonologists caring for flavoring-exposed workers have novel challenges. These include examining excessive FEV1 declines in serial spirometry and improving surveillance spirometry quality so that excessive declines can be detected at an earlier stage. The best means of preventing permanent impairment from irreversible occupational lung disease is to intervene for workers with excessive FEV1 decline within the normal range and before diagnostic criteria for occupational lung disease can be met. Regulation of diacetyl and 2,3-pentanedione, which does not yet exist, may not prevent all occupational lung disease in flavoring-exposed workers. (Copyright 2012 by Lippincott Williams & Wilkins.) |
Workplace violence prevention for healthcare workers-an online course
Hartley D , Ridenour M , Craine J , Costa B . Rehabil Nurs 2012 37 (4) 202-6 PURPOSE: Workplace assaults against healthcare workers originate from many sources, but are predominantly committed by patients. Therefore, training in strategies for preventing patient-on-nurse violence is very important throughout a nurse's career. METHODS: The online course described in this article presents prevention strategies from the institutional and individual levels. These are reinforced by video case studies of five real-life incidents with key learning points discussed. RESULTS: The physical and psychological consequences of workplace assaults can result in higher absenteeism, increased turnover, decreased job satisfaction, lower productivity, and a host of other negative outcomes. DISCUSSION: Preventing these negative outcomes is beneficial to the nurse, the patients, and the organization. This course provides a convenient interactive tool that uses units approximately 20 minutes in duration with stop and pick up where you left off capabilities. CONCLUSION: The free online course will be available starting in the summer or fall of 2012. |
Exposure limits for nanoparticles: report of an international workshop on nano reference values
Van Broekhuizen P , Van Veelen W , Streekstra WH , Schulte P , Reijnders L . Ann Occup Hyg 2012 56 (5) 515-24 This article summarizes the outcome of the discussions at the international workshop on nano reference values (NRVs), which was organized by the Dutch trade unions and employers' organizations and hosted by the Social Economic Council in The Hague in September 2011. It reflects the discussions of 80 international participants representing small- and medium-size enterprises (SMEs), large companies, trade unions, governmental authorities, research institutions, and non-governmental organizations (NGOs) from many European countries, USA, India, and Brazil. Issues that were discussed concerned the usefulness and acceptability of precaution-based NRVs as a substitute for health-based occupational exposure limits (OELs) and derived no-effect levels (DNELs) for manufactured nanoparticles (NPs). Topics concerned the metrics for measuring NPs, the combined exposure to manufactured nanomaterials (MNMs) and process-generated NPs, the use of the precautionary principle, the lack of information about the presence of nanomaterials, and the appropriateness of soft regulation for exposure control. The workshop concluded that the NRV, as an 8-h time-weighted average, is a comprehensible and useful instrument for risk management of professional use of MNMs with a dispersible character. The question remains whether NRVs, as advised for risk management by the Dutch employers' organization and trade unions, should be under soft regulation or that a more binding regulation is preferable. |
Exposures to pharmaceutical dust at a mail order pharmacy
Fent KW , Durgam S . J Occup Environ Hyg 2012 9 (9) D161-6 Mail order pharmacies are the fastest growing sector of the U.S. prescription drug retail market. In 2004, they accounted for 6.1% of all prescriptions filled, which was an 18% increase over the previous year.(1) Although large volumes of prescriptions are filled at mail order pharmacies, the potential for employee exposures to pharmaceutical dust has not been fully evaluated. In 2010, the National Institute for Occupational Safety and Health (NIOSH) received a health hazard evaluation request from managers at a mail order pharmacy concerning potential pharmaceutical dust exposures to employees. | The mail order pharmacy was divided into two areas: (1) the pharmacy, where automatic dispensing machines were located and most prescriptions were filled, and (2) the warehouse, where other activities such as manual counting and replenishment of canisters were performed. Two brands of automatic dispensing machines were used for filling high throughput prescriptions: Baker (one large customized machine made by McKesson Corporation, San Francisco, Calif.) and Optifill (two smaller customized machines made by AmerisourceBergen, Valley Forge, Pa.). All three machines used gravity to dispense pharmaceutical tablets and capsules. |
Genetic characterization of atypical Mansonella (Mansonella) ozzardi microfilariae in human blood samples from northeastern Peru.
Marcos LA , Arrospide N , Recuenco S , Cabezas C , Weil GJ , Fischer PU . Am J Trop Med Hyg 2012 87 (3) 491-4 DNA sequence comparisons are useful for characterizing proposed new parasite species or strains. Microfilariae with an atypical arrangement of nuclei behind the cephalic space have been recently described in human blood samples from the Amazon region of Peru. Three blood specimens containing atypical microfilariae were genetically characterized using three DNA markers (5S ribosomal DNA, 12S ribosomal DNA, and cytochrome oxidase I). All atypical microfilariae were clustered into the Mansonella group and indistinguishable from M. ozzardi based on these DNA markers. |
Imported malaria: an update
Nilles EJ , Arguin PM . Am J Emerg Med 2012 30 (6) 972-80 Evidence suggests that imported malaria is a diagnostic challenge with initial misdiagnosis rates of 40% or greater. Given that prompt diagnosis and appropriate treatment are the only intervention proven to prevent progression to severe malaria and death, these figures are concerning. The purpose of this clinical review is to provide the most up-to-date and practical information on the diagnosis and treatment of imported malaria for the emergency health care provider. We highlight common pitfalls, errors, and mistakes in arriving at the correct diagnosis. We also emphasize the 3 key aspects to avoid progression to severe disease: rapid diagnosis, prompt initiation of treatment, and appropriate choice of antimalarial treatment. |
Sport and exercise as contributors to the health of nations
Khan KM , Thompson AM , Blair SN , Sallis JF , Powell KE , Bull FC , Bauman AE . Lancet 2012 380 (9836) 59-64 Self-reported rates of participation in sport vary by country. In the UK, about 40% of men and women aged 16 years or older participate in at least one sport every week. Although few data exist to assess trends for participation in sport, there is little evidence of change in the past decade among adults. Large cohort studies suggest that such participation in sport is associated with a 20-40% reduction in all-cause mortality compared with non-participation. Randomised trials and crossover clinical studies suggest that playing sport is associated with specific health benefits. Some sports have relatively high injury risk although neuromuscular training programmes can prevent various lower extremity injuries. Clinicians can influence a large number of patients through brief interventions that promote physical activity, and encouragement toward participation in sport for some physically inactive patients qualifies as evidence-based therapy. Exercise might also be considered as a fifth vital sign and should be recorded in patients' electronic medical records and routine histories. |
Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy
Lee IM , Shiroma EJ , Lobelo F , Puska P , Blair SN , Katzmarzyk PT . Lancet 2012 380 (9838) 219-29 BACKGROUND: Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the effect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level. METHODS: For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population. FINDINGS: Worldwide, we estimate that physical inactivity causes 6% (ranging from 3.2% in southeast Asia to 7.8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3.9-9.6) of type 2 diabetes, 10% (5.6-14.1) of breast cancer, and 10% (5.7-13.8) of colon cancer. Inactivity causes 9% (range 5.1-12.5) of premature mortality, or more than 5.3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533,000 and more than 1.3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0.68 (range 0.41-0.95) years. INTERPRETATION: Physical inactivity has a major health effect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially. FUNDING: None. |
The implications of megatrends in information and communication technology and transportation for changes in global physical activity
Pratt M , Sarmiento OL , Montes F , Ogilvie D , Marcus BH , Perez LG , Brownson RC . Lancet 2012 380 (9838) 282-93 Physical inactivity accounts for more than 3 million deaths per year, most from non-communicable diseases in low-income and middle-income countries. We used reviews of physical activity interventions and a simulation model to examine how megatrends in information and communication technology and transportation directly and indirectly affect levels of physical activity across countries of low, middle, and high income. The model suggested that the direct and potentiating effects of information and communication technology, especially mobile phones, are nearly equal in magnitude to the mean effects of planned physical activity interventions. The greatest potential to increase population physical activity might thus be in creation of synergistic policies in sectors outside health including communication and transportation. However, there remains a glaring mismatch between where studies on physical activity interventions are undertaken and where the potential lies in low-income and middle-income countries for population-level effects that will truly affect global health. |
Local public health systems and the incidence of sexually transmitted diseases
Rodriguez HP , Chen J , Owusu-Edusei K , Suh A , Bekemeier B . Am J Public Health 2012 102 (9) 1773-81 OBJECTIVES: We examined the associations of local public health system organization and local health department resources with county-level sexually transmitted disease (STD) incidence rates in large US health jurisdictions. METHODS: We linked annual county STD incidence data (2005-2008) to local health department director responses (n = 211) to the 2006 wave of the National Longitudinal Study of Local Public Health Systems, the 2005 national Local Health Department Profile Survey, and the Area Resource File. We used nested mixed effects regression models to assess the relative contribution of local public health system organization, local health department financial and resource factors, and sociodemographic factors known to be associated with STD incidence to county-level (n = 307) STD incidence. RESULTS: Jurisdictions with local governing boards had significantly lower county-level STD incidence. Local public health systems with comprehensive services where local health departments shoulder much of the effort had higher county-level STD rates than did conventional systems. CONCLUSIONS: More integration of system partners in local public health system activities, through governance and interorganizational arrangements, may reduce the incidence and burden of STDs. (Am J Public Health. Published online ahead of print July 19, 2012: e1-e9. doi:10.2105/AJPH.2011.300497). |
Ethnic inequality in Guatemalan women's use of modern reproductive health care
Ishida K , Stupp P , Turcios-Ruiz R , William DB , Espinoza E . Int Perspect Sex Reprod Health 2012 38 (2) 99-108 CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services. METHODS: Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics. RESULTS: The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage. CONCLUSION: The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use. |
Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities
Cunningham TJ , Seeman TE , Kawachi I , Gortmaker SL , Jacobs DR , Kiefe CI , Berkman LF . Soc Sci Med 2012 75 (5) 922-31 Inflammation is etiologically implicated in cardiometabolic diseases for which there are known racial/ethnic disparities. Prior studies suggest there may be an association between self-reported experiences of racial/ethnic discrimination and inflammation, particularly C-reactive protein (CRP). It is not known whether that association is influenced by race/ethnicity and gender. In separate hierarchical linear models with time-varying covariates, we examined that association among 901 Black women, 614 Black men, 958 White women, and 863 White men in the Coronary Artery Risk Development in Young Adults (CARDIA) study in four US communities. Self-reported experiences of racial/ethnic discrimination were ascertained in 1992-93 and 2000-01. Inflammation was measured as log-transformed CRP in those years and 2005-06. All analyses were adjusted for blood pressure, plasma total cholesterol, triglycerides, homeostatic model assessment for insulin resistance (HOMA-IR), age, education, and community. Our findings extend prior research by suggesting that, broadly speaking, self-reported experiences of racial/ethnic discrimination are associated with inflammation; however, this association is complex and varies for Black and White women and men. Black women reporting 1 or 2 experiences of discrimination had higher levels of CRP compared to Black women reporting no experiences of discrimination (beta = 0.141, SE = 0.062, P < 0.05). This association was not statistically significant among Black women reporting 3 or more experiences of discrimination and not independent of modifiable risks (smoking and obesity) in the final model. White women reporting 3 or more experiences of discrimination had significantly higher levels of CRP compared to White women reporting no experiences of discrimination independent of modifiable risks in the final model (beta = 0.300, SE = 0.113, P < 0.01). The association between self-reported experiences of racial/ethnic discrimination and CRP was not statistically significant among Black and White men reporting 1 or 2 experiences of discrimination. Further research in other populations is needed. |
Health care providers' advice to quit smoking, National Health Interview Survey, 2000, 2005, and 2010
Kruger J , Shaw L , Kahende J , Frank E . Prev Chronic Dis 2012 9 E130 Although the prevalence of cigarette smoking has declined in the United States, little documentation exists to ascertain which health care providers (HCPs) promote smoking cessation. We used data from the 2000, 2005, and 2010 Cancer Control Supplement of the National Health Interview Survey to examine changes in the number of adults who received smoking cessation advice from their HCP. The percentage of smokers who received cessation advice was 53.3% in 2000, 58.9% in 2005, and 50.7% in 2010. To affect noticeably declining rates, HCPs should increase their efforts to advise smokers to quit. |
Deaths: leading causes for 2008
Heron M . Natl Vital Stat Rep 2012 60 (6) 1-94 OBJECTIVES: This report presents final 2008 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2008. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. RESULTS: in 2008, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for approximately 76 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2008 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Environmental Health
- Epidemiology and Surveillance
- Genetics and Genomics
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Physical Activity
- Public Health Leadership and Management
- Reproductive Health
- Social and Behavioral Sciences
- Substance Use and Abuse
- Vital Statistics
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