The use of antiplatelet agents for secondary prevention of ischemic stroke in U.S. ambulatory care settings
Niska R , Han B . J Health Care Poor Underserved 2009 20 (3) 831-9 INTRODUCTION: We examined stroke prevention with antiplatelet agents by U.S. nonfederal office physicians and hospital outpatient departments from 2005-2006. METHODS: The nationally representative dataset used a multistage (112 primary sampling units, physicians/ hospitals, patient medical records) random sample of 1,702 visits by patients 20 years or older with cerebrovascular disease (national estimate: 15.4 million annual visits). Dependent variable: use of antiplatelet agents for patients without contraindications. Independent variables: age, sex, race/ethnicity, payment, primary care provider, prior visits in last year, comorbidities. Logistic regression was used to investigate associations with recommended interventions. RESULTS: Antiplatelet agents were prescribed at 31.1% of visits. Positive predictors: seeing the patient's primary care provider and having five or more comorbidities. Negative predictors: non-Hispanic Black race/ethnicity and having six or more prior visits in the last year. CONCLUSION: Variations by visit characteristics suggest that improvement in using antiplatelet agents is possible, especially for non-Hispanic Black patients. |
Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack
Brackbill RM , Hadler JL , DiGrande L , Ekenga CC , Farfel MR , Friedman S , Perlman SE , Stellman SD , Walker DJ , Wu D , Yu S , Thorpe LE . JAMA 2009 302 (5) 502-16 CONTEXT: The World Trade Center Health Registry provides a unique opportunity to examine long-term health effects of a large-scale disaster. OBJECTIVE: To examine risk factors for new asthma diagnoses and event-related posttraumatic stress (PTS) symptoms among exposed adults 5 to 6 years following exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study with wave 1 (W1) enrollment of 71,437 adults in 2003-2004, including rescue/recovery worker, lower Manhattan resident, lower Manhattan office worker, and passersby eligibility groups; 46,322 adults (68%) completed the wave 2 (W2) survey in 2006-2007. MAIN OUTCOME MEASURES: Self-reported diagnosed asthma following September 11; event-related current PTS symptoms indicative of probable posttraumatic stress disorder (PTSD), assessed using the PTSD Checklist (cutoff score > or = 44). RESULTS: Of W2 participants with no stated asthma history, 10.2% (95% confidence interval [CI], 9.9%-10.5%) reported new asthma diagnoses postevent. Intense dust cloud exposure on September 11 was a major contributor to new asthma diagnoses for all eligibility groups: for example, 19.1% vs 9.6% in those without exposure among rescue/recovery workers (adjusted odds ratio, 1.5 [95% CI, 1.4-1.7]). Asthma risk was highest among rescue/recovery workers on the WTC pile on September 11 (20.5% [95% CI, 19.0%-22.0%]). Persistent risks included working longer at the WTC site, not evacuating homes, and experiencing a heavy layer of dust in home or office. Of participants with no PTSD history, 23.8% (95% CI, 23.4%-24.2%) reported PTS symptoms at either W1 (14.3%) or W2 (19.1%). Nearly 10% (9.6% [95% CI, 9.3%-9.8%]) had PTS symptoms at both surveys, 4.7% (95% CI, 4.5%-4.9%) had PTS symptoms at W1 only, and 9.5% (95% CI, 9.3%-9.8%) had PTS symptoms at W2 only. At W2, passersby had the highest rate of PTS symptoms (23.2% [95% CI, 21.4%-25.0%]). Event-related loss of spouse or job was associated with PTS symptoms at W2. CONCLUSION: Acute and prolonged exposures were both associated with a large burden of asthma and PTS symptoms 5 to 6 years after the September 11 WTC attack. |
Atypical aspergillus flavus isolates associated with chronic azole therapy
Brandt ME , Gade L , McCloskey CB , Balajee SA . J Clin Microbiol 2009 47 (10) 3372-5 A case of chronic sinus disease due to morphologically atypical Aspergillus flavus is described. Multiple fungal isolates sporulated poorly or not at all, displaying unusual color and microscopic morphology including the absence of typical vesicles and phialides, which caused the isolates to resemble several other fungal genera superficially. The patient received multiple antifungal therapies over at least 10 years with various azole drugs including voriconazole, itraconazole, and posaconazole. We speculate that the lengthy exposure to azole antifungal drugs may have caused or promoted the atypical morphology seen in these isolates. |
How are lifetime polytobacco users different than current cigarette-only users? Results from a Canadian young adult population
Bombard JM , Pederson LL , Koval JJ , O'Hegarty M . Addict Behav 2009 34 (12) 1069-72 Current cigarette smoking combined with ever use of other tobacco products (lifetime polytobacco use) is important to examine as users may be at greater risk for illicit drug use, nicotine addiction, and adverse health outcomes. We determined estimates and patterns of lifetime polytobacco use and conducted multivariable analyses to determine demographic, family and friend, psychosocial, and lifestyle factors associated with use among a sample of Canadian young adults. Overall prevalence was 36.3% for current cigarette use; 10.1% for current cigarette use only and 26.2% for lifetime polytobacco use. Among polytobacco users, current cigarette use and ever cigar use was most frequent (67.2%). For males, the final model contained demographic, family and friends, and lifestyle factors. For females, the final model also included psychosocial factors. Illicit drug use was the strongest significant predictor for lifetime polytobacco use among males. We found gender specific differences when comparing lifetime polytobacco users to current cigarette-only users, in particular; male lifetime polytobacco users were more likely to use drugs and alcohol. Interventions focusing on individual substances should consider addressing combinations of use. |
Systematic review: safety and efficacy of extended-duration antiviral chemoprophylaxis against pandemic and seasonal influenza
Khazeni N , Bravata DM , Holty JE , Uyeki TM , Stave CD , Gould MK . Ann Intern Med 2009 151 (7) 464-73 BACKGROUND: Neuraminidase inhibitors (NAIs) are stockpiled internationally for extended use in an influenza pandemic. PURPOSE: To evaluate the safety and efficacy of extended-duration (>4 weeks) NAI chemoprophylaxis against influenza. DATA SOURCES: Studies published in any language through 11 June 2009 identified by searching 10 electronic databases and 3 trial registries. STUDY SELECTION: Randomized, placebo-controlled, double-blind human trials of extended-duration NAI chemoprophylaxis that reported outcomes of laboratory-confirmed influenza or adverse events. DATA EXTRACTION: 2 reviewers independently assessed study quality and abstracted information from eligible studies. DATA SYNTHESIS: Of 1876 potentially relevant citations, 7 trials involving 7021 unique participants met inclusion criteria. Data were pooled by using random-effects models. Chemoprophylaxis with NAIs decreased the frequency of symptomatic influenza (relative risk [RR], 0.26 [95% CI, 0.18 to 0.37]; risk difference [RD], -3.9 percentage points [CI, -5.8 to -1.9 percentage points]) but not asymptomatic influenza (RR, 1.03 [CI, 0.81 to 1.30]; RD, -0.4 percentage point [CI, -1.6 to 0.9 percentage point]). Adverse effects were not increased overall among NAI recipients (RR, 1.01 [CI, 0.94 to 1.08]; RD, 0.1 percentage point [CI, -0.2 to 0.4 percentage point]), but nausea and vomiting were more common among those who took oseltamivir (RR, 1.48 [CI, 1.86 to 2.33]; RD, 1.7 percentage points [CI, 0.6 to 2.9 percentage points]). Prevention of influenza did not statistically significantly differ between zanamivir and oseltamivir. LIMITATIONS: All trials were industry-sponsored. No study was powered to detect rare adverse events, and none included diverse racial groups, children, immunocompromised patients, or individuals who received live attenuated influenza virus vaccine. CONCLUSION: Extended-duration zanamivir and oseltamivir chemoprophylaxis seems to be highly efficacious for preventing symptomatic influenza among immunocompetent white and Japanese adults. Extended-duration oseltamivir is associated with increased nausea and vomiting. Safety and efficacy in several subpopulations that might receive extended-duration influenza chemoprophylaxis are unknown. |
Chlamydia screening of young sexually active, Medicaid-insured women by race and ethnicity, 2002-2005
Christiansen-Lindquist L , Tao G , Hoover K , Frank R , Kent C . Sex Transm Dis 2009 36 (10) 642-6 OBJECTIVE: To estimate Chlamydia screening rates of young sexually active Medicaid-insured women by race and ethnicity and age from 2002 to 2005. METHODS: Using Medicaid child claims data from the MarketScan database, we estimated the proportion of sexually active women aged 15 to 21 years screened for Chlamydia by race and ethnicity and by age group (15-16, 17-18, and 19-21 years) using codes for medical diagnostic and procedural claims. RESULTS: Overall, Chlamydia screening increased from 34% in 2002 to 44% in 2005. In all years, black women had significantly higher screening rates compared with white women (e.g., 51% vs. 39% in 2005). When stratified by age, black women were still significantly more likely to be screened for Chlamydia than white women. CONCLUSIONS: Although it is encouraging that screening has increased over time and that black women were more likely to be screened than white women, rates remain suboptimal for all women. Effective and targeted interventions are needed to improve Chlamydia screening of young women. As interventions to increase screening are developed and implemented, the estimation method described in this article can be used to track Chlamydia screening trends in racial and ethnic populations over time. |
Demographic, psychological, and behavioral modifiers of the Antiretroviral Treatment Access Study (ARTAS) intervention
Gardner LI , Marks G , Craw J , Metsch L , Strathdee S , Anderson-Mahoney P , Del Rio C . AIDS Patient Care STDS 2009 23 (9) 735-42 The present study sought to identify demographic, structural, behavioral, and psychological subgroups for which the Antiretroviral Treatment Access Study (ARTAS) intervention had stronger or weaker effects in linking recently diagnosed HIV-positive persons to medical care. The study, carried out from 2001 to 2003, randomized 316 participants to receive either passive referral or a strengths-based linkage intervention to facilitate entry into HIV primary care. The outcome was attending at least one HIV primary care visit in each of two consecutive 6-month periods. Participants (71% male; 29% Hispanic; 57% black non-Hispanic), were recruited from sexually transmitted disease clinics, hospitals and community-based organizations in four U.S. cities. Thirteen effect modifier variables measured at baseline were examined. Subgroup differences were formally tested with interaction terms in unadjusted and adjusted log-linear regression models. Eighty-six percent (273/316) of participants had complete 12-month follow-up data. The intervention significantly improved linkage to care in 12 of 26 subgroups. In multivariate analysis of effect modification, the intervention was significantly (p < 0.05) stronger among Hispanics than other racial/ethnic groups combined, stronger among those with unstable than stable housing, and stronger among those who were not experiencing depressive symptoms compared to those who were. The ARTAS linkage intervention was successful in many but not all subgroups of persons recently diagnosed with HIV infection. For three variables, the intervention effect was significantly stronger in one subgroup compared to the counterpart subgroup. To increase its scope, the intervention may need to be tailored to the specific needs of groups that did not respond well to the intervention. |
Facemasks and hand hygiene to prevent influenza transmission in households: a randomized trial
Cowling BJ , Chan KH , Fang VJ , Cheng CK , Fung RO , Wai W , Sin J , Seto WH , Yung R , Chu DW , Chiu BC , Lee PW , Chiu MC , Lee HC , Uyeki TM , Houck PM , Peiris JS , Leung GM . Ann Intern Med 2009 151 (7) 437-46 BACKGROUND: Few data are available about the effectiveness of nonpharmaceutical interventions, such as hand hygiene and facemasks, for preventing influenza virus transmission. OBJECTIVE: To investigate whether hand hygiene and use of facemasks prevents household transmission of influenza. DESIGN: Cluster randomized controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. SETTING: Households in Hong Kong. PATIENTS: 407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households. INTERVENTION: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members. MEASUREMENTS: Influenza virus infection in household contacts, as confirmed by reverse transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days. RESULTS: Sixty (8%) household contacts in the 259 households had RT-PCR-confirmed influenza virus infection in the 7 days after intervention. Hand hygiene without or with facemasks seemed to reduce influenza transmission, but the differences in transmission compared with the control group were not statistically significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR-confirmed infection seemed to be reduced, an effect attributable to reductions in infection among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions was variable. Limitation: The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness. CONCLUSION: Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza. Primary Funding Source: Centers for Disease Control and Prevention. |
H1N1 2009 influenza virus infection during pregnancy in the USA
Jamieson DJ , Honein MA , Rasmussen SA , Williams JL , Swerdlow DL , Biggerstaff MS , Lindstrom S , Louie JK , Christ CM , Bohm SR , Fonseca VP , Ritger KA , Kuhles DJ , Eggers P , Bruce H , Davidson HA , Lutterloh E , Harris ML , Burke C , Cocoros N , Finelli L , Macfarlane KF , Shu B , Olsen SJ , Novel Influenza A Pregnancy Working Group . Lancet 2009 374 (9688) 451-8 BACKGROUND: Pandemic H1N1 2009 influenza virus has been identified as the cause of a widespread outbreak of febrile respiratory infection in the USA and worldwide. We summarised cases of infection with pandemic H1N1 virus in pregnant women identified in the USA during the first month of the present outbreak, and deaths associated with this virus during the first 2 months of the outbreak. METHODS: After initial reports of infection in pregnant women, the US Centers for Disease Control and Prevention (CDC) began systematically collecting additional information about cases and deaths in pregnant women in the USA with pandemic H1N1 virus infection as part of enhanced surveillance. A confirmed case was defined as an acute respiratory illness with laboratory-confirmed pandemic H1N1 virus infection by real-time reverse-transcriptase PCR or viral culture; a probable case was defined as a person with an acute febrile respiratory illness who was positive for influenza A, but negative for H1 and H3. We used population estimates derived from the 2007 census data to calculate rates of admission to hospital and illness. FINDINGS: From April 15 to May 18, 2009, 34 confirmed or probable cases of pandemic H1N1 in pregnant women were reported to CDC from 13 states. 11 (32%) women were admitted to hospital. The estimated rate of admission for pandemic H1N1 influenza virus infection in pregnant women during the first month of the outbreak was higher than it was in the general population (0.32 per 100 000 pregnant women, 95% CI 0.13-0.52 vs 0.076 per 100 000 population at risk, 95% CI 0.07-0.09). Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation. INTERPRETATION: Pregnant women might be at increased risk for complications from pandemic H1N1 virus infection. These data lend support to the present recommendation to promptly treat pregnant women with H1N1 influenza virus infection with anti-influenza drugs. FUNDING: US CDC. |
HIV prevalence and associated risk factors among individuals aged 13-34 years in rural Western Kenya
Amornkul PN , Vandenhoudt H , Nasokho P , Odhiambo F , Mwaengo D , Hightower A , Buve A , Misore A , Vulule J , Vitek C , Glynn J , Greenberg A , Slutsker L , De Cock KM . PLoS One 2009 4 (7) e6470 OBJECTIVES: To estimate HIV prevalence and characterize risk factors among young adults in Asembo, rural western Kenya. DESIGN: Community-based cross-sectional survey. METHODS: From a demographic surveillance system, we selected a random sample of residents aged 13-34 years, who were contacted at home and invited to a nearby mobile study site. Consent procedures for non-emancipated minors required assent and parental consent. From October 2003 - April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered. RESULTS: Of 2606 eligible residents, 1822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner/parental objection. Females comprised 53% of 1762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women aged 25-29 years (36.5%) and men aged 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity. CONCLUSIONS: Asembo has extremely high HIV and HSV-2 prevalence, and probable high incidence, among young adults. Further research on circumstances around HIV acquisition in young women and novel prevention strategies (vaccines, microbicides, pre-exposure prophylaxis, HSV-2 prevention, etc.) are urgently needed. |
New approaches to detection and identification of Rickettsia africae and Ehrlichia ruminantium in Amblyomma variegatum (Acari: Ixodidae) ticks from the Caribbean
Robinson JB , Eremeeva ME , Olson PE , Thornton SA , Medina MJ , Sumner JW , Daschi GA . J Med Entomol 2009 46 (4) 942-51 Imported from Africa in the 1700s and despite frequent modern eradication efforts, Amblyomma variegatum (F.) spread through the Caribbean by cattle transport, small ruminants, and migrating birds. A. variegatum is a vector for Rickettsia africae, the causative agent of African tick bite fever, and Ehrlichia ruminantium, the causative agent of heartwater. We examined 95 A. variegatum and six Rhipicephalus (Boophilus) microplus (Canestrini) collected from cattle at an abattoir in Antigua. Engorged tick extracts adsorbed on Nobotu filter paper strips and new nested polymerase chain reaction (PCR) assays for E. ruminantium and Dermatophilus congolensis were used to evaluate these ticks for the presence of these pathogenic bacteria. Amblyomma ticks (62.4%) contained R. africae DNA by PCR/restriction fragment length polymorphism analysis and DNA sequencing of the OmpA and 17-kDa antigen genes. Twenty Amblyomma and two Rh. microplus contained E. ruminantium DNA. No E. chaffeensis, Anaplasma phagocytophilum, Coxiella burnetii, or D. congolensis DNA was detected in these ticks. The continued presence of Am. variegatum in the Caribbean poses a significant risk of infection in cattle with E. ruminantium and in humans by R. africae. Eradication efforts are essential to prevent the further spread of Am. variegatum. |
Studies of vector competency and efficiency of North American fleas for Yersinia pestis: state of the field and future research needs
Eisen RJ , Eisen L , Gage KL . J Med Entomol 2009 46 (4) 737-44 The etiological agent of plague, Yersinia pestis, is most commonly transmitted by the bite of infectious fleas. To date, at least 28 flea species occurring in North America have been experimentally confirmed as vectors of Y. pestis. Transmission efficiency differs among species and also between different studies of a single species. These differences may, however, in large part reflect nonstandardized experimental conditions used during the first half of the 20th century when such studies were conducted in response to the rapid spread of Y. pestis across the western United States after its introduction at the beginning of this century. The majority of these early transmission studies focused on the blocked flea mechanism of transmission, which typically does not occur until > 2-3 wk after the flea becomes infected. Recent studies have challenged the paradigm that Y. pestis is usually spread by blocked fleas by demonstrating that numerous flea species, including the oriental rat flea Xenopsylla cheopis, which was the focus of the early classical studies on blocked flea transmission, are capable of"early-phase" transmission during the first few days after becoming infected and before a complete blockage can form. The aims of this review are to 1) summarize Y. pestis vector competency and efficiency studies for fleas occurring in North America, 2) discuss the implications of the results of these studies for our understanding of the dynamics of plague epizootics, 3) demonstrate why older transmission studies need to be repeated using a standardized experimental system, and 4) outline future directions for studies of fleas as vectors of Y. pestis. |
Identification of Culex (Melanoconion) species of the United States using female cibarial armature (Diptera: Culicidae)
Williams MR , Savage HM . J Med Entomol 2009 46 (4) 745-52 Species within the subgenus Culex (Melanoconion) Theobald are the primary enzootic vectors of viruses in the Venezuelan equine encephalitis complex including Everglades virus, and probable enzootic vectors of eastern equine encephalitis and West Nile viruses. Adult females of this subgenus are often difficult or impossible to identify to species based on external morphological characters. The use of female cibarial armature allows for the identification of field-collected adult female specimens of Culex (Melanoconion). The cibarial armatures are described and illustrated for all species from the United States and a key to species using this character is presented. |
Mechanisms of cadmium carcinogenesis
Joseph P . Toxicol Appl Pharmacol 2009 238 (3) 272-279 Cadmium (Cd), a heavy metal of considerable occupational and environmental concern, has been classified as a human carcinogen by the International Agency for Research on Cancer (IARC). The carcinogenic potential of Cd as well as the mechanisms underlying carcinogenesis following exposure to Cd has been studied using in vitro cell culture and in vivo animal models. Exposure of cells to Cd results in their transformation. Administration of Cd in animals results in tumors of multiple organs/tissues. Also, a causal relationship has been noticed between exposure to Cd and the incidence of lung cancer in human. It has been demonstrated that Cd induces cancer by multiple mechanisms and the most important among them are aberrant gene expression, inhibition of DNA damage repair, induction of oxidative stress, and inhibition of apoptosis. The available evidence indicates that, perhaps, oxidative stress plays a central role in Cd carcinogenesis because of its involvement in Cd-induced aberrant gene expression, inhibition of DNA damage repair, and apoptosis. |
Reconstructing historical exposures to volatile organic compound-contaminated drinking water at a U.S. military base
Maslia ML , Aral MM , Faye RE , Suarez-Soto RJ , Sautner JB , Wang J , Jang W , Bove FJ , Ruckart PZ . Water Qual Expo Health 2009 1 (1) 49-68 Two of three water-distribution systems that have historically supplied drinking water to family housing at U.S. Marine Corps Base Camp Lejeune, North Carolina, were contaminated with volatile organic compounds (VOCs). Scientific data relating to the harmful effects of VOCs on a child or fetus are limited. Therefore, the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) is conducting an epidemiological study to evaluate potential associations between in utero and infant (up to 1 year of age) exposures to VOCs in contaminated drinking water at Camp Lejeune and specific birth defects and childhood cancers. The study includes births that occurred during the period 1968-1985 to women who were pregnant while they resided in family housing at Camp Lejeune. To support the epidemiological study, water-modeling techniques are being used to reconstruct historical conditions of groundwater flow, contaminant fate and transport, and the distribution of drinking water contaminated with VOCs. Results for this phase of the study indicate that PCE concentrations in drinking water, delivered to the Tarawa Terrace housing area, exceeded the current maximum contaminant level for PCE of 5 micrograms per liter (µg/L) for 346 months-November 1957-February 1987; the maximum simulated PCE concentration in Tarawa Terrace drinking water was 183 µg/L during March 1984 compared to a measured concentration of 215 µg/L during February 1985. |
Comment on "Household water treatment in poor populations: Is there enough evidence for scaling up now?"
Clasen T , Bartram J , Colford J , Luby S , Quick R , Sobsey M . Environ Sci Technol 2009 43 (14) 5542-5544 In their recent paper, Schmidt and Cairncross argue that promotion of household water treatment (HWT) among poor populations is premature (1). The paper makes useful points about the challenge of minimizing bias in assessing diarrheal disease that are relevant to studies of all water, sanitation, and hygiene interventions. However, their particular contention that the evidence does not support scaling up HWT is puzzling, not least because they reached the opposite conclusion—that it “should be strongly encouraged”—in a 2006 Cochrane review based mainly on the same evidence (2). Moreover, their assertion that HWT has not yet been shown to be acceptable and scalable on a sustained basis is difficult to reconcile with the fact that more than 850 million people in 58 low- and middle-income countries already report usually treating their water at home before drinking it (3). | The paper reflects issues that are at the heart of public health decision-making. Most fundamentally, how much evidence is required in order to justify an intervention, while research is continuing to improve our understanding of its effectiveness and how to target coverage and enhance adoption? | At face value, treating water at home in locations where that water is polluted with feces makes sense. The fact that fecal contamination of water is a significant health concern has been largely unquestioned since John Snow removed the handle of the Broad Street pump in 1854, and its contemporary relevance is confirmed by ongoing outbreaks of waterborne infectious disease in the developing and developed worlds. The fact that billions of individuals lack safe water is not in question, and the logic of simple measures to empower those households to act to protect their health is compelling. |
Trends in US sex ratio by plurality, gestational age and race/ethnicity
Branum AM , Parker JD , Schoendorf KC . Hum Reprod 2009 24 (11) 2936-44 BACKGROUND: The sex ratio in the USA has declined over recent decades, resulting in fewer male births. Concurrent changes in the childbearing population may have influenced the sex ratio, including increases in multiple births, improvements in perinatal survival and increased Hispanic births. METHODS: Data from the US natality files (1981-2006) were analyzed to determine the impact of changes in birth characteristics on male birth proportion. Male birth proportion was calculated as the number of male births divided by the total number. In separate analyses, trends in male birth proportion from 1981 to 2006 were adjusted for plurality (singleton, multiple), gestational age (<28, 28-32, 33-36, ≥37 weeks) and, from 1989, maternal Hispanic ethnicity. Separate analyses were conducted for white and black births. Log binomial regression was performed to estimate crude and adjusted trends with year as independent variable. RESULTS: Trends in male birth proportion differed significantly according to plurality among white (P < 0.01), but not black births. Adjustment for gestational age tempered the trends among white singletons (P < 0.0001) and multiples (P < 0.05) but had no effect on trends in black male birth proportion. Adjustment for Hispanic ethnicity had no impact on trends in black male birth proportion and any effect on white births was negated by changes in gestational age trends. CONCLUSIONS: Lack of consistent influences on, or patterns of change in, the proportion of male births between different subpopulations of births suggests that a single mechanism is unlikely to explain the oft-referenced decrease in the overall US sex ratio. |
Antimicrobial Resistance-Conferring Plasmids with Similarity to Virulence Plasmids from Avian Pathogenic Escherichia coli Strains in Salmonella enterica Serovar Kentucky Isolates from Poultry
Fricke WF , McDermott PF , Mammel MK , Zhao S , Johnson TJ , Rasko DA , Fedorka-Cray PJ , Pedroso A , Whichard JM , Leclerc JE , White DG , Cebula TA , Ravel J . Appl Environ Microbiol 2009 75 (18) 5963-71 Salmonella enterica, a leading cause of foodborne gastroenteritis worldwide, may be found in any raw food of animal, vegetable or fruit origin. Different Salmonella serovars vary in their distribution, virulence and host specificity. S. enterica serovar Kentucky (S. Kentucky), though often found in the food supply, is less commonly isolated from ill humans. The multidrug-resistant (MDR) isolate Salmonella Kentucky CVM29188, isolated from a chicken breast sample in 2003, contains three plasmids (146,811 bp; 101,461 bp; 46,121 bp), two of which carry resistance determinants (pCVM29188_146: strAB, tetRA and pCVM29188_101: blaCMY-2, sugE). Both resistance plasmids were transferable by conjugation, alone or in combination, to S. Kentucky, S. Newport and E. coli recipients. pCVM29188_146 shares a highly conserved plasmid backbone of 106 kb (>90% nucleotide identity) with two virulence plasmids from Avian Pathogenic Escherichia coli strains (pAPEC-O1-ColBM and pAPEC-O2-ColV). Shared APEC virulence factors include iutA/iucABCD, sitABCD, etsABC, iss, and iroBCDEN. PCR analyses of recent (1997-2005) S. Kentucky isolates from food animal, retail meat and human sources revealed that 172 (60%) contained a similar APEC-like plasmid backbone. Notably, though rare in human- and cattle-derived isolates, this plasmid backbone was found at high frequency (50-100%) among S. Kentucky isolates from chickens within the same time span. 94% of the APEC-positive isolates showed resistance to tetracycline and streptomycin. Together, our findings of a resistance-encoding APEC virulence plasmid in a poultry-derived S. Kentucky isolate and of similar resistance/virulence plasmids in most recent S. Kentucky isolates from chickens and, to lesser degree, from humans and cattle highlight the need for additional research in order to examine the prevalence and spread of combined virulence and resistance plasmids in bacteria in agricultural, environmental and clinical settings. |
Systems-based candidate genes for human response to influenza infection.
Zhang L , Katz JM , Gwinn M , Dowling NF , Khoury MJ . Infect Genet Evol 2009 9 (6) 1148-57 Influenza A is a serious respiratory illness that can be debilitating and may cause complications leading to hospitalization and death. The outcome of infection with the influenza A virus is determined by a complex interplay of viral and host factors. With the ongoing threat of seasonal influenza and the potential emergence of new, more virulent strains of flu viruses, we need to develop a better understanding of genetic variation in the human population and its association with severe outcomes from influenza infection. We propose a list of approximately 100 systems-based candidate genes for future study of the genetic basis of influenza disease and immunity in humans, based on evidence in the published literature for their potential role in the pathogenesis of this infection: binding of the virus to receptors on the host cell surface; cleavability of HA by host proteases; virus replication in host cells; destruction of host cells by apoptosis; state of immunocompetence of the individual host; and viral infections predisposing to bacterial infection. |
Health-related beliefs and decisions about accessing HIV medical care among HIV-infected persons who are not receiving care
Beer L , Fagan JL , Valverde E , Bertolli J . AIDS Patient Care STDS 2009 23 (9) 785-92 In the United States, the publically supported national HIV medical care system is designed to provide HIV medical care to those who would otherwise not receive such care. Nevertheless, many HIV-infected persons are not receiving medical care. Limited information is available from HIV-infected persons not currently in care about the reasons they are not receiving care. From November 2006 to February 2007, we conducted five focus groups at community-based organizations and health departments in five U.S. cities to elicit qualitative information about barriers to entering HIV care. The 37 participants were mostly male (n = 29), over the age of 30 (n = 34), and all but one had not received HIV medical care in the previous 6 months. The focus group discussions revealed health belief-related barriers that have often been overlooked by studies of access to care. Three key themes emerged: avoidance and disbelief of HIV serostatus, conceptions of illness and appropriate health care, and negative experiences with, and distrust of, health care. Our findings point to the potentially important influence of these health-related beliefs on individual decisions about whether to access HIV medical care. We also discuss the implications of these beliefs for provider-patient communication, and suggest that providers frame their communications with patients such that they are attentive to the issues identified by our respondents, to better engage patients as partners in the treatment process. |
Information-seeking styles among cancer patients before and after treatment by demographics and use of information sources
Eheman CR , Berkowitz Z , Lee J , Mohile S , Purnell J , Marie Rodriguez E , Roscoe J , Johnson D , Kirshner J , Morrow G . J Health Commun 2009 14 (5) 487-502 The type and quantity of information needed varies between patients who actively seek information and those who tend to avoid information.We analyzed data from a longitudinal study of adult cancer patients from outpatient clinics for whom information needs and behaviors were assessed by survey before and after treatment. We evaluated the relationships between information-seeking style (active, moderately active, and passive styles) and demographics, cancer type, and health status for the pretreatment and posttreatment periods and overall. The generalized estimating equations (GEE) approach was used to model the log odds of more active to more passive information-seeking preferences taking into consideration both the pretreatment and posttreatment periods. Analyses included 731 case participants, including female breast cancer patients (51%), male genitourinary cancer patients (18%), and lung cancer patients of both sexes (10%). At pretreatment, 17% reported an active information-seeking style, 69% were moderately active, and 14% were passive. During this period, 19% of those with at least some college education reported being very active compared with 14% of those with less education. With adjustment for all other covariates, male genitourinary and lung cancer patients had a higher odds of having a more active information-seeking style in the pretreatment than in the posttreatment period, with an odds of 4.5 (95% confidence interval [CI]: 2.4-8.4) and 5.4 (95% CI: 2.7-10.6), respectively. Controlling for all covariates, breast cancer patients had 1.5 (95% CI: 1.0-2.1) times higher odds of being more active in seeking information than other patients. Public health researchers and clinicians must work together to develop the most effective strategy for meeting the informational needs of these patients before and after treatment. |
Hepatitis C virus transmission in hemodialysis units: importance of infection control practices and aseptic technique
Thompson ND , Novak RT , Datta D , Cotter S , Arduino MJ , Patel PR , Williams IT , Bialek SR . Infect Control Hosp Epidemiol 2009 30 (9) 900-3 We investigated 4 hepatitis C virus (HCV) infection outbreaks at hemodialysis units to identify practices associated with transmission. Apparent failures to follow recommended infection control precautions resulted in patient-to-patient HCV transmission, through cross-contamination of the environment or intravenous medication vials. Fastidious attention to aseptic technique and infection control precautions are essential to prevent HCV transmission. |
Role of T lymphocytes in the pathogenesis of chlamydia disease
Igietseme JU , He Q , Joseph K , Eko FO , Lyn D , Ananaba G , Campbell A , Bandea C , Black CM . J Infect Dis 2009 200 (6) 926-34 Vaccines are needed to prevent the oculogenital diseases of Chlamydia trachomatis. Infected hosts develop immunity, although temporary, and experimental vaccines have yielded significant protective immunity in animal models, fueling the impetus for a vaccine. Because infections cause sequelae, the functional relationship between infection- and vaccine-induced immunity is unclear. We hypothesized that infection- and vaccine-induced immunity are functionally distinct, particularly in the ability to prevent sequelae. Chlamydia-immune mice, with immunity generated by either a previous infection or vaccination, exhibited a significant degree of protective immunity, marked by a lower-intensity, abbreviated course of infection. However, vaccinated mice were protected from infertility, whereas preinfected mice were not. Thus, infection-induced immunity does not prevent the pathologic process leading to infertility. Furthermore, T cell subsets, especially CD8 T cells, play a major role in Chlamydia-induced infertility. The results have important implications for the immunopathogenesis of chlamydial disease and new vaccine strategies. |
Evaluating the capability and cost of a mass influenza and pneumococcal vaccination clinic via computer simulation
Washington ML . Med Decis Making 2009 29 (4) 414-423 OBJECTIVE: To determine if a mass influenza/pneumococcal vaccination clinic could vaccinate 15,000 clients in 17 h; optimize personnel configuration to maximize number of clients vaccinated; and estimate costs (opportunity and clinic) and revenue. METHOD: The author used a discrete event simulation model to estimate the throughput of the vaccination clinic as the number of clients (arrival intensity) increased and as staff members were reassigned to different workflows. We represented workflows for 3 client types: "Medicare," "Special," and "Cash," where "Special" designates Medicare clients who needed assistance moving through the clinic. The costs of supplies, staff salaries, and client waiting time were included in the model. We compared the "original" model based on the staffing and performance of an actual clinic to an "optimized" model in which staff were reassigned to optimize number of clients vaccinated. RESULTS: A maximum of 13,138 and 15,094 clients in the original and optimized models, respectively, were vaccinated. At the original arrival rate (8300 clients vaccinated in 17 h), supplies cost about $191,000 and were the most expensive component of the clinic operation in both models. However, as the arrival intensity increased to 140%, the "Medicare" client opportunity cost increased from $23,887 and $21,474 to $743,510 and $740,760 for the simulated original and optimized models, respectively. CONCLUSION: The clinic could reach their target of 15,000 vaccinees with 2 fewer staff members by rearranging staff assignments from "Special" to "Medicare" and "Cash" stations. Computer simulation can help public health officials determine the most efficient use of staff, machinery, supplies, and time. |
Impact of measles outbreak response vaccination campaign in Dar es Salaam, Tanzania
Goodson JL , Wiesen E , Perry RT , Mach O , Kitambi M , Kibona M , Luman ET , Cairns KL . Vaccine 2009 27 (42) 5870-4 We assessed the impact of a measles outbreak response vaccination campaign (ORV) in Dar es Salaam, Tanzania. Age-specific incidence rates were calculated before and after the ORV. Incidence rate ratios for the two time periods were compared and used to estimate expected cases and deaths prevented by ORV. The ratio of measles incidence rates in the age groups targeted and not targeted by ORV decreased from 5.8 prior to ORV to 1.8 (p<0.0001) after; 506 measles cases and 18 measles deaths were likely averted. These results support the need for revised recommendations concerning ORV in general settings in Africa. |
Prevention factors for suicide ideation among abused pre/early adolescent youths
Logan JE . Inj Prev 2009 15 (4) 278-80 Suicide ideation is a problem among youths who have been previously abused. This study assesses whether three factors (ie, feeling connected to school, having parents who reward good behaviour, and feeling able to cope with peer conflict) are negatively associated with suicidal ideation for 2598 pre/early adolescents with various levels of prior abuse. For the entire youth population, those who reported all three factors were less than half as likely to have suicidal thoughts as those who did not report any of these factors (10.8% vs 30.3%, p<0.05). This pattern was similar and significant for youths who experienced peer abuse (10.2% vs 35.0%, p<0.05) and youths who experienced both early child abuse and peer abuse (21.6% vs 54.8%, p<0.05). Comprehensive programmes that improve school connectedness, parent-child relationships and coping skills to avoid violent peer conflicts may help decrease suicide ideation among youths, particularly those who have been previously abused. |
Emergency department visits for nursemaid's elbow in the United States, 2005-2006
Brown D . Orthop Nurs 2009 28 (4) 161-2 Nursemaid's elbow - also referred to as annular ligament displacement, pulled elbow, or radial head subluxation- is a partial or an incomplete dislocation of the elbow most often casued by a sudden pull on the extended pronated arm, such as in teh case of a child who stumbles while being led by the hand by an adult or by a parent tugging on an uncooperative child. The injury has been dsecribed as a slipping of the radial head distally beneath the annular ligament, although Kaplan and Lillis noted that the radil head does not move out of its position relative to the capitulum; rather, there is a dislocation of the annular ligament between the capitulum of the distal humerus. The anatomy and pathology of the elbow are described in detail elsewhere. |
Rapid detection of HIV-1 p24 antigen using magnetic immuno-chromatography (MICT)
Workman S , Wells SK , Pau CP , Owen SM , Dong XF , LaBorde R , Granade TC . J Virol Methods 2009 160 14-21 Detection of human immunodeficiency virus (HIV) infections has been enhanced by incorporating p24 antigen detection with current HIV antibody detection using enzyme immunoassays (EIAs). However, screening for HIV antibodies has increased through the use of rapid, lateral-flow HIV antibody detection assays that currently do not have the capability to detect HIV p24 antigen. In this report, a lateral-flow based assay using super-paramagnetic particles as the detection marker was developed for the detection of HIV-1 p24 antigen. This magnetic immuno-chromatographic test (MICT) uses an inexpensive, low-maintenance instrument that detects the magnetic moment of the super-paramagnetic particles in a magnetic field. MICT is simple to perform, provides a numerical output for easier determination of reactive results and can be completed in 40 min. The lower limit of detection for HIV-1 p24 spiked into assay sample buffer and 50% plasma was 30 pg/ml for both. Detection of HIV-1 p24 antigen at 50 pg/ml was reproducible in both inter-run and intra-run assays with coefficients of variation of <13%. Furthermore, the MICT p24 assay was able to detect intact virus spiked into 50% plasma (lower detection limit of [similar to]250,000 viral RNA copies/ml). MICT detection of increasing HIV-1 p24 levels in commercially available seroconversion panels by MICT was only slightly later than that detected by much more complex EIAs. MICT could provide a simple, low-cost, and portable method for rapid HIV-1 p24 detection in a variety of testing environments. |
The case for developing consensus standards for research in microbial pathogenesis: bacillus anthracis toxins as an example
Hughes MA , Burns DL , Juris SJ , Tang WJ , Clement KH , Eaton LJ , Kelly-Cirino CD , McKee ML , Powell BS , Bishop BL , Rudge TL , Shine N , Verma A , Willis MS , Morse SA . Infect Immun 2009 77 (10) 4182-6 Communication between research laboratories within a given field is often an important key to rapid successes within that field. ... |
Development of a neutralization assay for Nipah virus using pseudotype particles
Tamin A , Harcourt BH , Lo MK , Roth JA , Wolf MC , Lee B , Weingartl H , Audonnet JC , Bellini WJ , Rota PA . J Virol Methods 2009 160 1-6 Nipah virus (NiV) and Hendra virus (HeV) are zoonotic paramyxoviruses capable of causing severe disease in humans and animals. These viruses require biosafety level 4 (BSL-4) containment. Like other paramyxoviruses, the plaque reduction neutralization test (PRNT) can be used to detect antibodies to the surface glycoproteins, fusion (F) and attachment (G), and PRNT titers give an indication of protective immunity. Unfortunately, for NiV and HeV, the PRNT must be performed in BSL-4 containment and takes several days to complete. Thus, we have developed a neutralization assay using VSV pseudotype particles expressing the F and G proteins of NiV (pVSV-NiV-F/G) as target antigens. This rapid assay, which can be performed at BSL-2, was evaluated using serum samples from outbreak investigations and more than 300 serum samples from an experimental NiV vaccination study in swine. The results of the neutralization assays with pVSV-NiV-F/G as antigen showed a good correlation with those of standard PRNT. Therefore, this new method has the potential to be a rapid and cost-effective diagnostic method, especially in locations that lack high containment facilities, and will provide a valuable tool for basic research and vaccine development. |
Evaluation of two real-time PCR chemistries for the detection of Chlamydophila pneumoniae in clinical specimens
Mitchell SL , Budhiraja S , Thurman KA , Lanier Thacker W , Winchell JM . Mol Cell Probes 2009 23 (6) 309-11 Chlamydophila pneumoniae is an atypical bacterial respiratory pathogen that is responsible for approximately 3-10% of community-acquired pneumonia cases. We report the evaluation of two distinct real-time PCR assays for rapid and specific detection of C. pneumoniae. We tested 401 clinical specimens, finding 5.7% positive, and confirmed a localized outbreak. |
The use of aldehyde indicators to determine glutaraldehyde and alkaline glutaraldehyde contamination in chemical protective gloves
Vo E , Zhuang Z . Arch Environ Contam Toxicol 2009 57 (1) 185-192 The aim of this study was to assess the use of aldehyde indicator pads for detection of glutaraldehyde and alkaline glutaraldehyde permeation through chemical protective gloves under simulated in-use conditions. The quantitative analysis of glutaraldehyde permeation through a glove material was determined for Metricide, Wavicide, and 50% glutaraldehyde following a solvent-desorption process and gas chromatographic analysis. All glutaraldehyde solutions exhibited >99% adsorption (including both the glutaraldehyde oligomers of the reaction product and the excess glutaraldehyde) on the pads over the spiking range 0.05-5.0 muL. Breakthrough times for protective gloves were determined using the Thermo-Hand test method, and found to range from 76 to 150, from 170 to 230, and from 232 to 300 min for Metricide, Wavicide, and 50% glutaraldehyde, respectively. Glutaraldehyde recovery was calculated and ranged from 61 to 80% for all glutaraldehyde solutions. The mass of glutaraldehyde in these solutions at the time of breakthrough detection ranged from 17 to 18, from 18 to 19, and from 19 to 20 mug/cm2 for Wavicide, 50% glutaraldehyde solution, and Metricide, respectively. Aldehyde indicator pads and the Thermo-Hand test method together should find utility in detecting, collecting, and quantitatively analyzing glutaraldehyde permeation samples through chemical protective gloves under simulated in-use conditions. copyright 2009 US Government. |
Climate change and occupational safety and health: establishing a preliminary framework
Schulte PA , Chun H . J Occup Environ Hyg 2009 6 (9) 542-554 The relationship between global climate change and occupational safety and health has not been extensively characterized. To begin such an effort, it may be useful to develop a framework for identifying how climate change could affect the workplace; workers; and occupational morbidity, mortality, and injury. This article develops such a framework based on a review of the published scientific literature from 1988-2008 that includes climatic effects, their interaction with occupational hazards, and their manifestation in the working population. Seven categories of climate-related hazards are ide ntified: (1) increased ambient temperature, (2) air pollution, (3) ultraviolet exposure, (4) extreme weather, (5) vector-borne diseases and expanded habitats, (6) industrial transitions and emerging industries; and (7) changes in the built environment. This review indicates that while climate change may result in increasing the prevalence, distribution, and severity of known occupational hazards, there is no evidence of unique or previously unknown hazards. However, such a possibility should not be excluded, since there is potential for interactions of known hazards and new conditions leading to new hazards and risks. |
Translating questionnaire items for a multi-lingual worker population: the iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers
Fujishiro K , Gong F , Baron S , Jacobson CJ Jr , Delaney S , Flynn M , Eggerth DE . Am J Ind Med 2009 53 (2) 194-203 BACKGROUND: The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature. METHODS: Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers. RESULTS: Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item. CONCLUSIONS: Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools. Am. J. Ind. Med. 2009 Published 2009 Wiley-Liss, Inc. |
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