Risk of invasive pneumococcal infections among working age adults with asthma
Klemets P , Lyytikainen O , Ruutu P , Ollgren J , Kaijalainen T , Leinonen M , Pekka Nuorti J . Thorax 2010 65 (8) 698-702 BACKGROUND: Information about the risk of invasive pneumococcal infection (IPI) among adults with asthma is limited and inconsistent. To evaluate this association, a population-based case-control study was conducted. METHODS: Cases of IPI (Streptococcus pneumoniae isolated from blood or cerebrospinal fluid) were identified through national, population-based laboratory surveillance during 1995-2002. To maximise exclusion of chronic obstructive pulmonary disease, the analysis was limited to patients aged 18-49 years and 10 selected age-, sex- and health district-matched controls for each case from the Population Information System. Information on underlying medical conditions was obtained through linking surveillance data to other national health registries. Asthma requiring ≥1 hospitalisation in the past 12 months was defined as high risk asthma (HRA); low risk asthma (LRA) was defined as entitlement to prescription drug benefits and no hospitalisation for asthma in the past 12 months. RESULTS: 1282 patients with IPI and 12 785 control subjects were identified. Overall, 7.1% of cases and 2.5% of controls had asthma (6.0% and 2.4% had LRA whereas 1.1% and 0.1% had HRA, respectively. After adjustment for other independent risk factors in a conditional logistic regression model, IPI was associated with both LRA (matched OR (mOR) 2.8; 95% CI 2.1 to 3.6) and HRA (mOR, 12.3; 95% CI 5.4 to 28.0). The adjusted population-attributable risk was 0.039 (95% CI 0.023 to 0.055) for LRA and 0.01 (95% CI 0.0035 to 0.017) for HRA. CONCLUSIONS: Working age adults with asthma are at increased risk of IPI. In this population, approximately 5% of disease burden could be attributed to asthma. These findings support adding medicated asthma in adults to the list of indications for pneumococcal vaccination. |
Prevalence of diabetic retinopathy in the United States, 2005-2008
Zhang X , Saaddine JB , Chou CF , Cotch MF , Cheng YJ , Geiss LS , Gregg EW , Albright AL , Klein BE , Klein R . JAMA 2010 304 (6) 649-56 CONTEXT: The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. OBJECTIVES: To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. DESIGN, SETTING, AND PARTICIPANTS: Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. MAIN OUTCOME MEASUREMENTS: Diabetic retinopathy and vision-threatening diabetic retinopathy. RESULTS: The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). CONCLUSION: In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals. |
Effect of intrauterine diabetes exposure on the incidence of end-stage renal disease in young adults with type 2 diabetes
Pavkov ME , Hanson RL , Knowler WC , Sievers ML , Bennett PH , Nelson RG . Diabetes Care 2010 33 (11) 2396-8 OBJECTIVE: We examined the effect of intrauterine diabetes exposure (IDE) on the incidence of diabetic end-stage renal disease (ESRD) in Pima Indians with type 2 diabetes. RESEARCH DESIGN AND METHODS: Individuals were followed from their first diabetic examination until December 2006, death, ESRD, or age of 45 years. RESULTS: Among the 1,850 diabetic participants, 102 had IDE. ESRD developed in 57, five of whom had IDE. Cumulative incidence of ESRD by age 45 was 19.3% in participants with IDE and 5.1% in those without; age-sex-adjusted incidence rate ratio was 4.12, (95% CI=1.54-11.02). After additional adjustment for age at diabetes onset, ESRD incidence was similar in the two groups (incidence rate ratio=1.38, 95% CI=0.45-4.24). CONCLUSIONS: IDE increases the age-sex-adjusted incidence of ESRD 4-fold in young adults with type 2 diabetes, mediated primarily by the earlier onset of type 2 diabetes in those with IDE. |
A1C level and future risk of diabetes: a systematic review
Zhang X , Gregg EW , Williamson DF , Barker LE , Thomas W , Bullard KM , Imperatore G , Williams DE , Albright AL . Diabetes Care 2010 33 (7) 1665-73 We examined ranges of A1C useful for identifying persons at high risk for diabetes prior to preventive intervention by conducting a systematic review. From 16 included studies, we found that annualized diabetes incidence ranged from 0.1% at A1C <5.0% to 54.1% at A1C >or=6.1%. Findings from 7 studies that examined incident diabetes across a broad range of A1C categories showed 1) risk of incident diabetes increased steeply with A1C across the range of 5.0 to 6.5%; 2) the A1C range of 6.0 to 6.5% was associated with a highly increased risk of incident diabetes, 25 to 50% incidence over 5 years; 3) the A1C range of 5.5 to 6.0% was associated with a moderately increased relative risk, 9 to 25% incidence over 5 years; and 4) the A1C range of 5.0 to 5.5% was associated with an increased incidence relative to those with A1C <5%, but the absolute incidence of diabetes was less than 9% over 5 years. Our systematic review demonstrated that A1C values between 5.5 and 6.5% were associated with a substantially increased risk for developing diabetes. |
Diabetes prevalence, incidence, complications and mortality among Alaska Native people 1985-2006
Narayanan ML , Schraer CD , Bulkow LR , Koller KR , Asay E , Mayer AM , Raymer TW . Int J Circumpolar Health 2010 69 (3) 236-52 OBJECTIVES: To examine trends in diabetes prevalence, incidence, complications and mortality between 1985 and 2006 among Alaska Native people. STUDY DESIGN: We used data from the population-based Alaska Native Diabetes Registry, which includes all people who receive care in the Alaska Tribal Health System. METHODS: We compared the periods of 1986-1990 and 2002-2006 for diabetes-related amputations, renal replacement and mortality using Poisson regression. Complications and mortality data were examined for trends using Poisson regression. Survival analyses for those diagnosed since 31 December 1985 were performed using the Cox proportional hazard model. RESULTS: Age-adjusted diabetes prevalence increased from 17.3 in 1985 to 47.6/1,000 in 2006. The number of Alaska Native people living in Alaska with diabetes increased from 610 in 1985 to 3,386 in 2006. Diabetes incidence rates have also increased. Comparing age-adjusted rates for the 5-year periods 1986-1990 and 2002-2006, amputations decreased from 5.3 to 2.6/1,000, renal replacement decreased from 3.3 to 1.2/1,000 and mortality decreased from 41.7 to 33.2/1,000. Yearly analyses showed a downward trend for amputations, renal replacement and mortality rates. Survival analyses showed a significantly higher hazard ratio for any amputations, major amputations and renal replacement for the earlier time period compared to the most recent time period. CONCLUSIONS: An increase in risk factors, awareness, funding and case-finding may be contributing to the increase in prevalence and incidence of diagnosed diabetes. While diabetes prevalence and incidence are increasing among Alaska Native people, our results suggest that even in remote, rural areas, complications and mortality can be reduced. |
Public health response to a multidrug-resistant tuberculosis outbreak among Guatemalans in Tennessee
Miramontes R , Lambert L , Haddad MB , Boaz V , Hawkins S , Zylstra M , Allen R , Rivers S , Ali B , Chewning SS , Holt E , Warkentin J . South Med J 2010 103 (9) 882-6 BACKGROUND: In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate this outbreak. METHODS: A case was defined as either culture-confirmed MDR TB with a drug-susceptibility pattern closely resembling that of the index case, or a clinical diagnosis of active TB disease and corroborated contact with a person with culture-confirmedMDRTB. Medical records were reviewed, and patients and their contacts were interviewed. RESULTS: Five secondary TB cases were associated with the index case. Of 369 contacts of the index case, 189 (51%) were evaluated. Of those, 97 (51%) had positive tuberculin skin test (TST) results, 79 (81%) began therapy for latent TB infection (LTBI), and 38 (48%) completed LTBI therapy. CONCLUSION: Despite consistent follow up by public health officials, a low proportion of patients diagnosed with LTBI completed therapy. Clinicians and public health practitioners who serve immigrant communities should be vigilant for MDR TB. |
Improving partner services by embedding disease intervention specialists in HIV-clinics
Taylor MM , Mickey T , Winscott M , James H , Kenney K , England B . Sex Transm Dis 2010 37 (12) 767-70 BACKGROUND/OBJECTIVES: Notifying partners of HIV-infected persons and referring them for testing and treatment is an effective method of disease control and identification of undiagnosed STD and/or HIV. To improve partner elicitation interviews, disease intervention specialists (DIS) were placed in 3 HIV clinics during 2008 and 2009. METHODS: We reviewed the Arizona state STD surveillance database for 2007 to identify the providers (outside of the public STD clinics) reporting the highest number of syphilis cases. DIS were placed in the clinics for half a day per week (2 clinics) or on an on-call basis (1 clinic) to deliver penicillin and interview patients. We calculated changes in the number of patients interviewed, days elapsed from specimen collection to treatment (time to treatment), days elapsed from specimen collection to initial DIS contact (time to interview), and number of reported and locatable partners from these 3 clinics before and after the clinic placement of DIS. RESULTS: Before the placement of clinic-based DIS, 219 syphilis cases were diagnosed at the 3 clinics (January 2006 through January 2008). After DIS placement, 115 syphilis cases were diagnosed (February 2008 through September 2009) for a total of 334 cases in this analysis. A greater percent of patients completed a partner elicitation interview during the period of DIS placement (94% after vs. 81% before, P = 0.001). There were increases in the average number of locatable partners (1.1 after vs. 0.6 before, P = 0.004) and an increase in the average number of partners exposed and brought to treatment (CDC Disposition A) or infected and brought to treatment (CDC Disposition C) (0.6 after vs. 0.3 before, P = 0.02), and the time to interview decreased (18 days before vs. 9 days after, P = 0.02). CONCLUSIONS/IMPLICATIONS: Placing DIS within community HIV clinics improved partner services. STD and/or HIV programs should consider this method to improve partner notification. |
The Ribavirin Pregnancy Registry: findings after 5 years of enrollment, 2003-2009
Roberts SS , Miller RK , Jones JK , Lindsay KL , Greene MF , Maddrey WC , Williams IT , Liu J , Spiegel RJ . Birth Defects Res A Clin Mol Teratol 2010 88 (7) 551-9 INTRODUCTION: Ribavirin, with interferons or pegylated interferons, is used to treat chronic hepatitis C. Ribavirin is contraindicated in pregnancy (FDA Pregnancy Category X) and in men whose partners may become pregnant. In 2003, the Ribavirin Pregnancy Registry was established to monitor pregnancy exposures to ribavirin and to evaluate the potential human teratogenicity of prenatal exposure. METHODS: This voluntary registry enrolls pregnant women who have been exposed to ribavirin during pregnancy or during the six months prior to conception either directly, by taking ribavirin, or indirectly through sexual contact with a man taking ribavirin. Women are followed until delivery; live born infants are followed for one year. The Registry aims to enroll 131 live births following direct (maternal) exposure to ribavirin and 131 live births following indirect (male) exposures. RESULTS: After more than five years of operation, the Registry has enrolled 49 live births with direct exposure and 69 live births following indirect exposure. Six outcomes with birth defects have been reported. All were among live born infants: torticollis (2), hypospadias (1), polydactyly and a neonatal tooth (1), glucose-6-phosphate dehydrogenase deficiency (1), ventricular septal defect and cyst of 4th ventricle of the brain (1). Three received direct exposures ([6.1% (95% CI: 1.2, 16.9)], three were exposed indirectly [4.3% (95% CI: 0.9, 12.2)]. CONCLUSIONS: Although current enrollment is far short of the required sample size, preliminary findings have not detected a signal indicating human teratogenicity for ribavirin. However, findings must be interpreted with caution concerning direct or indirect prenatal ribavirin exposures. |
Management of prescription and nonprescription drug use during pregnancy
Morgan MA , Cragan JD , Goldenberg RL , Rasmussen SA , Schulkin J . J Matern Fetal Neonatal Med 2010 23 (8) 813-9 OBJECTIVE: To assess screening and treatment patterns of obstetrician-gynecologists regarding medication use during pregnancy. METHODS: A questionnaire was mailed to 770 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 58%. Most respondents reported always asking pregnant patients about use of over-the-counter (OTC) (86%) and prescription (98%) drugs; 24% reported not always asking about alternative medications. Far fewer reported always asking nonpregnant patients about use of alcohol (67%), illegal drugs (51%) and OTC medications (52%) than pregnant patients. Two-fifths (41%) reported prescribing a medication during pregnancy for which they had insufficient information about potential effects on the fetus; nearly half (47%) reported that there are medical conditions for which they would like to prescribe medications but do not due to insufficient safety information. Physician responses indicate that they are less likely to refer pregnant than nonpregnant patients to a specialist for treatment of certain conditions. CONCLUSIONS: These results indicate that obstetrician-gynecologists sometimes prescribe medications for pregnant patients under less than optimal conditions and emphasize the importance of generating up-to-date information on effects of medications during pregnancy and having it readily available to health care providers. |
Personal exposure to aerosolized red tide toxins (brevetoxins)
Cheng YS , Zhou Y , Naar J , Irvin CM , Su WC , Fleming LE , Kirkpatrick B , Pierce RH , Backer LC , Baden DG . J Occup Environ Hyg 2010 7 (6) 326-31 Florida red tides occur annually in the Gulf of Mexico from blooms of the marine dinoflagellate, Karenia brevis, which produces highly potent natural polyether toxins, brevetoxins. Several epidemiologic studies have demonstrated that human exposure to red tide aerosol could result in increased respiratory symptoms. Environmental monitoring of aerosolized brevetoxins was performed using a high-volume sampler taken hourly at fixed locations on Siesta Beach, Florida. Personal exposure was monitored using personal air samplers and taking nasal swab samples from the subjects who were instructed to spend 1 hr on Sarasota Beach during two sampling periods of an active Florida red tide event in March 2005, and in May 2008 when there was no red tide. Results showed that the aerosolized brevetoxins from the personal sampler were in modest agreement with the environmental concentration taken from a high-volume sampler. Analysis of nasal swab samples for brevetoxins demonstrated 68% positive samples in the March 2005 sampling period when air concentrations of brevetoxins were between 50 to 120 ng/m(3) measured with the high-volume sampler. No swab samples showed detectable levels of brevetoxins in the May 2008 study, when all personal samples were below the limit of detection. However, there were no statistical correlations between the amounts of brevetoxins detected in the swab samples with either the environmental or personal concentration. Results showed that the personal sample might provide an estimate of individual exposure level. Nasal swab samples showed that brevetoxins indeed were inhaled and deposited in the nasal passage during the March 2005 red tide event. |
Population aging and the use of office-based physician services
Cherry D , Lucas C , Decker SL . NCHS Data Brief 2010 (41) 1-8 KEY FINDINGS: From 1998 to 2008, the proportion of physician office-based visits in the United States became increasingly concentrated on those aged 45 and over. The intensity of physician office visits, as measured by medications prescribed or continued, imaging tests ordered or provided, and time spent with physicians, also became increasingly concentrated on those aged 45 and over. Although most physicians accept Medicare patients, acceptance of Medicare was higher among ophthalmologists and general surgeons than among general or family practitioners, internists, and psychiatrists. Over the past 30 years, the specialty concentration of visits has shifted significantly. In 1978, 62 percent of visits by patients aged 65 and over were to primary care physicians compared with 45 percent in 2008. The percentage of visits to physicians with a medical or surgical specialty increased from 37 percent to 55 percent. |
Antimicrobial resistance trends of Shigella serotypes in New York City, 2006-2009
Wong MR , Reddy V , Hanson H , Johnson KM , Tsoi B , Cokes C , Gallagher L , Lee L , Plentsova A , Dang T , Krueger A , Joyce K , Balter S . Microb Drug Resist 2010 16 (2) 155-61 Shigellosis is the third most common enteric bacterial infection in the United States. Although infection is typically self-limiting, empiric treatment is often prescribed. Because of increasing antimicrobial resistance to Shigella, empiric treatment options are decreasing. Identifying resistance patterns can inform empiric treatment recommendations. The goals of our study were to examine risk factors associated with antimicrobial resistance of Shigella and examine issues related to empiric treatment and antimicrobial resistance of Shigella. During June 2006-February 2009, we attempted to interview all New York City patients reported to have shigellosis. Their Shigella isolates were tested for antimicrobial susceptibility to examine the level of resistance and identify risk factors for resistance. Analysis was conducted on two groups distinguished by a large outbreak that was documented during the data collection period. Of the 477 nonoutbreak patients, 333 (70%) patients reported taking an antibiotic for shigellosis and 36 (11%) were treated with an antibiotic to which their Shigella infection was resistant. Among this group, high levels of antimicrobial resistance were detected to amoxicillin-clavulanate (66%), ampicillin (68%), and trimethoprim-sulfamethoxazole (66%). Non-travel-associated ciprofloxacin-resistant Shigella (five patients) and ciprofloxacin-resistant Shigella sonnei (four patients) were reported for the first time to our knowledge. Antimicrobial resistance is significantly higher in New York City residents compared with national data. Some patients were treated with therapies that were not effective and to which the patient's Shigella infection was resistant. Shigella infections should not be treated with antibiotics unless the patient presents with severe or underlying illness and is at risk for systemic illness. When treatment is indicated, local monitoring of Shigella for antimicrobial resistance will provide local clinicians with the best guidance for effective empiric treatments. |
A breast cancer prognostic signature predicts clinical outcomes in multiple tumor types
Wan YW , Qian Y , Rathnagiriswaran S , Castranova V , Guo NL . Oncol Rep 2010 24 (2) 489-94 Epidemiological studies indicate an increased risk of subsequent primary ovarian cancer from women with breast cancer. We have recently identified a 28-gene expression signature that predicts, with high accuracy, the clinical course in a large population of breast cancer patients. This prognostic gene signature also accurately predicts response to chemotherapy commonly used for treating breast cancer, including CMF, Tamoxifen, Paclitaxel, Docetaxel and Doxorubicin (Adriamycin), in a panel of 60 cancer cell lines of nine different tissue origins. This prompted us to investigate whether this prognostic gene signature could also predict clinical outcome in other cancer types of epithelial origins, including ovarian cancer (n=124), colon tumors (n=74) and lung adenocarcinomas (n=442). The results show that the gene expression signature contributes significantly more accurate (P<0.05; compared with random prediction) prognostic information in multiple cancer types independent of established clinical parameters. Furthermore, the functional pathway analysis with curated database delineated a biological network with tight connections between the signature genes and numerous well established cancer hallmarks, indicating important roles of this prognostic gene signature in tumor genesis and progression. |
Caffeine, selected metabolic gene variants, and risk for neural tube defects
Schmidt RJ , Romitti PA , Burns TL , Murray JC , Browne ML , Druschel CM , Olney RS . Birth Defects Res A Clin Mol Teratol 2010 88 (7) 560-9 BACKGROUND: Investigations of maternal caffeine intake and neural tube defects (NTDs) have not considered genetic influences. Caffeine metabolism gene effects were examined in the National Birth Defects Prevention Study. METHODS: Average daily caffeine was summed from self-reported coffee, tea, soda, and chocolate intake for mothers of 768 NTD cases, and 4143 controls delivered from 1997 to 2002. A subset of 306 NTD and 669 control infants and their parents were genotyped for CYP1A2*1F, NAT2 481C>T, and NAT2 590G>A. CYP1A2*1F was classified by fast or slow oxidation status, and NAT2 variants were categorized into rapid or slow acetylation status. Case-control logistic regression analyses, family-based transmission/disequilibrium tests and log-linear analyses, and hybrid log-linear analyses were conducted to produce odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs) for caffeine intake and maternal and infant gene variants, and to examine interaction effects. RESULTS: NTDs were independently associated with infant slow NAT2 acetylator status (RR, 2.00; 95% CI, 1.10-3.64) and maternal CYP1A2*1F fast oxidation status (OR, 1.49; 95% CI, 1.10-2.03). Mothers who consumed caffeine, oxidized CYP1A2*1F quickly, and acetylized NAT2 slowly had a nonsignificantly elevated estimated risk for an NTD-affected pregnancy (OR, 3.10; 95% CI, 0.86-11.21). Multiplicative interaction effects were observed between maternal caffeine and infant CYP1A2*1F fast oxidizer status (p(interaction) = 0.03). CONCLUSIONS: The association identified between maternal CYP1A2*1F fast oxidation status and NTDs should be examined further in the context of the other substrates of CYP1A2. Maternal caffeine and its metabolites may be associated with increased risk for NTD-affected pregnancies in genetically susceptible subgroups. |
Two-year follow-up of sexual behavior among HIV-uninfected household members of adults taking antiretroviral therapy in Uganda: no evidence of disinhibition
Bechange S , Bunnell R , Awor A , Moore D , King R , Mermin J , Tappero J , Khana K , Bartholow B . AIDS Behav 2010 14 (4) 816-23 This paper examines HIV risk behavior among HIV-uninfected adults living with people taking antiretroviral therapy (ART) in Uganda. A prospective cohort of 455 HIV-uninfected non-spousal household members of ART patients receiving home-based AIDS care was enrolled. Sexual behavior, HIV risk perceptions, AIDS-related anxiety, and the perception that AIDS is curable were assessed at baseline, 6, 12 and 24 months. Generalized linear mixture models were used to model risk behavior over time and to identify behavioral correlates. Overall, risky sex decreased from 29% at baseline to 15% at 24-months. Among women, risky sex decreased from 31% at baseline to 10% at 6 months and 15% at 24 months. Among men, risky sex decreased from 30% at baseline to 8% at 6 months and 13% at 24 months. Perceiving HIV/AIDS as curable and lower AIDS-related anxiety were independently associated with risky sex. No evidence of behavioral disinhibition was observed. Concerns regarding behavioral disinhibition should not slow down efforts to increase ART access in Africa. |
Awareness of diagnosis and knowledge of HPV in women patients: data from a multi-site study
McCree DH , Daley EM , Gorbach P , Hamm RM , Sharpe PA , Brandt HM , McFarlane M , Kerndt P , McDermott RJ , Perrin KM , StLawrence JS . Am J Health Educ 2010 41 (4) 197-205 BACKGROUND: Persistent infection with high-risk types of human papillomavirus (HPV) is associated with cervical and other anogenital cancers. PURPOSE: This paper reports results of awareness of an HPV diagnosis and HPV knowledge from a multi-site study of HPV knowledge, attitudes and behavior, and the impact of an HPV diagnosis on women and their partners. METHODS: During September 2003 - November 2005, a survey containing shared and site-specific items was administered to 736 women who had received HPV DNA testing in conjunction with cytology for cervical cancer screening. RESULTS: Overall, there was low knowledge about HPV transmissibility, curability and the effects of an HPV diagnosis across all sites regardless of a woman's racial/ethnic and/or socio-demographic background. Further, only about 50% of the women were aware of their HPV diagnosis even after receiving their results and counseling from a health care professional. DISCUSSION: There is need for consistent and clear information about HPV and HPV DNA testing as part of cervical cancer screening. Research concerning methods or best practices for improving communication between practitioner and patient about testing, diagnosis, counseling, behavioral consequences and follow-up care may be warranted. TRANSLATION TO HEALTH EDUCATION PRACTICE: General messages as well as population-specific messages need to be developed and disseminated to reduce confusion emanating from HPV diagnosis. Modes for delivering messages may need to vary. Further research should address message content and delivery. |
Cost-effectiveness of using social networks to identify undiagnosed HIV infection among minority populations
Shrestha RK , Sansom SL , Kimbrough L , Hutchinson AB , Daltry D , Maldonado W , Simpson-May GM , Illemszky S . J Public Health Manag Pract 2010 16 (5) 457-64 CONTEXT: In 2003, the Centers for Disease Control and Prevention launched the Advancing HIV Prevention project to implement new strategies for diagnosing human immunodeficiency virus (HIV) infections outside medical settings and prevent new infections by working with HIV-infected persons and their partners. OBJECTIVES: To assess the cost and effectiveness of a social network strategy to identify new HIV diagnoses among minority populations. DESIGN, SETTINGS, AND PARTICIPANTS: Four community-based organizations (CBOs) in Boston, Philadelphia, and Washington, District of Columbia, implemented a social network strategy for HIV counseling and testing from October 2003 to December 2005. We used standardized cost collection forms to collect program costs attributable to staff time, travel, incentives, test kits, testing supplies, office space, equipment, and utilities. The CBOs used the networks of high-risk and HIV-infected persons (recruiters) who referred their partners and associates for HIV counseling and testing. We obtained HIV-testing outcomes from project databases. MAIN OUTCOME MEASURES: Number of HIV tests, number of new HIV-diagnoses notified, total program cost, cost per person tested, cost per person notified of new HIV diagnosis. RESULTS: Two CBOs, both based in Philadelphia, identified 25 and 17 recruiters on average annually and tested 136 and 330 network associates, respectively. Among those tested, 12 and 13 associates were notified of new HIV diagnoses (seropositivity: 9.8%, 4.4%). CBOs in Boston, Massachusetts, and Washington, District of Columbia, identified 26 and 24 recruiters per year on average and tested 228 and 123 network associates. Among those tested, 12 and 11 associates were notified of new HIV diagnoses (seropositivity: 5.1%, 8.7%). The cost per associate notified of a new HIV diagnosis was $11 578 and $12 135 in Philadelphia, and $16 437 and $16 101 in Boston, Massachusetts, and Washington, District of Columbia. CONCLUSIONS: The cost of notifying someone with a new HIV diagnosis using social networks varied across sites. Our analysis provides useful information for program planning and evaluation. |
Health care-associated invasive MRSA infections, 2005-2008
Kallen AJ , Mu Y , Bulens S , Reingold A , Petit S , Gershman K , Ray SM , Harrison LH , Lynfield R , Dumyati G , Townes JM , Schaffner W , Patel PR , Fridkin SK . JAMA 2010 304 (6) 641-8 CONTEXT: Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance; MRSA prevention programs that may affect MRSA transmission and infection are increasingly common in health care settings. Whether there have been changes in MRSA infection incidence as these programs become established is unknown; however, recent data have shown that rates of MRSA bloodstream infections (BSIs) in intensive care units are decreasing. OBJECTIVE: To describe changes in rates of invasive health care-associated MRSA infections from 2005 through 2008 among residents of 9 US metropolitan areas. DESIGN, SETTING, AND PARTICIPANTS: Active, population-based surveillance for invasive MRSA in 9 metropolitan areas covering a population of approximately 15 million persons. All reports of laboratory-identified episodes of invasive (from a normally sterile body site) MRSA infections from 2005 through 2008 were evaluated and classified based on the setting of the positive culture and the presence or absence of health care exposures. Health care-associated infections (ie, hospital-onset and health care-associated community-onset), which made up 82% of the total infections, were included in this analysis. MAIN OUTCOME MEASURES: Change in incidence of invasive health care-associated MRSA infections and health care-associated MRSA BSIs using population of the catchment area as the denominator. RESULTS: From 2005 through 2008, there were 21,503 episodes of invasive MRSA infection; 17,508 were health care associated. Of these, 15,458 were MRSA BSIs. The incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10,000 population in 2005 and decreased 9.4% per year (95% confidence interval [CI], 14.7% to 3.8%; P = .005), and the incidence of health care-associated community-onset infections was 2.20 per 10,000 population in 2005 and decreased 5.7% per year (95% CI, 9.7% to 1.6%; P = .01). The decrease was most prominent for the subset of infections with BSIs (hospital-onset: -11.2%; 95% CI -15.9% to -6.3%; health care-associated community-onset: -6.6%; 95% CI -9.5% to -3.7%). CONCLUSION: Over the 4-year period from 2005 through 2008 in 9 diverse metropolitan areas, rates of invasive health care-associated MRSA infections decreased among patients with health care-associated infections that began in the community and also decreased among those with hospital-onset invasive disease. |
Global use of Haemophilus influenzae type b conjugate vaccine
Ojo LR , O'Loughlin RE , Cohen AL , Loo JD , Edmond KM , Shetty SS , Bear AP , Privor-Dumm L , Griffiths UK , Hajjeh R . Vaccine 2010 28 (43) 7117-22 Haemophilus influenzae type b (Hib) conjugate vaccines have been underutilized globally. We report progress in global use of Hib vaccines included in national immunization schedules. The number of countries using Hib vaccine increased from 89/193 (46%) in 2004 to 158/193 (82%) by the end of 2009. The increase was greatest among low-income countries eligible for financial support from the GAVI Alliance [13/75 (17%) in 2004, 60/72 (83%) by the end of 2009], and can be attributed to various factors. Additional efforts are still needed to increase vaccine adoption in lower middle income countries [20/31 (65%) by the end of 2009]. |
Public health in an era of personal health records: opportunities for innovation and new partnerships
Bonander J , Gates S . J Med Internet Res 2010 12 (3) e33 In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public's health. |
Field triage: optimising injury outcomes through use of a revised on-scene decision-making protocol
Kapil V , Sattin RW , Sasser S , McGuire LC , Hunt R . Inj Prev 2010 16 (4) 284-5 In the USA, unintentional injuries are the leading cause of death for people aged 1–44.1 Injuries are associated with significant physical, emotional and financial consequences that can affect the lives of individuals, their families and society. Injuries also place an enormous burden on hospital emergency departments and trauma care systems, with unintentional injuries alone accounting for approximately one-quarter of all emergency department visits.2 | The CDC Injury Research Agenda | CDC's National Center for Injury Prevention and Control (NCIPC) recognises that injuries may occur despite our best efforts at primary prevention. Therefore NCIPC's Division of Injury Response works not only to prevent injuries but also to improve injury care and response to minimise the consequences of injury. In 2009, NCIPC published the CDC Injury Research Agenda outlining critical research needs and priorities for 2009–2018.3 This Research Agenda includes a section on ‘acute care’, which focuses on improving acute care practices to help improve outcomes for those who are injured. SAVIR and NCIPC are collaborating to promote the Research Agenda and to identify potential partners and resources to support these research priorities. One specific priority area identified for this collaborative effort and highlighted in the Research Agenda is ‘field triage…the on-scene decision-making by emergency medical services (EMS) providers at injury scenes for the care and transport of the injured to the most appropriate facility in a timely fashion’. |
Multilocus sequence typing of sequential Candida albicans isolates from patients with persistent or recurrent fungemia
Da Matta DA , Melo AS , Guimaraes T , Frade JP , Lott TJ , Colombo AL . Med Mycol 2010 48 (5) 757-62 Multilocus sequence typing (MLST) is a useful tool to explore the phylogenetics and epidemiology of Candida albicans isolates recovered from cases of invasive candidiasis. The goal of this study was to determine whether the same or different strains were responsible for persistent or recurrent fungemia through the use of MLST and ABC typing on sequential C. albicans isolates from the same patient. We applied both typing methods to 21 C. albicans strains recovered from 8 patients with persistent or recurrent candidemia. The isolates were collected during a multicenter surveillance study in four public tertiary care hospitals in Brazil. Persistent candidemia was defined as two or more blood cultures positive for C. albicans on 2 or more separate days. Recurrent candidemia was defined as an episode of candidemia occurring at least 1 month after the apparent complete resolution of an infectious episode caused by Candida species. We observed that, except for one patient, all strains from the first and second samples of the same patient showed the same MLST diploid sequence type (DST), ABC type and susceptibility profile to antifungals. Three distinct strains, well discriminated by MLST, were found in the seven samples collected sequentially over 10 days from one patient. The strains from the first four samples were indistinguishable, the fifth and sixth were also indistinguishable but different from the first four and seventh samples. Significantly, the seventh strain was the only C. albicans clade 2 isolate found in our total collection involving 61 patients, although clade 2 is commonly found worldwide. To the best of our knowledge, this is the first study describing the recovery of three distinct C. albicans strains in the same patient with a persistent blood stream infection within a short period of time. |
Near-infrared spectroscopy as a complementary age grading and species identification tool for African malaria vectors
Sikulu M , Killeen GF , Hugo LE , Ryan PA , Dowell KM , Wirtz RA , Moore SJ , Dowell FE . Parasit Vectors 2010 3 49 Near-infrared spectroscopy (NIRS) was recently applied to age-grade and differentiate laboratory reared Anopheles gambiae sensu strico and Anopheles arabiensis sibling species of Anopheles gambiae sensu lato complex. In this study, we report further on the accuracy of this tool for simultaneously estimating the age class and differentiating the morphologically indistinguishable An. gambiae s.s. and An. arabiensis from semi-field releases and wild populations. Nine different ages (1, 3, 5, 7, 9, 11, 12, 14, 16 d) of An. arabiensis and eight different ages (1, 3, 5, 7, 9, 10, 11, 12 d) of An. gambiae s.s. maintained in 250 x 60 x 40 cm cages within a semi-field large-cage system and 105 wild-caught female An. gambiae s.l., were included in this study. NIRS classified female An. arabiensis and An. gambiae s.s. maintained in semi-field cages as <7 d old or ≥7 d old with 89% (n = 377) and 78% (n = 327) accuracy, respectively, and differentiated them with 89% (n = 704) accuracy. Wild caught An. gambiae s.l. were identified with 90% accuracy (n = 105) whereas their predicted ages were consistent with the expected mean chronological ages of the physiological age categories determined by dissections. These findings have importance for monitoring control programmes where reduction in the proportion of older mosquitoes that have the ability to transmit malaria is an important outcome. |
Electronic laboratory system reduces errors in National Tuberculosis Program: a cluster randomized controlled trial
Blaya JA , Shin SS , Yale G , Suarez C , Asencios L , Contreras C , Rodriguez P , Kim J , Cegielski P , Fraser HS . Int J Tuberc Lung Dis 2010 14 (8) 1009-15 OBJECTIVE: To evaluate the impact of the e-Chasqui laboratory information system in reducing reporting errors compared to the current paper system. DESIGN: Cluster randomized controlled trial in 76 health centers (HCs) between 2004 and 2008. METHODS: Baseline data were collected every 4 months for 12 months. HCs were then randomly assigned to intervention (e-Chasqui) or control (paper). Further data were collected for the same months the following year. Comparisons were made between intervention and control HCs, and before and after the intervention. RESULTS: Intervention HCs had respectively 82% and 87% fewer errors in reporting results for drug susceptibility tests (2.1% vs. 11.9%, P = 0.001, OR 0.17, 95%CI 0.09-0.31) and cultures (2.0% vs. 15.1%, P < 0.001, OR 0.13, 95%CI 0.07-0.24), than control HCs. Preventing missing results through online viewing accounted for at least 72% of all errors. e-Chasqui users sent on average three electronic error reports per week to the laboratories. CONCLUSIONS: e-Chasqui reduced the number of missing laboratory results at point-of-care health centers. Clinical users confirmed viewing electronic results not available on paper. Reporting errors to the laboratory using e-Chasqui promoted continuous quality improvement. The e-Chasqui laboratory information system is an important part of laboratory infrastructure improvements to support multidrug-resistant tuberculosis care in Peru. |
Four-year calibration stability of the EasyOne portable spirometer
Skloot GS , Edwards NT , Enright PL . Respir Care 2010 55 (7) 873-7 BACKGROUND: Clinical practice guidelines recommend daily spirometer calibration checks and weekly linearity checks. The long-term stability of the volume and flow accuracy of a specific model of spirometer should be carefully characterized before modification of the frequency of calibration checks is considered for that model of spirometer. METHODS: The EasyOne ultrasonic flow-sensing spirometer was chosen for use by the clinical centers at the 2002 inception of the World Trade Center Worker and Volunteer Medical Screening Program. The screening program quality-control procedure required that the expiratory and inspiratory volume accuracy of each spirometer be checked every day of testing, and the flow accuracy (linearity) checked every week. The calibration check results were transferred to a central database for summary. RESULTS: Over 5,000 calibration-check results (4,109 single-speed and 1,189 three-speed) were accumulated from a total of 34 spirometers during the period February 2003 through March 2007. The mean single-speed calibration errors (and 5th-95th percentiles) were -2 mL (-80 to 70 mL) for exhalation and -10 mL (-80 to 60 mL) for inhalation. 98% of the exhalation and 97% of the inhalation calibration checks were accurate within 3.0%. There was no evidence of significant non-linearity according to the results of the 3-speed calibration checks (mean errors of -3, -5, and -6 mL at each speed). CONCLUSIONS: The EasyOne retained inhalation and exhalation volume accuracy of better than 3% for at least 4 years. Routine multiple-speed volume calibration checks may not be necessary with the EasyOne. The acceptability and repeatability of patient efforts should be the primary focus of quality-assurance programs with spirometers that have been demonstrated to remain accurate for long periods. |
Determination of the ratio of diffusion charging-based surface area to geometric surface area for spherical particles in the size range of 100-900nm
Ku BK . J Aerosol Sci 2010 41 (9) 835-847 Diffusion charging-based surface area for spherical particles was measured and compared with geometric surface area in the submicrometer size ranging from 100 to 900. nm. Spherical aerosol particles (polystyrene latex particles (PSL) and droplets of diethylhexyl sebacate (DEHS)) were generated by electrosprays for 100-600. nm particles and by a condensation generator for 700-900. nm particles. Two commercially available diffusion chargers (DCs) (DC2000CE, Ecochem, USA; LQ1-DC, Matter Engineering, Switzerland) were challenged with monodisperse uncharged spherical aerosols. Results showed that the surface areas measured by the two DCs were proportional to mobility diameter to power 1.22 and 1.38, respectively, in the size range from 100 to 900. nm. Comparison of the DC-based surface area with theoretical active surface area resulted in reasonable agreement within 30%, indicating that the DCs underestimate geometric surface area of particles. The deviation of the DC-based surface area from the geometric surface area was quantitatively measured and was found to be up to 94% in the size range studied. Three types of aerosol particles were used to validate the correction of the DC deviation from the geometric surface area for particles larger than 100. nm based on the fit obtained for spherical particles in this study: spherical silver particles, carbon nanofibers, and titanium dioxide agglomerates. Comparison of the corrected DC-based surface area to Brunauer-Emmett-Teller (BET)-measured surface area indicated that the DC surface area reasonably agrees with the BET value for the particles tested except carbon nanofibers with 300 nm modal diameter. 2010. |
Role of prenatal characteristics and early growth on pubertal attainment of British girls
Maisonet M , Christensen KY , Rubin C , Holmes A , Flanders WD , Heron J , Ong KK , Golding J , McGeehin MA , Marcus M . Pediatrics 2010 126 (3) e591-600 OBJECTIVES: The objective of this study was to explore the influence of maternal prenatal characteristics and behaviors and of weight and BMI gain during early childhood on the timing of various puberty outcomes in girls who were enrolled in the Avon Longitudinal Study of Parents and Children. METHODS: Repeated self-assessments of pubertal development were obtained from approximately 4000 girls between the ages of 8 and 14. Data on prenatal characteristics and weight at birth and 2, 9, and 20 months of age were obtained from questionnaires, birth records, and clinic visits. Infants' weights were converted to weight-for-age and BMI SD scores (SDSs; z scores), and change values were obtained for the 0- to 20-month and other intervals within that age range. We used parametric survival models to estimate associations with age of entry into Tanner stages of breast and pubic hair and menarche. RESULTS: Maternal initiation of menarche at age <12, smoking during pregnancy, and primiparity were associated with earlier puberty. A 1-unit increase in the weight SDS change values for the 0- to 20-month age interval was associated with earlier ages of entry into pubertal outcomes (0.19-0.31 years). Increases in the BMI SDS change values were also associated with earlier entry into pubertal outcomes (0.07-0.11 years). CONCLUSIONS: Many of the maternal prenatal characteristics and weight and BMI gain during infancy seemed to have similar influences across different puberty outcomes. Either such early factors have comparable influences on each of the hormonal processes involved in puberty, or processes are linked and awakening of 1 aspect triggers the others. |
Read all about it: the role of the media in improving construction safety and health
Schneider S , Check P . J Safety Res 2010 41 (3) 283-7 Around 1,000 construction workers are killed every year on the job in the United States, usually individual fatalities separated by time and distance. Although national news media may give front-page coverage or evening-news priority to the less frequent catastrophic incidents in which several workers die at one time, individual deaths typically do not receive high-visibility national news coverage. These deaths may be reported fleetingly as community news in local newspapers or broadcasts. Reporters are usually tasked to cover a wide range of breaking news on short deadlines. Rarely, as a rule, do junior or general-assignment reporters have the luxury of choosing a specialized beat to follow or the time needed to become deeply familiar with sources, issues, and terminology in specialized areas. Senior reporters who may have more latitude are faced with a myriad of issues that compete for equal time in the public interest. | Because of these factors, it may be argued that the true toll of work-related injury and death in construction, and the fact that these tragedies can be prevented, are not well recognized by the general public in day-to-day news coverage. This presents a challenge and an opportunity for safety and health professionals to (a) encourage news media to provide deeper, more sustained coverage of construction injury and death, and (b) offer data, insights, and expertise that will help reporters and editors to do so. This paper discusses the potential of traditional news media to improve construction safety and health by highlighting fundamental issues through in-depth reporting, as well as the role of internet-based and social media as a complement to traditional media. |
Work schedules and health behavior outcomes at a large manufacturer
Bushnell PT , Colombi A , Caruso CC , Tak S . Ind Health 2010 48 (4) 395-405 There is evidence that work schedules may influence rates of unhealthy behaviors, suggesting that addressing work schedule challenges may improve health. Health Risk Assessment (HRA) survey responses were collected during 2000-2008 in a multinational chemical and coatings manufacturer. Responses of 26,442 were sufficiently complete for analysis. Rates of smoking, lack of exercise, moderate to high alcohol use, obesity (BMI >= 30), and short sleep duration were compared by work schedule type (day, night, or rotating shift) and daily work hours (8, 10, or 12 h). Prevalence rate ratios (RRs) were calculated, adjusting for age group, sex, marital/living status, job tenure, and occupational group. The reference group was 8-h day shift employees. Overall prevalence rates were: sleep duration of 6 h or less per night 47%, smoking 17.3%, no exercise 22.0%, BMI >= 30 28.3%, and moderate to heavy alcohol consumption 22.2%. Statistically significant RRs include the following: Short sleep duration: 10 h rotating shift (RR=1.6), 12 h day and 12 h rotating shifts (RR=1.3); Smoking: 12 It day and rotating shifts (RR=1.6), 10 and 12 h night and 8 h rotating shift (RR=1.4); No exercise: 8, 10, and 12 h rotating shifts (RR=1.2 to 1.3), 12 h day schedules (RR=1.3). Obesity (BMI >= 30): 8 and 10 h night shifts (RR=1.3 and 1.4, respectively). |
Making green jobs safe
Schulte PA , Heidel D , Okun A , Branche C . Ind Health 2010 48 (4) 377-379 Can a job be “Green” if it is not safe? Unfortunately, | the current answer is yes. The United Nations | Environment Program defines a green job as work in | agricultural, manufacturing, research and development, | administrative, and service activities that contribute | substantially to preserving or restoring environmental | quality1). The US Bureau of Labor Statistics proposes | to define green jobs as jobs involved in producing | green products and services that increase the use of | energy from renewable sources, increase energy efficiency, or protect, restore, or mitigate damage to the | environment2). From these definitions it is apparent that, | although a green job must preserve environmental quality and/or produce green products and services, green | jobs have no requirement that they be safe for those | individuals performing the jobs (or for that matter, the | consumers using green products and services). |
Needlestick injuries among sanitation workers in Mexico City
Thompson B , Moro PL , Hancy K , Ortega-Sanchez IR , Santos-Preciado JI , Franco-Paredes C , Weniger BG , Chen RT . Rev Panam Salud Publica 2010 27 (6) 467-468 Sanitation workers (SW) are exposed to a wide | range of biological, chemical, and physical hazards. | Needlestick injuries constitute a recognized physical | hazard, but few studies have been conducted to document the magnitude of the problem among SW. Contaminated sharp objects can transmit bloodborne | pathogens, such as human immunodeficiency (HIV), | hepatitis B (HBV), and hepatitis C (HCV) viruses. Needles and syringes contaminated with HBV and HCV | have been found in public recreational areas in South | London, United Kingdom (1). Although transmission | of such pathogens to sanitation workers and community members has not been demonstrated, there is the | potential for infection. We were not aware of any prior | study among SW in a developing country. Given this | lack of information, we conducted a survey of needlestick and sharps injuries among SW in Mexico City. | In July–August 2003, a non-random, convenience sample of 69 SW was selected from 13 of the 16 | Mexico City districts by finding and approaching sanitation vehicles during their daily rounds. Workers | were identified and interviewed on the street, while | working or during a break. Questionnaires determined | the frequency of sustaining a needlestick injury at | work, finding syringes with regular waste, vaccination | status, and health care-seeking practices. Epi InfoTM | Version 3.3.2 (Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America) was | used for data entry, descriptive epidemiology, and | analysis. |
Job demands and pesticide exposure among immigrant Latino farmworkers
Grzywacz JG , Quandt SA , Vallejos QM , Whalley LE , Chen H , Isom S , Barr DB , Arcury TA . J Occup Health Psychol 2010 15 (3) 252-66 The goal of this study was to understand the potential threat of job stressors to farmworker health. To accomplish this goal we studied pesticide exposure, an issue with immediate and long-term health consequences, and predictions from the Demands-Control model of occupational stress. Longitudinal, self-report data and urine samples were collected at monthly intervals from a cohort of Latino farmworkers (N = 287) during the 2007 agricultural season. The primary hypothesis was that greater exposure to psychological demands, physical exertion, and hazardous work conditions are associated with greater odds of detecting dialkylphosphate (DAP) urinary pesticide metabolites, biomarkers indicating exposure to pesticides. Contrary to this hypothesis, results indicated that none of the elements of the Demands-Control model were independently associated with detection of DAP urinary pesticide metabolites. However, analyses produced several interaction effects, including evidence that high levels of control may buffer the effects of physical job demands on detection of DAP urinary pesticide metabolites. |
Characterization of exposures to airborne nanoscale particles during friction stir welding of aluminum
Pfefferkorn FE , Bello D , Haddad G , Park JY , Powell M , McCarthy J , Bunker KL , Fehrenbacher A , Jeon Y , Virji MA , Gruetzmacher G , Hoover MD . Ann Occup Hyg 2010 54 (5) 486-503 Friction stir welding (FSW) is considered one of the most significant developments in joining technology over the last half century. Its industrial applications are growing steadily and so are the number of workers using this technology. To date, there are no reports on airborne exposures during FSW. The objective of this study was to investigate possible emissions of nanoscale (<100 nm) and fine (<1 microm) aerosols during FSW of two aluminum alloys in a laboratory setting and characterize their physicochemical composition. Several instruments measured size distributions (5 nm to 20 microm) with 1-s resolution, lung deposited surface areas, and PM(2.5) concentrations at the source and at the breathing zone (BZ). A wide range aerosol sampling system positioned at the BZ collected integrated samples in 12 stages (2 nm to 20 microm) that were analyzed for several metals using inductively coupled plasma mass spectrometry. Airborne aerosol was directly collected onto several transmission electron microscope grids and the morphology and chemical composition of collected particles were characterized extensively. FSW generates high concentrations of ultrafine and submicrometer particles. The size distribution was bimodal, with maxima at approximately 30 and approximately 550 nm. The mean total particle number concentration at the 30 nm peak was relatively stable at approximately 4.0 x 10(5) particles cm(-3), whereas the arithmetic mean counts at the 550 nm peak varied between 1500 and 7200 particles cm(-3), depending on the test conditions. The BZ concentrations were lower than the source concentrations by 10-100 times at their respective peak maxima and showed higher variability. The daylong average metal-specific concentrations were 2.0 (Zn), 1.4 (Al), and 0.24 (Fe) microg m(-3); the estimated average peak concentrations were an order of magnitude higher. Potential for significant exposures to fine and ultrafine aerosols, particularly of Al, Fe, and Zn, during FSW may exist, especially in larger scale industrial operations. |
Ground failures in coal mines with weak roof
Molinda G , Mark C . Electron J Geotech Eng 2010 15 1-42 Coal miners who work and travel under supported roof expect to be protected from rock falls. However, rock fall accidents and injuries continue to occur in coal mines that have been supported according to the roof control plan. Experience at coal mines with large numbers of falls indicates that many have weak roof. Control of this roof may require additional ground control measures. An understanding of the geologic and stress conditions which lead to roof falls is necessary to assess the risk of failure and to design roof reinforcement to improve stability. Six common roof fall types, with attached field examples, are described. Roof support practices for each fall type are also described. |
Lessons learned after 10 years of IPAQ use in Brazil and Colombia
Hallal PC , Gomez LF , Parra DC , Lobelo F , Mosquera J , Florindo AA , Reis RS , Pratt M , Sarmiento OL . J Phys Act Health 2010 7 Suppl 2 S259-64 BACKGROUND: To describe the lessons learned after 10 years of use of the International Physical Activity Questionnaire (IPAQ) in Brazil and Colombia, with special emphasis on recommendations for future research in Latin America using this instrument. METHODS: We present an analytical commentary, based on data from a review of the Latin American literature, as well as expert consultation and the authors' experience in administering IPAQ to over 43,000 individuals in Brazil and Colombia between 1998 and 2008. RESULTS: Validation studies in Latin America suggest that the IPAQ has high reliability and moderate criteria validity in comparison with accelerometers. Cognitive interviews suggested that the occupational and housework sections of the long IPAQ lead to confusion among respondents, and there is evidence that these sections generate overestimated scores of physical activity. Because the short IPAQ considers the 4 physical activity domains altogether, people tend to provide inaccurate answers to it as well. CONCLUSIONS: Use of the leisure-time and transport sections of the long IPAQ is recommended for surveillance and studies aimed at documenting physical activity levels in Latin America. Use of the short IPAQ should be avoided, except for maintaining consistency in surveillance when it has already been used at baseline. |
Evaluation of a legislatively mandated influenza vaccination program for adults in Rhode Island, USA
Ahmed F , Paine V , Zhang F , Gary E , Lindley MC . J Public Health Manag Pract 2010 16 (5) E01-8 CONTEXT: There have been disruptions in influenza vaccine supply in the United States during the 2000-2001, 2001-2002, 2004-2005, and 2005-2006 influenza seasons. Some providers received limited or no vaccine, while others obtained their order in full, depending on with whom the order was placed. A state law was passed that mandates the Rhode Island Department of Health to include the purchase and distribution of influenza vaccine for adults in its immunization program. OBJECTIVE: To evaluate the first 2 years of the statewide adult influenza immunization program. DESIGN: We conducted key informant interviews of 25 providers in 2008 and surveyed all enrolled providers in 2008 (year 1) and 2009 (year 2). SETTING: State of Rhode Island. PARTICIPANTS: Physician practices and facilities that provide influenza vaccination to adults, including private practices, nursing homes, health centers, urgent care facilities, hospitals, mass immunizers, and businesses. INTERVENTION: Enrolled providers received influenza vaccines free and billed insurers, Medicare, and Medicaid for vaccine administration costs. MAIN OUTCOME MEASURES: Provider satisfaction with different program components and overall satisfaction. RESULTS: For year 1, there was higher satisfaction with enrollment, training, vaccine ordering, and vaccine shipment than with paperwork and claims. Of the survey respondents, 71% reported that the program paperwork was reasonable and 30% reported difficulties in receiving reimbursement. Satisfaction with the vaccination start date of October 17, 2007, was 80%. There was high overall satisfaction (94%). In response to streamlining of reporting requirements and setting an earlier start date of October 7, 2008, for year 2, there was a significant increase in satisfaction with paperwork (89%) and with vaccination start date (90%). CONCLUSIONS: The findings may be useful in guiding the development of vaccination programs to provide influenza and other vaccines for adults at the state or national level. |
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