Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007-2010
Ostchega Y , Hughes JP , Terry A , Fakhouri TH , Miller I . Am J Hypertens 2012 25 (12) 1271-8 BACKGROUND: Both abdominal obesity, defined as waist circumference (WC) ≥102 cm for men and WC ≥88 cm for women and increased body mass index (BMI; kg/m(2)) are known to be associated with hypertension. The aim of this study was to examine the independent and the combined relationship between abdominal obesity and increased BMI and hypertension by age, race, and gender in a national sample. METHODS: This report is based on national level cross-sectional data for adults aged 18 years and older (11,145 participants) from the US National Health and Nutrition Examination Survey (NHANES) 2007-2010. RESULTS: Abdominal obesity, after adjusting for BMI categories and other covariables, was independently associated with hypertension. That is, survey participants classified as abdominally obese had almost 50% increased odds of being hypertensive (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27-1.81) after controlling for BMI. After adjusting for covariables, the groups of individuals classified as abdominally obese and normal BMI; as abdominally obese and overweight; and abdominally obese and obese each had a progressive increase in the odds of hypertension when compared with individuals who had a normal BMI and no abdominal obesity (OR 1.81, 95% CI 1.28-2.57, OR 1.87, 95% CI 1.55-2.25, and OR 3.23, 95% CI 2.63-3.96, respectively). CONCLUSIONS: Abdominal obesity is independently associated with hypertension after adjusting for BMI. After adjusting for covariables and parameterizing BMI categories and abdominal obesity the new variable showed a progressive increase in the odds of hypertension. Both BMI and WC should be included in models assessing hypertension risks. (American Journal of Hypertension, (2012); doi:10.1038/ajh.2012.120.) |
Demographic and clinical correlates of diabetes-related quality of life among youth with type 1 diabetes
Lawrence JM , Yi-Frazier JP , Black MH , Anderson A , Hood K , Imperatore G , Klingensmith GJ , Naughton M , Mayer-Davis EJ , Seid M . J Pediatr 2012 161 (2) 201-207 e2 OBJECTIVES: To evaluate the reliability and cluster structure of the Pediatric Quality of Life Inventory Type 1 Diabetes Module 3.0 (PedsQL-T1DM) and associated subscales and to explore the associations between PedsQL-T1DM total score and demographic and clinical characteristics and clinical indicators among a large racially/ethnically diverse cohort of youth with type 1 diabetes. STUDY DESIGN: Principal components analysis was conducted on responses from the PedsQL-T1DM child self-report forms completed by SEARCH for Diabetes in Youth study participants aged ≥5 years. Multivariate linear regression models were fit to examine the associations among PedsQL-T1DM total score, demographic and clinical characteristics, and clinical indicators. RESULTS: The sample comprised 2602 youth with a mean age of 13.6 +/- 4.1 years and a mean T1DM duration of 62.1 +/- 47.0 months. Principal components analysis did not support the 5 existing PedsQL-T1DM subscales. In multivariate analyses, the PedsQL-T1DM total score was negatively and significantly associated with younger age (5-7 years), female sex, receiving insulin by injection (vs pump), having parents without a college degree, Medicaid/Medicare insurance, and having a comorbid medical condition. Youth with poor glycemic control based on their age-specific hemoglobin A1c target values and those with depressive symptoms had significantly lower PedsQL-T1DM scores than their counterparts with good control and no or limited depressive symptoms. CONCLUSION: This study has identified sociodemographic and clinical characteristics of youth with T1DM more likely to experience poor diabetes-specific quality of life. The association of lower PedsQL-T1DM scores with depressive symptoms and poor glycemic control is especially concerning and may be the focus of future interventions and studies. |
Risk factors for mechanical ventilation in U.S. children hospitalized with seasonal influenza and 2009 pandemic influenza A
Eriksson CO , Graham DA , Uyeki TM , Randolph AG . Pediatr Crit Care Med 2012 13 (6) 625-31 OBJECTIVE: We tested the hypothesis that the use of mechanical ventilator support in children hospitalized with influenza during the 2009 H1N1 influenza A (H1N1) pandemic was higher than would be expected in children hospitalized for seasonal influenza after adjusting for patient risk. DESIGN: Retrospective cohort study. SETTING: Forty-three U.S. pediatric hospitals. PATIENTS: Children <18 yrs old with a discharge diagnosis of influenza admitted July 2006 through March 2009 (seasonal influenza) and June through December 2009 (2009 pandemic influenza A). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 10,173 children hospitalized with seasonal influenza and 9837 with presumed 2009 pandemic influenza A. The 2009 pandemic influenza A cohort was older (median 5.0 vs. 1.9 yrs), more likely to have asthma (30% vs. 18%), and less likely to receive mechanical ventilation (7.1% [n = 701] vs. 9.2% [n = 940]). Using logistic regression, we created a multivariable model of risk factors associated with endotracheal mechanical ventilator support in the seasonal influenza cohort and used this model to predict the number of expected mechanical ventilation cases in children with presumed 2009 pandemic influenza A. Adjusted for underlying health conditions, race, age, and a co-diagnosis of bacterial pneumonia, the observed/expected rate of mechanical ventilation in the presumed 2009 pandemic influenza A cohort was 0.74 (95% confidence interval, 0.68-0.79). Early hospital treatment with influenza antiviral medications was associated with decreased initiation of mechanical ventilation on hospital day ≥3 in the seasonal influenza (odds ratio, 0.66; 95% confidence interval, 0.45-0.97) and 2009 pandemic influenza A (odds ratio, 0.23; 95% confidence interval, 0.16-0.34) periods; influenza antiviral use in the 2009 pandemic influenza A period was much higher (70% vs. 19%; p < .001). CONCLUSIONS: Although the number of children with a hospital discharge diagnosis of influenza almost tripled during the 2009 pandemic influenza A period, the risk-adjusted proportion of children receiving mechanical ventilation was lower than we would have predicted in a seasonal influenza cohort. Early hospital use of influenza antiviral medications was associated with a decrease in late-onset mechanical ventilation. |
Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin
Kowdley KV , Wang CC , Welch S , Roberts H , Brosgart CL . Hepatology 2012 56 (2) 422-33 Estimates of the prevalence of chronic hepatitis B (CHB) in the United States differ significantly, and the contribution of foreign-born (FB) persons has not been adequately described. The aim of this study was to estimate the number of FB persons in the United States living with CHB by their country of origin. We performed a systematic review for reports of HBsAg seroprevalence rates in 102 countries (covering PubMed from 1980 to July 2010). Data from 1,373 articles meeting inclusion criteria were extracted into country-specific databases. We identified 256 seroprevalence surveys in emigrants from 52 countries (including 689,078 persons) and 1,797 surveys in the general populations of 98 countries (including 17,861,035 persons). Surveys including individuals with lower or higher risk of CHB than the general population were excluded. Data were combined using meta-analytic methods to determine country-specific pooled CHB prevalence rates. Rates were multiplied by the number of FB living in the United States in 2009 by country of birth from the U.S. Census Bureau to yield the number of FB with CHB from each country. We estimate a total of 1.32 million (95% confidence interval: 1.04-1.61) FB in the United States living with CHB in 2009; 58% migrated from Asia and 11% migrated from Africa, where hepatitis B is highly endemic. Approximately 7% migrated from Central America, a region with lower CHB rates, but many more emigrants to the United States. This analysis suggests that the number of FB persons living with CHB in the United States may be significantly greater than previously reported. Assuming 300,000-600,000 U.S.-born persons with CHB, the total prevalence of CHB in the United States may be as high as 2.2 million. (Hepatology 2012). |
Exploring discordance between biologic and self-reported measures of semen exposure: a qualitative study among female patients attending an STI clinic in Jamaica
Carter MW , Bailey A , Snead MC , Costenbader E , Townsend M , Macaluso M , Jamieson DJ , Hylton-Kong T , Warner L , Steiner MJ . AIDS Behav 2012 17 (2) 728-36 We explored the use of qualitative interviews to discuss discrepancies between two sources of information on unprotected sex: biomarker results and self-reported survey data. The study context was a randomized trial in Kingston, Jamaica examining the effect of STI counseling messages on recent sexual behavior using prostate-specific antigen (PSA) as the primary study outcome. Twenty women were interviewed. Eleven participants were selected because they tested positive for PSA indicating recent semen exposure, yet reported no unprotected sex in a quantitative survey ("discordant"): 5 reported abstinence and 6 reported condom use. Nine participants who also tested positive for PSA but reported unprotected sex in the survey were interviewed for comparison ("concordant"). Qualitative interviews with 6 of the 11 discordant participants provided possible explanations for their PSA test results, and 5 of those were prompted by direct discussion of those results. Rapid PSA testing combined with qualitative interviews provides a novel tool for investigating and complementing self-reported sexual behavior. |
HIVQUAL-T: monitoring and improving HIV clinical care in Thailand, 2002-08
Thanprasertsuk S , Supawitkul S , Lolekha R , Ningsanond P , Agins BD , McConnell MS , Fox KK , Srisongsom S , Chunwimaleung S , Gass R , Simmons N , Chaovavanich A , Jirajariyavej S , Leusaree T , Akksilp S , Mock PA , Chasombat S , Lertpiriyasuwat C , Tappero JW , Levine WC . Int J Qual Health Care 2012 24 (4) 338-47 OBJECTIVE: We report experience of HIVQUAL-T implementation in Thailand. DESIGN: Program evaluation. SETTING: Twelve government hospital clinics. PARTICIPANTS: People living with HIV/AIDS (PLHAs) aged ≥15 years with two or more visits to the hospitals during 2002-08. INTERVENTION: HIVQUAL-T is a process for HIV care performance measurement (PM) and quality improvement (QI). The program includes PM using a sample of eligible cases and establishment of a locally led QI infrastructure and process. PM indicators are based on Thai national HIV care guidelines. QI projects address needs identified through PM; regional workshops facilitate peer learning. Annual benchmarking with repeat measurement is used to monitor progress. MAIN OUTCOME MEASURE: Percentages of eligible cases receiving various HIV services. RESULTS: Across 12 participating hospitals, HIV care caseloads were 4855 in 2002 and 13,887 in 2008. On average, 10-15% of cases were included in the PM sample. Percentages of eligible cases receiving CD4 testing in 2002 and 2008, respectively, were 24 and 99% (P< 0.001); for ARV treatment, 100 and 90% (P= 0.74); for Pneumocystis jiroveci pneumonia prophylaxis, 94 and 93% (P= 0.95); for Papanicolau smear, 0 and 67% (P< 0.001); for syphilis screening, 0 and 94% (P< 0.001); and for tuberculosis screening, 24 and 99% (P< 0.01). PM results contributed to local QI projects and national policy changes. CONCLUSIONS: Hospitals participating in HIVQUAL-T significantly increased their performance in several fundamental areas of HIV care linked to health outcomes for PLHA. This model of PM-QI has improved clinical care and implementation of HIV guidelines in hospital-based clinics in Thailand. |
Annular rash outbreak in a family
Rangamani S , Van Schooneveld TC , Cornish NE , Varman M . Pediatr Infect Dis J 2012 31 (9) 998 A previously healthy 6-year-old female child presented to the outpatient clinic with a generalized erythematous, annular, slightly raised and mildly pruritic rash that was present primarily on the right upper arm for 1 week. She complained of low-grade fever (up to 37.9°C), myalgia and fatigue. One week previously, her primary physician had treated her with oral azithromycin and cephalexin for the rash. Despite this, the rash worsened, and lesions were present on the trunk, face and neck, sparing palms and soles. The patient denied respiratory symptoms, diarrhea, vomiting, headache, recent travel and tick bite exposure. Her medical history included only allergic rhinitis treated with diphenhydramine and montelukast. The patient’s mother and 15-year-old sister, both of whom had familial Mediterranean fever, developed a similar rash on their face, arms and trunk. In addition, the boyfriend of the 15-year-old sister and the playmate of the patient who frequently visited the home had begun to develop similar lesions. | The family reported owning 1 rat, 3 cats and 3 dogs. They volunteered regularly in an animal shelter and had recently adopted a kitten found in a trash dumpster. The patient and the other family members had been in close contact with the kitten. When initially adopted, the kitten had an annular erythematous rash, cough, runny nose and hair loss, which was improving with antibiotics treatment. |
Changes in incidence and antifungal drug resistance in candidemia: results from population-based laboratory surveillance in Atlanta and Baltimore, 2008-2011
Cleveland AA , Farley MM , Harrison LH , Stein B , Hollick R , Lockhart SR , Magill SS , Derado G , Park BJ , Chiller TM . Clin Infect Dis 2012 55 (10) 1352-61 BACKGROUND: Candidemia is common and associated with high morbidity and mortality; changes in population-based incidence rates have not been reported. METHODS: We conducted active, population-based surveillance in metropolitan Atlanta, Georgia, and Baltimore City/ County, Maryland (combined population 5.2 million), during 2008-2011. We calculated candidemia incidence and antifungal drug resistance compared to prior surveillance (Atlanta: 1992-1993; Baltimore: 1998-2000). RESULTS: We identified 2,675 cases of candidemia with 2,329 isolates during 3 years of surveillance. Mean annual crude incidence per 100,000 person-years was 13.3 in Atlanta, and 26.2 in Baltimore. Rates were highest among adults aged ≥65 years (Atlanta, 59.1; Baltimore, 72.4), and infants (aged <1 year) (Atlanta, 34.3; Baltimore, 46.2). In both locations compared to prior surveillance, adjusted incidence significantly declined for infants of both black and white race (Atlanta, black risk ratio (RR): 0.26, 95% confidence interval [CI]: [0.17-0.38]; white RR: 0.19, 95% CI: [0.12-0.29]; Baltimore, black RR: 0.38, 95% CI: [0.22-0.64], white RR: 0.51, 95% CI: [0.29-0.90]). Prevalence of fluconazole resistance (7%) was unchanged compared to prior surveillance; 32 (1%) isolates were echinocandin-resistant, and nine (eight C. glabrata) were multi-drug resistant to both fluconazole and an echinocandin. CONCLUSIONS: We describe marked shifts in candidemia epidemiology over the past two decades. Adults aged ≥ 65 years replaced infants as the highest incidence group; adjusted incidence has declined significantly in infants. Use of antifungal prophylaxis, improvements in infection control, or changes in catheter insertion practices may be contributing to these declines. Further surveillance for antifungal resistance and efforts to determine effective prevention strategies are needed. |
Yersinia pestis infection and laboratory conditions alter flea-associated bacterial communities
Jones RT , Vetter SM , Montenieiri J , Holmes J , Bernhardt SA , Gage KL . ISME J 2012 7 (1) 224-8 We collected Oropsylla montana from rock squirrels, Spermophilus varigatus, and infected a subset of collected fleas with Yersinia pestis, the etiological agent of plague. We used bar-tagged DNA pyrosequencing to characterize bacterial communities of wild, uninfected controls and infected fleas. Bacterial communities within Y. pestis-infected fleas were substantially more similar to one another than communities within wild or control fleas, suggesting that infection alters the bacterial community in a directed manner such that specific bacterial lineages are severely reduced in abundance or entirely eliminated from the community. Laboratory conditions also significantly altered flea-associated bacterial communities relative to wild communities, but much less so than Y. pestis infection. The abundance of Firmicutes decreased considerably in infected fleas, and Bacteroidetes were almost completely eliminated from both the control and infected fleas. Bartonella and Wolbachia were unaffected or responded positively to Y. pestis infection. (The ISME Journal advance online publication, 16 August 2012; doi:10.1038/ismej.2012.95.) |
When data are not missing at random: implications for measuring health conditions in the Behavioral Risk Factor Surveillance System
Frankel MR , Battaglia MP , Balluz L , Strine T . BMJ Open 2012 2 (4) OBJECTIVES: To examine the effect on estimated levels of health conditions produced from large-scale surveys, when either list-wise respondent deletion or standard demographic item-level imputation is employed. To assess the degree to which further bias reduction results from the inclusion of correlated ancillary variables in the item imputation process. DESIGN: Large cross-sectional (US level) household survey. PARTICIPANTS: 218,726 US adults (18 years and older) in the 2006 Behavioral Risk Factor Surveillance System Survey. This survey is the largest US telephone survey conducted by the Centers for Disease Control and Prevention. PRIMARY AND SECONDARY OUTCOME MEASURES: Estimated rates of severe depression among US adults. RESULTS: The use of list-wise respondent deletion and/or demographic imputation results in the underestimation of severe depression among adults in the USA. List-wise deletion produces underestimates of 9% (8.7% vs 9.5%). Demographic imputation produces underestimates of 7% (8.9% vs 9.5%). Both of these differences are significant at the 0.05 level. CONCLUSION: The use of list-wise deletion and/or demographic-only imputation may produce significant distortion in estimating national levels of certain health conditions. |
Correlation of prospective and cross-sectional measures of HIV type 1 incidence in a higher-risk cohort in Ho Chi Minh City, Vietnam
Sexton CJ , Costenbader EC , Vinh DT , Chen PL , Hoang TV , Lan NT , Feldblum P , Kim A , Giang LT . AIDS Res Hum Retroviruses 2012 28 (8) 866-73 The primary aim of this study was to estimate HIV incidence within a high-risk population in Ho Chi Minh City (HCMC), Vietnam using both cross-sectional and prospective methodologies. A secondary aim was to develop a local correction factor for the BED and avidity index incidence assays. The research study design consisted of three phases: (1) cross-sectional, (2) prospective, and (3) BED false recent (BED FR). A total of 1619 high-risk, sexually active individuals were enrolled in the cross-sectional phase and 355 of the opiate-negative, HIV-negative women were subsequently enrolled in the prospective phase. Four-hundred and three men and women with known HIV infection duration of greater than 12 months were enrolled in the BED FR phase. The HIV prevalence for all participants in the cross-sectional phase was 15.8%. HIV incidence in the cross-sectional group was estimated using the BED IgG capture assay and AxSYM avidity index assay for recent HIV infection and incidence within the prospective cohort was determined by observations of HIV seroconversion. HIV incidence in opiate-negative women was estimated using the BED assay to be 0.8% unadjusted and 0.5% after applying the locally derived BED false recent rate of 1.7%; no seroconversions were observed in the prospective cohort. We also screened the cross-sectional samples for evidence of acute infection using nucleic acid testing, 4th generation HIV EIA, and SMARTube coupled with Genscreen and Determine diagnostic tests; no confirmed acute infections were identified by any method. HIV incidence within this opiate-negative study population was low and incidence estimates from the two methods compared favorably with each other. Incidence estimates and false recent rates using the AxSYM assay were higher: AI FRR of 2.7% and adjusted incidence of 1.7% per year (95% CI, 0.6, 2.8). By comparison, both HIV prevalence and incidence estimates for the opiate-positive group were higher. |
Common source outbreaks of Campylobacter infection in the USA, 1997-2008
Taylor EV , Herman KM , Ailes EC , Fitzgerald C , Yoder JS , Mahon BE , Tauxe RV . Epidemiol Infect 2012 141 (5) 1-10 SUMMARY: Campylobacter is a common but decreasing cause of foodborne infections in the USA. Outbreaks are uncommon and have historically differed from sporadic cases in seasonality and contamination source. We reviewed reported outbreaks of campylobacteriosis. From 1997 to 2008, 262 outbreaks were reported, with 9135 illnesses, 159 hospitalizations, and three deaths. The annual mean was 16 outbreaks for 1997-2002, and 28 outbreaks for 2003-2008. Almost half occurred in warmer months. Foodborne transmission was reported in 225 (86%) outbreaks, water in 24 (9%), and animal contact in seven (3%). Dairy products were implicated in 65 (29%) foodborne outbreaks, poultry in 25 (11%), and produce in 12 (5%). Reported outbreaks increased during a period of declining overall incidence, and seasonality of outbreaks resembled that of sporadic infections. Unlike sporadic illnesses, which are primarily attributed to poultry, dairy products are the most common vehicle identified for outbreaks. |
Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City
Tieu HV , Spikes P , Patterson J , Bonner S , Egan JE , Goodman K , Stewart K , Frye V , Xu G , Hoover DR , Koblin BA . AIDS Care 2012 24 (9) 1111-9 The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts. |
Understanding reduced rotavirus vaccine efficacy in low socio-economic settings
Lopman BA , Pitzer VE , Sarkar R , Gladstone B , Patel M , Glasser J , Gambhir M , Atchison C , Grenfell BT , Edmunds WJ , Kang G , Parashar UD . PLoS One 2012 7 (8) e41720 INTRODUCTION: Rotavirus vaccine efficacy ranges from >90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. METHODS: We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. RESULTS: Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. DISCUSSION: The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements. |
Parental views of school-located delivery of adolescent vaccines
Kelminson K , Saville A , Seewald L , Stokley S , Dickinson LM , Daley MF , Suh C , Kempe A . J Adolesc Health 2012 51 (2) 190-6 PURPOSE: School-located immunization has the potential to increase adolescent vaccination rates. This study assessed parents' attitudes toward administration of adolescent vaccines (tetanus, diphtheria, acellular pertussis [Tdap], meningococcal conjugate [MenACWY], human papillomavirus [HPV], and influenza) at school. METHODS: We conducted a mailed survey of parents of sixth graders from July 2009 to September 2009 in three urban/suburban (Aurora, CO) middle schools assessing barriers and facilitators to school vaccination and willingness to consent for vaccines at school. Unadjusted and adjusted analyses examined the association of parent and student characteristics with parent willingness to consent to school-located vaccination. RESULTS: The response rate was 62% (500/806). Parents reported 82% of teens had a regular site of health care, and 17% were uninsured. Overall, 71% of parents would consent for vaccines at school; 72% for Tdap, 71% for MenACWY, 53% for HPV (parents of girls), and 67% for seasonal influenza. Among parents who answered it was important their child receives recommended vaccines, (88%) would consent for influenza vaccine at school, compared with Tdap (76%), MenACWY (74%), and HPV (72%). Multivariable logistic regression analysis demonstrated parents of uninsured teens (odds ratio [OR] 3.77, 95% confidence interval [CI]: 1.40, 12.23), who were unmarried (OR 1.90, 95% CI: 1.14, 3.25), or had a child attending the school with the highest percent eligibility for free/reduced lunch (OR 2.75, 95% CI: 1.36, 5.80) were significantly more willing to consent for vaccines at school. CONCLUSIONS: These data suggest parents are generally supportive of school-located vaccine delivery, particularly for annual influenza vaccination and for uninsured and low-income adolescents. |
Challenges in confirming a varicella outbreak in the two-dose vaccine era
Mahamud A , Wiseman R , Grytdal S , Basham C , Asghar J , Dang T , Leung J , Lopez A , Schmid DS , Bialek SR . Vaccine 2012 30 (48) 6935-9 BACKGROUND: A second dose of varicella vaccine was recommended for the U.S. children in 2006. We investigated a suspected varicella outbreak in School District X, Texas to determine 2-dose varicella vaccine effectiveness (VE). METHODS: A varicella case was defined as an illness with maculopapulovesicular rash without other explanation with onset during April 1-June 10, 2011, in a School District X student. We conducted a retrospective cohort in the two schools with the majority of cases. Lesion, saliva, and environmental specimens were collected for varicella-zoster virus (VZV) PCR testing. VE was calculated using historic attack rates among unvaccinated. RESULTS: In School District X, 82 varicella cases were reported, including 60 from Schools A and B. All cases were mild, with a median of 14 lesions. All 10 clinical specimens and 58 environmental samples tested negative for VZV. Two-dose varicella vaccination coverage was 66.4% in Schools A and B. Varicella VE in affected classrooms was 80.9% (95% CI: 67.2-88.9) among 1-dose vaccinees and 94.7% (95% CI: 89.2-97.4) among 2-dose vaccinees in School A, with a second dose incremental VE of 72.1% (95% CI: 39.0-87.3). Varicella VE among School B students did not differ significantly by dose (80.1% vs. 84.2% among 1-dose and 2-dose vaccines, respectively). CONCLUSION: Laboratory testing could not confirm varicella as the etiology of this outbreak; clinical and epidemiologic data suggests varicella as the likely cause. Better diagnostics are needed for diagnosis of varicella in vaccinated individuals so that appropriate outbreak control measures can be implemented. |
Tracking H1N1 vaccine doses administered using CDC's Countermeasure and Response Administration system
Shimabukuro TT , Sapkota S , Nichols BL , Williams WG , Mullins SW , Lee L , Waite S , Andujar U , Faler G , Hill HH , Tropper J . J Emerg Manag 2012 10 (4) 277-282 During the influenza A (H1N1) 2009 pandemic, the Countermeasure and Response Administration (CRA) system, a Centers for Disease Control and Prevention (CDC) computer-based informatics application, monitored H1N1 vaccine uptake during the early stages of the US vaccination program, from October through the end of November 2009. CRA, which directly monitors vaccine doses administered, was developed to support the mass tracking of medical countermeasure use during public health events and to complement population-based survey data on vaccination coverage during a pandemic influenza vaccination program. CRA provided weekly near real-time reports of H1N1 vaccine doses administered at national and state levels. On average, during any given week, 58.8 percent of the total data available to be reported was actually reported to CDC. During the 8-week mandatory reporting period, a cumulative total of 13,109,962 first-dose vaccine doses administered were reported through CRA, representing approximately 4.4 percent of the US population. Nearly 60 percent of these doses were administered to individuals aged 6 months to 24 years, an age interval that was included in the initial target groups prioritized to receive vaccine. CRA was a key component of the national surveillance system providing information on early uptake of H1N1 vaccine and monitoring program progress. These accomplishments indicate that CRA can effectively function as an immunization tool to monitor vaccine uptake during a pandemic. |
Respiratory and olfactory cytotoxicity of inhaled 2,3-pentanedione in Sprague-Dawley rats
Hubbs AF , Cumpston AM , Goldsmith WT , Battelli LA , Kashon ML , Jackson MC , Frazer DG , Fedan JS , Goravanahally MP , Castranova V , Kreiss K , Willard PA , Friend S , Schwegler-Berry D , Fluharty KL , Sriram K . Am J Pathol 2012 181 (3) 829-44 Flavorings-related lung disease is a potentially disabling disease of food industry workers associated with exposure to the alpha-diketone butter flavoring, diacetyl (2,3-butanedione). To investigate the hypothesis that another alpha-diketone flavoring, 2,3-pentanedione, would cause airway damage, rats that inhaled air, 2,3-pentanedione (112, 241, 318, or 354 ppm), or diacetyl (240 ppm) for 6 hours were sacrificed the following day. Rats inhaling 2,3-pentanedione developed necrotizing rhinitis, tracheitis, and bronchitis comparable to diacetyl-induced injury. To investigate delayed toxicity, additional rats inhaled 318 (range, 317.9-318.9) ppm 2,3-pentanedione for 6 hours and were sacrificed 0 to 2, 12 to 14, or 18 to 20 hours after exposure. Respiratory epithelial injury in the upper nose involved both apoptosis and necrosis, which progressed through 12 to 14 hours after exposure. Olfactory neuroepithelial injury included loss of olfactory neurons that showed reduced expression of the 2,3-pentanedione-metabolizing enzyme, dicarbonyl/L-xylulose reductase, relative to sustentacular cells. Caspase 3 activation occasionally involved olfactory nerve bundles that synapse in the olfactory bulb (OB). An additional group of rats inhaling 270 ppm 2,3-pentanedione for 6 hours 41 minutes showed increased expression of IL-6 and nitric oxide synthase-2 and decreased expression of vascular endothelial growth factor A in the OB, striatum, hippocampus, and cerebellum using real-time PCR. Claudin-1 expression increased in the OB and striatum. We conclude that 2,3-pentanedione is a respiratory hazard that can also alter gene expression in the brain. |
Sequence quality analysis tool for HIV type 1 protease and reverse transcriptase
Delong AK , Wu M , Bennett D , Parkin N , Wu Z , Hogan JW , Kantor R . AIDS Res Hum Retroviruses 2012 28 (8) 894-901 Access to antiretroviral therapy is increasing globally and drug resistance evolution is anticipated. Currently, protease (PR) and reverse transcriptase (RT) sequence generation is increasing, including the use of in-house sequencing assays, and quality assessment prior to sequence analysis is essential. We created a computational HIV PR/RT Sequence Quality Analysis Tool (SQUAT) that runs in the R statistical environment. Sequence quality thresholds are calculated from a large dataset (46,802 PR and 44,432 RT sequences) from the published literature ( http://hivdb.Stanford.edu ). Nucleic acid sequences are read into SQUAT, identified, aligned, and translated. Nucleic acid sequences are flagged if with >five 1-2-base insertions; >one 3-base insertion; >one deletion; >six PR or >18 RT ambiguous bases; >three consecutive PR or >four RT nucleic acid mutations; >zero stop codons; >three PR or >six RT ambiguous amino acids; >three consecutive PR or >four RT amino acid mutations; >zero unique amino acids; or <0.5% or >15% genetic distance from another submitted sequence. Thresholds are user modifiable. SQUAT output includes a summary report with detailed comments for troubleshooting of flagged sequences, histograms of pairwise genetic distances, neighbor joining phylogenetic trees, and aligned nucleic and amino acid sequences. SQUAT is a stand-alone, free, web-independent tool to ensure use of high-quality HIV PR/RT sequences in interpretation and reporting of drug resistance, while increasing awareness and expertise and facilitating troubleshooting of potentially problematic sequences. |
Single-walled carbon nanotubes induce fibrogenic effect by disturbing mitochondrial oxidative stress and activating NF-kappaB signaling
He X , Young SH , Fernback JE , Ma Q . J Clin Toxicol 2012 Single-walled carbon nanotubes (SWCNTs) are newly discovered material of crystalline carbon that forms single-carbon layer cylinders with nanometer diameters and varying lengths. Although SWCNTs are potentially suitable for a range of novel applications, their extremely small size, fiber-like shape, large surface area, and unique surface chemistry raise potential hazard to humans, including lung toxicity and fibrosis. The molecular mechanisms by which SWCNTs cause lung damage remain elusive. Here we show that SWCNTs dose and time-dependently caused toxicity in cultured human bronchial epithelial (BEAS-2B), alveolar epithelial (A549), and lung fibroblast (WI38) cells. At molecular levels, SWCNTs induced significant mitochondrial depolarization and ROS production at subtoxic doses. SWCNTs stimulated the secretion of proinflammatory cytokines and chemokines TNFalpha, IL-1beta, IL-6, IL-10 and MCP1 from macrophages (Raw 264.7), which was attributed to the activation of the canonical signaling pathway of NF-kappaB by SWCNT. Finally, SWCNTs stimulated profibrogenic growth factors TGFbeta1 production and fibroblast-to-myofibroblast-transformation. These results indicate that SWCNTs has a potential to induce human lung damage and fibrosis by damaging mitochondria, generating ROS, and stimulating production of proinflammatory and profibrogenic cytokines and growth factors. |
Multidrug-resistant tuberculosis drug susceptibility and molecular diagnostic testing
Kalokhe AS , Shafiq M , Lee JC , Ray SM , Wang YF , Metchock B , Anderson AM , Nguyen MLT . Am J Med Sci 2012 345 (2) 143-8 Multidrug-resistant tuberculosis (MDR TB), defined by resistance to the 2 most effective first-line drugs, isoniazid and rifampin, is on the rise globally and is associated with significant morbidity and mortality. Despite the increasing availability of novel rapid diagnostic tools for Mycobacterium tuberculosis (Mtb) drug susceptibility testing, the clinical applicability of these methods is unsettled. In this study, the mechanisms of action and resistance of Mtb to isoniazid and rifampin, and the utility, advantages and limitations of the available Mtb drug susceptibility testing tools are reviewed, with particular emphasis on molecular methods with rapid turnaround including line probe assays, molecular beacon-based real-time polymerase chain reaction and pyrosequencing. The authors conclude that neither rapid molecular drug testing nor phenotypic methods are perfect in predicting Mtb drug susceptibility and therefore must be interpreted within the clinical context of each patient. |
Patterns of cellular and HPV 16 methylation as biomarkers for cervical neoplasia
Patel DA , Rozek LS , Colacino JA , Van Zomeren-Dohm A , Ruffin MT , Unger ER , Dolinoy DC , Swan DC , Onyekwuluje J , Degraffinreid CR , Paskett ED . J Virol Methods 2012 184 84-92 Aberrant promoter methylation of biologically relevant genes in cervical cancer and uneven CpG distribution within the human papillomavirus 16 (HPV 16) enhancer region have been reported. Cervical samples and questionnaires from 151 women screened for cervical cancer in Appalachian Ohio were analyzed. Methylation was measured by bisulfite sequencing in candidate gene sites in ESR1, DCC, p16, and LINE1 elements. Among 89 HPV 16-positive women, CpG sites in the E6 promoter and enhancer regions and the L1 region of the HPV 16 genome were measured. Methylation levels were compared by cervical cytology and HPV 16 status. HPV methylation was low regardless of cytology status, however E6 methylation was significantly higher in women with normal cytology. ESR1 and DCC methylation were significantly higher in HPV 16-positive women. Increased methylation at sites in the E6 promoter region was associated with lower odds of abnormal cytology. Increased methylation in candidate genes was associated with higher odds of abnormal cytology, particularly DCC region 2.4, DCC region 2.6, ESR1 region 3.2, and LINE1 site 1.2. HPV 16 genome CpG methylation was low except for the L1 region. In general, lower HPV 16 methylation and higher candidate gene methylation levels were associated with higher odds of abnormal cytology. |
Factors that impact turnaround time of surgical pathology specimens in an academic institution
Patel S , Smith JB , Kurbatova E , Guarner J . Hum Pathol 2012 43 (9) 1501-5 Turnaround time of laboratory results is important for customer satisfaction. The College of American Pathologists' checklist requires an analytic turnaround time of 2 days or less for most routine cases and lets every hospital define what a routine specimen is. The objective of this study was to analyze which factors impact turnaround time of nonbiopsy surgical pathology specimens. We calculated the turnaround time from receipt to verification of results (adjusted for weekends and holidays) for all nonbiopsy surgical specimens during a 2-week period. Factors studied included tissue type, number of slides per case, decalcification, immunohistochemistry, consultations with other pathologists, and diagnosis. Univariate and multivariate analyses were performed. A total of 713 specimens were analyzed, 551 (77%) were verified within 2 days and 162 (23%) in 3 days or more. Lung, gastrointestinal, breast, and genitourinary specimens showed the highest percentage of cases being signed out in over 3 days. Diagnosis of malignancy (including staging of the neoplasia), consultation with other pathologists, having had a frozen section, and use of immunohistochemical stains were significantly associated with increased turnaround time in univariate analysis. Decalcification was not associated with increased turnaround time. In multivariate analysis, consultation with other pathologists, use of immunohistochemistry, diagnosis of malignancy, and the number of slides studied continued to be significantly associated with prolonged turnaround time. Our findings suggest that diagnosis of malignancy is central to significantly prolonging the turnaround time for surgical pathology specimens, thus institutions that serve cancer centers will have longer turnaround time than those that do not. |
Interferon-gamma release assays for prediction of tuberculosis
Kawamura LM , Grinsdale JA , Ho CS , Jereb JA . Lancet Infect Dis 2012 12 (8) 584 Molebogeng Rangaka and colleagues1 have comprehensively reviewed the prognostic characteristics of interferon-γ release assays (IGRAs). Their findings show that the advantages of these assays are not offset by any loss of ability to predict development of tuberculosis in people with latent Mycobacterium tuberculosis infection. | Studies that directly compared the assay with the tuberculin skin test confirm the low accuracy of both for estimation of prognosis; tuberculosis will never develop in most people with a positive result from either test, but tuberculosis will develop in some who had negative results. Although the accuracy of both tests is disappointing, IGRAs are no worse—and for some comparisons are better—than tuberculin skin test. | In USA, the benefits of IGRAs support their wide adoption. First, most of our tuberculosis caseload has shifted to BCG-vaccinated immigrant groups, and IGRAs have greater specificity in this group.2 Our experience in San Francisco, CA—where IGRAs have replaced tuberculin skin test in most settings—is that the proportion of immigrants and homeless people with positive test results decreased substantially after switching the in tests (table). The subsequent decrease in medical assessment improves efficiency and cost-effectiveness and fewer patients are inconvenienced by treatment and its toxic effects than if tuberculin skin test was used. The studies reviewed by Rangaka and colleagues report that IGRAs offer these benefits with fewer false-negative results than tuberculin skin test. |
Acute pulmonary dose-responses to inhaled multi-walled carbon nanotubes
Porter DW , Hubbs AF , Chen TB , McKinney W , Mercer RR , Wolfarth MG , Battelli L , Wu N , Sriram K , Leonard S , Andrew ME , Willard P , Sujhi T , Morinobu E , Tsuruoka S , Munekane F , Frazier DG , Castranova V . Nanotoxicology 2012 7 (7) 1179-94 This study investigated the in vivopulmonary toxicity of inhaled multi-walled carbon nanotubes (MWCNT). Mice inhaled aerosolized MWCNT (10 mg/m(3), 5 hours/day) for 2, 4, 8 or 12 days. MWCNT lung burden was linearly related to exposure duration. MWCNT-induced pulmonary inflammation was assessed by determining whole lung lavage (WLL) polymorphonuclear leukocytes (PMN). Lung cytotoxicity was assessed by WLL fluid LDH activities. WLL fluid albumin concentrations were determined as a marker of alveolar air-blood barrier integrity. These parameters significantly increased in MWCNT-exposed mice versus controlsand were dose-dependent. Histopathologic alterations identified in the lung included 1) bronciolocentricinflammation, 2) bronchiolar epithelial hyperplasia and hypertrophy, 3) fibrosis, 4) vascular changes and 5) rare pleural penetration. MWCNT translocated to the lymph node where the deep paracortex was expanded after 8 or 12 days. Acute inhalation of MWCNT induced dosedependent pulmonary inflammation and damage with rapid development of pulmonary fibrosis, and also demonstrated that MWCNT can reach the pleura after inhalation exposure. |
Characterization of poliovirus variants selected for resistance to the antiviral compound V-073
Liu H , Roberts JA , Moore D , Anderson B , Pallansch MA , Pevear DC , Collett MS , Oberste MS . Antimicrob Agents Chemother 2012 56 (11) 5568-74 V-073, a small-molecule capsid inhibitor originally developed for non-polio enterovirus indications is considerably more potent against polioviruses. All poliovirus isolates tested to date (n = 45), including wild, vaccine, vaccine-derived, and laboratory strains, are susceptible to the antiviral capsid inhibitor V-073. We grew poliovirus in the presence of V-073 to allow for the identification of variants with reduced susceptibility to the drug. Sequence analysis of 160 independent resistant variants (80 isolates of poliovirus type 1, 40 isolates each of type 2 and 3) established that V-073 resistance involved a single amino acid change in either of two virus capsid proteins, VP1 (67 of 160 [42%]) or VP3 (93 of 160 [58%]). In resistant variants with a VP1 change, the majority (53 of 67 [79%]) exhibited a substitution of isoleucine at position 194 (equivalent position 192 in type 3) with either methionine or phenylalanine. Of those with a VP3 change, alanine at position 24 was replaced with valine in all variants (93 of 93). The resistance phenotype was relatively stable upon passage of viruses in cell culture in the absence of drug. Single-step growth studies showed no substantial differences between drug-resistant variants and the virus stocks from which they were derived, while the resistant viruses were generally more thermally labile than the corresponding drug-susceptible parental viruses. These studies provide a foundation from which to build a greater understanding of resistance to antiviral compound V-073. |
Health challenges of young travelers visiting friends and relatives compared with those traveling for other purposes
Han P , Yanni E , Jentes ES , Hamer DH , Chen LH , Wilson ME , Macleod WB , Ooi WW , Kogelman L , Karchmer AW , Barnett ED . Pediatr Infect Dis J 2012 31 (9) 915-919 BACKGROUND: The study objective was to assess differences in demographics and travel health challenges between youths ≤18 years old traveling internationally to visit friends and relatives (VFRs) compared with those traveling for other purposes (non-VFR). METHODS: The Boston Area Travel Medicine Network consists of 5 clinics collecting anonymous data from international pretravel consultations. Data on all travelers ≤18 years of age seen between January 2008 and July 2010 were used. VFRs were compared with non-VFRs on demographics, primary language, trip characteristics, travel vaccinations administered, malaria prophylaxis and antidiarrheal medications prescribed. RESULTS: Thirty-five percent (610/1731) listed VFR as their purpose of travel. Almost half of VFRs were <5 (46%) years old compared with <5% of non-VFRs. Thirty percent of US-born VFRs with foreign-born parents were ≤2 years compared with 4% of foreign-born VFR children and 3% of US-born VFRs with US-born parents. More VFRs than non-VFRs planned travel to countries that were yellow fever holoendemic, had malaria risk and were high-risk for typhoid (44% versus 20%, 39% versus 12%, 25% versus 15%, P < 0.01). VFRs were less likely than non-VFRs to be prescribed atovaquone-proguanil (adjusted prevalence ratio = 0.57, confidence interval = 0.44-0.72) and to have had an antidiarrheal medication prescribed (adjusted prevalence ratio = 0.68, confidence interval = 0.60-0.75). CONCLUSIONS: To reduce travel-related morbidity, healthcare providers should be prepared to give travel advice to parents of VFR infants and children, particularly those US-born VFRs with foreign-born parents, regarding antimalarial and antidiarrheal medications and preventing yellow fever, malaria and typhoid. |
Occupational exposure to chlorinated solvents and risks of glioma and meningioma in adults
Neta G , Stewart PA , Rajaraman P , Hein MJ , Waters MA , Purdue MP , Samanic C , Coble JB , Linet MS , Inskip PD . Occup Environ Med 2012 69 (11) 793-801 OBJECTIVES: Chlorinated solvents are classified as probable or possible carcinogens. It is unknown whether exposure to these agents increases the risk of malignant or benign brain tumours. Our objective was to evaluate associations of brain tumour risk with occupational exposure to six chlorinated solvents (ie, dichloromethane, chloroform, carbon tetrachloride, 1,1,1-trichloroethane, trichloroethylene and perchloroethylene). METHODS: 489 glioma cases, 197 meningioma cases and 799 controls were enrolled in a hospital-based case-control study conducted at three USA hospitals in Arizona, Massachusetts and Pennsylvania. Information about occupational history was obtained through a detailed inperson interview that included job-specific modules of questions such that the interview was tailored to each individual's particular work history. An industrial hygienist assessed potential solvent exposure based on this information and an exhaustive review of the relevant industrial hygiene literature. Unconditional logistic regression models were used to calculate OR and 95% CI for each solvent for ever/never, duration, cumulative, average weekly and highest exposure. RESULTS: Overall, we found no consistent evidence of an increased risk of glioma or meningioma related to occupational exposure to the six chlorinated solvents evaluated. There was some suggestion of an association between carbon tetrachloride and glioma in analyses restricted to exposed subjects, with average weekly exposure above the median associated with increased risk compared with below the median exposure (OR = 7.1, 95% CI 1.1 to 45.2). CONCLUSIONS: We found no consistent evidence for increased brain tumour risk related to chlorinated solvents. |
Prevalence, management, and control of hypertension among US workers: does occupation matter?
Davila EP , Kuklina EV , Valderrama AL , Yoon PW , Rolle I , Nsubuga P . J Occup Environ Med 2012 54 (9) 1150-6 OBJECTIVE: The role of occupation in the management of cardiovascular risk factors including hypertension is not well known. METHODS: We analyzed the 1999-2004 National Health and Nutrition Examination Survey data of 6928 workers aged 20 years or older from 40 occupational groups. Hypertension was defined as measured blood pressure of 140/90 mm Hg or greater or self-reported use of antihypertensive medication, treatment as use of antihypertensive medication, awareness as ever being told by a doctor about having hypertension, and control as having blood pressure of less than 140/90 mm Hg among treated participants. RESULTS: Protective service workers ranked among the lowest in awareness (50.6%), treatment (79.3%), and control (47.7%) and had lower odds of hypertension control and treatment compared with executive/administrative/managerial workers, adjusting for sociodemographic, body-weight, smoking, and alcohol. CONCLUSIONS: Protective service workers may benefit the most from worksite hypertension management programs. |
Profitability and occupational injuries in U.S. underground coal mines
Asfaw A , Mark C , Pana-Cryan R . Accid Anal Prev 2012 50 778-86 BACKGROUND: Coal plays a crucial role in the U.S. economy yet underground coal mining continues to be one of the most dangerous occupations in the country. In addition, there are large variations in both profitability and the incidence of occupational injuries across mines. OBJECTIVE: The objective of this study was to examine the association between profitability and the incidence rate of occupational injuries in U.S. underground coal mines between 1992 and 2008. DATA AND METHOD: We used mine-specific data on annual hours worked, geographic location, and the number of occupational injuries suffered annually from the employment and accident/injury databases of the Mine Safety and Health Administration, and mine-specific data on annual revenue from coal sales, mine age, workforce union status, and mining method from the U.S. Energy Information Administration. A total of 5669 mine-year observations (number of minesxnumber of years) were included in our analysis. We used a negative binomial random effects model that was appropriate for analyzing panel (combined time-series and cross-sectional) injury data that were non-negative and discrete. The dependent variable, occupational injury, was measured in three different and non-mutually exclusive ways: all reported fatal and nonfatal injuries, reported nonfatal injuries with lost workdays, and the 'most serious' (i.e. sum of fatal and serious nonfatal) injuries reported. The total number of hours worked in each mine and year examined was used as an exposure variable. Profitability, the main explanatory variable, was approximated by revenue per hour worked. Our model included mine age, workforce union status, mining method, and geographic location as additional control variables. RESULTS: After controlling for other variables, a 10% increase in real total revenue per hour worked was associated with 0.9%, 1.1%, and 1.6% decrease, respectively, in the incidence rates of all reported injuries, reported injuries with lost workdays, and the most serious injuries reported. CONCLUSION: We found an inverse relationship between profitability and each of the three indicators of occupational injuries we used. These results might be partially due to factors that affect both profitability and safety, such as management or engineering practices, and partially due to lower investments in safety by less profitable mines, which could imply that some financially stressed mines might be so focused on survival that they forgo investing in safety. |
Physical activity: more of the same is not enough
Hallal PC , Bauman AE , Heath GW , Kohl HW 3rd , Lee IM , Pratt M . Lancet 2012 380 (9838) 190-91 For millennia, exercise has been recommended by physicians and scholars. For more than 60 years, science has shown that the health benefits of a physically active lifestyle are extensive and robust. In 1953, The Lancet published landmark papers by Jerry Morris and colleagues on the associations between physical activity at work and coronary heart disease.1, 2 Sedentary London Transport Authority bus drivers were at a higher risk of cardiac events than were their more active conductor peers. These publications laid the groundwork for physical activity epidemiology and stimulated the development of substantial research linking inactivity to increased risk of many non-communicable diseases. | We now know that physical inactivity is a significant predictor of cardiovascular disease, type 2 diabetes mellitus, obesity, some cancers, poor skeletal health, some aspects of mental health, and overall mortality, as well as poor quality of life. Men and women of all ages, socioeconomic groups, and ethnicities are healthier if they achieve the public health recommendation of at least 150 min per week of moderate-intensity aerobic physical activity, such as brisk walking.3 Immediate and future health benefits are also clearly described for children and adolescents, for whom at least 60 min per day of vigorous or moderate-intensity physical activity is recommended.4, 5 Muscular strengthening physical activities are also recommended for health improvement.3 |
Factors associated with condom use problems during vaginal sex with main and non-main partners
D'Anna L H , Korosteleva O , Warner L , Douglas J , Paul S , Metcalf C , McIlvaine E , Malotte CK . Sex Transm Dis 2012 39 (9) 687-693 BACKGROUND: Incorrect condom use is a common problem that can undermine their prevention impact. We assessed the prevalence of 2 condom use problems, breakage/slippage and partial use, compared problems by partnership type, and examined associations with respondent, partner, and partnership characteristics. METHODS: Data were collected at 3-month intervals during a 12-month period (1999-2000) among urban sexually transmitted disease (STD) clinic users. Condom use problems were compared between partnership types using z tests for equality of proportions. Logistic generalized estimating equations modeling accounted for within-participant correlation of repeated measures. RESULTS: Overall 3297 respondents reported 9304 main and 6793 non-main partnerships; condoms were used at least once in 4942 (53.0%) and 4523 (66.6%) of these partnerships, respectively. Condom breakage/slippage was reported during 6.0% of uses (5.1% main, 9.4% non-main) and partial use during 12.5% of uses (12.8% main, 11.5% non-main). The proportion of respondents experiencing any condom use problem in the prior 3 months was higher among main compared with non-main partnerships: 39.1% versus 29.9% had either problem; 22.5% versus 19.0% had breakage/slippage only; 21.8% versus 18.7% had partial use; and 8.7% versus 7.1% had both use problems. In multivariable analysis, factors associated with condom use problems varied by partnership type and respondent sex. The most common predictors of problems across models were sex while high and inconsistent condom use. CONCLUSIONS: This study highlights the diverse set of risk factors for condom use problems at the individual, partner, and partnerships levels. |
Assessing spatial gaps in sexually transmissible infection services and morbidity: an illustration with Texas county-level data from 2007
Owusu-Edusei K , Doshi SR . Sex Health 2012 9 (4) 334-40 BACKGROUND: In the United States, sexually transmissible infection (STI) and family planning (FP) clinics play a major role in the detection and treatment of STIs. However, an examination of the spatial distribution of these service sites and their association with STI morbidity and county-level socioeconomic characteristics is lacking. We demonstrate how mapping and regression methods can be used to assess the spatial gaps between STI services and morbidity. METHODS: We used 2007 county-level surveillance data on chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and syphilis. The geocoded STI service (STI or FP clinic) locations overlaid on the Texas county-level chlamydia, gonorrhoea and syphilis morbidity map indicated that counties with high incidence had at least one STI service site. Logistic regression was used to examine the association between having STI services and county-level socioeconomic characteristics. RESULTS: Twenty-two percent of chlamydia high-morbidity counties (>365 out of 100,000); 32% of gonorrhoea high-morbidity counties (>136 out of 100,000) and 23% of syphilis high-morbidity counties (≥4 out of 100,000 and at least two cases) had no STI services. When we controlled for socioeconomic characteristics, high-morbidity syphilis was weakly associated with having STI services. The percent of the population aged 15-24 years, the percent of Hispanic population, the crime rate and population density were significantly (P<0.05) associated with having STI services. CONCLUSION: Our results suggest that having an STI service was not associated with high morbidity. The methods used have demonstrated the utility of mapping to assess the spatial gaps that exist between STI services and demand. |
The relationship between Toxoplasma gondii infection and mood disorders in the third National Health and Nutrition Survey
Pearce BD , Kruszon-Moran D , Jones JL . Biol Psychiatry 2012 72 (4) 290-5 BACKGROUND: Toxoplasma gondii (T. gondii) is a neurotropic protozoan parasite that causes persistent infection in humans. A substantial literature suggests that schizophrenia is associated with increased seroprevalence of T. gondii, but a possible link of the parasite with mood disorders has not been as thoroughly investigated. METHODS: We examined the association of Toxoplasma-specific immunoglobulin G results with mood disorder outcomes in 7440 respondents from the third National Health and Nutrition Survey, which is a nationally representative sample of the United States noninstitutionalized civilian population. Regression models were adjusted for numerous potential confounders, including tobacco smoking and C-reactive protein levels. RESULTS: No statistically significant associations were found between T. gondii seroprevalence and a history of major depression (n = 574; adjusted odds ratio [OR]: .8; 95% confidence interval [CI]: .5-1.2), severe major depression (n = 515; adjusted OR: .8; 95% CI: .6-1.2), dysthymia (n = 548; adjusted OR: 1.1; 95% CI: .7-1.8), or dysthymia with comorbid major depression (n = 242, adjusted OR: 1.2; 95% CI: .6-2.4), all p values were > .05, including analysis stratified by gender. However, there was a significant relationship between T. gondii seroprevalence and bipolar disorder type I for respondents in which both manic and major depression symptoms were reported (n = 41; adjusted OR: 2.4; 95% CI: 1.2-4.8; p < .05). CONCLUSIONS: In a population-based sample, T. gondii seroprevalence is not elevated in unipolar mood disorders but is higher in a subset of respondents with a history of bipolar disorder type 1. |
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