Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer: a systematic review of the literature
Guy GP , Ekwueme DU . Pharmacoeconomics 2011 29 (10) 863-74 Skin cancer is the most common form of cancer in the US, and an important public health concern both in the US and throughout the world. Given high incidence rates among young adults and the large number of deaths, skin cancer has the potential to result in significant years of potential life lost (YPLL) and lost productivity. The purpose of this study was to systematically review the published literature on the YPLL and the value of productivity loss from morbidity and premature mortality resulting from melanoma and non-melanoma skin cancer (NMSC). Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches were conducted in MEDLINE, EMBASE, CINAHL and Econlit. We selected studies that measured the societal burden of melanoma and NMSC - through estimating either the YPLL and/or the indirect costs. We identified 16 relevant studies meeting our criteria, six were from the US and ten were from other industrialized countries; ten of the studies reported results on YPLL, eight on mortality costs and five on morbidity costs. Some studies reported results in more than one category. From each eligible article and report, we extracted detailed information on the study population/country, study design, data analysis methods and study results. Data abstracted for each eligible study included estimated number of YPLL, YPLL per death and morbidity and mortality costs. The average number of YPLL per death was approximately 15 for melanoma and 10 for NMSC. We found the costs attributable to melanoma and NMSC ranged from $US39.2 million to $US28.9 million for morbidity and $US3.3 billion to $US1.0 billion for mortality, respectively. It is clear from the published literature that skin cancer leads to significant YPLL and indirect costs associated with premature mortality and morbidity. Prevention and early detection efforts are important in helping reduce the incidence of melanoma and NMSC, and the related deaths and productivity losses. |
PCD's first annual Student Research Contest: Lui and Wallace examine hospitalization rates for at-risk populations
Posner SF . Prev Chronic Dis 2011 8 (5) A103 I am pleased to announce that A Common Denominator: Calculating Hospitalization Rates for Ambulatory Care–Sensitive Conditions in California by Camillia K. Lui and Steven P. Wallace is the winner of the first annual Preventing Chronic Disease (PCD) Student Research Contest. Ms Lui is a fourth-year doctoral student at the University of California, Los Angeles, in the Department of Community Health Sciences. Her advisor is Dr Steven Wallace. | PCD is dedicated to being the venue for sharing advances in public health research, practice, and policy, and we are committed to the development of young public health professionals as part of this effort. To this end, we have instituted the Student Research Contest as a way to engage students in the publication process and recognize the outstanding work of the next generation of the public health workforce. In July 2010, we announced our first annual call for student papers and reached out to multiple partners to distribute the call and encourage students to submit their work to PCD. | Papers were due in January 2011, and we received submissions on a range of topics from institutions throughout the United States. In February and March, a small team of editorial board members (Drs Bowman, Brownson, Lengerich, and Remington), PCD’s founding editor (Dr Lynne Wilcox), and I reviewed the submitted manuscripts. In March we selected the paper by Ms Lui and Dr Wallace as the winner. |
Pericardial fat is associated with impaired lung function and a restrictive lung pattern in adults: the Jackson Heart Study
Hickson DA , Liu J , Bidulescu A , Burchfiel CM , Taylor HA , Petrini MF . Chest 2011 140 (6) 1567-1573 BACKGROUND: Impaired lung function has been linked to obesity and systemic inflammation. Pericardial fat has been shown to be associated with anomalies in cardiac structure, function and atherosclerosis. We hypothesized that pericardial fat may have a similar role in the impairment of lung function. METHODS: Cross-sectional associations of pericardial fat volumes, quantified by multi-detector computed tomography, with forced expiratory volume in one second (FEV(1)) and vital capacity (FVC), assessed by spirometry, were investigated in 1,293 participants (54.5+/-10.8 years; 66.4% women) in the Jackson Heart Study. We also examined whether these associations were independent of visceral adipose tissue (VAT). RESULTS: Pericardial fat was associated with impaired lung function after multivariable adjustment, but these associations generally did not remain after adjustment for VAT. An exception was the FEV(1)/FVC ratio. Higher pericardial fat volumes were associated with higher odds of a restrictive lung pattern and lower odds of airway obstruction. Participants in the highest quartile had the highest odds of a restrictive lung pattern (odds ratio: 1.85, 95% confidence interval: 1.22, 2.79, compared with quartile 1), even after adjustment for VAT. The odds of obstruction decreased across increasing quartiles of pericardial fat. These relationships were generally graded, suggesting dose-response trends. CONCLUSION: Pericardial fat is generally associated with lower lung function and independently associated with a restrictive lung pattern in middle-aged and elderly adults. Further research is needed to fully understand the mechanisms through which pericardial fat contributes to pulmonary anomalies. |
Prevalence and predictors of total-body skin examination among US adults: 2005 National Health Interview Survey
Lakhani NA , Shaw KM , Thompson T , Yaroch AL , Glanz K , Hartman AM , Saraiya M . J Am Acad Dermatol 2011 65 (3) 645-8 In 2006, melanoma affected 53,919 persons and resulted in 8441 deaths.1 Periodic total-body skin examination (TBSE) may increase the detection of earlier-stage melanomas.2 However, skin cancer screening guidelines vary, with one organization citing insufficient evidence to recommend for or against routine TBSEs3 and another recommending skin cancer examination for individuals 20 years and older during a periodic health examination.4 | Using data from the National Health Interview Survey, an annual household survey, we examined the prevalence and correlates of having a TBSE by a physician. In 2000 and 2005, respondents were asked, “Have you ever had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?” Respondents who answered positively were also asked the date of their most recent skin examination. Sample sizes for adults (aged ≥18 years) were 30,119 in 2000 and 28,551 in 2005. TBSE percentages were age standardized using the direct method. Adjusted TBSE percentages were calculated as predictive margins from a multivariable logistic regression model. The predictive margin for a given group represents the average predicted response had everyone in the sample been in that group (Table I). |
Asthma outcome measures
Shen J , Johnston M , Hays RD . Expert Rev Pharmacoecon Outcomes Res 2011 11 (4) 447-53 Asthma is a common chronic disease with underlying inflammation of the airway. Advances in science have led to increased understanding of the heterogeneous nature of asthma and its complex mechanisms. Traditionally, asthma-practice guidelines have focused on optimizing lung function and the US FDA has required increases in lung function and reduction of exacerbation as primary outcomes in clinical trials of new asthma therapeutics. Improved lung function is a critical indicator of bronchodilator therapy, but the importance of long-term asthma control while maintained on controller medication is increasingly emphasized. The NIH asthma guidelines suggest the use of patient-reported outcomes, including health-related quality-of-life measures, to assess asthma control. Clinical practices and research studies concerning asthma can benefit from harmonizing the major outcome measures so that comparisons across studies can be made. In this article, we review common asthma outcome measures with a focus on recent efforts to harmonize outcomes for therapeutic clinical trials in asthma. |
Cumulative life stress in chronic fatigue syndrome
Nater UM , Maloney E , Heim C , Reeves WC . Psychiatry Res 2011 189 (2) 318-20 We studied the impact of cumulative life stress on CFS in a population-based study. We found that exposure to stressors was significantly more common in persons with CFS compared to NF controls; those with CFS reported experiencing significantly higher levels of psychological distress. Also, post-traumatic stress disorder was significantly more common in people with CFS. These results not only corroborate findings from other studies but, importantly, extend those by: a) measuring a comprehensive spectrum of stress variables, b) for the first time presenting data on stress in a population-based study, thus minimizing the effects of recruitment bias, and c) diagnosing CFS by means of standardized, validated scales, thus allowing replication and extension of our findings. Stress may be an important factor in the pathophysiology of CFS. Consequently, future studies should provide a more detailed understanding of the processes that lead from stress to CFS using longitudinal designs. |
Serologically confirmed household transmission of 2009 pandemic influenza A (H1N1) virus during the first pandemic wave--New York City, April-May 2009
Jackson ML , France AM , Hancock K , Lu X , Veguilla V , Sun H , Liu F , Hadler J , Harcourt BH , Esposito DH , Zimmerman CM , Katz JM , Fry AM , Schrag SJ . Clin Infect Dis 2011 53 (5) 455-62 BACKGROUND: Understanding transmissibility of influenza viruses within households is critical for guiding public health response to pandemics. We studied serologically confirmed infection and disease among household contacts of index case patients with 2009 pandemic influenza A (H1N1) virus (pH1N1) infection in a setting of minimal community pH1N1 transmission. METHODS: We defined index case patients as students and staff of a New York City high school with laboratory-confirmed pH1N1 infection during the earliest phase of the pH1N1 outbreak in April 2009. We visited households of index case patients twice, once in early May and again in June/July 2009. At each visit, household members (both index case patents and household contacts) provided serum samples and completed questionnaires about illness and possible risk factors. Serologic testing was performed using microneutralization and hemagglutination-inhibition assays. RESULTS: Of 79 eligible household contacts in 28 households, 19% had serologically confirmed pH1N1 infection, and 28% of those infected were asymptomatic. Serologically confirmed infection varied by age among household contacts: 36% of contacts younger than 10 years were infected, compared with 46% of contacts age 10-18 years, 8% of contacts aged 19-54 years, and 22% of contacts aged 55 years and older. CONCLUSIONS: Infection rates were high for household contacts of persons with confirmed pH1N1, particularly for contacts aged 10-18 years, and asymptomatic infection was common. Efforts to reduce household transmission during influenza pandemics are important adjuncts to strategies to reduce community illness. |
Obesity and influenza
Jain S , Chaves SS . Clin Infect Dis 2011 53 (5) 422-4 The association between obesity and influenza was first noted during the early phase of the 2009 influenza A(H1N1) pandemic, when data from many countries around the world indicated that obese persons were disproportionally represented among influenza-associated hospitalizations and deaths [1–6]. Obese (body mass index [BMI] ≥30 kg/m2) or morbidly obese patients (BMI ≥40 kg/m2) appeared to be at increased risk of influenza-associated intensive care unit (ICU) admission and death [7–9]. Furthermore, obese patients hospitalized with 2009 H1N1 infection admitted to an ICU had longer duration of mechanical ventilation, as well as ICU and hospital length of stay compared with those who were not obese [10]. Because certain chronic medical conditions (including cardiovascular and metabolic diseases) that place persons at risk for influenza-related complications are highly correlated with obesity [11], attempts to tease apart the independent contribution of obesity to influenza disease severity have been challenging. |
Prevalence of genital human papillomavirus among females in the United States, the National Health and Nutrition Examination Survey, 2003-2006
Hariri S , Unger ER , Sternberg M , Dunne EF , Swan D , Patel S , Markowitz LE . J Infect Dis 2011 204 (4) 566-73 BACKGROUND: Genital human papillomaviruses (HPV) include >40 sexually transmitted viruses. Most HPV infections do not progress to disease, but infection with certain types of HPV can cause cervical and other anogenital and oropharyngeal cancer, and other types of HPV are associated with anogenital warts. HPV vaccines prevent infection with HPV 16 and 18, which account for 70% of cases of cervical cancer, and HPV 6 and 11, which cause 90% of the cases of anogenital warts. METHODS: Using data and self-collected cervicovaginal specimens from 4150 females, 14-59 years of age, from consecutive National Health and Nutrition Examination Surveys (2003-2006), we estimated the prevalence of type-specific HPV DNA and examined sociodemographic and sexual determinants. RESULTS: The overall prevalence of HPV was 42.5% in females 14-59 years of age and varied significantly by age, race or ethnicity, and number of sex partners. Individual type prevalence was less than 7%, ranging from <0.5% through 6.5%. The most common type was nononcogenic HPV 62 (found in 6.5% of subjects), followed by HPV 53 and HPV 16 (4.7%), both of which are oncogenic types. The most prevalent species was nononcogenic alpha3. CONCLUSIONS: HPV infection is common among US females, with the highest burden of infection found in young females 20-24 years of age. Monitoring trends in HPV type distribution will contribute to our understanding of the early impact of HPV vaccines. |
Emergence of parapneumonic empyema in the USA
Grijalva CG , Zhu Y , Nuorti JP , Griffin MR . Thorax 2011 66 (8) 663-8 BACKGROUND: Although recent reports suggest that the incidence of parapneumonic empyema has increased in several regions of the USA, national trends in disease burden are unknown. National trends in the incidence of parapneumonic empyema hospitalisations and changes in empyema by associated pathogens were examined. METHODS: National hospitalisation data (1996-2008) were analysed and rates estimated using census estimates as denominators. Incidence rate ratios (IRR) compared 2008 with 1996 rates. Discharge diagnosis codes were used to characterise pathogens associated with empyema hospitalisations. RESULTS: Overall, national parapneumonic empyema-related hospitalisation rates increased from 3.04 per 100,000 in 1996 to 5.98 per 100,000 in 2008, a 2.0-fold increase (95% CI 1.8 to 2.1). The increases were observed among children (IRR 1.9 (95% CI 1.4 to 2.7)) and adults aged 18-39, 40-64 and ≥65 years (IRR 1.8 (95% CI 1.5 to 2.1), 2.0 (95% CI 1.6 to 3.1) and 1.7 (95% CI 1.5 to 2.0), respectively). Overall, pneumococcal empyema rates remained relatively stable in all age groups whereas streptococcal- (non-pneumococcal) and staphylococcal-related empyema rates increased 1.9-fold and 3.3-fold, respectively, with consistent increases across age groups. The overall in-hospital case fatality ratio for parapneumonic empyema-related hospitalisations was 8.0% (95% CI 6.4% to 9.5%) in 1996 and 7.2% (95% CI 6.3% to 8.1%) in 2008 (p=0.395). Of the empyemas where study pathogens were listed (37.6%), staphylococcal-related empyema had the largest absolute increases across age groups and was associated with longer hospital stay and higher in-hospital mortality than other empyemas. CONCLUSIONS: Although parapneumonic empyema-related hospitalisations remained relatively rare, they increased substantially during the study period. A number of pathogens, especially staphylococcus, contributed to this increase. |
HIV-1 RNA rectal shedding is reduced in men with low plasma HIV-1 RNA viral loads and is not enhanced by sexually transmitted bacterial infections of the rectum
Kelley CF , Haaland RE , Patel P , Evans-Strickfaden T , Farshy C , Hanson D , Mayer K , Lennox JL , Brooks JT , Hart CE . J Infect Dis 2011 204 (5) 761-7 BACKGROUND: Among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) taking combination antiretroviral therapy (cART), the impact of rectal sexually transmitted infections (STIs) on rectal HIV-1 shedding is unknown. METHODS: Human immunodeficiency virus type 1 (HIV-1) RNA was quantified from rectal swabs collected for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) screening of HIV-1-infected MSM. Correlations of STIs with rectal viral load were explored using multinomial regression modeling. HIV-1 coreceptor tropism was predicted from sequencing in a subset of men. RESULTS: Thirty-one (39%) of 80 men (59 prescribed combination antiretroviral therapy [cART]) had HIV detected in 38 (42%) of 91 rectal swabs. Rectal HIV detection was associated with plasma virus loads above 3.15 log(10) copies/mL (95% confidence limit [CL] 2.73, 3.55) and paired rectal viral loads and plasma viral loads were correlated (Kendall's tau [tau] 0.68, Spearman rho [P] = .77). Rectal STIs and abnormal anal cytology were not associated with rectal viral load. HIV coreceptor distribution was very similar between the plasma and rectum in 3 of 4 men. CONCLUSIONS: Plasma and rectal viral load were correlated, and rectal STIs did not increase the likelihood of detecting HIV in the rectal secretions in MSM, including those with low or undetectable plasma viral load. Suppressing plasma viral load is likely to reduce risk of HIV transmission to insertive partners. |
Antimicrobial resistant gonorrhea in Atlanta: 1988-2006
Dionne-Odom J , Tambe P , Yee E , Weinstock H , Del Rio C . Sex Transm Dis 2011 38 (8) 780-2 Gonococcal isolates (n = 4336) were collected from men with urethritis at the Fulton County STD Clinic between 1988 and 2006. Antimicrobial susceptibility was performed by agar dilution. Increasing numbers of isolates from men who have sex with men and with fluoroquinolone resistance were noted. New antimicrobials effective against gonorrhea are urgently needed. |
Transmission shifts underlie variability in population responses to Yersinia pestis infection
Buhnerkempe MG , Eisen RJ , Goodell B , Gage KL , Antolin MF , Webb CT . PLoS One 2011 6 (7) e22498 Host populations for the plague bacterium, Yersinia pestis, are highly variable in their response to plague ranging from near deterministic extinction (i.e., epizootic dynamics) to a low probability of extinction despite persistent infection (i.e., enzootic dynamics). Much of the work to understand this variability has focused on specific host characteristics, such as population size and resistance, and their role in determining plague dynamics. Here, however, we advance the idea that the relative importance of alternative transmission routes may vary causing shifts from epizootic to enzootic dynamics. We present a model that incorporates host and flea ecology with multiple transmission hypotheses to study how transmission shifts determine population responses to plague. Our results suggest enzootic persistence relies on infection of an off-host flea reservoir and epizootics rely on transiently maintained flea infection loads through repeated infectious feeds by fleas. In either case, early-phase transmission by fleas (i.e., transmission immediately following an infected blood meal) has been observed in laboratory studies, and we show that it is capable of driving plague dynamics at the population level. Sensitivity analysis of model parameters revealed that host characteristics (e.g., population size and resistance) vary in importance depending on transmission dynamics, suggesting that host ecology may scale differently through different transmission routes enabling prediction of population responses in a more robust way than using either host characteristics or transmission shifts alone. |
Shut-in? Impact of chronic conditions on community participation restriction among older adults
Theis KA , Furner SE . J Aging Res 2011 2011 759158 Community participation may be especially important for older adults, who are often at risk for unwanted declines in participation. We estimated the prevalence of community participation restriction (PR) due to perceived environmental barriers among older adults (≥50 years) and compared the impact among those with selected chronic conditions. Individuals with low-prevalence conditions reported high community PR (9.1-20.4%), while those with highly prevalent conditions (e.g., arthritis) had relatively low community PR (5.1-10.0%) but represented the greatest absolute numbers of condition-associated burden (>1 million). Across all conditions, more than half of those with community PR reported being restricted "always or often." Community PR most often resulted from modifiable environmental barriers. Promising targets to reduce community PR among adults ≥50 years with chronic conditions, particularly arthritis, include building design, sidewalks/curbs, crowd control, and interventions that improve the built environment. |
Micronucleus frequencies in lymphocytes and reticulocytes in a pesticide-exposed population in Portugal
Costa C , Silva S , Neves J , Coelho P , Costa S , Laffon B , Snawder J , Teixeira JP . J Toxicol Environ Health A 2011 74 960-70 A wide range of chemical products known to be acutely toxic is currently used in the agricultural sector, including numerous pesticides with different compositions. Nevertheless, the effects in human health as result of chronic exposure to low levels are not yet completely understood. The methodology for determination of micronuclei (MN) in lymphocytes (CBMN) is well established, and accumulating data demonstrated a correlation to enhanced risk of cancer development. However, analysis of MN in reticulocytes (MN-RET) in humans is a recent tool on human biomonitoring. The aim of this study was to examine the influence of pesticide exposure on MN-RET and CBMN frequencies. In total, 177 individuals were studied (93 controls and 84 exposed). All individuals included in the exposed group were exposed regularly to various chemicals. Both MN-RET and CBMN were significantly higher in the exposed subjects compared to controls. The CBMN frequencies were quantitatively higher in females than males, especially within the exposed group. Smoking habits exerted no marked influence on the frequency of the biomarkers studied. A significant and positive correlation was found between both indicators. Within the exposed group, data showed that there was a significant correlation between MN-RET and recent exposure (exposure in the previous 10 d) that is not found when considering CBMN. It is conceivable that due to the short life span of reticulocytes, MN-RET were found to be more reliable to characterize recent genetic damage as opposed to CBMN. |
And that is how the story goes: CDC's National Environmental Health Tracking Network
Wall PA . J Environ Health 2011 74 (1) 36-7 In the summer of 2009, I was excited to | fi nally show my wife exactly what I had | been working on every day for the last | few years. The National Environmental Public Health Tracking Network (Tracking Network) had offi cially launched (Figure 1). She | had been primed over many dinner conversations about the challenges of integrating | health and environmental information that | was originally collected, stored, and maintained for different purposes. She had listened patiently as I explained a geeky triangle | of metadata, Extensible Markup Language | (XML), and user interface design. But I was | anxious to see if she would perceive CDC’s | vision for a robust environmental health information system to help people learn about | the health status of their communities, environmental factors that may affect them, and | what they can do to stay healthy. |
Comprehensive assessment of maize aflatoxin levels in Eastern Kenya, 2005 - 2007
Daniel JH , Lewis LW , Redwood YA , Kieszak S , Breiman RF , Flanders WD , Bell C , Mwihia J , Ogana G , Likimani S , Straetemans M , McGeehin MA . Environ Health Perspect 2011 119 (12) 1794-9 BACKGROUND: Aflatoxin, a potent fungal toxin, contaminates 25% of crops worldwide. Since 2004, 477 aflatoxin poisonings associated with eating contaminated maize have been documented in Eastern Kenya, with a case-fatality rate of 40%. OBJECTIVE: To characterize maize aflatoxin contamination during the high risk season (April-June) following the major harvests in 2005, 2006 (aflatoxicosis outbreak years), and 2007 (a non-outbreak year). METHODS: Households were randomly selected each year from the region in Kenya where outbreaks have consistently occurred. At each household, we obtained at least one maize sample (n = 716) for aflatoxin analysis using immunoaffinity methods and administered a questionnaire to determine the source (i.e. homegrown, purchased or relief) and amount of maize in the household. RESULTS: During outbreak years-2005 and 2006, 41% and 51% of maize samples respectively, had aflatoxin levels above the 20 ppb Kenyan regulatory limit for aflatoxin in grains for human consumption. In 2007 (non-outbreak year), 16% of samples were above the 20 ppb limit. In addition, geometric mean (GM) aflatoxin levels were significantly higher in 2005 (GM=12.92, max=48,000 ppb) and 2006 (GM=26.03, max=24,400 ppb) compared to 2007 (GM=1.95, max=2,500 ppb) (p value<.001). In all three years combined, maize aflatoxin levels were significantly higher in homegrown maize (GM=17.96) when compared to purchased maize (GM=3.64) or relief maize (GM=0.73) (p value<.0001). CONCLUSIONS: Aflatoxin contamination is extreme within this region and homegrown maize is the primary source of contamination. Prevention measures should focus on reducing homegrown maize contamination at the household level to avert future outbreaks. |
Determinants of serum polybrominated diphenyl ether (PBDE) levels among pregnant women in the CHAMACOS cohort
Castorina R , Bradman A , Sjodin A , Fenster L , Jones RS , Harley KG , Eisen EA , Eskenazi B . Environ Sci Technol 2011 45 (15) 6553-6560 We measured levels of 10 polybrominated diphenyl ether (PBDE) congeners in serum collected during pregnancy and at delivery from 416 pregnant, predominantly immigrant, women living in Monterey County, CA. The most frequently detected congeners were BDE-47, -99, -100, and -153, all components of the penta mixture, detected in >97% of samples. We used multivariable regression models to examine factors associated with exposure to individual PBDE congeners as well as their total summed concentration (ng/g lipid). Prenatal and delivery total PBDE levels were correlated between sampling times (n = 21; Pearson r = 0.99, p < 0.001). In multivariable models, total PBDE levels increased significantly with time residing in the U.S. (p < 0.001) and among women with ≥3 pieces of stuffed furniture in their homes (p < 0.05). Women's total PBDE levels increased 4.0% (95% CI = 2.8, 5.3) for each additional year residing in the U.S., after adjustment for prepregnancy BMI, weight gain during pregnancy, and SES. Having ≥3 pieces of stuffed furniture in the home was associated with a 26.8% (95% CI = 2.0, 57.5) increase in women's serum PBDE levels. Findings suggest PBDE indoor contamination in California homes is contributing to human exposures in a population of recent immigrants. |
Reliability of self-report of HIV status among men who have sex with men in Brazil
Salani Mota RM , Kerr LRFS , Kendall C , Pinho A , De Mello MB , Dourado I , Guimaraes MDC , Brito A , Batista S , Abreu F , Benzaken A , Oliveira L , Moraes A , Merchan-Hamann E , Freitas G , Albuquerque EM , McFarland W , Rutherford G . J Acquir Immune Defic Syndr 2011 57 S153-S156 INTRODUCTION: The aim of this study was to evaluate the reliability of self-reported HIV among men who have sex with men (MSM) in Brazil. METHODS: MSM 18 years of age or older were recruited to a multicenter study using respondent-driven sampling. We compared self-report of the HIV test with a rapid HIV test using the kappa coefficient. RESULTS: A total of 3859 MSM were recruited, and 39% reported ever having an HIV test; their results were reported and they agreed to a new test. Agreement between self-report and the test was very good (kappa = 0.88). CONCLUSION: Our results suggest that self-report of HIV infection is a reliable indicator among MSM. Copyright 2011 by Lippincott Williams & Wilkins. |
Use of data systems to address social determinants of health: a need to do more
Harrison KM , Dean HD . Public Health Rep 2011 126 Suppl 3 1-5 This supplement to Public Health Reports (PHR) focuses on data systems and their use in addressing social determinants of health (SDH). This particular topic requires attention now given the evidence of increasing burden and worsening inequities in some health outcomes, in spite of decades of work to change individual behaviors, as well as the need to be efficient in our use of existing data. A holistic approach to disease prevention is urgently needed to reduce the inequities that have been perpetuated in our society for so long. | Despite concerted, targeted, and coordinated efforts to reduce inequities in health outcomes, gross inequities still exist,1–4 and some evidence indicates that the gap between the best health outcomes and the worst health outcomes is growing.1,3–5 Well-meaning efforts have substantially focused on individual-related behavior changes, with less focus on wider social and structural determinants of health, which can be defined as follows:6,7 | Structural factors include those physical, social, cultural, organizational, community, economic, legal, or policy aspects of the environment that impede or facilitate efforts to avoid disease transmission. Social factors include the economic and social conditions that influence the health of people and communities as a whole, and include the conditions for early childhood development, education, employment, income and job security, food security, health services, and access to services, housing, social exclusion, and stigma.8 | In addition to addressing individual factors, there is an urgent need to address social and structural factors and to better understand their relationship to each other as we develop effective programs and policies to reduce inequities. |
Identifying the impact of social determinants of health on disease rates using correlation analysis of area-based summary information
Song R , Hall HI , Harrison KM , Sharpe TT , Lin LS , Dean HD . Public Health Rep 2011 126 Suppl 3 70-80 OBJECTIVES: We developed a statistical tool that brings together standard, accessible, and well-understood analytic approaches and uses area-based information and other publicly available data to identify social determinants of health (SDH) that significantly affect the morbidity of a specific disease. METHODS: We specified AIDS as the disease of interest and used data from the American Community Survey and the National HIV Surveillance System. Morbidity and socioeconomic variables in the two data systems were linked through geographic areas that can be identified in both systems. Correlation and partial correlation coefficients were used to measure the impact of socioeconomic factors on AIDS diagnosis rates in certain geographic areas. RESULTS: We developed an easily explained approach that can be used by a data analyst with access to publicly available datasets and standard statistical software to identify the impact of SDH. We found that the AIDS diagnosis rate was highly correlated with the distribution of race/ethnicity, population density, and marital status in an area. The impact of poverty, education level, and unemployment depended on other SDH variables. CONCLUSIONS: Area-based measures of socioeconomic variables can be used to identify risk factors associated with a disease of interest. When correlation analysis is used to identify risk factors, potential confounding from other variables must be taken into account. |
Impact of an emergent norovirus variant in 2009 on norovirus outbreak activity in the United States
Yen C , Wikswo ME , Lopman BA , Vinje J , Parashar UD , Hall AJ . Clin Infect Dis 2011 53 (6) 568-71 In October 2009, a new genogroup II, type 4 (GII.4) norovirus variant was identified in the United States. We collected norovirus outbreak data from 30 states to assess whether this new strain was associated with increased acute gastroenteritis activity. No increase in norovirus outbreaks was observed during the 2009-2010 winter. |
Collection of social determinant of health measures in U.S. national surveillance systems for HIV, viral hepatitis, STDs, and TB
Beltran VM , Harrison KM , Hall HI , Dean HD . Public Health Rep 2011 126 Suppl 3 41-53 Challenges exist in the study of social determinants of health (SDH) because of limited comparability of population-based U.S. data on SDH. This limitation is due to differences in disparity or equity measurements, as well as general data quality and availability. We reviewed the current SDH variables collected for HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis at the Centers for Disease Control and Prevention through its population-based surveillance systems and assessed specific system attributes. Results were used to provide recommendations for a core set of SDH variables to collect that are both feasible and useful. We also conducted an environmental literature scan to determine the status of knowledge of SDH as underlying causes of disease and to inform the recommended core set of SDH variables. |
Salmonella typhimurium infections associated with peanut products
Cavallaro E , Date K , Medus C , Meyer S , Miller B , Kim C , Nowicki S , Cosgrove S , Sweat D , Phan Q , Flint J , Daly ER , Adams J , Hyytia-Trees E , Gerner-Smidt P , Hoekstra RM , Schwensohn C , Langer A , Sodha SV , Rogers MC , Angulo FJ , Tauxe RV , Williams IT , Behravesh CB . N Engl J Med 2011 365 (7) 601-10 BACKGROUND: Contaminated food ingredients can affect multiple products, each distributed through various channels and consumed in multiple settings. Beginning in November 2008, we investigated a nationwide outbreak of salmonella infections. METHODS: A case was defined as laboratory-confirmed infection with the outbreak strain of Salmonella Typhimurium occurring between September 1, 2008, and April 20, 2009. We conducted two case-control studies, product "trace-back," and environmental investigations. RESULTS: Among 714 case patients identified in 46 states, 166 (23%) were hospitalized and 9 (1%) died. In study 1, illness was associated with eating any peanut butter (matched odds ratio, 2.5; 95% confidence interval [CI], 1.3 to 5.3), peanut butter-containing products (matched odds ratio, 2.2; 95% CI, 1.1 to 4.7), and frozen chicken products (matched odds ratio, 4.6; 95% CI, 1.7 to 14.7). Investigations of focal clusters and single cases associated with nine institutions identified a single institutional brand of peanut butter (here called brand X) distributed to all facilities. In study 2, illness was associated with eating peanut butter outside the home (matched odds ratio, 3.9; 95% CI, 1.6 to 10.0) and two brands of peanut butter crackers (brand A: matched odds ratio, 17.2; 95% CI, 6.9 to 51.5; brand B: matched odds ratio, 3.6; 95% CI, 1.3 to 9.8). Both cracker brands were made from brand X peanut paste. The outbreak strain was isolated from brand X peanut butter, brand A crackers, and 15 other products. A total of 3918 peanut butter-containing products were recalled between January 10 and April 29, 2009. CONCLUSIONS: Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products. |
Racial/ethnic variation in the association of lipid-related genetic variants with blood lipids in the US adult population.
Chang MH , Ned RM , Hong Y , Yesupriya A , Yang Q , Liu T , Janssens AC , Dowling NF . Circ Cardiovasc Genet 2011 4 (5) 523-33 BACKGROUND: Genome-wide association studies (GWAS) have identified a number of single nucleotide polymorphisms (SNPs) associated with serum lipid level in populations of European descent. The individual and the cumulative effect of these SNPs on blood lipids are largely unclear for the U.S. population. METHODS AND RESULTS: Using data from the second phase (1991-1994) of the Third National Health and Nutrition Examination Survey (NHANES III), a nationally-representative survey of the U.S. population, we examined associations of 57 GWAS-identified or well-established lipid-related genetic loci with plasma concentrations of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), TC/HDL-C ratio, and non-HDL-C. We used multivariable linear regression to examine single SNP associations and the cumulative effect of multiple SNPs (using a genetic risk score, GRS) on blood lipid levels. Analyses were conducted in adults for each of the three major racial/ethnic groups in the U.S.: non-Hispanic whites (n = 2,296), non-Hispanic blacks (n = 1,699), and Mexican Americans (n = 1,713). Allele frequencies for all SNPs varied significantly by race/ethnicity, except rs3764261 in CETP. Individual SNPs had very small effects on lipid levels, effects that were generally consistent in direction across racial/ethnic groups. More GWAS-validated SNPs were replicated in non-Hispanic whites (< 67%) than in non-Hispanic blacks (< 44%) or Mexican Americans (< 44%). Genetic risk scores were strongly associated with increased lipid levels in each race/ethnic group. The combination of all SNPs into a weighted GRS explained no more than 11% of the total variance in blood lipid levels. CONCLUSIONS: Our findings show that the combined association of SNPs, based on a genetic risk score, was strongly associated with increased blood lipid measures in all major race/ethnic groups in the U.S., which may help in identifying subgroups with a high risk for an unfavorable lipid profile. |
Relationships between hours of sleep and health-risk behaviors in US adolescent students
McKnight-Eily LR , Eaton DK , Lowry R , Croft JB , Presley-Cantrell L , Perry GS . Prev Med 2011 53 271-3 OBJECTIVE: To examine associations between insufficient sleep (<8h on average school nights) and health-risk behaviors. METHOD: 2007 national Youth Risk Behavior Survey data of U.S. high school students (n=12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression. RESULTS: Insufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.45-1.93), marijuana (AOR, 1.52; 95% CI, 1.31-1.76), and alcohol (AOR, 1.64; 95% CI, 1.46-1.84); current sexual activity (AOR, 1.41; 95% CI, 1.25-1.59); seriously considered attempting suicide (AOR, 1.86; 95% CI, 1.60-2.16); feeling sad or hopeless (AOR, 1.62; 95% CI, 1.43-1.84); physical fighting (AOR, 1.40; 95% CI, 1.24-1.60), not being physically active at least 60min≥5days in the past 7days (AOR, 1.16; 95% CI, 1.04-1.29), using the computer ≥3h/day (AOR, 1.58; 95% CI, 1.38-1.80), and drinking soda/pop >1time/day (AOR, 1.14; 95% CI, 1.03-1.28). CONCLUSION: Two-thirds of adolescent students reported insufficient sleep, which was associated with many health-risk behaviors. Greater awareness of the impact of sleep insufficiency is vital. |
Use of indoor tanning devices by high school students in the United States, 2009
Guy GP , Tai E , Richardson LC . Prev Chronic Dis 2011 8 (5) A116 The objectives of this study were to provide estimates of indoor tanning device use among US high school students and provide baseline data before implementation of a 10% excise tax on indoor tanning device use mandated by recent federal health care reform legislation. We examined the frequency of indoor tanning device use by using data from the 2009 national Youth Risk Behavior Survey. Overall, 15.6% of students used an indoor tanning device during the 12 months before the survey; almost half of those students used an indoor tanning device 10 or more times. Reported use and frequency of use varied by age, sex, and race/ethnicity. Given the high prevalence of indoor tanning device use among US high school students and the associated risk of melanoma, strategies to reduce exposure must be examined. |
Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study
Ford ES , Zhao G , Tsai J , Li C . Am J Public Health 2011 101 (10) 1922-9 OBJECTIVES: We examined the relationship between 4 low-risk behaviors - never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption - and mortality in a representative sample of people in the United States. METHODS: We used data from 16,958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006. | RESULTS: The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes. CONCLUSIONS: Low-risk lifestyle factors exert a powerful and beneficial effect on mortality. (Am J Public Health. Published online ahead of print August 18, 2011:e1-e8. doi:10.2105/AJPH.2011.300167) |
Health care seeking among men with genital ulcer disease in South Africa: correlates and relationship to human immunodeficiency virus-1 and herpes simplex virus type 2 detection and shedding
Leichliter JS , Lewis DA , Sternberg M , Habel MA , Paz-Bailey G . Sex Transm Dis 2011 38 (9) 865-870 BACKGROUND: Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. METHODS: Men with GUD (n = 615) were recruited from primary health care clinics in Gauteng province, South Africa for a randomized controlled trial of episodic acyclovir therapy. We used baseline survey and sexually transmitted infection/HIV-testing data to examine delay in health care seeking (defined as time from ulcer recognition to baseline study visit). RESULTS: Median delay in health care seeking for GUD was 5 days, and one-quarter of men had previously sought care for the current ulcer. Previous care seekers were older, had more episodes of ulceration in the past year, and were more likely to test seropositive for HIV-1 and HSV-2. Delay in health care seeking was significantly associated with age, education level, and sex during the ulceration episode. Delays in care seeking were related to poorer HIV-1 outcomes; these findings were valid after controlling for advanced HIV. CONCLUSIONS: Interventions to help shorten the duration between ulcer recognition and health care seeking for men with GUD are needed. |
Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility
Wise ME , Marquez P , Sharapov U , Hathaway S , Katz K , Tolan S , Beaton A , Drobeniuc J , Khudyakov Y , Hu DJ , Perz J , Thompson ND , Bancroft E . Am J Infect Control 2011 40 (1) 16-21 BACKGROUND: Effective measures exist to prevent health care-associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents. METHODS: Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune. Persons residing in the facility during 2008 were enrolled in a retrospective cohort study to identify risk factors for acute HBV infection. We assessed infection control practices at the facility. RESULTS: Nine of 81 residents (11%) enrolled in the cohort study had acute HBV infection. Five of 15 residents (33%) undergoing podiatric care on a single day subsequently developed acute infection (rate ratio, 4.33; 95% confidence interval, 1.18-15.92). Infection control observations of the consulting podiatrist revealed opportunities for cross-contamination of instruments with blood. Other potential health care and behavioral modes of transmission were identified as well. Residents were offered HBV vaccination, and infection control recommendations were implemented by the podiatrist and facility. CONCLUSIONS: Of the multiple potential transmission modes identified, exposure to HBV during podiatry was likely the dominant mode in this outbreak. Long-term care facilities should ensure compliance with infection control standards among staff and consulting health care providers. |
Dengue: a potential transfusion-transmitted disease
Tomashek KM , Margolis HS . Transfusion 2011 51 (8) 1654-60 Dengue is caused by four related RNA viruses of the genus Flavivirus, dengue virus (DENV)−1, −2, −3, and −4. Infection with DENV is usually asymptomatic but each DENV is capable of causing the full spectrum of clinical disease from mild, undifferentiated acute febrile illness, to classic dengue fever and more severe disease including dengue hemorrhagic fever and dengue shock syndrome. Severe disease manifestations including hypovolemic shock and clinically significant hemorrhage are more commonly observed among patients during their second or subsequent episodes of DENV infection.1 Infection with one DENV produces lifelong immunity against that DENV type and short-term (≤2 months) cross-protection against infection with the other three DENVs. Therefore, an individual has a lifetime risk of up to four DENV infections. | DENVs are transmitted from person to person through the bite of an infected Aedes aegypti mosquito (less commonly Aedes albopictus or Aedes polynesiensis).2 Unlike other related flaviviruses such as West Nile virus, humans are the main amplifying host for DENV. While there is a sylvatic nonhuman primate cycle of DENV transmission, it rarely crosses to humans, and antibodies to the sylvatic virus appear to protect against human DENV. The transmission cycle begins when a mosquito ingests DENV in a blood meal from an infected person (Fig. 1). DENV replicates and disseminates within the mosquito and reaches the salivary glands after 8 to 12 days (extrinsic incubation period). Higher ambient temperatures may reduce the extrinsic incubation period and increase the chance they will infect a human before dying.3 The mosquito remains infectious for life (typically less than 1 month) and can transmit infection with 102 viral particles.4 DENV replicates in humans for an intrinsic incubation period of 3 to 14 days before symptom onset. Infected persons can transmit DENV to mosquitoes as early as 1 to 2 days before symptoms develop5 and throughout the approximately 7-day viremic period. Infected persons, even those who remain asymptomatic, have concentrations as high as 107 viral RNA copies per milliliter of blood.6,7 |
Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC)
Ahmed F , Temte JL , Campos-Outcalt D , Schunemann HJ . Vaccine 2011 29 (49) 9171-6 The Advisory Committee on Immunization Practices (ACIP) provides expert external advice and guidance to the Director of the Centers for Disease Control and Prevention and the Secretary of the U.S. Department of Health and Human Services on use of vaccines and related agents for control of vaccine-preventable disease in the United States. During the October 2010 ACIP meeting, the ACIP voted to adopt a new framework for developing evidence-based recommendations that is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Key factors considered in the development of recommendations include the balance of benefits and harms, type of evidence, values and preferences of the people affected, and health economic analyses. Category A recommendations will be made for all persons in an age- or risk-factor-based group. Category B recommendations will be made for individual clinical decision making; category B recommendations do not apply to all members of an age- or risk-factor-based group, but in the context of a clinician-patient interaction, vaccination may be found to be appropriate for a person. Evidence tables will be used to summarize the benefits and harms and the strengths and limitations of the body of evidence. The new evidence framework will enhance the ACIP's decision-making process by making it more transparent, consistent and systematic. |
Novel chikungunya vaccine candidate with an IRES-based attenuation and host range alteration mechanism
Plante K , Wang E , Partidos CD , Weger J , Gorchakov R , Tsetsarkin K , Borland EM , Powers AM , Seymour R , Stinchcomb DT , Osorio JE , Frolov I , Weaver SC . PLoS Pathog 2011 7 (7) e1002142 Chikungunya virus (CHIKV) is a reemerging mosquito-borne pathogen that has recently caused devastating urban epidemics of severe and sometimes chronic arthralgia. As with most other mosquito-borne viral diseases, control relies on reducing mosquito populations and their contact with people, which has been ineffective in most locations. Therefore, vaccines remain the best strategy to prevent most vector-borne diseases. Ideally, vaccines for diseases of resource-limited countries should combine low cost and single dose efficacy, yet induce rapid and long-lived immunity with negligible risk of serious adverse reactions. To develop such a vaccine to protect against chikungunya fever, we employed a rational attenuation mechanism that also prevents the infection of mosquito vectors. The internal ribosome entry site (IRES) from encephalomyocarditis virus replaced the subgenomic promoter in a cDNA CHIKV clone, thus altering the levels and host-specific mechanism of structural protein gene expression. Testing in both normal outbred and interferon response-defective mice indicated that the new vaccine candidate is highly attenuated, immunogenic and efficacious after a single dose. Furthermore, it is incapable of replicating in mosquito cells or infecting mosquitoes in vivo. This IRES-based attenuation platform technology may be useful for the predictable attenuation of any alphavirus. |
Human papillomavirus (HPV) 6, 11, 16, and 18 prevalence among females in the United States--National Health and Nutrition Examination Survey, 2003-2006: opportunity to measure HPV vaccine impact?
Dunne EF , Sternberg M , Markowitz LE , McQuillan G , Swan D , Patel S , Unger ER . J Infect Dis 2011 204 (4) 562-5 The 2003-2006 National Health and Nutrition Examination Surveys were used to assess human papillomavirus (HPV) types 6, 11, 16, and 18 DNA detection from females aged 14-59 years who self-collected cervicovaginal swab specimens. Prevalence was 8.8% (95% confidence interval [CI], 7.8%-10.0%) and was highest among women aged 20-24 years (18.5%; 95% CI, 14.9%-22.8%). Age group, education, marital status, and sexual behavior were associated with detection. These data provide baseline information before HPV vaccine introduction. Early impact of vaccine in the United States may be determined by a reduction in the prevalence of HPV 6, 11, 16, and 18 infection among young women. |
Cost-effectiveness of 2009 pandemic influenza A(H1N1) vaccination in the United States
Prosser LA , Lavelle TA , Fiore AE , Bridges CB , Reed C , Jain S , Dunham KM , Meltzer MI . PLoS One 2011 6 (7) e22308 BACKGROUND: Pandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination. METHODOLOGY: A computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted. RESULTS: For vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000-$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery. CONCLUSIONS: Vaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination. |
An empirical analysis of overlap publication in Chinese language and English research manuscripts
Tucker JD , Chang H , Brandt A , Gao X , Lin M , Luo J , Song P , Sun K , Zhang X . PLoS One 2011 6 (7) e22149 BACKGROUND: There are a number of sound justifications for publishing nearly identical information in Chinese and English medical journals, assuming several conditions are met. Although overlap publication is perceived as undesirable and ethically questionable in Europe and North America, it may serve an important function in some regions where English is not the native tongue. There is no empirical data on the nature and degree of overlap publication in English and Chinese language journals. METHODS/PRINCIPAL FINDINGS: A random sample of 100 English manuscripts from Chinese institutions was selected from PubMed. Key words and institutions were searched in the China National Knowledge Infrastructure, a comprehensive Chinese language research database. Unacknowledged overlap was a priori defined according to International Committee of Medical Journal Editor (ICMJE) guidelines following examination by two individuals. 19% (95% CI 11-27) of English manuscripts from Chinese institutions were found to have substantial overlap with Chinese published work based on full text examination. None of the manuscripts met all of the criteria established by the ICMJE for an acknowledged overlap publication. Individual-level, journal-level, and institutional factors seem to influence overlap publication. Manuscripts associated with an institution outside of China and with more than one institution were significantly less likely to have substantial overlap (p<0.05). CONCLUSIONS/SIGNIFICANCE: Overlap publication was common in this context, but instances of standard ICMJE notations to acknowledge this practice were rare. This research did not cite the identified overlap manuscripts with the hope that these empirical data will inform journal policy changes and structural initiatives to promote clearer policies and manuscripts. |
Documenting occupational history: the value to patients, payers, and researchers
Luckhaupt SE , Calvert GM , Sweeney MH . J AHIMA 2011 82 (7) 34-7 Recording patient work history is vital to identifying work-related injuries and illnesses. As electronic health records become widespread, this is an important time to ensure occupational health data elements are included in EHR standards. |
Review of standards for surface and dermal sampling
Ashley K , Brisson MJ , White KT . J ASTM Int 2011 8 (6) JAI103678 This article summarizes the body of available standards for sampling of chemical and biological agents on workplace surfaces, including skin. These standards consist of voluntary consensus standards such as those promulgated by ASTM International, the International Organization for Standardization (ISO), and the European Committee for Standardization (CEN), as well as methods produced by U.S. Federal agencies such as the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). Gaps in availabilities of standards are discussed along with activities underway to address needs in the field of occupational and environmental hygiene. In many cases, the available standards have been developed largely in response to regulatory requirements. For example, ASTM International standards, which describe requirements for wiping surfaces and methodologies for determining metals and metalloids such as lead and beryllium, were produced primarily in response to regulatory requirements for sampling settled dust for these elements in the United States. Methods for collection of asbestos samples, vacuum sampling, dry wipe sampling, and bulk sampling have also been promulgated. Standardized methods for non-metal contaminants and biological agents are more limited in availability. In particular, there is a lack of standardized methodologies for dermal sampling and limited standard guidance on selection of appropriate surface sampling methods and data evaluation. Activities are currently ongoing within ASTM International and ISO to address some of the gaps, but additional activity is needed to address remaining requirements for consensus standards. |
Trace beryllium determination in polyvinyl alcohol wipes by extraction and fluorescence detection: interlaboratory analysis
Ashley K , Wise TJ , Marlow D , Agrawal A , Cronin JP , Adams L , Ashley E , Lee PA . Anal Methods 2011 3 (8) 1906-1909 In the occupational hygiene field, polyvinyl alcohol (PVA)-based wipe materials are used extensively for beryllium (Be) sample collection and analysis. Hence there is a need for validated methods to determine trace Be in such sampling media. In this work an interlaboratory study was carried out to evaluate the performance of an extraction and fluorescence method for determining trace Be in PVA wipes containing refractory beryllium oxide (BeO). The method entails heated extraction with dilute ammonium bifluoride (NH4HF2), followed by fluorescence measurement of extracted Be in extract aliquots after reaction with the high quantum-yield fluorophore, hydroxybenzoquinoline sulfonate (HBQS). Certified BeO-spiked PVA wipe materials were prepared at six different levels ranging from 0.030 to 5.6 mg Be per wipe. Dry wipe materials and wipes wetted with 0.5 mL of deionized water were spiked as above. Duplicates of these materials, plus media blanks, were distributed to eight participating laboratories; spiking levels were unknown to the volunteers. Each participant was requested to carry out extraction and fluorescence measurement in accordance with an ASTM International standard test method, ASTM D7202, and to report their results in units of mg Be per wipe sample. Interlaboratory precision, as estimated by percent relative standard deviations (RSDs), ranged between 4.5% and 16%. Estimated percent Be recoveries were 90–99% for dry wipes and between 87 and 93% for wetted wipe materials after volume correction for water content. |
Use of direct reading surface sampling methods for site characterization and remediation of methamphetamine contaminated properties
Snawder JE , Striley CAF , Esswein EJ , Hessel J , Sammons DL , Robertson SA , Johnson BC , MacKenzie BA , Smith JP , Walker CV . J ASTM Int 2011 8 (6) JAI103481 Residual methamphetamine contamination in clandestine laboratories represents a hazard to emergency response personnel, remediation workers and the general public. To address this threat, two rapid, sensitive surface sampling techniques to assess the location and level of methamphetamine contamination were developed. Both methods employ established industrial hygiene surface sampling materials (wipes and swabs) but differ in their sensitivity and detection technology. One method, based on colorimetric disclosure, detects and confirms a collected sample or visible residues. The second method uses a lateral flow immunochemical assay (LFIA) for semi-quantitative detection of trace contamination. The National Institute for Occupational Safety and Health (NIOSH) partnered with public health agencies to develop applications of the methods for assessment of methamphetamine contamination of suspected properties. These applications focused on safe strategies for site assessment, hazard characterization, and remediation effectiveness. To conduct the field studies, NIOSH researchers and their partners visited more than a dozen suspected laboratories including mobile labs, abandoned properties, occupied residences, and motel rooms. NIOSH found greater than 95% agreement between positive identification of the presence of methamphetamine by LFIA and laboratory-based, liquid chromatography mass spectroscopy (LC- MS) methods. Test results were used to develop site assessments and make personal protective equipment recommendations. Results were also used to conduct process-based decontamination of properties and to make health-based decisions on remediation, re-occupancy of residences, as well as determine the degree of contamination of personal property in an inactive clandestine laboratory. By partnering with stakeholders, NIOSH was able to achieve two primary goals: (1) to develop a level of awareness in health department sanitarians, law enforcement personnel and other first responders that methamphetamine surface contamination was a potentially significant route of exposure; (2) to validate our methods in the field and to develop protocols for proper use and interpretation of the results. |
Validation of an evacuated canister method for measuring part-per-billion levels of chemical warfare agent simulants
Coffey CC , LeBouf RF , Calvert CA , Slaven JE . J Air Waste Manag Assoc 2011 61 (8) 826-833 The National Institute for Occupational Safety and Health (NIOSH) research on direct-reading instruments (DRIs) needed an instantaneous sampling method to provide independent confirmation of the concentrations of chemical warfare agent (CWA) simulants. It was determined that evacuated canisters would be the method of choice. There is no method specifically validated for volatile organic compounds (VOCs) in the NIOSH Manual of Analytical Methods. The purpose of this study was to validate an evacuated canister method for sampling seven specific VOCs that can be used as a simulant for CWA agents (cyclohexane) or influence the DRI measurement of CWA agents (acetone, chloroform, methylene chloride, methyl ethyl ketone, hexane, and carbon tetrachloride [CCl(4)]). The method used 6-L evacuated stainless-steel fused silica-lined canisters to sample the atmosphere containing VOCs. The contents of the canisters were then introduced into an autosampler/preconcentrator using a microscale purge and trap (MPT) method. The MPT method trapped and concentrated the VOCs in the air sample and removed most of the carbon dioxide and water vapor. After preconcentration, the samples were analyzed using a gas chromatograph with a mass selective detector. The method was tested, evaluated, and validated using the NIOSH recommended guidelines. The evaluation consisted of determining the optimum concentration range for the method; the sample stability over 30 days; and the accuracy, precision, and bias of the method. This method meets the NIOSH guidelines for six of the seven compounds (excluding acetone) tested in the range of 2.3-50 parts per billion (ppb), making it suitable for sampling of these VOCs at the ppb level. |
La Crosse encephalitis surveillance using single versus paired serologic testing
Murphree R , Dunn JR , Schaffner W , Jones TF . Zoonoses Public Health 2011 59 (3) 181-3 We evaluated the validity of single versus paired serologic testing for La Crosse virus (LACV) encephalitis surveillance. Compared with paired serology, a single positive IgG or IgM immunoflourescent antibody titre appears useful for LACV encephalitis surveillance with sensitivity, 75%; specificity, 98%; positive predictive value, 95%; and overall test efficiency 92%. |
Molecular mechanisms underlying chemopreventive activities of glycyrrhizic acid against UVB-radiation-induced carcinogenesis in SKH-1 hairless mouse epidermis
Cherng JM , Tsai KD , Yu YW , Lin JC . Radiat Res 2011 176 (2) 177-86 Glycyrrhizic acid has been shown to possess anti-inflammation, antiviral and chemoprotective activity against tumors. We evaluated the protective effects of glycyrrhizic acid in UVB-radiation-induced skin tumor formation in SKH-1 hairless mice and the early molecular biomarkers of these effects. Mice irradiated at 180 mJ/cm(2) twice per week showed 100% tumor incidence in 20 weeks. Feeding with glycyrrhizic acid prior to UVB irradiation caused delays in tumor appearance, multiplicity and size. Feeding with glycyrrhizic acid for 2 weeks before a single UVB irradiation (180 mJ/cm(2)) resulted in significant decrease in UVB-radiation-induced thymine dimer-positive cells, expression of proliferative cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL)-positive cells, and apoptotic sunburn cells together with an increase in p53- and p21/Cip1-positive cell populations in epidermis. Simultaneously, glycyrrhizic acid also significantly inhibited NF-kappaB, cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), and nitric oxide (NO) levels. Thus glycyrrhizic acid ameliorates UVB-radiation-induced tumorigenesis via downregulation of cell proliferation controls involving thymine dimer, PCNA, apoptosis and transcription factor NF-kappaB and of inflammatory responses involving COX-2, PGE2 and NO while upregulating of p53 and p21/Cip1 to prevent DNA damage and facilitate DNA repair. |
Impact of targeted testing for latent tuberculosis infection using commercially available diagnostics
Mancuso JD , Tribble D , Mazurek GH , Li Y , Olsen C , Aronson NE , Geiter L , Goodwin D , Keep LW . Clin Infect Dis 2011 53 (3) 234-44 BACKGROUND: The interferon-gamma release assays (IGRAs) are increasingly being used as an alternative to the tuberculin skin test (TST). Although IGRAs may have better specificity and certain logistic advantages to the TST, their use may contribute to overtesting of low-prevalence populations if testing is not targeted. The objective of this study was to evaluate the accuracy of a risk factor questionnaire in predicting a positive test result for latent tuberculosis infection using the 3 commercially available diagnostics. METHODS: A cross-sectional comparison study was performed among recruits undergoing Army basic training at Fort Jackson, South Carolina, from April through June 2009. The tests performed included: (1) a risk factor questionnaire; (2) the QuantiFERON Gold In-Tube test (Cellestis Limited, Carnegie, Victoria, Australia); (3) the T-SPOT.TB test (Oxford Immunotec Limited, Abingdon, United Kingdom); and (4) the TST (Sanofi Pasteur Ltd., Toronto, Ontario, Canada). Prediction models used logistic regression to identify factors associated with positive test results. RFQ prediction models were developed independently for each test. RESULTS: Use of a 4-variable model resulted in 79% sensitivity, 92% specificity, and a c statistic of 0.871 in predicting a positive TST result. Targeted testing using these risk factors would reduce testing by >90%. Models predicting IGRA outcomes had similar specificities as the skin test but had lower sensitivities and c statistics. CONCLUSIONS: As with the TST, testing with IGRAs will result in false-positive results if the IGRAs are used in low-prevalence populations. Regardless of the test used, targeted testing is critical in reducing unnecessary testing and treatment. CLINICAL TRIAL REGISTRATION: NCT00804713. |
Influenza virus-like particle can accommodate multiple subtypes of hemagglutinin and protect from multiple influenza types and subtypes
Pushko P , Pearce MB , Ahmad A , Tretyakova I , Smith G , Belser JA , Tumpey TM . Vaccine 2011 29 (35) 5911-8 Despite existing vaccines and specific therapies, epidemics of seasonal influenza annually claim 200,000-500,000 lives worldwide. Pandemic influenza represents an even greater threat, with numerous potentially pandemic viruses circulating in nature. Development of multi-specific vaccines against multiple pandemic or seasonal strains is important for human health and the global economy. Here we report a novel virus-like particle (VLP) platform that contains three hemagglutinin (HA) subtypes. This recombinant vaccine design resulted in the expression of three HA subtypes co-localized within a VLP. Experimental triple-HA VLPs containing HA proteins derived from H5N1, H7N2, and H2N3 viruses were immunogenic and protected ferrets from challenge from all three potentially pandemic viruses. Similarly, VLPs containing HA subtypes derived from seasonal H1N1, H3N2, and type B influenza viruses protected ferrets from three seasonal influenza viruses. We conclude that this technology may represent a novel strategy for rapid development of trivalent seasonal and pandemic vaccines. |
Bloodstream and non-invasive isolates of Candida glabrata have similar population structures and fluconazole susceptibilities
Lott TJ , Frade JP , Lyon GM , Iqbal N , Lockhart SR . Med Mycol 2011 50 (2) 136-42 We have compared multilocus sequence typing (MLST) and fluconazole susceptibility profiles of Candida glabrata bloodstream isolates obtained during active, population-based surveillance to those obtained from non-sterile sites of individuals with no evidence of fungal disease (i.e., non-invasive isolates) in the same US city during an overlapping time period. In each of the two populations, different proportions of the same six major sequence types (STs) encompassed 82% of the isolates. One ST was more prevalent in the candidemia population and two other STs were more prevalent in the non-invasive population, but the overall allelic frequencies within the groups suggested little, if any, genotypic diversity between them. Fluconazole susceptibility profiles of isolates from the patients in the two groups were not significantly different and were not associated with a particular sequence type. Our results support the hypothesis that C. glabrata strains causing bloodstream infections are genetically indistinguishable from those normally residing in/on the host, suggesting that relative pathogenicity may be closely tied to commensalism. |
A comprehensive evaluation of the proficiency testing program for the HIV-1 BED incidence assay
Dobbs T , Liu X , Anderson R , Nkengasong J , Parekh BS . J Clin Microbiol 2011 49 (10) 3470-3 The HIV-1 BED incidence assay was developed at the Centers for Disease Control and Prevention (CDC) and since 2005 is available as a commercial kit for use in HIV-1 incidence surveillance. A BED-specific proficiency testing (PT) program was initiated in 2006 which included a panel of 8 coded specimens (6 unique and 2 duplicates) to participating laboratories. Number of participating laboratories increased from 12 to 38 from 2006 to 2009; Overall, 96.1% of laboratories reported results and 95.4% of those reporting achieved 100% score. Observed mean normalized optical density (OD-n) values of all participants correlated well with expected OD-n values for all specimens (R(2)=0.98) used for 7 PT rounds. BED testing demonstrated high reproducibility among all laboratories with agreement of 99.3% (574/578) between initial and confirmatory classification and regression statistics of R(2)=0.96, slope=1.022 and intercept=0.0066. Reproducibility among duplicate specimens was very high during each PT round with mean deviation of 1.8%. Analysis of controls and calibrator specimen for all 343 runs showed a coefficient of variation (CV) of about 20% for raw OD in the dynamic range, which was reduced to <=10% when OD was normalized (OD-n). Most laboratories that failed the PT assessment had transcriptional errors, kit reagent problems or specimen handling errors. Thus, the BED-specific PT program enabled us to track performance of different laboratories conducting the BED assay while identifying areas for improvements. This program will also serve as a template for future PT programs for new incidence assays as they become available. |
Development of a 5-layer passive organic dermal (POD) sampler
Olsen LD , Snawder JE , Kriech AJ , Osborn LV . Polycycl Aromat Compd 2011 31 (3) 154-172 A 5-layer passive organic dermal sampler was developed to allow the collection, retention, and recovery of a variety of organic compound classes simultaneously. The 5-layers, from outside in, consisted of polypropylene, polyurethane foam, C-18 solid-phase extraction disk, ethylene tetrafluoroethylene, and activated carbon cloth. The layers were enclosed in aluminum foil and placed in a muslin envelope that had a 40.0 mm diameter opening. Ten samplers were spiked separately with three levels of diesel oil, a 50/50 diesel oil/asphalt mixture, and asphalt binder. For the diesel oil spikes, recoveries were 69.9, 71.3, 88.8, and 95.4% for 10, 10, 50, and 100 mg of diesel oil. For the 50/50 mixture, recoveries were 105.4, 92.8, and 92.0% for 10, 50, and 100 mg of the 50/50 mixture. For the asphalt binder spikes, recoveries were 104.7, 100.2, and 100.1% for 10, 50, and 100 mg of asphalt binder. For repeatability assessment, 7 samplers were spiked with 50 mg of the 50/50 mixture and recoveries averaged 92.6% (standard deviation 8.6). Samplers tested on asphalt paving workers proved functional, comfortable, flexible, and durable. |
Diversity of factor H-binding protein in Neisseria meningitidis carriage isolates
Marsh JW , Shutt KA , Pajon R , Tulenko MM , Liu S , Hollick RA , Kiehlbauch JA , Clark TA , Stephens DS , Arnold KE , Myers RA , Mayer LW , Harrison LH . Vaccine 2011 29 (35) 6049-58 Several meningococcal vaccines under development for prevention of serogroup B disease target the factor H-binding protein (FHbp), an immunogenic lipoprotein expressed on the surface of Neisseria meningitidis. Based upon sequence and phylogenetic analyses, FHbp can be classified into 3 protein variants (1, 2 or 3) or 2 subfamilies (A or B). The potential effect of FHbp-containing vaccines on meningococcal carriage is not known. We determined the diversity of FHbp among a population of carriage isolates obtained from Georgia and Maryland high school students in 1998 and 2006-2007. Analysis of the fHbp gene sequence from 408 carriage isolates identified 30 different FHbp protein sequences. The majority of carriage isolates harbored FHbp proteins belonging to variant 2/subfamily A. Association between FHbp proteins and genetic lineage was observed among the carriage isolates. However, split decomposition analysis, together with tests of linkage disequilibrium and pairwise homoplasy suggest recombination at fHbp contribute to allelic diversity. Of note, the FHbp proteins in serogroup B vaccines under development are either absent or not well represented in this carriage population. The FHbp genetic repertoire observed in carriage isolate populations will be useful in understanding the potential impact of FHbp-containing vaccines on meningococcal carriage. |
Maternity care practices and breastfeeding experiences of women in different racial and ethnic groups: Pregnancy Risk Assessment and Monitoring System (PRAMS)
Ahluwalia IB , Morrow B , D'Angelo D , Li R . Matern Child Health J 2011 16 (8) 1672-8 Research shows that maternity care practices are important to promoting breastfeeding in the early post partum period; however, little is known about the association between maternity care practices and breastfeeding among different racial and ethnic groups. We examined the association between maternity care practices and breastfeeding duration to ≥10 weeks overall and among various racial and ethnic groups using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS). PRAMS is a state, population-based surveillance system that collects information on maternal behaviors. We used maternity care practices data from 11 states and New York City with response rates ≥70% from 2004 to 2006. Multiple maternity care practices were examined and the analysis adjusted for demographic characteristics, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), lifestyle, and infant variables. The outcome variable for multivariable analysis was breastfeeding duration to <10 weeks or ≥10 weeks. PRAMS data show that 22.1% of women did not breastfeed, about 27.7% breastfed for <10 weeks and 50.2% breastfed for ≥10 weeks. Breastfeeding patterns varied with white and Hispanic women reporting highest breastfeeding initiation and duration prevalence. Overall, practices positively associated with ≥10 duration were: breastfeeding initiated within the first hour after birth (adjusted OR [AOR] = 1.29; 95% CI: 1.16-1.45); fed breast milk only (AOR = 2.40; 95% CI: 2.15-2.68); breastfed on demand (AOR = 1.23; 95% CI 1.08-1.40) and receiving telephone support (AOR = 1.20; 95% CI: 1.03-1.39). Maternity care practices associated with breastfeeding to ≥10 weeks varied across three racial/ethnic groups. One practice, that of giving newborns breast milk only, was positively associated with breastfeeding duration of ≥10 weeks across all three groups. Maternity care practices associated with breastfeeding continuation to ≥10 weeks varied by race/ethnicity. For example: breastfeeding within the first hour, baby given a pacifier, and assistance from hospital staff, were significantly associated with breastfeeding duration among black and white women and not Hispanics. The practice of breastfeeding on demand was significantly associated with breastfeeding to ≥10 weeks for black and Hispanic women and not for whites. Hospitals may want to examine the implementation of specific practices in relation to the cultural backgrounds of women to promote breastfeeding. |
Facemask use by children during infectious disease outbreaks
Roberge R . Biosecur Bioterror 2011 9 (3) 225-31 An overview of available literature on the use of protective facemasks by children for protection from respiratory infectious agents reveals relatively few articles dealing specifically with the topic, despite their use during recent outbreaks (eg, severe acute respiratory syndrome, pandemic influenza). Little is known about the physiological and psychological burdens imposed by these devices and a child's ability to correctly use and tolerate them. This article focuses on the myriad issues associated with protective facemask use by children in the hope of educating public health personnel, healthcare professionals, and families on their limitations and associated risks, and in the hope of fostering much-needed research. |
Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009
Akinbami LJ , Liu X , Pastor PN , Reuben CA . NCHS Data Brief 2011 70 (70) 1-8 Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders of childhood (1). The symptoms of ADHD (inattention, impulsive behavior, and hyperactivity) begin in childhood and often persist into adulthood. These symptoms frequently lead to functional impairment in academic, family, and social settings (2,3). The causes and risk factors for ADHD are unknown, but genetic factors likely play a role (4). Diagnosis of ADHD involves several steps, including a medical exam; a checklist for rating ADHD symptoms based on reports from parents, teachers, and sometimes the child; and an evaluation for coexisting conditions (5). Recent national surveys have documented an increase in the prevalence of ADHD during the past decade (6,7). This report presents recent trends in prevalence and differences between population subgroups of children aged 5-17 years. |
Comment on "Listeriosis in human pregnancy: a systematic review"
Silk BJ , Mahon BE . J Perinat Med 2011 39 (6) 749-50 No abstract available. |
Sensitization and chronic beryllium disease at a primary manufacturing facility, part 1: historical exposure reconstruction
Virji MA , Park JY , Stefaniak AB , Stanton ML , Day GA , Kent MS , Kreiss K , Schuler CR . Scand J Work Environ Health 2011 38 (3) 247-58 OBJECTIVES: Previous epidemiologic studies of beryllium sensitization (BeS) and chronic beryllium disease (CBD) have reported inconsistent exposure-response relationships, likely due to exposure misclassification. The objective of this study was to develop historical estimates of size-selective personal exposure to beryllium for an epidemiologic study. METHODS: In 1999, a cross-sectional survey of workers hired after 1 January 1994 was conducted at a beryllium production facility. Personal exposure data from two air sampling surveys conducted in 1999 were used to obtain total, respirable, and submicron particle baseline exposure estimates (BEE) for a job-exposure matrix (JEM). General area air samples collected from 1994-1999 were used to estimate annual changes in exposures (temporal factors) for 24 different process areas. Historical exposure estimates (HEE) were calculated by applying the temporal factors to the BEE. Workers were assigned HEE based on their work history, and their historical exposure profile was summarized as cumulative, average, or highest-ever job exposure. RESULTS: Changes in exposure over a 6-year period were observed in 10 of the 24 process areas with an overall mean decline of 18% per year. The overall total exposure for study participants over their work tenure ranged from: 0.001-34.44 mcg/m (3)-year, 0.01-16.26 mcg/m (3), and 0.01-17.54 mcg /m (3)for cumulative, average, and highest-ever job, respectively. For respirable exposures, the ranges were: 0.001-15.54 mcg/m (3)-year, 0.01-3.56 mcg/m (3), 0.01-5.54 mcg /m (3)for cumulative, average, and highest-ever job, respectively. CONCLUSIONS: Using this JEM, exposure-response relationships for BeS and CBD can be explored over a range of exposure metrics such as total, respirable, and submicron beryllium mass concentrations, including summary measures such as cumulative, average, or highest exposures, with the ultimate objective of elucidating a quantitative exposure-response relationship. |
Sensitization and chronic beryllium disease at a primary manufacturing facility, part 2: validation of historical exposures
Park JY , Virji MA , Stefaniak AB , Stanton ML , Day GA , Kent MS , Schuler CR , Kreiss K . Scand J Work Environ Health 2011 38 (3) 259-69 OBJECTIVE: The aim of this study was to evaluate the validity of a job exposure matrix (JEM) constructed for the period 1994-1999. Historical exposure estimates (HEE) for the JEM were constructed for all job and year combinations by applying temporal factors reflecting annual change in area air measurements (1994-1998) to the personal baseline exposure estimates (BEE) collected in 1999. The JEM was generated for an epidemiologic study to examine quantitative exposure-response relationships with sensitization and chronic beryllium disease. METHODS: The validity of the BEE and HEE was evaluated by comparing them with a validation dataset of independently collected personal beryllium exposure measurements from 1999 and 1994-1998, respectively. Agreement between the JEM and validation data was assessed using relative bias and concordance correlation coefficients (CCC). RESULTS: The BEE and HEE overestimated the measured exposures in their respective validation datasets by 8% and 6%, respectively. The CCC reflecting the deviation of the fitted line from the concordance line, showed good agreement for both BEE (CCC=0.80) and HEE (CCC=0.72). Proportional difference did not change with exposure levels or by process area and year. Overall, the agreement between the JEM and validation estimates (from combined HEE and BEE) was high (CCC=0.77). CONCLUSIONS: This study demonstrated that the reconstructed beryllium exposures at a manufacturing facility were reliable and can be used in epidemiologic studies. |
Excess risk of head and chest colds among teachers and other school workers
Tak S , Groenewold M , Alterman T , Park RM , Calvert GM . J Sch Health 2011 81 (9) 560-565 BACKGROUND: Work-related injuries and illnesses in the educational services sector have not been well studied. This analysis examined whether teachers and other school workers are at higher risk of head/chest cold compared to all other workers in the United States. METHODS: Seven years (1998-2004) of National Health Interview Survey data on currently employed workers were combined to provide a basis for estimating the incidence proportion of head/chest cold. RESULTS: The adjusted odds ratio for head/chest cold was significantly elevated for teachers and other workers employed at schools compared to all other workers. When examined by month, an excess of increased head/chest cold risk during the school year suggested that a portion of head/chest cold among teachers and other school workers is attributable to their workplace, perhaps due to close contact with students at school. CONCLUSION: Head/chest cold, a surrogate for acute respiratory infection, was more common among school workers during the school year and less common during July than for all other workers in the United States. Targeted training for school workers and students may be beneficial to reduce work-related exposure to viruses and bacteria that infect the respiratory system. |
Forces and moments on the knee during kneeling and squatting
Pollard JP , Porter WL , Redfern MS . J Appl Biomech 2011 27 (3) 233-41 Euler angle decomposition and inverse dynamics were used to determine the knee angles and net forces and moments applied to the tibia during kneeling and squatting with and without kneepads for 10 subjects in four postures: squatting (Squat), kneeling on the right knee (One Knee), bilateral kneeling near full flexion (Near Full) and bilateral kneeling near 90 degrees flexion (Near 90). Kneepads affected the knee flexion (p = .002), medial forces (p = .035), and internal rotation moments (p = .006). Squat created loading conditions that had higher varus (p < .001) and resultant moments (p = .027) than kneeling. One Knee resulted in the highest force magnitudes and net moments (p < .001) of the kneeling postures. Thigh-calf and heel-gluteus contact forces decreased the flexion moment on average by 48% during Squat and Near Full. |
In vitro human epidermal penetration of 1-bromopropane
Frasch HF , Dotson GS , Barbero AM . J Toxicol Environ Health A 2011 74 (19) 1249-60 1-Bromopropane (1-BP; CAS number 106-94-5), also known as n-propyl bromide, is a halogenated short-chain alkane used as an organic solvent with numerous commercial and industrial applications, including garment dry cleaning and vapor degreasing of metals. The purpose of this study was to determine the dermal absorption characteristics and corrosivity of 1-BP. Heat-separated human epidermal membranes were mounted on static diffusion cells. Different exposure scenarios were studied (infinite dose, finite dose, and transient exposure) using neat 1-BP and saturated aqueous solution as donor. Steady-state fluxes for infinite-dose neat 1-BP exposure averaged 625 to 960 mcg cm(-2) h(-1). The finite-dose (10 mcl/cm(2) = 13.5 mg/cm(2)) unoccluded donor resulted in penetration of <0.2% of the applied dose (22 mcg/cm(2)). A 10-min transient exposure to infinite dose resulted in total penetration of 179 mcg/cm(2). Steady-state 1-BP fluxes from neat application of a commercial dry cleaning solvent were similar (441 to 722 mcg cm(-2) h(-1)). The permeability coefficient of 1-BP in water vehicle was 0.257 +/- 0.141 cm/h. The absorption potential of 1-BP following dermal exposure is dependent upon the type and duration of exposure. Donor losses due to evaporation were approximately 500-fold greater than dermal absorption flux; evaporation flux was 420 mg cm(-2) h(-1). 1-BP is cytotoxic but not corrosive, based on results from a cultured reconstructed human epidermal model (EpiDerm Skin Corrosivity Test). |
AORN Ergonomic Tool 6: lifting and carrying supplies and equipment in the perioperative setting
Waters T , Baptiste A , Short M , Plante-Mallon L , Nelson A . AORN J 2011 94 (2) 173-9 Perioperative team members often are required to lift and carry heavy supplies and equipment into and around the OR; this includes lifting equipment such as hand tables, fluoroscopy boards, stirrups, Wilson frames, irrigation containers for lithotripsy, and heavy instrument pans. Lifting heavy objects creates considerable risk for musculoskeletal injuries to the back and shoulders. AORN Ergonomic Tool 6: Lifting and Carrying Supplies and Equipment in the Perioperative Setting can help caregivers evaluate lifting and carrying tasks and take measures to protect themselves from injury. Caregivers can use the revised National Institute for Occupational Safety and Health lifting equation to assess whether a specific lifting task can be performed safely. |
In vivo efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in Central Ethiopia
Hwang J , Alemayehu BH , Hoos D , Melaku Z , Tekleyohannes SG , Teshi T , Birhanu SG , Demeke L , Gobena K , Kassa M , Jima D , Reithinger R , Nettey H , Green M , Malone JL , Kachur SP , Filler S . Malar J 2011 10 (1) 209 BACKGROUND: In vivo efficacy assessments of the first-line treatments for Plasmodium falciparum malaria are essential for ensuring effective case management. In Ethiopia, artemether-lumefantrine (AL) has been the first-line treatment for uncomplicated P. falciparum malaria since 2004. METHODS: Between October and November 2009, we conducted a 42-day, single arm, open label study of AL for P. falciparum in individuals >6 months of age at two sites in Oromia State, Ethiopia. Eligible patients who had documented P. falciparum mono-infection were enrolled and followed according to the standard 2009 World Health Organization in vivo drug efficacy monitoring protocol. The primary and secondary endpoints were PCR uncorrected and corrected cure rates, as measured by adequate clinical and parasitological response on days 28 and 42, respectively. RESULTS: Of 4426 patients tested, 120 with confirmed falciparum malaria were enrolled and treated with AL. Follow-up was completed for 112 patients at day 28 and 104 patients at day 42. There was one late parasitological failure, which was classified as undetermined after genotyping. Uncorrected cure rates at both day 28 and 42 for the per protocol analysis were 99.1% (95% CI 95.1-100.0); corrected cure rates at both day 28 and 42 were 100.0%. Uncorrected cure rates at day 28 and 42 for the intention to treat analysis were 93.3% (95% CI 87.2-97.1) and 86.6% (95% CI 79.1-92.1), respectively, while the corrected cure rates at day 28 and 42 were 94.1% (95% CI 88.2-97.6) and 87.3% (95% CI 79.9-92.7), respectively. Using survival analysis, the unadjusted cure rate was 99.1% and 100.0% adjusted by genotyping for day 28 and 42, respectively. Eight P. falciparum patients (6.7%) presented with Plasmodium vivax infection during follow-up and were excluded from the per protocol analysis. Only one patient had persistent parasitaemia at day 3. No serious adverse events were reported, with cough and nausea/ vomiting being the most common adverse events. CONCLUSIONS: AL remains a highly effective and well-tolerated treatment for uncomplicated falciparum malaria in the study setting after several years of universal access to AL. A high rate of parasitaemia with P. vivax possibly from relapse or new infection was observed. TRIAL REGISTRATION: NCT01052584. |
Disability from Japanese encephalitis in Cambodia and Viet Nam
Hills SL , Van Cuong N , Touch S , Mai HH , Soeung SC , Lien TT , Samnang C , Sovann L , Van Diu P , Lac LD , Heng S , Huong VM , Grundy JJ , Huch C , Lewthwaite P , Solomon T , Jacobson JA . J Trop Pediatr 2011 57 (4) 241-4 A cohort of Japanese encephalitis (JE) survivors in Cambodia and Viet Nam were assessed at least 4 months after hospital discharge in order to understand the extent of disability after JE. We used a simple assessment tool which focuses on the impact on daily life. In total, 64 disability assessments were conducted: 38 in Cambodia and 26 in Viet Nam. In Cambodia, 4 (11%) children had severe sequelae, suggesting the children would likely be dependent, 15 (39%) had moderate sequelae and 17 (45%) had mild sequelae. In Viet Nam, two (8%) persons had severe sequelae, five (19%) had moderate sequelae and eight (31%) had mild sequelae. In many JE-endemic areas there are no multi-disciplinary teams with sophisticated equipment to assess patients after JE disease. This assessment tool can assist with patient management and generate data to support the need for programmes to prevent disease and improve outcomes for survivors. |
Using a concept map as a tool for strategic planning: The Healthy Brain Initiative
Anderson LA , Day KL , Vandenberg AE . Prev Chronic Dis 2011 8 (5) A117 Concept mapping is a tool to assist in strategic planning that allows planners to work through a sequence of phases to produce a conceptual framework. Although several studies describe how concept mapping is applied to various public health problems, the flexibility of the methods used in each phase of the process is often overlooked. If practitioners were more aware of the flexibility, more public health endeavors could benefit from using concept mapping as a tool for strategic planning. The objective of this article is to describe how the 6 concept-mapping phases originally outlined by William Trochim guided our strategic planning process and how we adjusted the specific methods in the first 2 phases to meet the specialized needs and requirements to create The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health. In the first stage (phases 1 and 2 of concept mapping), we formed a steering committee, convened 4 work groups over a period of 3 months, and generated an initial set of 42 action items grounded in science. In the second stage (phases 3 and 4), we engaged stakeholders in sorting and rating the action items and constructed a series of concept maps. In the third and final stage (phases 5 and 6), we examined and refined the action items and generated a final concept map consisting of 44 action items. We then selected the top 10 action items, and in 2007, we published The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health, which represents the strategic plan for The Healthy Brain Initiative. |
Women's bike seats: a pressing matter for competitive female cyclists
Guess MK , Partin SN , Schrader S , Lowe B , Lacombe J , Reutman S , Wang A , Toennis C , Melman A , Mikhail M , Connell KA . J Sex Med 2011 8 (11) 3144-53 INTRODUCTION: There are numerous genital complaints in women cyclists, including pain, numbness, and edema of pelvic floor structures. Debate ensues about the best saddle design for protection of the pelvic floor. AIM: To investigate the relationships between saddle design, seat pressures, and genital nerve function in female, competitive cyclists. METHODS: We previously compared genital sensation in healthy, premenopausal, competitive women bicyclists and runners. The 48 cyclists from our original study comprise the study group in this subanalysis. MAIN OUTCOME MEASURES: Main outcome measures were: (i) genital vibratory thresholds (VTs) determined using the Medoc Vibratory Sensation Analyzer 3000 and (ii) saddle pressures as determined using a specially designed map sensor. RESULTS: More than half of the participants (54.8%) used traditional saddles, and the remainder (45.2%) rode with cut-out saddles. On bivariate analysis, use of traditional saddles was associated with lower mean perineal saddle pressures (MPSP) than riding on cut-out saddles. Peak perineal saddle pressures (PPSP) were also lower; however, the difference did not reach statistical significance. Saddle design did not affect mean or peak total saddle pressures (MTSP, PTSP). Saddle width was significantly associated with PPSP, MTSP, and PTSP but not with MPSP. Women riding cut-out saddles had, on average, a 4 and 11 kPa increase in MPSP and PPSP, respectively, compared with women using traditional saddles (P = 0.008 and P = 0.010), after adjustment for other variables. Use of wider saddles was associated with lower PPSP and MTSP after adjustment. Although an inverse correlation was seen between saddle pressures and VTs on bivariate analysis, these differences were not significant after adjusting for age. CONCLUSION: Cut-out and narrower saddles negatively affect saddle pressures in female cyclists. Effects of saddle design on pudendal nerve sensory function were not apparent in this cross-sectional analysis. Longitudinal studies evaluating the long-term effects of saddle pressure on the integrity of the pudendal nerve, pelvic floor, and sexual function are warranted. |
Do women using long-acting reversible contraception reduce condom use? A novel study design incorporating semen biomarkers
Gallo MF , Warner L , Jamieson DJ , Steiner MJ . Infect Dis Obstet Gynecol 2011 2011 107140 Long-acting reversible contraceptive (LARC) methods are highly effective against pregnancy. A barrier to their widespread promotion can include the concern they will lead reduced condom use and, thus, will put couples at higher risk for sexually transmitted infections (STIs). We review evidence from previous studies of condom "migration" associated with the use of LARC and propose a novel study design to address the two main methodological issues that have limited these earlier studies. Namely, we propose to use a randomized controlled trial design and to use a biological marker of semen exposure for measuring changes in condom use. |
Expanded data from the new birth certificate, 2008
Osterman MJ , Martin JA , Mathews TJ , Hamilton BE . Natl Vital Stat Rep 2011 59 (7) 1-28 OBJECTIVES: This report presents data for selected items exclusive to the 2003 U.S. Standard Certificate of Live Birth as well as key items considered not comparable between the 1989 (unrevised) and 2003 (revised) versions for states and territories that implemented the 2003 revision as of January 1, 2008. Information is shown for educational attainment, tobacco use during pregnancy, month prenatal care began, and checkboxes in the following categories: "risk factors in this pregnancy," "obstetric procedures," "characteristics of labor and delivery," "method of delivery," "abnormal conditions of the newborn," and "congenital anomalies of the newborn." METHODS: Descriptive statistics are presented on births occurring in 2008 to residents of the 27 states that implemented the revised birth certificate. RESULTS: There were 2,748,302 births to residents of the 27-state reporting area, representing 65 percent of 2008 U.S. births. About 78 percent of women had at least a high school diploma; 24.5 percent had an advanced education. One out of 10 women smoked during pregnancy (24-state reporting area) and one out of five smokers quit while pregnant. Almost three-quarters of women began prenatal care in the first trimester of pregnancy. The rate of prepregnancy diabetes was 6.5 per 1,000 and gestational diabetes was 40.6; risk of both types rose with maternal age. Nearly one out of four women had a primary cesarean delivery; less than 1 out of 10 women had a vaginal birth after cesarean delivery. About 27 percent of women attempted a trial of labor before a cesarean delivery. Seven percent of all infants were admitted to a neonatal intensive care unit. |
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