Looking again at the Look AHEAD study
Gregg EW , Wing R . Lancet Diabetes Endocrinol 2017 5 (10) 763-764 Despite clear evidence that structured weight loss interventions reduce diabetes incidence in high-risk adults, it is unclear whether such benefits extend to prevention of cardiovascular disease (CVD) and other diabetes complications, and this controversy has influenced the scope of recommendations for lifestyle interventions.1 Although results from the Da Qing Diabetes Prevention Follow-up Study2 in China showed reduced CVD mortality, and findings from the Diabetes Prevention Program study3 showed reduced microvascular disease, these benefits were limited to women. Perhaps the biggest source of doubt about the role of weight loss on cardiovascular disease outcomes has come from the Look AHEAD study, which was the largest randomised controlled trial designed specifically to test the effect of lifestyle-based weight loss on CVD incidence in people with type 2 diabetes, and achieved perhaps the largest long-term cumulative weight loss ever for a major trial.4 Although the study showed benefits of the weight loss intervention on diverse outcomes, including chronic kidney disease, disability, depression, and sleep quality, there was no significant effect on CVD, which remains the single largest cause of morbidity and mortality in most adult populations.5, 6, 7 |
An American Thoracic Society/National Heart, Lung, and Blood Institute Workshop Report: Addressing respiratory health equality in the United States
Celedon JC , Burchard EG , Schraufnagel D , Castillo-Salgado C , Schenker M , Balmes J , Neptune E , Cummings KJ , Holguin F , Riekert KA , Wisnivesky JP , Garcia JGN , Roman J , Kittles R , Ortega VE , Redline S , Mathias R , Thomas A , Samet J , Ford JG . Ann Am Thorac Soc 2017 14 (5) 814-826 Health disparities related to race, ethnicity, and socioeconomic status persist and are commonly encountered by practitioners of pediatric and adult pulmonary, critical care, and sleep medicine in the United States. To address such disparities and thus progress toward equality in respiratory health, the American Thoracic Society and the National Heart, Lung, and Blood Institute convened a workshop in May of 2015. The workshop participants addressed health disparities by focusing on six topics, each of which concluded with a panel discussion that proposed recommendations for research on racial, ethnic, and socioeconomic disparities in pulmonary, critical care, and sleep medicine. Such recommendations address best practices to advance research on respiratory health disparities (e.g., characterize broad ethnic groups into subgroups known to differ with regard to a disease of interest), risk factors for respiratory health disparities (e.g., study the impact of new tobacco or nicotine products on respiratory diseases in minority populations), addressing equity in access to healthcare and quality of care (e.g., conduct longitudinal studies of the impact of the Affordable Care Act on respiratory and sleep disorders), the impact of personalized medicine on disparities research (e.g., implement large studies of pharmacogenetics in minority populations), improving design and methodology for research studies in respiratory health disparities (e.g., use study designs that reduce participants' burden and foster trust by engaging participants as decision-makers), and achieving equity in the pulmonary, critical care, and sleep medicine workforce (e.g., develop and maintain robust mentoring programs for junior faculty, including local and external mentors). Addressing these research needs should advance efforts to reduce, and potentially eliminate, respiratory, sleep, and critical care disparities in the United States. |
Ascertainment of Alaska native stroke incidence, 2005-2009: Lessons for assessing the global burden of stroke
Boden-Albala B , Allen J , Roberts ET , Bulkow L , Trimble B . J Stroke Cerebrovasc Dis 2017 26 (9) 2019-2026 BACKGROUND: Stroke is a critical public health issue in the United States and globally. System models to optimally capture stroke incidence in rural and culturally diverse communities are needed. The epidemiological transition to a western lifestyle has been associated with an increased burden of vascular risk factors among Alaska Native (AN) people. The burden of stroke in AN communities remains understudied. METHODS: The Alaska Native Stroke Registry (ANSR) was designed to screen and capture all stroke cases between 2005 and 2009 through its integration into the existing single-payer Alaska Tribal Health System infrastructure. Registry staff received notification each time stroke International Classification of Diseases, Ninth Revision codes (430-436) were initiated anywhere in the system. Trained chart abstractors reviewed medical records to document incident strokes among AN patients, which were adjudicated. RESULTS: Between October 2005 and October 2009, over 2100 alerts were screened identifying 514 unique stroke cases, of which 372 were incident strokes. The average annual incidence of stroke (per 100,000) among AN adults was 190.6: 219.2 in men and 164.7 in women. Overall, the ischemic stroke incidence rate was 148.5 per 100,000 with men (184.6) having higher ischemic rates per 100,000 than women (118.3). Men have higher rates of ischemic stroke at all ages, whereas older women experienced higher rates of hemorrhagic strokes over the age of 75 years. CONCLUSIONS: We report a high rate of overall stroke, 190.6 per 100,000. The ANSR methods and findings have implications for other indigenous populations and for global health populations currently undergoing similar epidemiological transitions. |
Notes from the Field: Cluster of Acute Flaccid Myelitis in Five Pediatric Patients - Maricopa County, Arizona, 2016.
Iverson SA , Ostdiek S , Prasai S , Engelthaler DM , Kretschmer M , Fowle N , Tokhie HK , Routh J , Sejvar J , Ayers T , Bowers J , Brady S , Rogers S , Nix WA , Komatsu K , Sunenshine R . MMWR Morb Mortal Wkly Rep 2017 66 (28) 758-760 In 2016, CDC saw an increase in cases of acute flaccid myelitis (AFM); 144 persons in 37 states and the District of Columbia were confirmed to have AFM. After investigations in California (1) and Colorado (2) in 2014, CDC characterized AFM as an acute flaccid paralysis (AFP) distinguishable by magnetic resonance imaging (MRI) abnormalities of the gray matter of the anterior and posterior spinal cord segments, involving one or more spinal segments (3). Although certain viruses (e.g., nonpoliovirus enteroviruses, adenoviruses, and West Nile virus) can cause rare cases of AFP, and findings from the 2014 outbreak investigations indicated that enterovirus D68 (EV-D68) was temporally associated with AFM, no viral etiology for AFM has been definitively established (3). In September 2016, an acute care hospital in Arizona notified the Maricopa County Department of Public Health (MCDPH) of a suspected case of AFM and subsequent cluster of 11 children who were evaluated with similar neurologic deficits; differential diagnoses included transverse myelitis and AFM. The Maricopa County Department of Public Health, in cooperation with the Arizona Department of Health Services, CDC, the Translational Genomics Research Institute (TGen, Flagstaff, Arizona), and the acute care hospital, initiated an investigation to confirm AFM cases and identify an etiology. | The 2015 Council of State and Territorial Epidemiologists and CDC case definition for probable AFM requires acute onset of flaccid limb weakness and cerebrospinal fluid (CSF) pleocytosis (CSF white blood cell [WBC] count >5/mm3 when corrected for red blood cells). A confirmed case must have an MRI demonstrating lesions restricted primarily to the gray matter of the spinal cord, in addition to acute onset of flaccid limb weakness (4). Based on medical chart abstraction and review of the MRI images, a CDC neurology subject matter expert verified four confirmed cases of AFM and one probable case. Among the six patients whose cases did not meet the AFM confirmed or probable case definition, two had focal limb weakness and pleocytosis (CSF WBC = 7/mm3 and 22/mm3, respectively), but MRI results indicated alternative etiologies (acute disseminated encephalomyelitis and neuromyelitis optica, respectively). The case that met the probable case definition had pleocytosis (CSF WBC = 7/mm3), but MRI findings were inconsistent with AFM, and no other plausible diagnosis was identified. |
Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the pneumonia etiology research for child health (PERCH) case–control study
McCollum ED , Park DE , Watson NL , Buck WC , Bunthi C , Devendra A , Ebruke BE , Elhilali M , Emmanouilidou D , Garcia-Prats AJ , Githinji L , Hossain L , Madhi SA , Moore DP , Mulindwa J , Olson D , Awori JO , Vandepitte WP , Verwey C , West JE , Knoll MD , O’Brien KL , Feikin DR , Hammit LL . BMJ Open Respir Res 2017 4 (1) e000193 Introduction Paediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls. Methods Pneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1–59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics. Results Primary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/ absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases. Conclusions Listening panel and case–control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries. |
Positive health check: developing a web-based video counseling tool for HIV primary care clinics
Harshbarger C , Taylor O , Uhrig JD , Lewis MA . J Commun Healthc 2017 10 (2) 70-77 HIV prevention efforts are increasingly aimed at engaging people living with HIV (PLWH) in healthcare to enhance treatment adherence and retention in care. Clinics need evidence-based interventions to support these goals and guidance on how to successfully implement these interventions in clinical settings. We describe the development of Positive Health Check (PHC) digital health intervention to support adherence and retention in care as well as a pilot implementation to determine feasibility. We developed PHC using input from seven HIV primary care providers. Over 15 months, providers gave feedback on the development of PHC by participating in nine inquiries, via online methods or webinars, addressing topics related to intervention development and implementation. After a 1-month pilot test, four providers shared their impressions of PHC implementation via a structured, open-ended interview. Providers’ comments resulted in script revisions, feedback on the filming of four virtual doctors (actors) balanced by race and gender, a user-friendly visual design, and more engaging messaging. Implementation feedback informed protocols to increase privacy and strategies to gain buy-in from clinics. Providers responded positively after using the final version of PHC, and again after the 1-month pilot implementation. Using a collaborative development approach with healthcare providers is a viable method for developing clinic-based interventions to support clinical encounters for PLWH. Intervention development should include strategies to support integrating mobile interventions into clinic workflows. © 2017 Informa UK Limited, trading as Taylor & Francis Group |
Prevalence of enteric infections among hospitalized patients in two referral hospitals in Ghana
Akuffo R , Armah G , Clemens M , Kronmann KC , Jones AH , Agbenohevi P , Sagoe K , Puplampu N , Talla Nzussouo N , Ampofo W , Koram K , Duplessis C , Dueger E . BMC Res Notes 2017 10 (1) 292 BACKGROUND: Diarrhea is an important cause of morbidity and mortality worldwide. In Africa and Ghana in particular, it is estimated to contribute directly to 19 and 25% of pediatric mortality among children under 5 years, respectively. METHODS: Surveillance for hospitalized acute diarrheal illness was initiated in November 2010 through October 2012 in a referral hospital in southern Ghana, and a teaching hospital in northern Ghana. Consenting hospitalized patients who met a standardized case definition for acute diarrheal illness provided demographic and epidemiologic data. Stool samples were collected and tested by culture for bacteria and by enzyme immunoassays for a panel of viruses and parasites. RESULTS: A total of 429 patients were enrolled; 216 (50.3%) were under 5 years, and 221 (51.5%) were females. Stool samples were received from 153 patients. Culture isolates included Shigella sp., Salmonella spp., Plesiomonas sp. and Vibrio cholerae. Of 147 samples tested for viruses, 41 (27.9%) were positive for rotaviruses, 11 (7.5%) for astroviruses, 10 (6.8%) for noroviruses, and 8 (5.4%) for adenoviruses. Of 116 samples tested for parasitic infections; 4 (3.4%) were positive for Cryptosporidium sp. and 3 (2.6%) for Giardia lamblia. Of the enrolled patients, 78.8% had taken antibiotics prior to sample collection. CONCLUSIONS: Diarrheal pathogens were identified across all ages, however, predominantly (81%) in the children under 5 years of age. This study also detected high antibiotic use which has the potential of increasing antibiotic resistance. The most common enteric pathogen detected (49.4%) was rotavirus. |
Exploring factors associated with declining HIV diagnoses among African American females
McCree DH , Jeffries 4th W L , Beer L , Gant Z , Elmore K , Sutton M . J Racial Ethn Health Disparities 2017 5 (3) 598-604 HIV diagnoses among females in the USA declined 40% during 2005-2014 with the largest decline (42%) among Black/African Americans. African American females remain disproportionately affected. We explored contributions of STD rates and sexual risk behaviors among African American females, HIV diagnoses among potential male partners, and sexual risk behaviors and viral suppression rates among HIV-positive potential male partners to declining rates of HIV diagnoses among African American females. Results suggest temporal trends in the factors that increase HIV infectiousness and transmissibility within sexual networks, i.e., decreases in rates of other sexually transmitted infections among African American females, decreases in HIV diagnoses among potential male partners, and increases in viral suppression among heterosexual and bisexual HIV-positive potential male partners in care, may explain the decline. Findings highlight a need for future research that provides context to the sexual risk behaviors and sexual network factors in order to continue progress. |
Factors associated with the duration of moderate-to-severe diarrhea among children in rural western Kenya enrolled in the Global Enteric Multicenter Study, 2008-2012
Schilling KA , Omore R , Derado G , Ayers T , Ochieng JB , Farag TH , Nasrin D , Panchalingam S , Nataro JP , Kotloff KL , Levine MM , Oundo J , Parsons MB , Bopp C , Laserson K , Stauber CE , Rothenberg R , Breiman RF , O'Reilly CE , Mintz ED . Am J Trop Med Hyg 2017 97 (1) 248-258 Diarrheal disease is a leading cause of death among young children worldwide. As rates of acute diarrhea (AD; 1-6 days duration) have decreased, persistent diarrhea (PD; > 14 days duration) accounts for a greater proportion of the diarrheal disease burden. We describe factors associated with the duration of moderate-to-severe diarrhea in Kenyan children < 5 years old enrolled in the Global Enteric Multicenter Study. We found 587 (58%) children experienced AD, 360 (35%) had prolonged acute diarrhea (ProAD; 7-13 days duration), and 73 (7%) had PD. We constructed a Cox proportional hazards model to identify factors associated with diarrheal duration. Risk factors independently associated with longer diarrheal duration included infection with Cryptosporidium (hazard ratio [HR]: 0.868, P = 0.035), using an unimproved drinking water source (HR: 0.87, P = 0.035), and being stunted at enrollment (HR: 0.026, P < 0.0001). Diarrheal illness of extended duration appears to be multifactorial; given its association with adverse health and development outcomes, effective strategies should be implemented to reduce the duration and severity of diarrheal illness. Effective treatments for Cryptosporidium should be identified, interventions to improve drinking water are imperative, and nutrition should be improved through exclusive breastfeeding in infants ≤ 6 months and appropriate continued feeding practices for ill children. |
From one to the other: responding to Ebola cases on either side of the line
Merrill RD , Ward SE , Oppert MC , Schneider DA . Pan Afr Med J 2017 27 12 This case study is adapted from events that occurred along the Sierra Leone and Guinea land border during the 2014-2016 Ebola epidemic in West Africa. The response activities involved Sierra Leone and Guinea officials, along with assistance from U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO). This case study builds upon an understanding of basic surveillance systems and outbreak response activities. Through this exercise, students will understand how to incorporate communication and coordination into surveillance and response efforts with counterparts across the border in neighbouring countries. This integration is important to reduce the spread of communicable diseases between neighbouring countries. The time required to complete this case study is 2-3 hours. |
High mortality and coinfection in a prospective cohort of human immunodeficiency virus/acquired immune deficiency syndrome patients with histoplasmosis in Guatemala
Samayoa B , Roy M , Cleveland AA , Medina N , Lau-Bonilla D , Scheel CM , Gomez BL , Chiller T , Arathoon E . Am J Trop Med Hyg 2017 97 (1) 42-48 Histoplasmosis is one of the most common and deadly opportunistic infections among persons living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome in Latin America, but due to limited diagnostic capacity in this region, few data on the burden and clinical characteristics of this disease exist. Between 2005 and 2009, we enrolled patients ≥ 18 years of age with suspected histoplasmosis at a hospital-based HIV clinic in Guatemala City. A case of suspected histoplasmosis was defined as a person presenting with at least three of five clinical or radiologic criteria. A confirmed case of histoplasmosis was defined as a person with a positive culture or urine antigen test for Histoplasma capsulatum. Demographic and clinical data were also collected and analyzed. Of 263 enrolled as suspected cases of histoplasmosis, 101 (38.4%) were confirmed cases. Median time to diagnosis was 15 days after presentation (interquartile range [IQR] = 5-23). Crude overall mortality was 43.6%; median survival time was 19 days (IQR = 4-69). Mycobacterial infection was diagnosed in 70 (26.6%) cases; 26 (25.7%) histoplasmosis cases were coinfected with mycobacteria. High mortality and short survival time after initial symptoms were observed in patients with histoplasmosis. Mycobacterial coinfection diagnoses were frequent, highlighting the importance of pursuing diagnoses for both diseases. |
Incidence of active tuberculosis and cohort retention among adolescents in western Kenya
Nduba V , Van't Hoog AH , Mitchell EMH , Borgdorff M , Laserson KF . Pediatr Infect Dis J 2017 37 (1) 10-15 SETTING: Siaya County, with the highest tuberculosis notification rates in Kenya. OBJECTIVE: To determine the incidence of active tuberculosis and one year cohort retention in 12-18 year old adolescents, in preparation for Phase III tuberculosis vaccine trials. METHODS: Adolescents were enrolled and followed up for 1-2 years to determine tuberculosis incidence. Adolescents with a positive tuberculin skin test (TST), history of cohabitation with a tuberculosis case, or at least one tuberculosis symptom received clinical and sputum examination and a chest radiograph. Definite tuberculosis cases were bacteriologically confirmed and clinical cases diagnosed by a clinician based on a suggestive chest radiograph and having clinical symptoms. Risk factors were explored using Poisson regression. RESULTS: Among 4934 adolescents without tuberculosis at baseline, 26 tuberculosis cases were identified during follow up with a corresponding incidence density of 4.4 (95% CI, 3.0-6.4) events per 1000 person years of observation, 12 definite tuberculosis cases; incidence density of 2.0 (95% CI, 0.9-3.1). Having previous tuberculosis (RR= 12.5, CI 1.8, 100) and presence of TST conversion (RR=3.4, CI 1.5, 7.7) were significantly associated with higher risk of tuberculosis. Overall (4086/4925) 83.0% of adolescents were retained in the study after 1 year of follow up. Being female, older, out of school and being orphaned were significant risk factors for loss to follow up. CONCLUSION: The tuberculosis incidence in adolescents will help inform future tuberculosis vaccine trial sample size calculations for this setting. The predictive factors for tuberculosis and retention can be further explored in future trials. |
Demographic and ecological risk factors for human influenza A virus infections in rural Indonesia
Root ED , Agustian D , Kartasasmita C , Uyeki TM , Simoes EAF . Influenza Other Respir Viruses 2017 11 (5) 425-433 BACKGROUND: Indonesia has the world's highest reported mortality for human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus. Indonesia is an agriculturally-driven country where human-animal mixing is common and provides a unique environment for zoonotic influenza A virus transmission. OBJECTIVES: To identify potential demographic and ecological risk factors for human infection with seasonal influenza A viruses in rural Indonesia, a population-based study was conducted in Cileunyi and Soreang sub-districts near Bandung in western Java from 2008 to 2011. METHODS: Passive influenza surveillance with RT-PCR confirmation of influenza A viral RNA in respiratory specimens was utilized for case selection and ascertainment. A population census and mapping were utilized for population data collection. The presence of influenza A(H3N2) and A(H1N1)pdm09 virus infections in a household was modeled using Generalized Estimating Equations. RESULTS: Each additional child aged <5 years in a household increased the odds of H3N2 approximately 5 times (OR=4.59, 95%CI: 3.30-6.24) and H1N1pdm09 by 3.5 times (OR=3.53, 95%CI: 2.51-4.96). In addition, the presence of 16-30 birds in the house was associated with an increased odds of H3N2 (OR=5.08, 95%CI: 2.00-12.92) and H1N1pdm09 (OR=12.51 95%CI: 6.23-25.13). CONCLUSION: Our findings suggest an increase in influenza A virus infections in rural Indonesian villagers living in households with young children and poultry. This article is protected by copyright. All rights reserved. |
Explaining variation in adult Anopheles indoor resting abundance: the relative effects of larval habitat proximity and insecticide-treated bed net use
McCann RS , Messina JP , MacFarlane DW , Bayoh MN , Gimnig JE , Giorgi E , Walker ED . Malar J 2017 16 (1) 288 BACKGROUND: Spatial determinants of malaria risk within communities are associated with heterogeneity of exposure to vector mosquitoes. The abundance of adult malaria vectors inside people's houses, where most transmission takes place, should be associated with several factors: proximity of houses to larval habitats, structural characteristics of houses, indoor use of vector control tools containing insecticides, and human behavioural and environmental factors in and near houses. While most previous studies have assessed the association of larval habitat proximity in landscapes with relatively low densities of larval habitats, in this study these relationships were analysed in a region of rural, lowland western Kenya with high larval habitat density. METHODS: 525 houses were sampled for indoor-resting mosquitoes across an 8 by 8 km study area using the pyrethrum spray catch method. A predictive model of larval habitat location in this landscape, previously verified, provided derivations of indices of larval habitat proximity to houses. Using geostatistical regression models, the association of larval habitat proximity, long-lasting insecticidal nets (LLIN) use, house structural characteristics (wall type, roof type), and peridomestic variables (cooking in the house, cattle near the house, number of people sleeping in the house) with mosquito abundance in houses was quantified. RESULTS: Vector abundance was low (mean, 1.1 adult Anopheles per house). Proximity of larval habitats was a strong predictor of Anopheles abundance. Houses without an LLIN had more female Anopheles gambiae s.s., Anopheles arabiensis and Anopheles funestus than houses where some people used an LLIN (rate ratios, 95% CI 0.87, 0.85-0.89; 0.84, 0.82-0.86; 0.38, 0.37-0.40) and houses where everyone used an LLIN (RR, 95% CI 0.49, 0.48-0.50; 0.39, 0.39-0.40; 0.60, 0.58-0.61). Cooking in the house also reduced Anopheles abundance across all species. The number of people sleeping in the house, presence of cattle near the house, and house structure modulated Anopheles abundance, but the effect varied with Anopheles species and sex. CONCLUSIONS: Variation in the abundance of indoor-resting Anopheles in rural houses of western Kenya varies with clearly identifiable factors. Results suggest that LLIN use continues to function in reducing vector abundance, and that larval source management in this region could lead to further reductions in malaria risk by reducing the amount of an obligatory resource for mosquitoes near people's homes. |
Safer and more appropriate opioid prescribing: a large healthcare system's comprehensive approach
Losby JL , Hyatt JD , Kanter MH , Baldwin G , Matsuoka D . J Eval Clin Pract 2017 23 (6) 1173-1179 RATIONALE, AIMS, AND OBJECTIVES: The United States is in the midst of a public health epidemic with more than 40 people dying each day from prescription opioid overdoses. Health care systems are taking steps to address the opioid overdose epidemic by implementing policy and practice interventions to mitigate the risks of long-term opioid therapy. Kaiser Permanente Southern California launched a comprehensive initiative to transform the way that chronic pain is viewed and treated. Kaiser Permanente Southern California created prescribing and dispensing policies, monitoring and follow-up processes, and clinical coordination through electronic health record integration. The purpose of this paper is to describe the implementation of these interventions and assess the impact of this set of interventions on opioid prescribing. METHOD: The study used a retrospective pre-post evaluation design to track outcomes before and after the intervention. Kaiser Permanente Southern California members age 18 and older excluding cancer, hospice, and palliative care patients and this sub-population of 3 203 880 was approximately 75% of all Kaiser Permanente Southern California members. All data are from Kaiser Permanente's pharmacy data systems and electronic health record collected on a rolling basis as interventions were implemented from January 2010 to December 2015. RESULTS: There were reductions in all tracked outcomes: a 30% reduction in prescribing opioids at high doses; a 98% reduction in the number of prescriptions with quantities greater than 200 pills; a 90% decrease in the combination of an opioid prescription with benzodiazepines and carisoprodol; a 72% reduction in the prescribing of Long Acting/Extended Release opioids; and a 95% reduction in prescriptions of brand name opioid-acetaminophen products. In addition, methadone prescribing did not increase during this period. CONCLUSIONS: This study adds promising results that a comprehensive system-level strategy has the ability to positively affect opioid prescribing. The basic components of the intervention are generalizable and applicable to other health care settings. |
Using prescription monitoring program data to characterize out-of-pocket payments for opioid prescriptions in a state Medicaid program
Hartung DM , Ahmed SM , Middleton L , Van Otterloo J , Zhang K , Keast S , Kim H , Johnston K , Deyo RA . Pharmacoepidemiol Drug Saf 2017 26 (9) 1053-1060 BACKGROUND: Out-of-pocket payment for prescription opioids is believed to be an indicator of abuse or diversion, but few studies describe its epidemiology. Prescription drug monitoring programs (PDMPs) collect controlled substance prescription fill data regardless of payment source and thus can be used to study this phenomenon. OBJECTIVE: To estimate the frequency and characteristics of prescription fills for opioids that are likely paid out-of-pocket by individuals in the Oregon Medicaid program. RESEARCH DESIGN: Cross-sectional analysis using Oregon Medicaid administrative claims and PDMP data (2012 to 2013). SUBJECTS: Continuously enrolled nondually eligible Medicaid beneficiaries who could be linked to the PDMP with two opioid fills covered by Oregon Medicaid. MEASURES: Patient characteristics and fill characteristics for opioid fills that lacked a Medicaid pharmacy claim. Fill characteristics included opioid name, type, and association with indicators of high-risk opioid use. RESULTS: A total of 33 592 Medicaid beneficiaries filled a total of 555 103 opioid prescriptions. Of these opioid fills, 74 953 (13.5%) could not be matched to a Medicaid claim. Hydromorphone (30%), fentanyl (18%), and methadone (15%) were the most likely to lack a matching claim. The 3 largest predictors for missing claims were opioid fills that overlapped with other opioids (adjusted odds ratio [aOR] 1.37; 95% confidence interval [CI], 1.34-1.4), long-acting opioids (aOR 1.52; 95% CI, 1.47-1.57), and fills at multiple pharmacies (aOR 1.45; 95% CI, 1.39-1.52). CONCLUSIONS: Prescription opioid fills that were likely paid out-of-pocket were common and associated with several known indicators of high-risk opioid use. |
Changing the conversation about opioid tapering
Dowell D , Haegerich TM . Ann Intern Med 2017 167 (3) 208-209 Research has uncovered potential harms of long-term opioid therapy, particularly at high dosages(1). These findings make it clear that before starting long-term therapy or increasing dosages, clinicians and patients need to carefully weigh the uncertain benefits of opioids for chronic pain against their increasingly clear risks (2, 3). However, little evidence has been available to help weigh the benefits and harms of reducing dosages or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively (4). Frank and colleagues’ review (5) provides helpful information for clinicians and patients about tapering and discontinuing long-term opioid therapy for chronic pain. | Conclusions should be drawn with caution given the overall very low quality of evidence, as noted by the authors. However, study quality was fair or good for 16 studies (many of which were published recently), and the review focuses on findings from these higher-quality studies. Among the higher-quality studies evaluating pain, function, and quality of life, all found improvements in all outcomes evaluated after opioid dose reduction. | It is important to note how dose reduction was accomplished. Opioids were tapered with buy-in from patients who agreed to decrease the dosage or discontinue therapy. Dosages were reduced relatively slowly (over 22 weeks in 1 study). Patients were provided multidisciplinary care through interdisciplinary pain programs or with behavioral interventions, such as cognitive behavioral therapy or mindfulness meditation, and were followed closely–at least weekly in some studies. Consistent with these practices, the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (2) recommends providing multimodal care for chronic pain, collaborating with patients, and tapering slowly. |
The use of gamma-survey measurements to better understand radon potential in urban areas
Berens AS , Diem J , Stauber C , Dai D , Foster S , Rothenberg R . Sci Total Environ 2017 607-608 888-899 Accounting for as much as 14% of all lung cancers worldwide, cumulative radon progeny exposure is the leading cause of lung cancer among never-smokers both internationally and in the United States. To understand the risk of radon progeny exposure, studies have mapped radon potential using aircraft-based measurements of gamma emissions. However, these efforts are hampered in urban areas where the built environment obstructs aerial data collection. To address part of this limitation, this study aimed to evaluate the effectiveness of using in situ gamma readings (taken with a scintillation probe attached to a ratemeter) to assess radon potential in an urban environment: DeKalb County, part of the Atlanta metropolitan area, Georgia, USA. After taking gamma measurements at 402 survey sites, empirical Bayesian kriging was used to create a continuous surface of predicted gamma readings for the county. We paired these predicted gamma readings with indoor radon concentration data from 1351 residential locations. Statistical tests showed the interpolated gamma values were significantly but weakly positively related with indoor radon concentrations, though this relationship is decreasingly informative at finer geographic scales. Geology, gamma readings, and indoor radon were interrelated, with granitic gneiss generally having the highest gamma readings and highest radon concentrations and ultramafic rock having the lowest of each. Our findings indicate the highest geogenic radon potential may exists in the relatively undeveloped southeastern part of the county. It is possible that in situ gamma, in concert with other variables, could offer an alternative to aerial radioactivity measurements when determining radon potential, though future work will be needed to address this project's limitations. |
Pilot intervention study of household ventilation and fine particulate matter concentrations in a low-income urban area, Dhaka, Bangladesh
Weaver AM , Parveen S , Goswami D , Crabtree-Ide C , Rudra C , Yu J , Mu L , Fry AM , Sharmin I , Luby SP , Ram PK . Am J Trop Med Hyg 2017 97 (2) 615-623 Fine particulate matter (PM2.5) is a risk factor for pneumonia; ventilation may be protective. We tested behavioral and structural ventilation interventions on indoor PM2.5 in Dhaka, Bangladesh. We recruited 59 good ventilation (window or door in ≥ 3 walls) and 29 poor ventilation (no window, one door) homes. We monitored baseline indoor and outdoor PM2.5 for 48 hours. We asked all participants to increase ventilation behavior, including opening windows and doors, and operating fans. Where permitted, we installed windows in nine poor ventilation homes, then repeated PM2.5 monitoring. We estimated effects using linear mixed-effects models and conducted qualitative interviews regarding motivators and barriers to ventilation. Compared with poor ventilation homes, good ventilation homes were larger, their residents wealthier and less likely to use biomass fuel. In multivariable linear mixed-effects models, ventilation structures and opening a door or window were inversely associated with the number of hours PM2.5 concentrations exceeded 100 and 250 mug/m3. Outdoor air pollution was positively associated with the number of hours PM2.5 concentrations exceeded 100 and 250 mug/m3. Few homes accepted window installation, due to landlord refusal and fear of theft. Motivators for ventilation behavior included cooling of the home and sunlight; barriers included rain, outdoor odors or noise, theft risk, mosquito entry, and, for fan use, perceptions of wasting electricity or unavailability of electricity. We concluded that ventilation may reduce indoor PM2.5 concentrations but, there are barriers to increasing ventilation and, in areas with high ambient PM2.5 concentrations, indoor concentrations may remain above recommended levels. |
Sociodemographic characteristics and health outcomes among lesbian, gay, and bisexual U.S. adults using Healthy People 2020 leading health indicators
Lunn MR , Cui W , Zack MM , Thompson WW , Blank MB , Yehia BR . LGBT Health 2017 4 (4) 283-294 PURPOSE: This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs). METHODS: Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate. RESULTS: In 2013-2015, sexual minority adults represented 2.4% of the U.S. POPULATION: Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion. CONCLUSION: Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors. |
Case studies in applied epidemiology
Dicker RC . Pan Afr Med J 2017 27 1 A hallmark of field epidemiology training is its focus on acquisition of practical epidemiologic knowledge and skills to address priority public health issues. The training must prepare the trainee to conduct the core functions of a field epidemiologist – investigate outbreaks, conduct public health surveillance, collect and analyze data, use epidemiologic judgment, and communicate effectively. While these functions or competencies are best learned through practice in the field under the guidance of experienced mentors, even the classroom component that usually precedes the fieldwork can help prepare the trainee. For example, to supplement a lecture on the steps of an outbreak investigation, the unfolding circumstances of an actual outbreak can be presented in the classroom, and trainees could be asked what decisions they would make, what hypotheses they would consider, what statistics they might calculate (and given the data, calculate them), what conclusions they might draw from the data, and so on. | The first outbreak known to be used in this way to teach epidemiologic field investigation principles and methods is the now legendary outbreak of gastroenteritis following a church supper in Oswego, New York in 1940. The Oswego Problem was used as a teaching example at the nearby Albany Medical College in 1942. Alexander Langmuir brought Oswego to the Communicable Disease Center (CDC, now the Centers for Disease Control and Prevention), where he used it to teach outbreak investigation to the first cohort of Epidemic Intelligence Service (EIS) Officers in 1951 [1], Oswego was soon followed by Epidemic Disease in South Carolina and many others. |
Notes from the Field: Cronobacter sakazakii infection associated with feeding extrinsically contaminated expressed human milk to a premature infant - Pennsylvania, 2016
Bowen A , Wiesenfeld HC , Kloesz JL , Pasculle AW , Nowalk AJ , Brink L , Elliot E , Martin H , Tarr CL . MMWR Morb Mortal Wkly Rep 2017 66 (28) 761-762 In April 2016, a female infant was born via Cesarean delivery at 29 estimated gestational weeks and had a birthweight of 3 pounds (1,405 grams). Her clinical course in the neonatal intensive care unit was unremarkable until she developed signs of sepsis at age 21 days. Cultures of blood and cerebrospinal fluid yielded Cronobacter sakazakii, a gram-negative pathogenic bacillus. Despite treatment with ampicillin and cefepime, she developed seizures; brain imaging revealed liquefaction necrosis of the entire left cerebral hemisphere and right frontal lobe. The infant developed spastic cerebral palsy and global developmental delay and required a ventriculoperitoneal shunt and a gastrostomy feeding tube. | The infant had been fed pasteurized donor human milk and expressed maternal milk (EMM) during the first week after birth; thereafter, she received EMM mixed with a commercial liquid human milk fortifier. Maternal milk was expressed using a dedicated bedside hospital breast pump and the mother’s personal breast pump throughout the infant’s hospitalization. The infant did not receive powdered infant formula products. |
Evaluation of the use of zero-augmented regression techniques to model incidence of Campylobacter infections in FoodNet
Tremblay M , Crim SM , Cole DJ , Hoekstra RM , Henao OL , Dopfer D . Foodborne Pathog Dis 2017 14 (10) 587-592 The Foodborne Diseases Active Surveillance Network (FoodNet) is currently using a negative binomial (NB) regression model to estimate temporal changes in the incidence of Campylobacter infection. FoodNet active surveillance in 483 counties collected data on 40,212 Campylobacter cases between years 2004 and 2011. We explored models that disaggregated these data to allow us to account for demographic, geographic, and seasonal factors when examining changes in incidence of Campylobacter infection. We hypothesized that modeling structural zeros and including demographic variables would increase the fit of FoodNet's Campylobacter incidence regression models. Five different models were compared: NB without demographic covariates, NB with demographic covariates, hurdle NB with covariates in the count component only, hurdle NB with covariates in both zero and count components, and zero-inflated NB with covariates in the count component only. Of the models evaluated, the nonzero-augmented NB model with demographic variables provided the best fit. Results suggest that even though zero inflation was not present at this level, individualizing the level of aggregation and using different model structures and predictors per site might be required to correctly distinguish between structural and observational zeros and account for risk factors that vary geographically. |
Trends in beverage prices following the introduction of a tax on sugar-sweetened beverages in Barbados
Alvarado M , Kostova D , Suhrcke M , Hambleton I , Hassell T , Alafia Samuels T , Adams J , Unwin N . Prev Med 2017 105S S23-S25 A 10% excise tax on sugar sweetened beverages (SSBs) was implemented in Barbados in September 2015. A national evaluation has been established to assess the impact of the tax. We present a descriptive analysis of initial price changes following implementation of the SSB tax using price data provided by a major supermarket chain in Barbados over the period 2014-2016. We summarize trends in price change before and after the tax using year-on-year mean price per liter change between SSBs and non-SSBs. We find that prior to the tax, year-on-year price growth of SSBs and non-SSBs was very similar (approximately 1%). During the quarter in which the tax was implemented, the trends diverged, with SSB prices growing by almost 3% while prices of non-SSBs decreased slightly. The growth of SSB prices outpaced non-SSBs prices in each quarter thereafter, reaching 5.9% growth compared to <1% for non-SSBs. Future analyses will assess the trends in prices of SSBs and non-SSBs over a longer period and will integrate price data from additional sources to assess heterogeneity of post-tax price changes. A continued examination of the impact of the SSB tax in Barbados will expand the evidence base available to policymakers worldwide in considering SSB taxes as a lever for reducing the consumption of added sugars at the population level. |
Economic burden of chronic conditions among survivors of cancer in the United States
Guy GP Jr , Yabroff KR , Ekwueme DU , Rim SH , Li R , Richardson LC . J Clin Oncol 2017 35 (18) 2053-2061 Purpose The prevalence of cancer survivorship and chronic health conditions is increasing. Limited information exists on the economic burden of chronic conditions among survivors of cancer. This study examines the prevalence and economic effect of chronic conditions among survivors of cancer. Methods Using the 2008 to 2013 Medical Expenditure Panel Survey, we present nationally representative estimates of the prevalence of chronic conditions (heart disease, high blood pressure, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma) and multiple chronic conditions (MCCs) and the incremental annual health care use, medical expenditures, and lost productivity for survivors of cancer attributed to individual chronic conditions and MCCs. Incremental use, expenditures, and lost productivity were evaluated with multivariable regression. Results Survivors of cancer were more likely to have chronic conditions and MCCs compared with adults without a history of cancer. The presence of chronic conditions among survivors of cancer was associated with substantially higher annual medical expenditures, especially for heart disease ($4,595; 95% CI, $3,262 to $5,927) and stroke ($3,843; 95% CI, $1,983 to $5,704). The presence of four or more chronic conditions was associated with increased annual expenditures of $10,280 (95% CI, $7,435 to $13,125) per survivor of cancer. Annual lost productivity was higher among survivors of cancer with other chronic conditions, especially stroke ($4,325; 95% CI, $2,687 to $5,964), and arthritis ($3,534; 95% CI, $2,475 to $4,593). Having four or more chronic conditions was associated with increased annual lost productivity of $9,099 (95% CI, $7,224 to $10,973) per survivor of cancer. The economic impact of chronic conditions was similar among survivors of cancer and individuals without a history of cancer. Conclusion These results highlight the importance of ensuring access to lifelong personalized screening, surveillance, and chronic disease management to help manage chronic conditions, reduce disruptions in employment, and reduce medical expenditures among survivors of cancer. |
Population genetic structure, antibiotic resistance, capsule switching and evolution of invasive pneumococci before conjugate vaccination in Malawi.
Chaguza C , Cornick JE , Andam CP , Gladstone RA , Alaerts M , Musicha P , Peno C , Bar-Zeev N , Kamng'ona AW , Kiran AM , Msefula CL , McGee L , Breiman RF , Kadioglu A , French N , Heyderman RS , Hanage WP , Bentley SD , Everett DB . Vaccine 2017 35 4594-4602 INTRODUCTION: Pneumococcal infections cause a high death toll in Sub Saharan Africa (SSA) but the recently rolled out pneumococcal conjugate vaccines (PCV) will reduce the disease burden. To better understand the population impact of these vaccines, comprehensive analysis of large collections of pneumococcal isolates sampled prior to vaccination is required. Here we present a population genomic study of the invasive pneumococcal isolates sampled before the implementation of PCV13 in Malawi. MATERIALS AND METHODS: We retrospectively sampled and whole genome sequenced 585 invasive isolates from 2004 to 2010. We determine the pneumococcal population genetic structure and assessed serotype prevalence, antibiotic resistance rates, and the occurrence of serotype switching. RESULTS: Population structure analysis revealed 22 genetically distinct sequence clusters (SCs), which consisted of closely related isolates. Serotype 1 (ST217), a vaccine-associated serotype in clade SC2, showed highest prevalence (19.3%), and was associated with the highest MDR rate (81.9%) followed by serotype 12F, a non-vaccine serotype in clade SC10 with an MDR rate of 57.9%. Prevalence of serotypes was stable prior to vaccination although there was an increase in the PMEN19 clone, serotype 5 ST289, in clade SC1 in 2010 suggesting a potential undetected local outbreak. Coalescent analysis revealed recent emergence of the SCs and there was evidence of natural capsule switching in the absence of vaccine induced selection pressure. Furthermore, majority of the highly prevalent capsule-switched isolates were associated with acquisition of vaccine-targeted capsules. CONCLUSIONS: This study provides descriptions of capsule-switched serotypes and serotypes with potential to cause serotype replacement post-vaccination such as 12F. Continued surveillance is critical to monitor these serotypes and antibiotic resistance in order to design better infection prevention and control measures such as inclusion of emerging replacement serotypes in future conjugate vaccines. |
Progress toward measles elimination - Bangladesh, 2000-2016
Khanal S , Bohara R , Chacko S , Sharifuzzaman M , Shamsuzzaman M , Goodson JL , Dabbagh A , Kretsinger K , Dhongde D , Liyanage J , Bahl S , Thapa A . MMWR Morb Mortal Wkly Rep 2017 66 (28) 753-757 In 2013, at the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), a regional goal was established to eliminate measles and control rubella and congenital rubella syndrome* by 2020 (1). WHO-recommended measles elimination strategies in SEAR countries include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs)dagger; 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets targets for recommended performance indicators; and 3) developing and maintaining an accredited measles laboratory network (2). In 2014, Bangladesh, one of 11 countries in SEAR, adopted a national goal for measles elimination by 2018 (2,3). This report describes progress and challenges toward measles elimination in Bangladesh during 2000-2016. Estimated coverage with the first MCV dose (MCV1) increased from 74% in 2000 to 94% in 2016. The second MCV dose (MCV2) was introduced in 2012, and MCV2 coverage increased from 35% in 2013 to 93% in 2016. During 2000-2016, approximately 108.9 million children received MCV during three nationwide SIAs conducted in phases. During 2000-2016, reported confirmed measles incidence decreased 82%, from 34.2 to 6.1 per million population. However, in 2016, 56% of districts did not meet the surveillance performance target of ≥2 discarded nonmeasles, nonrubella cases section sign per 100,000 population. Additional measures that include increasing MCV1 and MCV2 coverage to ≥95% in all districts with additional strategies for hard-to-reach populations, increasing sensitivity of measles case-based surveillance, and ensuring timely transport of specimens to the national laboratory will help achieve measles elimination. |
Intussusception among children less than 2 years of age: Findings from pre-vaccine introduction surveillance in Pakistan
Yousafzai MT , Thobani R , Qazi SH , Saddal N , Yen C , Aliabadi N , Ali SA . Vaccine 2017 36 (51) 7775-7779 BACKGROUND: Rotavirus vaccination introduction in routine immunization is under consideration in Pakistan. Data on the baseline epidemiology of intussusception will inform surveillance strategies for intussusception after rotavirus vaccine introduction in Pakistan. We describe the epidemiology of intussusception-associated hospitalizations among children <2years of age in Karachi, Pakistan. METHODS: We conducted a retrospective chart review for July 01, 2012 through June 30, 2015 at the National Institute of Child Health (NICH) and Aga Khan University Hospital (AKUH) Karachi. At AKUH, the International Classification of Disease, ninth revision, code 560.0 for intussusception was used to retrieve intussusception case records. At NICH, daily Operation Theater, Emergency Room, and surgical daycare log sheets and surgical ward census sheets were used to identify cases. Records of children who fulfilled eligibility criteria and the Brighton Collaboration level one case definition of intussusception were selected for data analysis. We used structured case report forms to extract data for the descriptive analysis. RESULTS: We identified 158 cases of confirmed intussusception; 30 cases (19%) were from AKUH. More than half (53%) of the cases occurred in children aged 6-12months, followed by 35% among those aged <6months. Two-thirds (106/158) of the cases were male. The most common presenting complaints were vomiting and bloody stool. At NICH, almost all (93%) were managed surgically, while at AKUH, approximately 57% of the cases were managed with enemas. Three deaths occurred, all from NICH. Cases occurred without any seasonality. At NICH, 4% (128/3618) of surgical admissions among children aged <2years were attributed to intussusception, while that for AKUH was 2% (30/1702). CONCLUSION: In this chart review, intussusception predominantly affected children 0-6 months of age and occurred more commonly in males. This information on the baseline epidemiology of intussusception will inform post-vaccine introduction adverse event monitoring related to intussusception in Pakistan. |
Attitudes about vaccines to prevent Ebola virus disease in Guinea at the end of a large Ebola epidemic: Results of a national household survey
Irwin KL , Jalloh MF , Corker J , Alpha Mahmoud B , Robinson SJ , Li W , James NE , Sellu M , Jalloh MB , Diallo AA , Tracy L , Hajjeh R , VanSteelandt A , Bunnell R , Martel L , Raghunathan PL , Marston B . Vaccine 2017 35 6915-6923 INTRODUCTION: In 2014-2016, an Ebola epidemic devastated Guinea; more than 3800 cases and 2500 deaths were reported to the World Health Organization. In August 2015, as the epidemic waned and clinical trials of an experimental, Ebola vaccine continued in Guinea and neighboring Sierra Leone, we conducted a national household survey about Ebola-related knowledge, attitudes, and practices (KAP) and opinions about "hypothetical" Ebola vaccines. METHODS: Using cluster-randomized sampling, we selected participants aged 15+ years old in Guinea's 8 administrative regions, which had varied cumulative case counts. The questionnaire assessed socio-demographic characteristics, experiences during the epidemic, Ebola-related KAP, and Ebola vaccine attitudes. To assess the potential for Ebola vaccine introduction in Guinea, we examined the association between vaccine attitudes and participants' characteristics using categorical and multivariable analyses. RESULTS: Of 6699 persons invited to participate, 94% responded to at least 1 Ebola vaccine question. Most agreed that vaccines were needed to fight the epidemic (85.8%) and that their family would accept safe, effective Ebola vaccines if they became available in Guinea (84.2%). These measures of interest and acceptability were significantly more common among participants who were male, wealthier, more educated, and lived with young children who had received routine vaccines. Interest and acceptability were also significantly higher among participants who understood Ebola transmission modes, had witnessed Ebola response teams, knew Ebola-affected persons, believed Ebola was not always fatal, and would access Ebola treatment centers. In multivariable analyses of the majority of participants living with young children, interest and acceptability were significantly higher among those living with vaccinated children than among those living with unvaccinated children. DISCUSSION: The high acceptability of hypothetical vaccines indicates strong potential for introducing Ebola vaccines across Guinea. Strategies to build public confidence in use of Ebola vaccines should highlight any similarities with safe, effective vaccines routinely used in Guinea. |
Racial and ethnic differences in homicides of adult women and the role of intimate partner violence - United States, 2003-2014
Petrosky E , Blair JM , Betz CJ , Fowler KA , Jack SPD , Lyons BH . MMWR Morb Mortal Wkly Rep 2017 66 (28) 741-746 Homicide is one of the leading causes of death for women aged ≤44 years.* In 2015, homicide caused the death of 3,519 girls and women in the United States. Rates of female homicide vary by race/ethnicity (1), and nearly half of victims are killed by a current or former male intimate partner (2). To inform homicide and intimate partner violence (IPV) prevention efforts, CDC analyzed homicide data from the National Violent Death Reporting System (NVDRS) among 10,018 women aged ≥18 years in 18 states during 2003-2014. The frequency of homicide by race/ethnicity and precipitating circumstances of homicides associated with and without IPV were examined. Non-Hispanic black and American Indian/Alaska Native women experienced the highest rates of homicide (4.4 and 4.3 per 100,000 population, respectively). Over half of all homicides (55.3%) were IPV-related; 11.2% of victims of IPV-related homicide experienced some form of violence in the month preceding their deaths, and argument and jealousy were common precipitating circumstances. Targeted IPV prevention programs for populations at disproportionate risk and enhanced access to intervention services for persons experiencing IPV are needed to reduce homicides among women. |
Trends in teen driver licensure, driving patterns and crash involvement in the United States, 2006-2015
Shults RA , Williams AF . J Safety Res 2017 62 181-184 Introduction The Monitoring the Future (MTF) survey provides nationally-representative annual estimates of licensure and driving patterns among U.S. teens. A previous study using MTF data reported substantial declines in the proportion of high school seniors that were licensed to drive and increases in the proportion of nondrivers following the recent U.S. economic recession. Method To explore whether licensure and driving patterns among U.S. high school seniors have rebounded in the post-recession years, we analyzed MTF licensure and driving data for the decade of 20062015. We also examined trends in teen driver involvement in fatal and nonfatal injury crashes for that decade using data from the Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System, respectively. Results During 20062015, the proportion of high school seniors that reported having a driver's license declined by 9 percentage points (11%) from 81% to 72% and the proportion that did not drive during an average week increased by 8 percentage points (44%) from 18% to 26%. The annual proportion of black seniors that did not drive was consistently greater than twice the proportion of nondriving white seniors. Overall during the decade, 17- and 18-year-old drivers experienced large declines in fatal and nonfatal injury crashes, although crashes increased in both 2014 and 2015. Conclusions The MTF data indicate that licensure and driving patterns among U.S. high school seniors have not rebounded since the economic recession. The recession had marked negative effects on teen employment opportunities, which likely influenced teen driving patterns. Possible explanations for the apparent discrepancies between the MTF data and the 2014 and 2015 increases in crashes are explored. Practical applications MTF will continue to be an important resource for clarifying teen driving trends in relation to crash trends and informing strategies to improve teen driver safety. |
Transcriptomics in toxicology.
Joseph P . Food Chem Toxicol 2017 109 650-662 Xenobiotics, of which many are toxic, may enter the human body through multiple routes. Excessive human exposure to xenobiotics may exceed the body's capacity to defend against the xenobiotic-induced toxicity and result in potentially fatal adverse health effects. Prevention of the adverse health effects, potentially associated with human exposure to the xenobiotics, may be achieved by detecting the toxic effects at an early, reversible and, therefore, preventable stage. Additionally, an understanding of the molecular mechanisms underlying the toxicity may be helpful in preventing and/or managing the ensuing adverse health effects. Human exposures to a large number of xenobiotics are associated with hepatotoxicity or pulmonary toxicity. Global gene expression changes taking place in biological systems, in response to exposure to xenobiotics, may represent the early and mechanistically relevant cellular events contributing to the onset and progression of xenobiotic-induced adverse health outcomes. Hepatotoxicity and pulmonary toxicity resulting from exposure to xenobiotics are discussed as specific examples to demonstrate the potential application of transcriptomics or global gene expression analysis in the prevention of adverse health effects associated with exposure to xenobiotics. |
Quantitation of fentanyl analogs in dried blood spots by flow-through desorption coupled to online solid phase extraction tandem mass spectrometry
Shaner RL , Schulze ND , Seymour C , Hamelin EI , Thomas JD , Johnson RC . Anal Methods 2017 9 (25) 3876-3883 An automated dried blood spot (DBS) elution coupled with solid phase extraction and tandem mass spectrometric analysis for multiple fentanyl analogs was developed and assessed. This method confirms human exposures to fentanyl, sufentanil, carfentanil, alfentanil, lofentanil, α-methyl fentanyl, and 3-methyl fentanyl in blood with minimal sample volume and reduced shipping and storage costs. Seven fentanyl analogs were detected and quantitated from DBS made from venous blood. The calibration curve in matrix was linear in the concentration range of 1.0 ng mL-1 to 100 ng mL-1 with a correlation coefficient greater than 0.98 for all compounds. The limit of detection varied from 0.15 ng mL-1 to 0.66 ng mL-1 depending on target analyte. Analysis of the entire DBS minimized the effects of hematocrit on quantitation. All quality control materials evaluated resulted in <15% error; analytes with isotopically labeled internal standards had <15% RSD, while analytes without matching standards had 15-24% RSD. This method provides an automated means to detect seven fentanyl analogs, and quantitate four fentanyl analogs with the benefits of DBS at levels anticipated from an overdose of these potent opioids. © 2017 The Royal Society of Chemistry. |
Enterococcus crotali sp. nov., isolated from faecal material of a timber rattlesnake
McLaughlin RW , Shewmaker PL , Whitney AM , Humrighouse BW , Lauer AC , Loparev VN , Gulvik CA , Cochran PA , Dowd SE . Int J Syst Evol Microbiol 2017 67 (6) 1984-1989 A facultatively anaerobic, Gram-stain-positive bacterium, designated ETRF1T, was found in faecal material of a timber rattlesnake (Crotalus horridus). Based on a comparative 16S rRNA gene sequence analysis, the isolate was assigned to the genus Enterococcus. The 16S rRNA gene sequence of strain ETRF1T showed >97 % similarity to that of the type strains of Enterococcus rotai, E. caccae, E. silesiacus, E haemoperoxidus, E. ureasiticus, E. moraviensis, E. plantarum, E. quebecensis, E. ureilyticus, E. termitis, E. rivorum and E. faecalis. The organism could be distinguished from these 12 phylogenetically related enterococci using conventional biochemical testing, the Rapid ID32 Strep system, comparative pheS and rpoA gene sequence analysis, and comparative whole genome sequence analysis. The estimated in silico DNA-DNA hybridization values were <70 %, and average nucleotide identity values were <96 %, when compared to these 12 species, further validating that ETRF1T represents a unique species within the genus Enterococcus. On the basis of these analyses, strain ETRF1T (=CCUG 65857T=LMG 28312T) is proposed as the type strain of a novel species, Enterococcus crotali sp. nov. |
Characterizing reactivity to Onchocerca volvulus antigens in multiplex bead assays
Feeser KR , Cama V , Priest JW , Thiele EA , Wiegand RE , Lakwo T , Feleke SM , Cantey PT . Am J Trop Med Hyg 2017 97 (3) 666-672 Multiplex bead assays (MBAs) may provide a powerful integrated tool for monitoring, evaluation, and post-elimination surveillance of onchocerciasis and co-endemic diseases; however, the specificity and sensitivity of Onchocerca volvulus antigens have not been characterized within this context. An MBA was developed to evaluate three antigens (OV-16, OV-17, and OV-33) for onchocerciasis. Receiver operating characteristics (ROC) analyses were used to characterize antigen performance using a panel of 610 specimens: 109 O. volvulus-positive specimens, 426 non-onchocerciasis controls with filarial and other confirmed parasitic infection, and 75 sera from patients with no other parasitic infection. The IgG and IgG4 assays for OV-16 demonstrated sensitivities of 95.4% and 96.3%, and specificities of 99.4% and 99.8%, respectively. The OV-17 IgG and IgG4 assays had sensitivities of 86.2% and 76.1% and specificities of 79.2% and 82.8%. For OV-33, the IgG and IgG4 assays had sensitivities of 90.8% and 96.3%, and specificities of 96.8% and 98.6%. The OV-16 IgG4-based MBA had the best assay characteristics, followed by OV-33 IgG4. The OV-16 IgG4 assay would be useful for monitoring and evaluation using the MBA platform. Further evaluations are needed to review the potential use of OV-33 as a confirmatory test in the context of program evaluations. |
Variations in cause-of-death determination for sudden unexpected infant deaths
Shapiro-Mendoza CK , Parks SE , Brustrom J , Andrew T , Camperlengo L , Fudenberg J , Payn B , Rhoda D . Pediatrics 2017 140 (1) e20170087 OBJECTIVES: To quantify and describe variation in cause-of-death certification of sudden unexpected infant deaths (SUIDs) among US medical examiners and coroners. METHODS: From January to November 2014, we conducted a nationally representative survey of US medical examiners and coroners who certify infant deaths. Two-stage unequal probability sampling with replacement was used. Medical examiners and coroners were asked to classify SUIDs based on hypothetical scenarios and to describe the evidence considered and investigative procedures used for cause-of-death determination. Frequencies and weighted percentages were calculated. RESULTS: Of the 801 surveys mailed, 60% were returned, and 377 were deemed eligible and complete. Medical examiners and coroners classification of infant deaths varied by scenario. For 3 scenarios portraying potential airway obstruction and negative autopsy findings, 61% to 69% classified the death as suffocation/asphyxia. In the last scenario, which portrayed a healthy infant in a safe sleep environment with negative autopsy findings, medical examiners and coroners classified the death as sudden infant death syndrome (38%) and SUID (30%). Reliance on investigative procedures to determine cause varied, but 94% indicated using death scene investigations, 88% full autopsy, 85% toxicology analyses, and 82% medical history review. CONCLUSIONS: US medical examiners and coroners apply variable practices to classify and investigate SUID, and thus, they certify the same deaths differently. This variability influences surveillance and research, impacts true understanding of infant mortality causes, and inhibits our ability to accurately monitor and ultimately prevent future deaths. Findings may inform future strategies for promoting standardized practices for SUID classification. |
Maternal stressors and social support and risks of delivering babies with gastroschisis or hypospadias
Carmichael SL , Ma C , Tinker S , Shaw GM . Am J Epidemiol 2017 185 (12) 1-7 We examined the association of maternal stressful life events and social support with risks of gastroschisis and hypospadias, using data from the National Birth Defects Prevention Study, a population-based case-control study of US births taking place in 2006-2011. We examined maternal self-reports of 7 life events and 3 sources of social support during the periconceptional period among mothers of 593 gastroschisis cases, 1,142 male hypospadias cases, and 4,399 nonmalformed controls. Responses to the questions on stressful life events were summed to form an index (higher is worse), as were responses to questions on social support (higher is better). We used logistic regression to estimate adjusted odds ratios and 95% confidence intervals. The adjusted odds ratios for gastroschisis for a 4-point increase in the stress index were 3.5 (95% confidence interval (CI): 2.6, 4.8) among nonteenage mothers (age ≥20 years) and 1.0 (95% CI: 0.5, 1.7) among teenage mothers (age <20 years). The odds ratio for hypospadias (among all mothers) was 0.8 (95% CI: 0.7, 1.1). Adjusted odds ratios for a social support score of 3 (versus 0) in the 3 respective groups were 0.6 (95% CI: 0.4, 1.0), 1.0 (95% CI: 0.5, 2.3), and 0.6 (95% CI: 0.4, 0.9). Given the lack of prior research on these outcomes and stress, results should be interpreted with caution. |
A national profile of attention-deficit hyperactivity disorder diagnosis and treatment among US children aged 2 to 5 years
Danielson ML , Visser SN , Gleason MM , Peacock G , Claussen AH , Blumberg SJ . J Dev Behav Pediatr 2017 38 (7) 455-464 OBJECTIVE: Clinical guidelines provide recommendations for diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD), with specific guidance on caring for children younger than 6 years. This exploratory study describes ADHD diagnosis and treatment patterns among young children in the United States using 2 nationally representative parent surveys. METHODS: The National Survey of Children's Health (2007-2008, 2011-2012) was used to produce weighted prevalence estimates of current ADHD and ADHD medication treatment among US children aged 2 to 5 years. The National Survey of Children with Special Health Care Needs (2009-2010) provided additional estimates on types of medication treatment and receipt of behavioral treatment among young children with special health care needs (CSHCN) with ADHD. RESULTS: In 2011 to 2012, 1.5% of young children (approximately 237,000) had current ADHD compared to 1.0% in 2007 to 2008. In 2011 to 2012, 43.7% of young children with current ADHD were taking medication for ADHD (approximately 104,000). In young CSHCN with ADHD, central nervous system stimulants were the most common medication type used to treat ADHD, and 52.8% of young CSHCN with current ADHD had received behavioral treatment for ADHD in the past year. CONCLUSION: Nearly a quarter million In young CSHCN have current ADHD, with a prevalence that has increased by 57% from 2007 to 2008 to 2011 to 2012. The demographic patterns of diagnosis and treatment described in this study can serve as a benchmark to monitor service use patterns of young children diagnosed with ADHD over time. |
The effects of an integrated community case management strategy on the appropriate treatment of children and child mortality in Kono District, Sierra Leone: A program evaluation
Ratnayake R , Ratto J , Hardy C , Blanton C , Miller L , Choi M , Kpaleyea J , Momoh P , Barbera Y . Am J Trop Med Hyg 2017 97 (3) 964-973 Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month (P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] (P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district. |
Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda
Waiswa P , Manzi F , Mbaruku G , Rowe AK , Marx M , Tomson G , Marchant T , Willey BA , Schellenberg J , Peterson S , Hanson C . Implement Sci 2017 12 (1) 89 BACKGROUND: Quality improvement is a recommended strategy to improve implementation levels for evidence-based essential interventions, but experience of and evidence for its effects in low-resource settings are limited. We hypothesised that a systemic and collaborative quality improvement approach covering district, facility and community levels, supported by report cards generated through continuous household and health facility surveys, could improve the implementation levels and have a measurable population-level impact on coverage and quality of essential services. METHODS: Collaborative quality improvement teams tested self-identified strategies (change ideas) to support the implementation of essential maternal and newborn interventions recommended by the World Health Organization. In Tanzania and Uganda, we used a plausibility design to compare the changes over time in one intervention district with those in a comparison district in each country. Evaluation included indicators of process, coverage and implementation practice analysed with a difference-of-differences and a time-series approach, using data from independent continuous household and health facility surveys from 2011 to 2014. Primary outcomes for both countries were birth in health facilities, breastfeeding within 1 h after birth, oxytocin administration after birth and knowledge of danger signs for mothers and babies. Interpretation of the results considered contextual factors. RESULTS: The intervention was associated with improvements on one of four primary outcomes. We observed a 26-percentage-point increase (95% CI 25-28%) in the proportion of live births where mothers received uterotonics within 1 min after birth in the intervention compared to the comparison district in Tanzania and an 8-percentage-point increase (95% CI 6-9%) in Uganda. The other primary indicators showed no evidence of improvement. In Tanzania, we saw positive changes for two other outcomes reflecting locally identified improvement topics. The intervention was associated with an increase in preparation of clean birth kits for home deliveries (31 percentage points, 95% CI 2-60%) and an increase in health facility supervision by district staff (14 percentage points, 95% CI 0-28%). CONCLUSIONS: The systemic quality improvement approach was associated with improvements of only one of four primary outcomes, as well as two Tanzania-specific secondary outcomes. Reasons for the lack of effects included limited implementation strength as well a relatively short follow-up period in combination with a 1-year recall period for population-based estimates and a limited power of the study to detect changes smaller than 10 percentage points. TRIAL REGISTRATION: Pan African Clinical Trials Registry: PACTR201311000681314. |
A daily dose of 5 mg folic acid for 90 days is associated with increased serum unmetabolized folic acid and reduced natural killer cell cytotoxicity in healthy Brazilian adults
Paniz C , Bertinato JF , Lucena MR , De Carli E , Amorim Pmds , Gomes GW , Palchetti CZ , Figueiredo MS , Pfeiffer CM , Fazili Z , Green R , Guerra-Shinohara EM . J Nutr 2017 147 (9) 1677-1685 Background: The effects of high-dose folic acid (FA) supplementation in healthy individuals on blood folate concentrations and immune response are unknown.Objective: The aim of the study was to evaluate the effects of daily consumption of a tablet containing 5 mg FA on serum folate; number and cytotoxicity of natural killer (NK) cells; mRNA expression of dihydrofolate reductase (DHFR), methylenetetrahydrofolate reductase (MTHFR), interferon gamma (IFNG), tumor necrosis factor alpha (TNFA), and interleukin 8 (IL8) genes; and concentrations of serum inflammatory markers.Methods: This prospective clinical trial was conducted in 30 healthy Brazilian adults (15 women), aged 27.7 y (95% CI: 26.4, 29.1 y), with a body mass index (in kg/m2) of 23.1 (95% CI: 22.0, 24.3). Blood was collected at baseline and after 45 and 90 d of the intervention. Serum folate concentrations were measured by microbiological assay and HPLC-tandem mass spectrometry [folate forms, including unmetabolized folic acid (UMFA)]. We used real-time polymerase chain reaction to assess mononuclear leukocyte mRNA expression and flow cytometry to measure the number and cytotoxicity of NK cells.Results: Serum folate concentrations increased by approximately 5-fold after the intervention (P < 0.001), and UMFA concentrations increased by 11.9- and 5.9-fold at 45 and 90 d, respectively, when compared with baseline (P < 0.001). UMFA concentrations increased (>1.12 nmol/L) in 29 (96.6%) participants at day 45 and in 26 (86.7%) participants at day 90. We observed significant reductions in the number (P < 0.001) and cytotoxicity (P = 0.003) of NK cells after 45 and 90 d. Compared with baseline, DHFR mRNA expression was higher at 90 d (P = 0.006) and IL8 and TNFA mRNA expressions were higher at 45 and 90 d (P = 0.001 for both).Conclusion: This noncontrolled intervention showed that healthy adults responded to a high-dose FA supplement with increased UMFA concentrations, changes in cytokine mRNA expression, and reduced number and cytotoxicity of NK cells. This trial was registered at www.ensaiosclinicos.govbr as RBR-2pr7zp. |
Surveillance for silicosis deaths among persons aged 15-44 years - United States, 1999-2015
Mazurek JM , Wood JM , Schleiff PL , Weissman DN . MMWR Morb Mortal Wkly Rep 2017 66 (28) 747-752 Silicosis is usually a disease of long latency affecting mostly older workers; therefore, silicosis deaths in young adults (aged 15-44 years) suggests acute or accelerated disease. To understand the circumstances surrounding silicosis deaths among young persons, CDC analyzed the underlying and contributing causes of death using multiple cause-of-death data (1999-2015) and industry and occupation information abstracted from death certificates (1999-2013). During 1999-2015, among 55 pneumoconiosis deaths of young adults with International Classification of Diseases, Tenth Revision (ICD-10) code J62 (pneumoconiosis due to dust containing silica), section sign 38 (69%) had code J62.8 (pneumoconiosis due to other dust containing silica), and 17 (31%) had code J62.0 (pneumoconiosis due to talc dust) listed on their death certificate. Decedents whose cause of death code was J62.8 most frequently worked in the manufacturing and construction industries and production occupations where silica exposure is known to occur. Among the 17 decedents who had death certificates listing code J62.0 as cause of death, 13 had certificates with an underlying or a contributing cause of death code listed that indicated multiple drug use or drug overdose. In addition, 13 of the 17 death certificates listing code J62.0 as cause of death had information on decedent's industry and occupation; among the 13 decedents, none worked in talc exposure-associated jobs, suggesting that their talc exposure was nonoccupational. Examining detailed information on causes of death (including external causes) and industry and occupation of decedents is essential for identifying silicosis deaths associated with occupational exposures and reducing misclassification of silicosis mortality. |
Occupational health contributions to the development and promise of occupational health psychology
Sauter SL , Hurrell JJ . J Occup Health Psychol 2017 22 (3) 251-258 Occupational health psychology (OHP), as it is known today, is preceded by over a century of inquiry in psychology, sociology, philosophy, and other disciplines regarding the conditions of work and the welfare of workers, organizations, and society. This diverse body of research is richly detailed in reports on the history of OHP. Less represented in these reports are the formative interests of the occupational health field in OHP. In the present discussion, we begin by giving greater visibility to these interests. As we show, the expressions occupational health psychology and occupational health psychologist and a vision for training and participation of psychologists in occupational health research and practice appear in the occupational health literature four decades ago. We describe how this interest inspired initiatives in OHP by the National Institute for Occupational Safety and Health which, in turn, influenced the formalization of OHP as a discipline in the United States. We then document sustained interests of occupational health in OHP today and illustrate the promise of this interest for psychologists, for the discipline of OHP itself, and for the health, safety, and well-being of working people. We conclude by arguing that, to realize this promise, there is value to closer and more formal engagement of psychologists and OHP institutions with the field of occupational health. |
Evaluating the stability of a freestanding Mast Climbing Work Platform
Wimer B , Pan C , Lutz T , Hause M , Warren C , Dong R , Xu S . J Safety Res 2017 62 163-172 Mast Climbing Work Platforms (MCWPs) are becoming more common at construction sites and are being used as an alternative to traditional scaffolding. Although their use is increasing, little to no published information exists on the potential safety hazards they could pose for workers. As a last line of defense, a personal fall-arrest system can be used to save a worker in a fall incident from the platform. There has been no published information on whether it is safe to use such a personal fall-arrest system with MCWPs. In this study, the issues of concern for occupational safety included: (a) the overall stability of the freestanding mast climber during a fall-arrest condition and (b) whether that fall-arrest system could potentially present safety hazards to other workers on the platform during a fall-arrest condition. This research project investigated those safety concerns with respect to the mast climber stability and the workers using it by creating fall-arrest impact forces that are transmitted to the equipment and by subsequently observing the movement of the mast climber and the working deck used by the workers. This study found that when the equipment was erected and used according to the manufacturer's recommendations during a fall-arrest condition, destabilizing forces were very small and there were no signs of potential of MCWP collapse. However, potential fall hazards could be presented to other workers on the platform during a fall arrest. Workers near an open platform are advised to wear a personal fall-arrest system to reduce the risk of being ejected. Due to the increasing use of MCWPs at construction sites, there is a corresponding need for evidence and science-based safety guidelines or regulations and further research should be conducted to continue to fill the knowledge gap with MCWP equipment. © 2017 |
Health consequences of electric lighting practices in the modern world: A report on the National Toxicology Program's workshop on shift work at night, artificial light at night, and circadian disruption
Lunn RM , Blask DE , Coogan AN , Figueiro MG , Gorman MR , Hall JE , Hansen J , Nelson RJ , Panda S , Smolensky MH , Stevens RG , Turek FW , Vermeulen R , Carreon T , Caruso CC , Lawson CC , Thayer KA , Twery MJ , Ewens AD , Garner SC , Schwingl PJ , Boyd WA . Sci Total Environ 2017 607-608 1073-1084 The invention of electric light has facilitated a society in which people work, sleep, eat, and play at all hours of the 24-hour day. Although electric light clearly has benefited humankind, exposures to electric light, especially light at night (LAN), may disrupt sleep and biological processes controlled by endogenous circadian clocks, potentially resulting in adverse health outcomes. Many of the studies evaluating adverse health effects have been conducted among night- and rotating-shift workers, because this scenario gives rise to significant exposure to LAN. Because of the complexity of this topic, the National Toxicology Program convened an expert panel at a public workshop entitled "Shift Work at Night, Artificial Light at Night, and Circadian Disruption" to obtain input on conducting literature-based health hazard assessments and to identify data gaps and research needs. The Panel suggested describing light both as a direct effector of endogenous circadian clocks and rhythms and as an enabler of additional activities or behaviors that may lead to circadian disruption, such as night-shift work and atypical and inconsistent sleep-wake patterns that can lead to social jet lag. Future studies should more comprehensively characterize and measure the relevant light-related exposures and link these exposures to both time-independent biomarkers of circadian disruption and biomarkers of adverse health outcomes. This information should lead to improvements in human epidemiological and animal or in vitro models, more rigorous health hazard assessments, and intervention strategies to minimize the occurrence of adverse health outcomes due to these exposures. |
Quick fixes to improve workers' health: Results using engineering assessment technology
Haas EJ , Cecala AB . Min Eng 2017 69 (7) 105-109 Personal respirable dust sampling and the evaluation of control technologies have been providing exposure information to the mining industry but not necessarily in a way that shows how technology can be integrated to provide organizational support and resources for workers to mitigate dust sources on site. In response, the U.S. National Institute for Occupational Safety and Health (NIOSH) used previously developed Helmet-CAM technology to design and engage in a behavioral/engineering cooperative intervention to initiate and enhance mine site conversations about the risks and potential occurrences of respirable silica dust exposures on the job as well as provide impetus and solutions for mitigating higher sources of dust. The study involved 48 workers from five mine sites, who agreed to participate between April 2015 and September 2016. Using the Helmet-CAM in this series of longitudinal interventions revealed several exposure trends in respirable silica dust sources and, in many cases, simple quick-fix strategies to reduce their sources. This paper focuses on several specific identified sources of dust that were elevated but could be reduced through basic engineering fixes, low-cost resources, and supportive communication from management to remind and engage workers in protective work practices. |
Recurrence of Guinea worm disease in Chad after a 10-year absence: Risk factors for human cases identified in 2010-2011
Sreenivasan N , Weiss A , Djiatsa JP , Toe F , Djimadoumaji N , Ayers T , Eberhard M , Ruiz-Tiben E , Roy S . Am J Trop Med Hyg 2017 97 (2) 575-582 A decade after reporting its last case of Guinea worm disease (GWD), a waterborne parasitic disease targeted for eradication, Chad reported 20 confirmed human cases from 17 villages-10 cases in 2010 and 10 cases in 2011. In 2012, the first GWD dog infections were diagnosed. We conducted a case-control study during April-May 2012 to identify human transmission risk factors and epidemiologic links. We recruited 19 cases and 45 controls matched by age, sex, time, and location of exposure based on the case patients' periods of infection 10-14 months earlier. Data were analyzed with simple conditional logistic regression models using Firth penalized likelihood methods. Unusually, GWD did not appear to be associated with household primary water sources. Instead, secondary water sources, used outside the village or other nonprimary sources used at home, were risk factors (matched odds ratio = 38.1, 95% confidence interval = 1.6-728.2). This study highlights the changing epidemiology of GWD in Chad-household primary water sources were not identified as risk factors and few epidemiologic links were identified between the handfuls of sporadic cases per year, a trend that continues. Since this investigation, annual dog infections have increased, far surpassing human cases. An aquatic paratenic host is a postulated mode of transmission for both dogs and humans, although fish could not be assessed in this case-control study due to their near-universal consumption. GWD's evolving nature in Chad underscores the continued need for interventions to prevent both waterborne and potential foodborne transmission until the true mechanism is established. |
Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
Ndam NT , Mbuba E , Gonzalez R , Cistero P , Kariuki S , Sevene E , Ruperez M , Fonseca AM , Vala A , Maculuve S , Jimenez A , Quinto L , Ouma P , Ramharter M , Aponte JJ , Nhacolo A , Massougbodji A , Briand V , Kremsner PG , Mombo-Ngoma G , Desai M , Macete E , Cot M , Menendez C , Mayor A . BMC Med 2017 15 (1) 130 BACKGROUND: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. METHODS: P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. RESULTS: P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (-1.17 g/dL, 95% CI -2.09 to -0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (-1.66 g/dL, 95% CI -2.68 to -0.64) and Gabonese (-0.91 g/dL, 95% CI -1.79 to -0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (-0.16 g/dL, 95% CI -0.29 to -0.02) and increases in the drop of haemoglobin levels (-0.29 g/dL, 95% CI -0.44 to -0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). CONCLUSIONS: The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00811421 . Registered 18 December 2008. |
Serologic monitoring of public health interventions against Strongyloides stercoralis
Vargas P , Krolewiecki AJ , Echazu A , Juarez M , Cajal P , Gil JF , Caro N , Nasser J , Lammie P , Cimino RO . Am J Trop Med Hyg 2017 97 (1) 166-172 Northwestern Argentina is endemic for soil-transmitted helminths, and annual deworming programs are carried out in prioritized areas. High prevalence of Strongyloides stercoralis was reported in this area; therefore, control programs including ivermectin are being evaluated. The NIE-enzyme linked immunosorbent assay (ELISA) was used for this purpose. In this community trial, two groups of patients, classified according to housing and living conditions were evaluated. Simultaneous with baseline survey, Group 1 was moved to new households with access to improved water and sanitation facilities (W and S), where deworming (MDA, massive drug administration) took place within 1 month; whereas Group 2 received MDA but remained living with unimproved W and S. The mean time interval between baseline and the follow-up was 331 days for Group 1 and 508 for Group 2. Anti-NIE levels were measured for each individual before and after interventions and follow-up optical density (OD) ratios were calculated to quantify the variation. A significant decrease of the anti-NIE levels between baseline and follow-up was observed in both groups. Nonetheless, the number of patients that achieved the cure criteria (OD ratio < 0.6) was higher in Group 1 than Group 2 with values of 72.7% (24/33) and 45.0% (18/40), respectively (P = 0.0197). Our results support the conclusion that a combined intervention including deworming and improvements in life conditions is more effective, in terms of the proportion of subjects cured than deworming alone. Furthermore, we found that NIE-ELISA is a useful test for assessing the response to treatment and to evaluate the outcome of control intervention programs. |
Malaria-related hospitalizations in the United States, 2000-2014
Khuu D , Eberhard ML , Bristow BN , Javanbakht M , Ash LR , Shafir SC , Sorvillo FJ . Am J Trop Med Hyg 2017 97 (1) 213-221 Few data are available on the burden of malaria hospitalization in the United States. Study of malaria using hospital-based data can better define the impact of malaria and help inform prevention efforts. U.S. malaria cases identified from hospitalization discharge records in the 2000-2014 Nationwide Inpatient Sample were examined. Frequencies and population rates were reported by demographics, infecting species, clinical, financial, institutional, geographic, and seasonal characteristics, and disparities were identified. Time trends in malaria cases were assessed using negative binomial regression. From 2000 to 2014, there were an estimated 22,029 malaria-related hospitalizations (4.88 per 1 million population) in the United States, including 182 in-hospital deaths and 4,823 severe malaria cases. The rate of malaria-related hospitalizations did not change significantly over the study period. The largest number of malaria-related hospitalizations occurred in August. Malaria-related hospitalizations occurred disproportionately among patients who were male, black, or 25-44 years of age. Plasmodium falciparum accounted for the majority of malaria-related hospitalizations. On average, malaria patients were hospitalized for 4.36 days with charges of $25,789. Patients with a malaria diagnosis were more often hospitalized in the Middle Atlantic and South Atlantic census divisions, urban teaching, private not-for-profit, and large-bed-size hospitals. Malaria imposes a substantial disease burden in the United States. Enhanced primary and secondary prevention measures, including strategies to increase the use of pretravel consultations and prompt diagnosis and treatment are needed. |
Estimating the added utility of highly sensitive histidine-rich protein 2 detection in outpatient clinics in Sub-Saharan Africa
Plucinski MM , Rogier E , Dimbu PR , Fortes F , Halsey ES , Aidoo M . Am J Trop Med Hyg 2017 97 (4) 1159-1162 Most malaria testing is by rapid diagnostic tests (RDTs) that detect Plasmodium falciparum histidine-rich protein 2 (HRP2). Recently, several RDT manufacturers have developed highly sensitive RDTs (hsRDTs), promising a limit of detection (LOD) orders of magnitude lower than conventional RDTs. To model the added utility of hsRDTs, HRP2 concentration in Angolan outpatients was measured quantitatively using an ultrasensitive bead-based assay. The distribution of HRP2 concentration was bimodal in both afebrile and febrile patients. The conventional RDT was able to detect 81% of all HRP2-positive febrile patients and 52-77% of HRP2-positive afebrile patients. The added utility of hsRDTs was estimated to be greater in afebrile patients, where an hsRDT with a LOD of 200 pg/mL would detect an additional 50-60% of HRP2-positive persons compared with a conventional RDT with a LOD of 3,000 pg/mL. In febrile patients, the hsRDT would detect an additional 10-20% of cases. Conventional RDTs already capture the vast majority of symptomatic HRP2-positive individuals, and hsRDTs would have to reach a sufficiently low LOD approaching 200 pg/mL to provide added utility in identifying HRP2-positive, asymptomatic individuals. |
Evaluation of onchocerciasis transmission in Tanzania: Preliminary rapid field results in the Tukuyu Focus, 2015
Paulin HN , Nshala A , Kalinga A , Mwingira U , Wiegand R , Cama V , Cantey PT . Am J Trop Med Hyg 2017 97 (3) 673-676 To compare diagnostic tests for onchocerciasis in a setting that has suppressed transmission, a randomized, age-stratified study was implemented in an area in Tanzania that had received 15 rounds of annual mass drug administration (MDA) with ivermectin. Study participants (N = 948) from 11 villages underwent a questionnaire, skin examination, skin snips, and blood draw. The burden of symptomatic disease was low. Ov-16 antibody rapid diagnostic test (RDT) results were positive in 38 (5.5%) participants, with 1 (0.5%), 1 (0.4%), and 2 (0.8%) in children aged 0-5, 6-10, and 11-15 years, respectively. Despite significant impact of MDA on transmission, the area would have failed to meet World Health Organization serologic criteria for stopping MDA if a full evaluation had been conducted. The specificity of the RDT, which is 97-98%, may result in the identification of a number of false positives that would exceed the current stop MDA threshold. |
A comparison of Kenyan Biomphalaria pfeifferi and B. sudanica as vectors for Schistosoma mansoni, including a discussion of the need to better understand the effects of snail breeding systems on transmission
Mutuku M , Lu L , Otiato F , Mwangi IN , Kinuthia JM , Maina GM , Laidemitt MR , Lelo EA , Ochanda H , Loker ES , Mkoji GM . J Parasitol 2017 103 (6) 669-676 In Kenya, schistosomes infect an estimated 6 million people with >30 million people at risk of infection. We compared compatibility with, and ability to support and perpetuate, Schistosoma mansoni of Biomphalaria pfeifferi and Biomphalaria sudanica, 2 prominent freshwater snail species involved in schistosomiasis transmission in Kenya. Field-derived B. pfeifferi (from a stream in Mwea, central Kenya) and B. sudanica (from Nawa, Lake Victoria, in western Kenya) were exposed to S. mansoni miracidia isolated from fecal samples of naturally infected humans from Mwea or Nawa. Juvenile (<6 mm shell diameter), young adult (6-9 mm), and adult snails (>9 mm) were each exposed to a single miracidium. Schistosoma mansoni developed faster and consistently had higher infection rates (39.6-80.7%) in B. pfeifferi than in B. sudanica (2.4-21.5%), regardless of the source of S. mansoni or the size of the snails used. Schistosoma mansoni from Nawa produced higher infection rates in both B. pfeifferi and B. sudanica than did S. mansoni from Mwea. Mean daily cercariae production was greater for B. pfeifferi exposed to sympatric than allopatric S. mansoni (583-1,686 vs. 392-1,232), and mean daily cercariae production amongst B. sudanica were consistently low (50-590) with no significant differences between sympatric or allopatric combinations. Both non-miracidia exposed and miracidia-exposed B. pfeifferi had higher mortality rates than for B. sudanica, but mean survival time of shedding snails (9.3-13.7 weeks) did not differ significantly between the 2 snail species. A small proportion (1.5%) of the cercariae shedding B. pfeifferi survived up to 40 wk post-exposure. Biomphalaria pfeifferi was more likely to become infected and to shed more cercariae than B. sudanica, suggesting that the risk per individual snail of perpetuating transmission in Kenyan streams or lacustrine habitats may differ considerably. High infections rates exhibited by the preferential self-fertilizing B. pfeifferi relative to the out-crossing B. sudanica point out to the need to investigate further the role of host breeding systems in influencing transmission of schistosomiasis by snail hosts. |
State health agency and local health department workforce: Identifying top development needs
Beck AJ , Leider JP , Coronado F , Harper E . Am J Public Health 2017 107 (9) e1-e7 OBJECTIVES: To identify occupations with high-priority workforce development needs at public health departments in the United States. METHODS: We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed. RESULTS: Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees. CONCLUSIONS: Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates. (Am J Public Health. Published online ahead of print July 20, 2017: e1-e7. doi:10.2105/AJPH.2017.303875). |
Prostate specific antigen concentration in vaginal fluid after exposure to semen
Kulczycki A , Brill I , Snead MC , Macaluso M . Contraception 2017 OBJECTIVE: Prostate-specific antigen (PSA) is the best established biomarker of semen exposure. PSA in vaginal fluid returns to pre-exposure concentrations within 24-48 h, but the speed of decay during the first ten hours is unknown. We sought to determine how fast PSA concentrations decline during the first ten hours after exposure to semen. STUDY DESIGN: Women in the 50 enrolled couples were intravaginally inoculated with 10, 20, 100, and 200mul of their partner's semen and then collected vaginal swabs immediately after, 30min, 4 and 10h after exposure. Forty-seven sets of samples were tested for PSA. Mixed linear models for repeated measures examined the association between log-transformed PSA values and sampling time and semen exposure volume. Sensitivity analyses excluded data from non-abstainers. Fixed effect estimates from the statistical models were graphed. RESULTS: PSA values were highest at 200mul inoculation volumes and at earlier post-exposure timepoints, then decline steadily. The lowest inoculation volume (10mul) corresponded to the smallest concentration of PSA throughout the post-inoculation timepoints. Average PSA levels return to clinically non-detectable levels within 10h only at the lowest semen exposures. The PSA decay curve assumes a very similar profile across all timepoints and semen amounts. CONCLUSIONS: The PSA decay curve is similar for varying semen exposure volumes, with average PSA concentrations remaining above clinical thresholds 10h after exposure at all except the very smallest semen exposure levels. PSA is an objective marker of recent exposure to semen, permitting such detection with high accuracy. IMPLICATIONS: This study clarifies how PSA values vary at different semen exposure levels and timepoints during the first 10h post-exposure. Future contraceptive studies that use PSA as a semen biomarker will be better informed about PSA concentrations at different sampling times and exposure amounts. |
Health and economic burden of preeclampsia: no time for complacency
Li R , Tsigas EZ , Callaghan WM . Am J Obstet Gynecol 2017 217 (3) 235-236 Preeclampsia is a common and severe pregnancy complication and a leading cause of maternal and infant illness and death.1–3 The incidence of preeclampsia increased in the United States during the past 3 decades,4,5 and substantial evidence suggests that a history of preeclampsia is a significant risk factor for heart disease in the future years following pregnancy.6 In addition to adverse health consequences, preeclampsia is costly because of the medical services needed to treat pregnant and postpartum women and their infants, who are often born preterm.1,7 | In this issue, Stevens et al8 documented the short-term medical costs associated with preeclampsia. The authors combined state hospital discharge data with birth certificate data, commercial insurance claims data, and nationally representative Healthcare Cost and Utilization Project (HCUP) data to derive nationally representative estimates of the additional cost of medical treatment for women with preeclampsia and their newborns vs women without preeclampsia. This aggregated incremental cost was found to be $2.18 billion to the US health care system, including $1.03 billion in maternal health care costs and $1.15 billion for infants born to mothers with preeclampsia (in 2012 US dollars), which is about one third of the total $6.4 billion short-term estimated health care costs for preeclampsia pregnancies. This study is the first to quantify the medical costs associated with preeclampsia in the United States up to 1-year postdelivery. Previous studies estimated only the cost of hypertension during pregnancy in a Medicaid population in a single state,9 the per-person cost associated with pregnancies complicated by hypertension,10 or the cost of prematurity, regardless of the cause.7 |
Health-related quality of life for women ever experiencing infertility or difficulty staying pregnant
Boulet SL , Smith RA , Crawford S , Kissin DM , Warner L . Matern Child Health J 2017 21 (10) 1918-1926 INTRODUCTION: Information on the health-related quality of life (HRQOL) for women with infertility is limited and does not account for the co-occurrence of chronic conditions or emotional distress. METHODS: We used data from state-added questions on reproductive health included in the 2013 Behavioral Risk Factor Surveillance System in seven states. HRQOL indicators included: self-reported health status; number of days in the past 30 days when physical and mental health was not good; number of days in the past 30 days that poor physical or mental health limited activities. We computed rate ratios for HRQOL for women ever experiencing infertility or difficulty staying pregnant compared with women never reporting these conditions; interactions with chronic conditions and depressive disorders were assessed. RESULTS: Of 7,526 respondents aged 18-50 years, 387 (4.9%) reported infertility only and 339 (4.3%) reported difficulty staying pregnant only. Infertility was associated with an increase in average number of days with poor physical health for women with chronic conditions [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.04-3.29] but was protective for women without chronic conditions (RR 0.47, 95% CI 0.29-0.75). Difficulty staying pregnant was associated with an increase in average number of days of limited activity among both women with chronic conditions (RR 2.14, 95% CI 1.32-3.45) and women with depressive disorders (RR 1.72 95% CI 1.14-2.62). DISCUSSION: Many HRQOL measures were poorer for women who had infertility or difficulty staying pregnant compared to their counterparts; the association was modified by presence of chronic conditions and depressive disorders. |
Analysis of dependently truncated data in Cox framework
Liu Y , Li J , Zhang X . Commun Stat Simul Comput 2017 2017 (6) 1-19 Truncation is a known feature of bone marrow transplant (BMT) registry data, for which the survival time of a leukemia patient is left truncated by the waiting time to transplant. It was recently noted that a longer waiting time was linked to poorer survival. A straightforward solution is a Cox model on the survival time with the waiting time as both truncation variable and covariate. The Cox model should also include other recognized risk factors as covariates. In this paper we focus on estimating the distribution function of waiting time and the probability of selection under the aforementioned Cox model. |
The relationship between acculturation, ecodevelopment, and substance use among Hispanic adolescents
Martinez MJ , Huang S , Estrada Y , Sutton MY , Prado G . J Early Adolesc 2017 37 (7) 948-974 Using structural equation modeling, we examined the relationship of Hispanicism on recent substance use and whether Americanism moderated the effect in a sample of 1,141 Hispanic adolescents. The Bicultural Involvement Questionnaire (BIQ) was used to determine the degree of individual comfort in both Hispanic (Hispanicism) and American (Americanism) cultures. Hispanicism was associated with greater family functioning (beta =.36, p <.05) and school bonding (beta =.31, p <.01); Americanism moderated the effect of Hispanicism on substance use (beta =.92, p <.01). Findings suggest that Hispanic culture was protective against substance use; however, those effects differed depending on level of Americanism. |
Diversity and phylogenetic relationships among Bartonella strains from Thai bats.
McKee CD , Kosoy MY , Bai Y , Osikowicz LM , Franka R , Gilbert AT , Boonmar S , Rupprecht CE , Peruski LF . PLoS One 2017 12 (7) e0181696 Bartonellae are phylogenetically diverse, intracellular bacteria commonly found in mammals. Previous studies have demonstrated that bats have a high prevalence and diversity of Bartonella infections globally. Isolates (n = 42) were obtained from five bat species in four provinces of Thailand and analyzed using sequences of the citrate synthase gene (gltA). Sequences clustered into seven distinct genogroups; four of these genogroups displayed similarity with Bartonella spp. sequences from other bats in Southeast Asia, Africa, and Eastern Europe. Thirty of the isolates representing these seven genogroups were further characterized by sequencing four additional loci (ftsZ, nuoG, rpoB, and ITS) to clarify their evolutionary relationships with other Bartonella species and to assess patterns of diversity among strains. Among the seven genogroups, there were differences in the number of sequence variants, ranging from 1-5, and the amount of nucleotide divergence, ranging from 0.035-3.9%. Overall, these seven genogroups meet the criteria for distinction as novel Bartonella species, with sequence divergence among genogroups ranging from 6.4-15.8%. Evidence of intra- and intercontinental phylogenetic relationships and instances of homologous recombination among Bartonella genogroups in related bat species were found in Thai bats. |
Rocky Mountain spotted fever and pregnancy: Four cases from Sonora, Mexico
Licona-Enriquez JD , Delgado-de la Mora J , Paddock CD , Ramirez-Rodriguez CA , Candia-Plata MDC , Hernandez GA . Am J Trop Med Hyg 2017 97 (3) 795-798 We present a series of four pregnant women with Rocky Mountain spotted fever (RMSF) that occurred in Sonora, Mexico, during 2015-2016. Confirmatory diagnoses were made by polymerase chain reaction or serological reactivity to antigens of Rickettsia rickettsii by using an indirect immunofluorescence antibody assay. Each patient presented with fever and petechial rash and was treated successfully with doxycycline. Each of the women and one full-term infant delivered at 36 weeks gestation survived the infection. Three of the patients in their first trimester of pregnancy suffered spontaneous abortions. RMSF should be suspected in any pregnant woman presenting with fever, malaise and rash in regions where R. rickettsii is endemic. |
Temperature modulates dengue virus epidemic growth rates through its effects on reproduction numbers and generation intervals
Siraj AS , Oidtman RJ , Huber JH , Kraemer MUG , Brady OJ , Johansson MA , Perkins TA . PLoS Negl Trop Dis 2017 11 (7) e0005797 Epidemic growth rate, r, provides a more complete description of the potential for epidemics than the more commonly studied basic reproduction number, R0, yet the former has never been described as a function of temperature for dengue virus or other pathogens with temperature-sensitive transmission. The need to understand the drivers of epidemics of these pathogens is acute, with arthropod-borne virus epidemics becoming increasingly problematic. We addressed this need by developing temperature-dependent descriptions of the two components of r-R0 and the generation interval-to obtain a temperature-dependent description of r. Our results show that the generation interval is highly sensitive to temperature, decreasing twofold between 25 and 35 degrees C and suggesting that dengue virus epidemics may accelerate as temperatures increase, not only because of more infections per generation but also because of faster generations. Under the empirical temperature relationships that we considered, we found that r peaked at a temperature threshold that was robust to uncertainty in model parameters that do not depend on temperature. Although the precise value of this temperature threshold could be refined following future studies of empirical temperature relationships, the framework we present for identifying such temperature thresholds offers a new way to classify regions in which dengue virus epidemic intensity could either increase or decrease under future climate change. |
Ecology of filoviruses
Amman BR , Swanepoel R , Nichol ST , Towner JS . Curr Top Microbiol Immunol 2017 411 23-61 Filoviruses can cause severe and often fatal disease in humans. To date, there have been 47 outbreaks resulting in more than 31,500 cases of human illness and over 13,200 reported deaths. Since their discovery, researchers from many scientific disciplines have worked to better understand the natural history of these deadly viruses. Citing original research wherever possible, this chapter reviews laboratory and field-based studies on filovirus ecology and summarizes efforts to identify where filoviruses persist in nature, how virus is transmitted to other animals and ultimately, what drivers cause spillover to human beings. Furthermore, this chapter discusses concepts on what constitutes a reservoir host and highlights challenges encountered while conducting research on filovirus ecology, particularly field-based investigations. |
Evaluation of a spotted fever group Rickettsia public health surveillance system in Tennessee
Fill MA , Moncayo AC , Bloch KC , Dunn JR , Schaffner W , Jones TF . Am J Trop Med Hyg 2017 97 (3) 789-794 Spotted fever group (SFG) rickettsioses are endemic in Tennessee, with approximately 2,500 cases reported during 2000-2012. Because of this substantial burden of disease, we performed a three-part evaluation of Tennessee's routine surveillance for SFG rickettsioses cases and deaths to assess the system's effectiveness. Tennessee Department of Health (TDH) SFG rickettsioses surveillance records were matched to three patient series: 1) patients with positive serologic specimens from a commercial reference laboratory during 2010-2011, 2) tertiary medical center patients with positive serologic tests during 2007-2013, and 3) patients identified from death certificates issued during 1995-2014 with SFG rickettsiosis-related causes of death. Chart reviews were performed and patients were classified according to the Council of State and Territorial Epidemiologists' case definition. Of 254 SFG Rickettsia-positive serologic specimens from the reference laboratory, 129 (51%) met the case definition for confirmed or probable cases of rickettsial disease after chart review. The sensitivity of the TDH surveillance system to detect cases was 45%. Of the 98 confirmed or probable cases identified from the medical center, the sensitivity of the TDH surveillance system to detect cases was 34%. Of 27 patients identified by death certificates, 12 (44%) were classified as confirmed or probable cases; four (33%) were reported to TDH, but none were correctly identified as deceased. Cases of SFG rickettsioses were underreported and fatalities not correctly identified. Efforts are needed to improve SFG rickettsiosis surveillance in Tennessee. |
The eyes as a window to improved understanding of the prenatal effects of Zika virus infection
Prakalapakorn SG , Meaney-Delman D , Honein MA , Rasmussen SA . J AAPOS 2017 21 (4) 259-261 Much has been learned about Zika virus (ZIKV) | since the World Health Organization first reported | mosquito-borne transmission of ZIKV | in the Americas in Brazil in May of 2015.1 Historically, | ZIKV has been known to be transmitted by an arthropod | vector, but recently additional modes of transmission | have been identified, including sexual, intrauterine, and | perinatal.2 And although most people with ZIKV infection | are asymptomatic or only mildly affected, ZIKV has | recently been recognized to be associated with Guillain- | Barre syndrome, with about 1 in 4,000 persons infected | with ZIKV later developing the neurologic disorder.2 Of | most critical significance, a causal relationship between | prenatal ZIKV infection and serious brain anomalies and | microcephaly has recently been identified.3 A distinctive | constellation of anomalies has emerged and has been | defined as congenital Zika syndrome (CZS).4 |
Fatal Leptospira spp./Zika virus coinfection - Puerto Rico, 2016
Neaterour P , Rivera A , Galloway RL , Negron MG , Rivera-Garcia B , Sharp TM . Am J Trop Med Hyg 2017 97 (4) 1085-1087 Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of Leptospira spp./Zika virus (ZIKV) coinfection in Puerto Rico. The patient presented with a 5-day history of AFI; reported behavioral risk factors for leptospirosis; was diagnosed with possible leptospirosis, dengue, chikungunya, or ZIKV disease; and received appropriate treatment of leptospirosis and dengue. Following a 3-day hospitalization, the patient died due to acute gastrointestinal hemorrhage, and kidney and liver failure. Serologic diagnostic testing for leptospirosis and ZIKV disease was both negative; however, molecular diagnostic testing performed postmortem was positive for detection of Leptospira spp. and ZIKV nucleic acid. This case demonstrates the need for continued clinical awareness of leptospirosis in areas experiencing outbreaks of pathogens that cause AFI and the need for evaluation of coinfection with AFI-causing pathogens as a risk factor for increased severity of disease. |
Human cases of tularemia in Armenia, 1996-2012
Melikjanyan S , Palayan K , Vanyan A , Avetisyan L , Bakunts N , Kotanyan M , Guerra M . Am J Trop Med Hyg 2017 97 (3) 819-825 A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic of Armenia from 1996 to 2012 utilizing Geographic Information System software. A total of 266 human cases of tularemia were recorded in Armenia from 1996 to 2012, with yearly incidence ranging from 0 to 5.5 cases per 100,000 people. Cases predominantly affected the male population (62.8%), 11-20 year age group (37.2%), agricultural workers (49.6%), and persons residing in rural areas (93.6%). In 2003, a waterborne outbreak involving 158 cases occurred in Kotayk Marz, and in 2007, a foodborne outbreak with 17 cases occurred in Gegharkunik Marz, attributed to exposure of food products to contaminated hay. Geospatial analysis of all cases showed that the majority were associated with the steppe vegetation zone, elevations between 1,400 and 2,300 m, and the climate zone associated with dry, warm summers, and cold winters. Characterization of these environmental factors were used to develop a predictive risk model to improve surveillance and outbreak response for tularemia in Armenia. |
Cat scratch disease: U.S. clinicians' experience and knowledge
Nelson CA , Moore AR , Perea AE , Mead PS . Zoonoses Public Health 2017 65 (1) 67-73 Cat scratch disease (CSD) is a zoonotic infection caused primarily by the bacterium Bartonella henselae. An estimated 12,000 outpatients and 500 inpatients are diagnosed with CSD annually, yet little is known regarding clinician experience with and treatment of CSD in the United States. Questions assessing clinical burden, treatment and prevention of CSD were posed to 3,011 primary care providers (family practitioners, internists, paediatricians and nurse practitioners) during 2014-2015 as part of the annual nationwide DocStyles survey. Among the clinicians surveyed, 37.2% indicated that they had diagnosed at least one patient with CSD in the prior year. Clinicians in the Pacific and Southern regions were more likely to have diagnosed CSD, as were clinicians who saw paediatric patients, regardless of specialty. When presented with a question regarding treatment of uncomplicated CSD, only 12.5% of clinicians chose the recommended treatment option of analgesics and monitoring, while 71.4% selected antibiotics and 13.4% selected lymph node aspiration. In a scenario concerning CSD prevention in immunosuppressed patients, 80.6% of clinicians chose some form of precaution, but less than one-third chose the recommended option of counseling patients to treat their cats for fleas and avoid rough play with their cats. Results from this study indicate that a substantial proportion of U.S. clinicians have diagnosed CSD within the past year. Although published guidelines exist for treatment and prevention of CSD, these findings suggest that knowledge gaps remain. Therefore, targeted educational efforts about CSD may benefit primary care providers. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Health Economics
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Public Health Leadership and Management
- Reproductive Health
- Statistics as Topic
- Substance Use and Abuse
- Zoonotic and Vectorborne Diseases
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure