Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010
Kit BK , Carroll MD , Lacher DA , Sorlie PD , DeJesus JM , Ogden C . JAMA 2012 308 (6) 591-600 CONTEXT: For more than 20 years, primary prevention of coronary heart disease has included strategies intended to improve overall serum lipid concentrations among youths. OBJECTIVE: To examine trends in lipid concentrations among youths from 1988-1994 through 2007-2010. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of serum lipid concentrations among 16,116 youths aged 6 to 19 years who participated in the nationally representative National Health and Nutrition Examination Survey during 3 time periods: 1988-1994, 1999-2002, and 2007-2010. MAIN OUTCOME MEASURES: Among all youths, mean serum total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C); and among adolescents only, low-density lipoprotein cholesterol (LDL-C) and geometric mean triglyceride levels. Trends in adverse lipid concentrations are reported for TC levels of 200 mg/dL and greater, non-HDL-C levels of 145 mg/dL and greater, HDL-C levels of less than 40 mg/dL, LDL-C levels of 130 mg/dL and greater, and triglyceride levels of 130 mg/dL and greater. RESULTS: Among youths aged 6 to 19 years between 1988-1994 and 2007-2010, there was a decrease in mean TC (from 165 mg/dL [95% CI, 164-167] to 160 mg/dL [95% CI, 158-161]; P < .001) and a decrease in the prevalence of elevated TC (from 11.3% [95% CI, 9.8%-12.7%] to 8.1% [95% CI, 6.7%-9.5%]; P = .002). Mean HDL-C significantly increased between 1988-1994 and 2007-2010, but the prevalence of low HDL-C did not change. Mean non-HDL-C and prevalence of elevated non-HDL-C both significantly decreased over the study period. In 2007-2010, 22% (95% CI, 20.3%-23.6%) of youths had either a low HDL-C level or high non-HDL-C, which was lower than the 27.2% (95% CI, 24.6%-29.7%) in 1988-1994 (P = .001). Among adolescents (aged 12-19 years) between 1988-1994 and 2007-2010, there was a decrease in mean LDL-C (from 95 mg/dL [95% CI, 92-98] to 90 mg/dL [95% CI, 88-91]; P = .003) and a decrease in geometric mean triglycerides (from 82 mg/dL [95% CI, 78-86] to 73 mg/dL [95% CI, 70-76]; P < .001). Prevalence of elevated LDL-C and triglycerides between 1988-1994 and 2007-2010 also significantly decreased. CONCLUSIONS: Between 1988-1994 and 2007-2010, a favorable trend in serum lipid concentrations was observed among youths in the United States but almost 1 in 10 had elevated TC in 2007-2010. |
Willingness to pay for prostate cancer treatment among patients and their family members at 1 year after diagnosis
Li C , Zeliadt SB , Hall IJ , Smith JL , Ekwueme DU , Moinpour CM , Penson DF , Thompson IM , Keane TE , Ramsey SD . Value Health 2012 15 (5) 716-23 OBJECTIVES: To explore an alternative approach to quantifying the burden of side effects at 1 year after treatment for prostate cancer among both patients and their partners. METHODS: We analyzed data from 75 couples in the Family and Cancer Therapy Selection study. Paired patients and family members were independently asked about their willingness to pay (WTP) for a hypothetical new treatment that cures prostate cancer without side effects if they could reconsider their treatment decision by indicating the maximum amount they would be willing to pay given 11 separate "bids" ranging from $0 to $1500 per month. Descriptive and regression analyses were conducted for patients and family members controlling for sociodemographic characteristics and health status; Spearman correlations were also examined. RESULTS: Among 75 couples analyzed, the income-adjusted mean WTP estimates per month were $400.8 (standard error [SE] $54.3) for patients and $650.2 (SE 72.2) for family members. The WTP between patients and family members was correlated (Pearson rho 0.30; P = 0.01). After adjusting for covariates, the adjusted mean WTP per month was $588.1 (SE 65.77) for patients and $819.4 (SE 74.33) for family members. Wanting to avoid side effects at baseline predicted higher WTP for patients (P = 0.010). Experiencing sexual side effects was predictive of higher WTP for family members (P = 0.047). CONCLUSIONS: Fairly high WTP amounts for a hypothetical treatment without side effects suggests that patients and their partners are experiencing important burdens 1 year after treatment. The higher amounts partners are willing to pay and the correlation with sexual side effects suggest that they are perceptive of significant treatment burdens. |
Factors associated with never being screened for colorectal cancer
Stanley SL , King JB , Thomas CC , Richardson LC . J Community Health 2012 38 (1) 31-9 Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29 % of respondents had never been screened for CRC. In the adjusted model, 36.6 % of US adults age 50-59 years and 29.1 % of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2 %) reported never being screened than members of other racial and ethnic groups. Nearly 37 % of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29 % reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC. |
Is the obesity epidemic reversing favorable trends in blood pressure? Evidence from cohorts born between 1890 and 1990 in the United States
Goff DC Jr , Gillespie C , Howard G , Labarthe DR . Ann Epidemiol 2012 22 (8) 554-61 BACKGROUND: Previous reports have described favorable changes in the relationship between systolic blood pressure and age in recent birth cohorts. The obesity epidemic might threaten that pattern. OBJECTIVES: To update analyses of differences between birth cohorts in the relationship between systolic blood pressure and age and to determine whether increases in obesity have had adverse effects. METHODS: We examined the systolic blood pressure distributions across birth cohorts born between 1890 and 1990 in 68,070 participants, aged 18-74 years, in the National Health (and Nutrition) Examination Surveys between 1960 and 2008. We postulated that age-adjusted 10th, 25th, 50th, 75th, and 90th percentiles of systolic blood pressure had decreased in more recent versus earlier cohorts, and that this pattern had slowed or reversed recently due, at least in part, to obesity. RESULTS: After adjusting for gender, race, age and age(2), the 10th, 25th, 50th, 75th, and 90th percentiles of systolic blood pressure were 1.1, 1.4, 1.9, 2.5, and 3.4 mmHg lower for each decade more recently born (all P < .0001). Quadratic terms for birth cohort were positive and significant (P < .001) across all percentiles, consistent with a decelerating cohort effect. Mediation of this deceleration was observed for body mass index ranging from 20.4% to 44.3% (P < .01 at all percentiles). CONCLUSIONS: More recent cohorts born in the United States between 1890 and 1990 have had smaller increases in systolic blood pressure with aging. At any age, their systolic blood pressure distributions are shifted lower relative to earlier cohorts. Decreases of 1.9 mmHg in the median systolic blood pressure per decade translates into 11.4-13.3 mmHg over 6-7 decades, a shift that would contribute importantly to lower rates of cardiovascular diseases. These favorable changes are slowing, perhaps owing, at least in part, to the obesity epidemic. |
Anatomic distribution of malignant melanoma on the non-Hispanic black patient, 1998-2007
Myles ZM , Buchanan N , King JB , Singh S , White A , Wu M , Ajani U . Arch Dermatol 2012 148 (7) 797-801 OBJECTIVES: To provide a population-based description of the anatomic distribution of melanoma among non-Hispanic black patients and to explore how characteristics of this distribution relate to the etiologies previously reported for both white and black patients. DESIGN: Cross-sectional, retrospective. SETTING: United States, January 1, 1998, through December 31, 2007. PATIENTS: A total of 1439 non-Hispanic black patients with a diagnosis of malignant melanoma. MAIN OUTCOME MEASURES: Proportion of melanoma found per anatomic site (head, face, or neck; trunk; upper limb and shoulder; and the lower limb and hip) by patient sex, age, and region of diagnosis. RESULTS: The most frequent site of melanoma was the lower limb and hip (848 [58.9%]) and trunk (238 [16.5%]). The youngest median age was presented for diagnoses of the trunk (male: 56 years and females: 48 years). Presentation on the lower limb and hip accounted for most diagnoses in both the northern and southern geographic regions (north: 58.2% and south: 59.7%). CONCLUSIONS: By increasing knowledge about the burden of this disease within the black population, our findings can be used to improve the early detection of melanoma by both the patient and the provider. |
Replicating PEPFAR's success: how interventions shown to be effective abroad can be applied to the AIDS epidemic in the US
Fu J , Gavaghan A , Millett G , Walsh T . Health Aff (Millwood) 2012 31 (7) 1585-92 The President's Emergency Plan for AIDS Relief (PEPFAR), which began in 2003, initially responded to the global AIDS epidemic by applying lessons learned in treating the disease in the United States to addressing the emergency abroad. As the program expanded, it evolved to support interventions increasingly tailored to local needs in countries receiving PEPFAR assistance. This global experience has created a knowledge base of how to provide HIV/AIDS prevention, care, and treatment services in low-resource settings. It underscored the importance of treatment adherence, family-centered care, and integration of HIV into broader health care delivery systems. Applying these lessons can help US policy makers address existing gaps in HIV care in the United States, where the availability of HIV treatment has at times masked the continued need for testing, early diagnosis, targeted prevention for key populations, and a solid array of social services for people living with HIV/AIDS and their families. This article identifies PEPFAR practices that merit further exploration for adoption in the United States, including strategies to increase adherence to drug treatment regimens and to ensure that HIV services are broadly integrated with other aspects of health care. |
Species identification and antifungal susceptibility of Candida bloodstream isolates from population-based surveillance in two US cities: 2008-2011
Lockhart SR , Iqbal N , Ahlquist AM , Farley MM , Harrison LH , Bolden CB , Baughman W , Stein B , Hollick R , Park BJ , Chiller T . J Clin Microbiol 2012 50 (11) 3435-42 Between 2008 and 2011, population-based candidemia surveillance was conducted in Atlanta, GA and Baltimore, MD. Surveillance had been previously performed in Atlanta in 1992-1993 and in Baltimore in 1998-2000, making this the first population-based candidemia surveillance conducted over multiple time points in the US. From 2,675 identified cases of candidemia in the current surveillance, 2,329 Candida isolates were collected. Candida albicans no longer comprised the majority of isolates but remained the most frequently isolated species (38%), followed by C. glabrata (29%), C. parapsilosis (17%) and C. tropicalis (10%). The species distribution has changed over time; in both Atlanta and Baltimore the proportion of C. albicans decreased and the proportion of C. glabrata increased, while the proportion of C. parapsilosis increased in Baltimore only. There were 98 multi-species episodes, with C. albicans and C. glabrata the most frequently encountered combination. The new species-specific CLSI Candida MIC breakpoints were applied to these data. With the exception of C. glabrata (11.9% resistant), resistance to fluconazole was very low (2.3% for C. albicans, 6.2% for C.tropicalis and 4.1% for C. parapsilosis). There was no change in the proportion of fluconazole resistance between surveillance periods. Overall echinocandin resistance was low (1%) but was higher for C. glabrata isolates, ranging from 2.1% resistant to caspofungin in Baltimore to 3.1% resistant to anidulafungin in Atlanta. Given the increase at both sites and the higher echinocandin resistance, C. glabrata should be closely monitored in future surveillance. |
Traditional risk factors for Helicobacter pylori infection not found among patients undergoing diagnostic upper endoscopy-Republic of Georgia, 2007-2008
Tarkhashvili N , Chakvetadze N , Mebonia N , Chubinidze M , Bakanidze L , Shengelidze V , Mirtskhulava M , Chachava T , Katsitadze G , Gabunia U , Kordzaia D , Imnadze P , Guarner J , Sobel J . Int J Infect Dis 2012 16 (9) e697-702 OBJECTIVES: Helicobacter pylori causes gastritis, duodenal ulcers, and gastric cancer. Although household crowding, low socioeconomic status (SES), and poor sanitation are associated with infection elsewhere, risk factors of infection in the Republic of Georgia (ROG), a country with a high prevalence rate (>70%), remain unknown. In this study we explored potential risk factors of infection among symptomatic patients in ROG. METHODS: During 2007-2008, we prospectively recruited 390 subjects with gastrointestinal symptoms referred to five tertiary care centers for diagnostic upper endoscopy. We administered a questionnaire on potential risk factors and tested patients using three diagnostic tests: gastric biopsies underwent histological evaluation and rapid urease test (CLO test), and an ELISA was used to detect IgG against H. pylori in serum. We defined a case as having two or more positive results from the three available tests. Univariate and multivariate logistic regression analyses were performed. RESULTS: Overall, 217 (56%) patients met the study case definition. Subjects diagnosed with cancer had the highest rate of H. pylori infection (62%), followed by those with gastritis (55%), and ulcer (54%). Age >30 years (adjusted odds ratio (aOR 2.6, 95% confidence interval (CI) 1.6-4.3) and residing in the capital city (aOR 0.6, 95% CI 0.4-0.9) were significantly associated with infection. CONCLUSIONS: In this large cohort with gastrointestinal symptoms, only age >30 years and living in the capital were significant factors associated with infection. Lower SES, less education, and crowding did not confer an increased risk, in contrast to the findings of previous studies. Population-based studies are needed to identify potential routes and risk factors of H. pylori infection in ROG. |
Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding vs zidovudine/single-dose nevirapine prophylaxis): the Kesho Bora randomized controlled trial
Dioulasso B , Faso B , Meda N , Fao P , Ky-Zerbo O , Gouem C , Somda P , Hien H , Ouedraogo PE , Kania D , Sanou A , Kossiwavi IA , Sanogo B , Ouedraogo M , Siribie I , Valea D , Ouedraogo S , Some R , Rouet F , Rollins N , McFetridge L , Naidu K , Luchters S , Reyners M , Irungu E , Katingima C , Mwaura M , Ouattara G , Mandaliya K , Wambua S , Thiongo M , Nduati R , Kose J , Njagi E , Mwaura P , Newell ML , Mepham S , Viljoen J , Bland R , Mthethwa L . Clin Infect Dis 2012 55 (3) 449-460 BACKGROUND: Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. METHODS: From 2005 to 2008, HIV-infected pregnant women with CD4+ counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4+ counts of <200/mm(3). RESULTS: Among 824 randomized women, 789 had at least 1 study visit after cessation of ARV prophylaxis. Following delivery, progression risk up to 24 months postpartum in the triple ARV arm was significantly lower than in the AZT/sdNVP arm (15.7 vs 28.3; P =. 001), but the risks of progression after cessation of ARV prophylaxis (rather than after delivery) were not different (15.0 vs 13.8 18 months after ARV cessation). Among women with CD4+ counts of 200-349/mm(3) at enrollment, 24.0 (95 confidence interval [CI], 15.7-35.5) progressed with triple ARV, and 23.0 (95 CI, 17.8-29.5) progressed with AZT/sdNVP, whereas few women in either arm (<5) with initial CD4+ counts of >=350/mm(3) progressed. CONCLUSIONS: Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4+ cells of <350/mm(3), ARVs should not be discontinued in this group. CLINICAL TRIALS REGISTRATION: ISRCTN71468410. (2012 The Author.) |
Prevalence of hepatitis C virus infection among human immunodeficiency virus-1-infected pregnant women in Malawi: the BAN study
Chasela CS , Wall P , Drobeniuc J , King CC , Teshale E , Hosseinipour MC , Ellington SR , Codd M , Jamieson DJ , Knight RJ , Fitzpatrick P , Kourtis AP , Hoffman IF , Kayira D , Mumba N , Kamwendo DD , Martinson F , Powderly W , van der Horst C , Kamili S . J Clin Virol 2012 54 (4) 318-320 BACKGROUND: In Sub-Saharan Africa, prevalence estimates of hepatitis C virus (HCV) vary widely. OBJECTIVES: To assess the prevalence of HCV infection among HIV-infected, pregnant women screened for a large clinical trial in Lilongwe, Malawi. STUDY DESIGN: Plasma from 2041 HIV-infected, pregnant women was screened for anti-HCV IgG using a chemiluminiscent immunometric assay (CIA). Specimens with a signal-cut-off ratio≥1.00 were considered reactive and those with S/Co ratio<1.00 non-reactive. All CIA-reactive specimens were tested by a recombinant immunoblot assay (RIBA) for anti-HCV and by PCR for HCV RNA. RESULTS: Of 2041 specimens, 110 (5.3%, 95% CI: 4.5-6.5%) were CIA reactive. Of the 109 CIA reactive specimens available for RIBA testing, 2 (1.8%) were positive, 28 (25.7%) were indeterminate, and 79 (72.5%) were negative. All CIA-reactive specimens were HCV RNA negative (n=110). The estimated HCV prevalence based on the screening assay alone was 5.3%; based on supplemental RIBA testing, the status of HCV infection remained indeterminate in 1.4% (28/2040, 95% CI: 0.1-2.0) and the prevalence of confirmed HCV infections was 0.1% (2/2040, 95% CI: 0-0.4%). CONCLUSIONS: HCV seroprevalence among HIV-infected, pregnant women in Malawi confirmed by supplemental RIBA HCV 3.0 is low (0.1%); CIA showed a high false-reactivity rate in this population. |
The feasibility of identifying children with primary immunodeficiency disorders: preparation for the polio post-eradication era in Bangladesh
Sazzad HM , Rainey JJ , Mach O , Sutter R , Diordista S , Kawser CA , Mobarak R , Alam D , Chowdhury MA , Hossain MJ , Hasan AS , Luby SP . Vaccine 2012 30 (36) 5396-400 BACKGROUND: Persons with primary immunodeficiency disorders (PIDD) who receive oral poliovirus vaccine (OPV) or are household contacts of OPV recipients are at risk of excreting immunodeficiency-associated vaccine-derived polioviruses (iVDPVs). iVDPVs can be transmitted and cause paralytic polio. The objective of this study was to determine the feasibility of identifying infants and young children with PIDD in Bangladesh, and among those identified, to estimate the proportion excreting iVDPVs. METHODS: Patients admitted at 5 referral and teaching hospitals from the hospital catchment area were screened for PIDD using a standardized clinical case definition. PIDD was confirmed using results of testing for age-specific quantitative immunoglobulins (QIGs) levels. Stool specimens were collected according to WHO guidelines from children with confirmed PIDD. RESULTS: During February-July 2009, 13 patients were identified who met the clinical case definition for PIDD; their median age was 1.4 years (range: 2 months to 10 years). Six (46%) of the patients had age-specific QIG results that confirmed PIDD. Stool specimens from four patients tested negative for polio vaccine viruses. All four had received OPV between 50 and 264 days prior to study recruitment. CONCLUSION: Identifying children with PIDD at referral and teaching hospitals in Bangladesh is feasible, but a larger number of patients is needed to estimate the risk for iVDPV excretion. The national polio eradication program should expand surveillance for PIDD case-patients and regularly test persons with PIDD for poliovirus excretion. These efforts will be essential for developing effective prevention and control strategies following OPV cessation, especially for densely populated and tropical countries like Bangladesh where even a minimal iVDPV risk could have significant public health consequences. |
Finding tuberculosis at the first encounter with HIV care: don't miss the opportunity to save a life
Cain KP , Varma JK . Int J Tuberc Lung Dis 2012 16 (9) 1138 SINCE THE EMERGENCE of the tuberculosis (TB) | and human immunodefi ciency virus (HIV) syndemic, | public health offi cials have been asking the same | questions—how do we screen for, diagnose, and prevent TB in people living with HIV (PWHA)? Deaths | from TB in PWHA continue unabated. In 2010, approximately 1000 PWHA died per day of TB, a treatable, preventable disease.1 In this issue of the Journal, | Hanifa et al. again highlight this problem.2 The vast | literature on this topic leads us to two conclusions: | 1) for some scientifi c questions, studies keep fi nding the | same answers; here, we must focus on closing the gap | between what we know and what we do; and 2) despite extensive study, some important questions remain | about how best to prevent TB deaths in PWHA. | The article by Hanifa et al. meets the highest standards for a study of TB diagnosis in PWHA. Investigators enrolled a broad cross-section of people at | their fi rst encounter with HIV care, and all PWHA | underwent gold-standard TB testing. The main fi ndings were: 1) 18% of patients enrolled had cultureconfi rmed TB, similar to other settings;3 2) for screening, chronic cough is insensitive, combinations of | symptoms increase sensitivity but sacrifi ce specifi city, | and adding chest X-ray (CXR) to symptom screening | increases sensitivity; 3) sputum smear microscopy is | ineffective for PWHA; and 4) CXR allowed for early | initiation of TB treatment for two thirds of patients |
Hepatitis B and C virus infection among 1.2 million persons with access to care: factors associated with testing and infection prevalence
Spradling PR , Rupp L , Moorman AC , Lu M , Teshale EH , Gordon SC , Nakasato C , Boscarino JA , Henkle EM , Nerenz DR , Denniston MM , Holmberg SD . Clin Infect Dis 2012 55 (8) 1047-55 BACKGROUND: Little is known about viral hepatitis testing and infection prevalence among persons in private healthcare organizations (HCOs) in the United States. METHODS: To determine the frequency of and characteristics associated with viral hepatitis testing and infection prevalence among adults with access to care, we conducted an observational cohort study among 1.25 million adults from 4 US HCOs and included persons with ≥1 clinical encounter during 2006-2008 and ≥12 months of continuous follow-up before 2009. We compared the number of infections identified with the number expected based on adjusted data from the National Health and Nutrition Examination Survey (NHANES). RESULTS: Of 866 886 persons without a previous hepatitis B virus (HBV) diagnosis, 18.8% were tested for HBV infection, of whom 1.4% tested positive; among 865 659 without a previous hepatitis C virus (HCV) diagnosis, 12.7% were tested, of whom 5.5% tested positive. Less than half of those with ≥2 abnormal alanine aminotransferase (ALT) levels were subsequently tested for HBV or HCV. When tested, Asians (adjusted odds ratio [aOR] 6.33 relative to whites) were most likely HBV infected, whereas those aged 50-59 years were most likely HCV infected (aOR 6.04, relative to age <30 years). Based on estimates from NHANES, nearly one-half of HCV and one-fifth of HBV infections in this population were not identified. CONCLUSIONS: Even in this population with access to care and lengthy follow-up, only a fraction of expected viral hepatitis infections were identified. Abnormal ALT levels often but not consistently triggered testing. These findings have implications for the identification and care of 4-5 million US residents with HBV and HCV infection. |
HIV in persons born outside the United States, 2007-2010
Prosser AT , Tang T , Hall HI . JAMA 2012 308 (6) 601-7 CONTEXT: Persons born outside the United States comprise about 13% of the US population, and the challenges these persons face in accessing health care may lead to poorer human immunodeficiency virus (HIV) disease outcomes. OBJECTIVE: To describe the epidemiology of HIV among persons born outside the United States and among US-born persons diagnosed in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the estimated number of US-born persons and persons born outside the United States diagnosed with HIV from 2007 through 2010 in 46 states and 5 US territories, the demographic characteristics, and the HIV transmission risk factors reported to the National HIV Surveillance System. Foreign-born persons were defined as persons born outside the United States and its territories, inclusive of naturalized citizens. MAIN OUTCOME MEASURE: Diagnosis of HIV infection. RESULTS: From 2007 through 2010, HIV was diagnosed in 191,697 persons in the US population; of these, 16.2% (95% CI, 16.0%-16.3%) (n = 30,995) were born outside the United States. Of the 25,255 persons with a specified country or region of birth outside the United States, 14.5% (n = 3656) were from Africa, 41.0% (n = 10,343) were from Central America (including Mexico), and 21.5% (n = 5418) were from the Caribbean. The 4 states (California, Florida, New York, and Texas) reporting the highest numbers of persons born outside the United States and diagnosed with HIV were also the top 4 reporters of HIV cases overall. Among persons born outside the United States with HIV, 73.5% (n = 22,773) were male. Among whites, 1841 of 55,574 (3.3%) of HIV diagnoses were in persons born outside the United States; in blacks, 8614 of 86,547 diagnoses (10.0%); in Hispanics, 17,913 of 42,431 diagnoses (42.2%); and in Asians, 1987 of 3088 diagnoses (64.3%). The percentage infected through heterosexual contact was 39.4% among persons born outside the United States vs 27.2% for US-born persons. CONCLUSIONS: Among persons in 46 US states and 5 US territories who received a diagnosis of HIV from 2007 through 2010, 16.2% were born outside the United States. Compared with US-born persons diagnosed with HIV, persons born outside the United States had different epidemiologic characteristics. |
Chronic active varicella zoster virus infection
Wolf J , Nagel MA , Mahalingam R , Cohrs RJ , Schmid DS , Gilden D . Neurology 2012 79 (8) 828-9 This case report illustrates previously undescribed features of chronic active varicella zoster virus (VZV) infection, including a 4-month delay between the onset of zoster and zoster sine herpete, involvement of 9 dermatomes on progression of zoster to zoster sine herpete, and the presence of both VZV DNA and anti-VZV immunoglobulin G (IgG) in the CSF. |
Condom use problems during anal sex among men who have sex with men (MSM): findings from the Safe in the City Study
D'Anna LH , Margolis AD , Warner L , Korosteleva OA , O'Donnell L , Rietmeijer CA , Klausner JD , Nomura W , Malotte CK . AIDS Care 2012 24 (8) 1028-38 Our research aims were to: (1) assess the prevalence of two condom use problems: breakage or slippage and partial use (delayed application or early removal) among men who have sex with men (MSM) seeking services in urban US STD clinics; and (2) examine the association between these condom use problems and participant, partner and partnership characteristics. Analysis was restricted to HIV-negative MSM who reported having anal sex at least once in the preceding 3 months and who completed both the baseline and 3 month follow-up assessments. Two models were fitted using the generalized estimating equations (GEE) approach. A total of 263 MSM (median age=32 years) reported 990 partnerships. Partnerships with no condom use 422 (42.6%) were excluded. Thus, 207 MSM and 568 partnerships were included. Among condom users, 100% use was reported within 454 partnerships (79.9%) and <100% within 114 (20.1%), and 21(3.7%) reported both condom use problems, 25 (4.4%) reported only breakage, 67 (11.8%) reported only partial use, and 455 (80.1%) reported no errors. The breakage or slippage and partial use rates per condom used were 3.4% and 11.2%, respectively. A significantly higher rate of breakage or slippage occurred among non-main partnerships. Characteristics associated with increased odds for condom breakage or slippage were: lower education level (OR=2.78; CI: 1.1-7.5), non-main partner status (OR=4.1; CI: 1.5-11.7), and drunk or high during sex (OR=2.0; CI: 1.1-3.8), and for partial use: lower education level (OR=2.6; CI: 1.0-6.6), perceived partner sexually transmitted infections (STI) risk (OR=2.4; CI: 1.3-4.2), and inconsistent condom use (OR=3.7; CI: 2.0-6.6). A high percentage of MSM partnerships reported no condom use and among condom users, a sizable proportion did not use them consistently or correctly. MSM may benefit from interventions designed to increase proficiency for condom use with a particular focus on the behaviors of inconsistent and partial condom use. |
Pyrethroid resistance in Anopheles gambiae s.s. and Anopheles arabiensis in western Kenya: phenotypic, metabolic and target site characterizations of three populations
Ochomo E , Bayoh MN , Brogdon WG , Gimnig JE , Ouma C , Vulule JM , Walker ED . Med Vet Entomol 2012 27 (2) 156-64 Field and laboratory investigations revealed phenotypic, target site and metabolic resistance to permethrin in an Anopheles gambiae s.s. (Diptera: Culicidae) population in Bungoma District, a region in western Kenya in which malaria is endemic and rates of ownership of insecticide-treated bednets are high. The sensitivity of individual An. gambiae s.l. females as indicated in assays using World Health Organization (WHO) test kits demonstrated reduced mortality in response to permethrin, deltamethrin and bendiocarb. Estimated time to knock-down of 50% (KDT(50) ) of the test population in Centers for Disease Control (CDC) bottle bioassays was significantly lengthened for the three insecticides compared with that in a susceptible control strain. Anopheles arabiensis from all three sites showed higher mortality to all three insecticides in the WHO susceptibility assays compared with the CDC bottle assays, in which they showed less sensitivity and longer KDT(50) than the reference strain for permethrin and deltamethrin. Microplate assays revealed elevated activity of beta-esterases and oxidases, but not glutathione-S-transferase, in An. gambiae s.s. survivors exposed to permethrin in bottle bioassays compared with knocked down and unexposed individuals. No An. arabiensis showed elevated enzyme activity. The 1014S kdr allele was fixed in the Bungoma An. gambiae s.s. population and absent from An. arabiensis, whereas the 1014F kdr allele was absent from all samples of both species. Insecticide resistance could compromise vector control in Bungoma and could spread to other areas as coverage with longlasting insecticide-treated bednets increases. |
Serum PBDEs in a North Carolina toddler cohort: associations with handwipes, house dust, and socioeconomic variables
Stapleton HM , Eagle S , Sjodin A , Webster TF . Environ Health Perspect 2012 120 (7) 1049-54 BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are persistent, bioaccumulative, and endocrine-disrupting chemicals. OBJECTIVES: We used handwipes to estimate exposure to PBDEs in house dust among toddlers and examined sex, age, breast-feeding, race, and parents' education as predictors of serum PBDEs. METHODS: Eighty-three children from 12 to 36 months of age were enrolled in North Carolina between May 2009 and November 2010. Blood, handwipe, and house dust samples were collected and analyzed for PBDEs. A questionnaire was administered to collect demographic data. RESULTS: PBDEs were detected in all serum samples (geometric mean for SigmapentaBDE in serum was 43.3 ng/g lipid), 98% of the handwipe samples, and 100% of the dust samples. Serum SigmapentaBDEs were significantly correlated with both handwipe and house dust SigmapentaBDE levels, but were more strongly associated with handwipe levels (r = 0.57; p < 0.001 vs. r = 0.35; p < 0.01). Multivariate model estimates revealed that handwipe levels, child's sex, child's age, and father's education accounted for 39% of the variation in serum SigmaBDE3 levels (sum of BDEs 47, 99, and 100). In contrast, age, handwipe levels, and breast-feeding duration explained 39% of the variation in serum BDE 153. CONCLUSIONS: Our study suggests that hand-to-mouth activity may be a significant source of exposure to PBDEs. Furthermore, age, socioeconomic status, and breast-feeding were significant predictors of exposure, but associations varied by congener. Specifically, serum SigmaBDE3 was inversely associated with socioeconomic status, whereas serum BDE-153 was positively associated with duration of breast-feeding and mother's education. |
Urinary bisphenol A concentrations and implantation failure among women undergoing in vitro fertilization
Ehrlich S , Williams PL , Missmer SA , Flaws JA , Berry KF , Calafat AM , Ye X , Petrozza JC , Wright D , Hauser R . Environ Health Perspect 2012 120 (7) 978-83 BACKGROUND: Bisphenol A (BPA) is a synthetic chemical widely used in the production of polycarbonate plastic and epoxy resins found in numerous consumer products. In experimental animals, BPA increases embryo implantation failure and reduces litter size. OBJECTIVE: We evaluated the association of urinary BPA concentrations with implantation failure among women undergoing in vitro fertilization (IVF). METHODS: We used online solid phase extraction-high performance liquid chromatography-isotope dilution tandem mass spectrometry to measure urinary BPA concentrations in 137 women in a prospective cohort study among women undergoing IVF at the Massachusetts General Hospital Fertility Center in Boston, Massachusetts. We used logistic regression to evaluate the association of cycle-specific urinary BPA concentrations with implantation failure, accounting for correlation among multiple IVF cycles in the same woman using generalized estimating equations. Implantation failure was defined as a negative serum beta-human chorionic gonadotropin test (beta-hCG < 6 IU/L) 17 days after egg retrieval. RESULTS: Among 137 women undergoing 180 IVF cycles, urinary BPA concentrations had a geometric mean (SD) of 1.53 (2.22) microg/L. Overall, 42% (n = 75) of the IVF cycles resulted in implantation failure. In adjusted models, there was an increased odds of implantation failure with higher quartiles of urinary BPA concentrations {odds ratio (OR) 1.02 [95% confidence interval (CI): 0.35, 2.95}, 1.60 (95% CI: 0.70, 3.78), and 2.11 (95% CI: 0.84, 5.31) for quartiles 2, 3, and 4, respectively, compared with the lowest quartile (p-trend = 0.06). CONCLUSION: There was a positive linear dose-response association between BPA urinary concentrations and implantation failure. |
Establishing the practice of Health Impact Assessment in the United States
Wendel AM . J Environ Health 2012 75 (1) 32-3 It’s 4:00 p.m., Friday afternoon, and someone unfamiliar is knocking on your office door. She introduces herself as a city | planner and asks whether you could help | her with an upcoming redevelopment decision. She knows the health department has | environmental health, chronic disease, and | injury programs, and that redevelopment | affects these issues. She came to your office | first because she perceives redevelopment as | a change in the environment. Through her | planning education she has heard of “Health | Impact Assessment” (HIA) and thinks it | would help this situation. | The practice of HIA acknowledges that decisions made outside of the health sector can | profoundly affect public health. Furthermore, | the health sector’s engagement can promote | evidence-based policy change. HIA practice is | growing and environmental health professionals frequently lead the charge. The National Prevention Strategy states that HIA can facilitate accomplishing the key strategy of building healthy | and safe community environments (National | Prevention Council, 2011). As the provided scenario implies, awareness of HIA has reached city | planners and associated professionals. |
Excretion profiles and half-lives of ten urinary polycyclic aromatic hydrocarbon metabolites after dietary exposure
Li Z , Romanoff L , Bartell S , Pittman EN , Trinidad DA , McClean M , Webster TF , Sjodin A . Chem Res Toxicol 2012 25 (7) 1452-61 Human exposure to polycyclic aromatic hydrocarbons (PAHs) can be assessed by biomonitoring of their urinary monohydroxylated metabolites (OH-PAHs). Limited information exists on the human pharmacokinetics of OH-PAHs. This study aimed to investigate the excretion half-life of 1-hydroxypyrene (1-PYR), the most used biomarker for PAH exposure, and 9 other OH-PAHs following a dietary exposure in 9 nonsmoking volunteers with no occupational exposure to PAHs. Each person avoided food with known high PAH-content during the study period, except for a high PAH-containing lunch (barbecued chicken) on the first day. Individual urine samples (n = 217) were collected from 15 h before to 60 h following the dietary exposure. Levels of all OH-PAHs in all subjects increased rapidly by 9-141-fold after the exposure, followed by a decrease consistent with first-order kinetics, and returned to background levels 24-48 h after the exposure. The average time to reach maximal concentration ranged from 3.1 h (1-naphthol) to 5.5 h (1-PYR). Creatinine-adjusted urine concentrations for each metabolite were analyzed using a nonlinear mixed effects model including a term to estimate background exposure. The background-adjusted half-life estimate was 3.9 h for 1-PYR and ranged 2.5-6.1 h for the other 9 OH-PAHs, which in general, were shorter than those previously reported. The maximum concentrations after barbecued chicken consumption were comparable to the levels found in reported occupational settings with known high PAH exposures. It is essential to consider the relatively short half-life, the timing of samples relative to exposures, and the effect of diet when conducting PAH exposure biomonitoring studies. |
Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers
St Helen G , Bernert JT , Hall DB , Sosnoff CS , Xia Y , Balmes JR , Vena JE , Wang JS , Holland NT , Naeher LP . Environ Health Perspect 2012 120 (7) 1010-6 BACKGROUND: With an increase in indoor smoking bans, many smokers smoke outside establishments and near their entrances, which has become a public health concern. OBJECTIVES: We characterized the exposure of nonsmokers to secondhand smoke (SHS) outside a restaurant and bar in Athens, Georgia, where indoor smoking is banned, using salivary cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).Methods: In a crossover study, we assigned 28 participants to outdoor patios of a restaurant and a bar and an open-air site with no smokers on three weekend days; participants visited each site once and stayed for 3 hr. We collected saliva and urine samples immediately before and after the visits (postexposure) and on the following morning and analyzed samples for cotinine and total NNAL, respectively. Regression models were fitted and changes in biomarkers were contrasted between locations. RESULTS: Postexposure and preexposure geometric mean salivary cotinine concentrations differed by 0.115 ng/mL [95% confidence interval (CI): 0.105, 0.126)] and by 0.030 ng/mL (95% CI: 0.028, 0.031) for bar and restaurant visits, respectively. There were no significant post- and preexposure differences in cotinine levels after control site visits, and changes after bar and restaurant site visits were significantly different from changes after control site visits (p < 0.001). Results comparing next-day and preexposure salivary cotinine levels were similar. Next-day creatinine-corrected urinary NNAL concentrations also were higher than preexposure levels following bar and restaurant visits [1.858 pg/mg creatinine higher (95% CI: 0.897, 3.758) and 0.615 pg/mg creatinine higher (95% CI: 0.210, 1.761), respectively], and were significantly different from changes after the control visits (p = 0.005). CONCLUSION: Salivary cotinine and urinary NNAL increased significantly in nonsmokers after outdoor SHS exposure. Our findings indicate that such exposures may increase risks of health effects associated with tobacco carcinogens. |
Associations of prenatal exposure to organophosphate pesticide metabolites with gestational age and birth weight
Rauch SA , Braun JM , Barr DB , Calafat AM , Khoury J , Montesano AM , Yolton K , Lanphear BP . Environ Health Perspect 2012 120 (7) 1055-60 BACKGROUND: Prenatal exposure to organophosphate (OP) insecticides, a widely used class of pesticides, may be associated with decreased gestational age and lower birth weight. Single nucleotide polymorphisms in paroxanase (PON1) enzyme genotypes may modify the relationships between OP exposure and perinatal outcomes. OBJECTIVE: We examined the relationship of prenatal OP insecticide exposure, measured using urinary dialkyl phosphate (DAP) metabolite concentrations, with gestational age and birth weight. METHODS: We measured the concentrations of six nonspecific DAP metabolites of OP insecticides in two maternal spot urine samples collected in a prospective birth cohort. We performed multivariable regression to examine associations between the sum of six DAP concentrations (SigmaDAP) with gestational age and birth weight. We also examined whether these associations differed according to infant PON1192 and PON1-108 genotypes. RESULTS: Among 306 mother-infant dyads, a 10-fold increase in SigmaDAP concentrations was associated with a decrease in covariate-adjusted gestational age [-0.5 weeks; 95% confidence interval (CI): -0.8, -0.1] and birth weight (-151 g; CI: -287, -16); the decrements in birth weight were attenuated after adjusting for gestational age. The relationship between SigmaDAP concentrations and gestational age was stronger for white (-0.7 weeks; CI: -1.1, -0.3) than for black (-0.1 weeks; 95% CI: -0.9, 0.6) newborns. In contrast, there was a greater decrease in birth weight with increasing urinary SigmaDAP concentrations for black (-188 g; CI: -395, 19) than for white (-118 g; CI: -296, 60) newborns. Decrements in birth weight and gestational age associated with SigmaDAP concentrations were greatest among infants with PON1192QR and PON-108CT genotypes. CONCLUSIONS: Prenatal urinary SigmaDAP concentrations were associated with shortened gestation and reduced birth weight in this cohort, but the effects differed by race/ethnicity and PON1192/108 genotypes. |
Brominated flame retardants in the Australian population: 1993-2009
Toms LM , Guerra P , Eljarrat E , Barcelo D , Harden FA , Hobson P , Sjodin A , Ryan E , Mueller JF . Chemosphere 2012 89 (4) 398-403 Brominated flame retardants, including hexabromocyclododecane (HBCD) and polybrominated diphenyl ethers (PBDEs) are used to reduce the flammability of a multitude of electrical and electronic products, textiles and foams. The use of selected PBDEs has ceased, however, use of decaBDE and HBCD continues. While elevated concentrations of PBDEs in humans have been observed in Australia, no data is available on other BFRs such as HBCD. This study aimed to provide background HBCD concentrations from a representative sample of the Australian population and to assess temporal trends of HBCD and compare with PBDE concentrations over a 16year period. Samples of human milk collected in Australia from 1993 to 2009, primarily from primiparae mothers were combined into 12 pools from 1993 (2 pools); 2001; 2002/2003 (4 pools); 2003/2004; 2006; 2007/2008 (2 pools); and 2009. Concentrations of summation operatorHBCD ranged from not quantified (nq) to 19ngg(-1)lipid while alpha-HBCD and gamma-HBCD ranged from nq to 10ngg(-1)lipid and nq to 9.2ngg(-1)lipid. beta-HBCD was detected in only one sample at 3.6ngg(-1)lipid while summation operator(4)PBDE ranged from 2.5 to 15.8ngg(-1)lipid. No temporal trend was apparent in HBCD concentrations in human milk collected in Australia from 1993 to 2009. In comparison, PBDE concentrations in human milk show a peak around 2002/03 (mean summation operator(4)PBDEs=9.6ngg(-1)lipid) and 2003/04 (12.4ngg(-1)lipid) followed by a decrease in 2007/08 (2.7ngg(-1)lipid) and 2009 (2.6ngg(-1)lipid). In human blood serum samples collected from the Australian population, PBDE concentrations did not vary greatly (p=0.441) from 2002/03 to 2008/09. Continued monitoring including both human milk and serum for HBCD and PBDEs is required to observe trends in human body burden of HBCD and PBDEs body burden following changes to usage. |
Derby district redevelopment in Colorado: case study on the Health Impact Assessment process
Maclennan CF , Ghosh TS , Juliusson L , Vogt RL , Boehmer TK . J Environ Health 2012 75 (1) 8-13 Health Impact Assessment (HIA) is a tool that is increasingly utilized in the U.S. to shape policies that may impact the public's health. Domestic examples of HIAs and the process by which they were conducted, however, are rarely documented in the peer-reviewed literature. Through an existing relationship with the planning department in Commerce City, Colorado, Tri-County Health Department (TCHD) was able to identify a proposed redevelopment plan as a candidate for an HIA. The HIA focused on potential effects of the proposed redevelopment of Commerce City's historic Derby District on residents' physical activity and nutrition-related behaviors. This article describes the HIA process used by TCHD. Several sources of data were used, including participatory community input on walkability and safety, local health behavior data, and maps of health-influencing environmental characteristics. Using a variety of information sources including community input and local health behavior data can be useful in conducting HIAs and impacting policies. Local health departments should consider cultivating ongoing collaborative partnerships with municipal planning departments and community groups to conduct HIAs and to implement recommendations. |
Sentinel surveillance for influenza and other respiratory viruses in Cote d'Ivoire, 2003-2010
Kadjo HA , Ekaza E , Coulibaly D , Kouassi DP , Nzussouo NT , Kouakou B , Ouattara A , Adjogoua EV , Akoua-Koffi CG , Elia GA , Victoir K , Bretin-Dosso MC , Mott JA . Influenza Other Respir Viruses 2012 7 (3) 296-303 BACKGROUND: Many countries in Africa have lacked sentinel surveillance systems for influenza and are under-represented in data used for global vaccine strain selection. OBJECTIVES: We describe 8 years of sentinel surveillance data and the contribution of influenza and other viruses to medically attended influenza-like illness (ILI) in Cote d'Ivoire. METHODS: Sentinel surveillance was established in 2003. Nasopharyngeal (NP) specimens and epidemiologic data are collected from persons of all ages presenting with ILI at sentinel sites. Respiratory specimens have been tested for influenza using various viral and molecular diagnostic methods. A subset of 470 specimens collected from children aged 0-5 years were tested for multiple respiratory viruses using RT-PCR. RESULTS: From 2003 to 2010, 5074 NP specimens were collected from patients with ILI. Overall, 969/5074 (19%) of these specimens tested positive for influenza. Seasonal influenza A(H1N1) viruses predominated during 5 years and influenza A(H3N2) viruses predominated during 3 years. Influenza B viruses cocirculated with influenza A viruses during each year from 2004 to 2010. Seasonal peaks in influenza circulation were observed during the months of May, June, and October, with the largest peak corresponding with the primary rainfall season. Of 470 specimens collected from children under aged 5 who were tested for multiple respiratory viruses, a viral respiratory pathogen was detected in 401/470 (85%) of specimens. Commonly detected viruses were RSV (113 of 470 specimens, 24%), rhinoviruses (85/470, 18%), influenza (77/470, 16%), and parainfluenza (75/470, 16%). CONCLUSION: In Cote d'Ivoire, there is a significant annual contribution of influenza and other respiratory viruses to medically attended ILI. |
The National Amyotrophic Lateral Sclerosis (ALS) registry
Antao VC , Horton DK . J Environ Health 2012 75 (1) 28-30 A myotrophic lateral sclerosis (ALS) is a progressive and often fatal neuromuscular disease. Most people die within 2–5 years of being diagnosed with ALS (Mitsumoto, Chad, & Pioro, 1998). Community concerns about perceived clusters of cases of ALS have challenged public health agencies to consider the possible contribution of environmental contaminants to the development of this disease. The general categories of possible environmental risk factors that have been investigated include heavy metals, trace elements, solvents and other volatile organic chemicals, ionizing and non-ionizing radiation, and agricultural chemicals. | Several investigations have been conducted of heavy metal exposure, particularly lead, as a risk factor for ALS. Some case-control studies demonstrated a positive association between past exposure to lead and risk of ALS (Armon, Kurland, Daube, & O’Brien, 1991; Kamel et al., 2002; Roelofs-Iverson, Mulder, Elveback, Kurland, & Molgaard, 1984). Also, the epidemiologic literature offers some support for an association between ALS and past exposure to organic solvents (Gunnarsson, Lindberg, Söderfeldt, & Axelson, 1991; McGuire et al., 1997). | In addition, certain occupations, such as military work, have been listed as a risk factor for ALS (Nicholas et al., 1998; Schulte, Burnett, Boeniger, & Johnson, 1996; Sutedja et al., 2009; Weisskopf et al., 2005). Several other potential risk factors have been evaluated in the scientific literature including infectious agents (Fang et al., 2011), nutritional intake (Okamoto, Kihira, Kobashi et al., 2009; Wang et al., 2011; Woolsey, 2008), physical activity, and trauma (Beghi et al., 2010; Okamoto, Kihira, Kondo et al., 2009; Piazza, Siren, & Ehrenreich, 2004; Strickland, Smith, Dolliff, Goldman, & Roelofs, 1996). | The uncertainty about the incidence and prevalence of ALS, as well as the lack of knowledge about the role of environmental exposures in the etiology of ALS, has created a need for structured data collection. In 2008, President Bush signed the ALS Registry Act into law, allowing the Agency for Toxic Substances and Disease Registry (ATSDR) to create the National ALS Registry. The purpose of the registry is to quantify the incidence and prevalence of ALS in the U.S., describe the demographics of persons with ALS, and examine risk factors for the disease. |
A qualitative assessment of a performance measure for reporting influenza vaccination rates among healthcare personnel
MacCannell T , Shugart A , Schneider AK , Lindley MC , Lorick SA , Rao A , Woods LO , Ahmed F , Sinkowitz-Cochran RL . Infect Control Hosp Epidemiol 2012 33 (9) 945-8 To understand the feasibility of implementing a standardized performance measure for collecting and reporting influenza vaccination rates among healthcare personnel, qualitative, semistructured interviews were conducted with key informants in 32 healthcare facilities. Despite practical and logistical challenges to implementing the measure, respondents perceived clear benefits to its use. |
Combining estimates from two surveys: an example from monitoring 2009 influenza A (H1N1) pandemic vaccination
Furlow-Parmley C , Singleton JA , Bardenheier B , Bryan L . Stat Med 2012 31 (27) 3285-94 During the 2009 influenza A (H1N1) pandemic, there was an ongoing need to monitor 2009 H1N1 vaccination coverage at the national and state level to evaluate the vaccination campaign; thus, precise vaccination coverage estimates were needed in a timely fashion. The current objective is to describe and evaluate the methodology used to combine 2009 H1N1 vaccination coverage estimates from the Behavioral Risk Factor Surveillance System (BRFSS) and the National 2009 H1N1 Flu Survey (NHFS). H1N1 state level vaccination coverage estimates were combined by taking weighted averages of the BRFSS and NHFS estimates, with more weight given to the estimate with the larger effective sample size (sample size/design effect). The impact of the choice of weights was evaluated by comparing estimates when the design effect was removed from the weights. Combined vaccination coverage estimates for children generally fell midway between NHFS and BRFSS estimates because of larger NHFS sample sizes but smaller BRFSS design effects. Adult estimates were more closely weighted to BRFSS estimates because of larger BRFSS sample sizes. Combined standard errors were smaller than the survey-specific standard errors. When removing the design effect from the weights, the child combined estimates were more closely weighted to those from NHFS, resulting in larger standard errors. Adult combined estimates were similar regardless of choice of weight because of similar design effects across the two surveys. Combining estimates by weighting by the effective sample size allowed timely release of more precise estimates in all states during the 2009 H1N1 pandemic. (Copyright (c) 2012 John Wiley & Sons, Ltd.) |
Design and initiation of a study to assess the direct and indirect effects of influenza vaccine given to children in rural India
Sullender W , Fowler K , Krishnan A , Gupta V , Moulton LH , Lafond K , Widdowson MA , Lal RB , Broor S . Vaccine 2012 30 (35) 5235-9 The burden of disease due to influenza is not well characterized for children in developing countries and the effectiveness of available influenza vaccines in lower resource settings has not been established. We initiated a prospective, longitudinal, phase IV, household-randomized, controlled, observer-blinded three year study (2009-2011) in a rural community of India to measure the total and indirect household protective effects of immunizing children ages 6 months through 10 years with seasonal inactivated trivalent influenza vaccine (TIV) or a control vaccine (n=3697). Active weekly surveillance was conducted year round with home visits for identification of febrile acute respiratory illness (FARI) conducted for all vaccine recipients and household members (n=18,220). Nasal and throat swabs were collected from each FARI episode for influenza detection by real-time reverse transcription polymerase chain reaction. The primary outcome was reduction in laboratory confirmed influenza infections in the influenza vaccine versus control vaccine group, with secondary outcome assessing indirect effects among the entire study population. This report describes the study site, cluster study design, choice of study and control vaccines, and the initial enrollment in the study. |
A report template for molecular genetic tests designed to improve communication between the clinician and laboratory.
Scheuner MT , Hilborne L , Brown J , Lubin IM . Genet Test Mol Biomarkers 2012 16 (7) 761-9 AIM: Errors are most likely to occur during the pre- and postanalytic phases of the genetic testing process, which can contribute to underuse, overuse, and misuse of genetic tests. To mitigate these errors, we created a template for molecular genetic test reports that utilizes the combined features of synoptic reporting and narrative interpretation. METHODS: A variation of the Delphi consensus process with an expert panel was used to create a draft report template, which was further informed by focus group discussions with primary care physicians. RESULTS: There was agreement that molecular genetic test reports should present information in groupings that flow in a logical manner, and most participants preferred the following order of presentation: patient and physician information, test performed, test results and interpretation, guidance on next steps, and supplemental information. We define data elements for the report as "required," "optional," "possible," and "not necessary"; provide recommendations regarding the grouping of these data elements; and describe the ideal design of the report template, including the preferred order of the report sections, formatting of data, and length of the report. DISCUSSION: With input from key stakeholders and building upon prior work, we created a template for molecular genetic test reports designed to improve clinical decision making at the point of care. The template design should lead to more effective communication between the laboratory and ordering clinician. Studies are needed to assess the usefulness and effectiveness of molecular genetic test reports generated using this template. |
A smoking-associated 7-gene signature for lung cancer diagnosis and prognosis.
Wan YW , Raese RA , Fortney JE , Xiao C , Luo D , Cavendish J , Gibson LF , Castranova V , Qian Y , Guo NL . Int J Oncol 2012 41 (4) 1387-96 Smoking is responsible for 90% of lung cancer cases. There is currently no clinically available gene test for early detection of lung cancer in smokers, or an effective patient selection strategy for adjuvant chemotherapy in lung cancer treatment. In this study, concurrent coexpression with multiple signaling pathways was modeled among a set of genes associated with smoking and lung cancer survival. This approach identified and validated a 7-gene signature for lung cancer diagnosis and prognosis in smokers using patient transcriptional profiles (n=847). The smoking-associated gene coexpression networks in lung adenocarcinoma tumors (n=442) were highly significant in terms of biological relevance (network precision = 0.91, FDR<0.01) when evaluated with numerous databases containing multi-level molecular associations. The gene coexpression network in smoking lung adenocarcinoma patients was confirmed in qRT-PCR assays of the identified biomarkers and involved signaling pathway genes in human lung adenocarcinoma cells (H23) treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Furthermore, the western blotting results of p53, phosphop53, Rb and EGFR in NNK-treated H23 and transformed normal human lung epithelial cells (BEAS-2B) support their functional involvement in smoking-induced lung cancer carcinogenesis and progression. |
Evolutionary history and phylodynamics of influenza A and B neuraminidase (NA) genes inferred from large-scale sequence analyses.
Xu J , Davis CT , Christman MC , Rivailler P , Zhong H , Donis RO , Lu G . PLoS One 2012 7 (7) e38665 BACKGROUND: Influenza neuraminidase (NA) is an important surface glycoprotein and plays a vital role in viral replication and drug development. The NA is found in influenza A and B viruses, with nine subtypes classified in influenza A. The complete knowledge of influenza NA evolutionary history and phylodynamics, although critical for the prevention and control of influenza epidemics and pandemics, remains lacking. METHODOLOGY/PRINCIPAL FINDINGS: Evolutionary and phylogenetic analyses of influenza NA sequences using Maximum Likelihood and Bayesian MCMC methods demonstrated that the divergence of influenza viruses into types A and B occurred earlier than the divergence of influenza A NA subtypes. Twenty-three lineages were identified within influenza A, two lineages were classified within influenza B, and most lineages were specific to host, subtype or geographical location. Interestingly, evolutionary rates vary not only among lineages but also among branches within lineages. The estimated tMRCAs of influenza lineages suggest that the viruses of different lineages emerge several months or even years before their initial detection. The d(N)/d(S) ratios ranged from 0.062 to 0.313 for influenza A lineages, and 0.257 to 0.259 for influenza B lineages. Structural analyses revealed that all positively selected sites are at the surface of the NA protein, with a number of sites found to be important for host antibody and drug binding. CONCLUSIONS/SIGNIFICANCE: The divergence into influenza type A and B from a putative ancestral NA was followed by the divergence of type A into nine NA subtypes, of which 23 lineages subsequently diverged. This study provides a better understanding of influenza NA lineages and their evolutionary dynamics, which may facilitate early detection of newly emerging influenza viruses and thus improve influenza surveillance. |
Rotavirus vaccination programmes
Patel MM . BMJ 2012 345 e5286 In a linked research paper (doi:10.1136/bmj.e4752), Braeckman and colleagues analyse the effectiveness of a monovalent rotavirus vaccine after its routine introduction in Belgium.1 This is the first study of its kind from Europe, and the new data offer robust evidence on the effectiveness of the vaccine in a real life setting. | Public health problems are tackled by defining the extent of the problem, developing an intervention, and then deploying and evaluating the intervention. Each step is necessary for optimal control of the problem. Belgium is one of several countries that has recently implemented a nationwide rotavirus vaccination programme for controlling severe diarrhoea in children and it is currently evaluating the programme.1 | Efforts to control rotavirus began in 1973, when Ruth Bishop identified wheel shaped (rota) virus-like particles in the intestinal mucosa of infants with diarrhoea.2 In the ensuing decades rotavirus was confirmed as the main cause of severe diarrhoea in children under 5 years, accounting for nearly 40% of hospital admissions and 450 000 deaths related to diarrhoea every year.3 Several decades of research resulted in the development of two new rotavirus vaccines (monovalent and pentavalent vaccines), which are now recommended by the World Health Organization for all children worldwide.4 Around 30 countries now include rotavirus vaccines in their routine childhood immunisation programmes, with more countries intending to include them in future programmes.5 |
Variation in adult vaccination policies across Europe: an overview from VENICE network on vaccine recommendations, funding and coverage
Kanitz EE , Wu LA , Giambi C , Strikas RA , Levy-Bruhl D , Stefanoff P , Mereckiene J , Appelgren E , D'Ancona F . Vaccine 2012 30 (35) 5222-8 BACKGROUND: In 2010-2011, in the framework of the VENICE project, we surveyed European Union (EU) and Economic Area (EEA) countries to fill the gap of information regarding vaccination policies in adults. This project was carried out in collaboration with the United States National Vaccine Program Office, who conducted a similar survey in all developed countries. METHODS: VENICE representatives of all 29 EU/EEA-countries received an online questionnaire including vaccination schedule, recommendations, funding and coverage in adults for 17 vaccine-preventable diseases. RESULTS: The response rate was 100%. The definition of age threshold for adulthood for the purpose of vaccination ranged from 15 to 19 years (median=18 years). EU/EEA-countries recommend between 4 and 16 vaccines for adults (median=11 vaccines). Tetanus and diphtheria vaccines are recommended to all adults in 22 and 21 countries respectively. The other vaccines are mostly recommended to specific risk groups; recommendations for seasonal influenza and hepatitis B exist in all surveyed countries. Six countries have a comprehensive summary document or schedule describing all vaccines which are recommended for adults. None of the surveyed countries was able to provide coverage estimates for all the recommended adult vaccines. CONCLUSIONS: Vaccination policies for adults are not consistent across Europe, including the meaning of "recommended vaccine" which is not comparable among countries. Coverage data for adults should be collected routinely like for children vaccination. |
A qualitative analysis of vaccine safety perceptions and concerns among caretakers in Uganda
Braka F , Asiimwe D , Soud F , Lewis RF , Makumbi I , Gust D . Matern Child Health J 2012 16 (5) 1045-52 Parents and caretakers of young children often have concerns about vaccine safety and adverse events following immunization (AEFI). Little is known about vaccine safety perceptions in Uganda and their influence on parental decision-making about infant immunization. The study objectives were: to identify community sources of information on immunization, vaccine safety and AEFI; determine caretakers' knowledge of immunization; identify community concerns/fears about immunization and AEFI and their influence on caretakers' decisions to vaccinate; and obtain an understanding of knowledge, perceptions, and experience of health care workers (HCWs) and policy administrators on vaccine safety and AEFI. Twelve focus group discussions with 136 caretakers who were very or somewhat concerned about vaccine safety and 25 key informant interviews were conducted in two districts (1 urban and 1 rural) with district authorities and health facility staff as well as national level decision-makers between December and April 2006. Content analysis was used to analyze the results. The main themes identified related to general lack of information among caretakers about immunization, perceived immunization benefits, immunization concerns, and misconceptions. Specific caretaker concerns related to vaccine administration, immunization services and vaccine safety. Experiences with AEFI and concerns about vaccine safety negatively affected caretakers' decisions to vaccinate their children, notably in rural areas. HCWs demonstrated knowledge about AEFI and their management although incidences reported to facilities were rare. Inadequate communication between HCWs and caretakers was noted. Concerns and misconceptions about vaccination still exist among caretakers in Uganda and influence decisions to vaccinate. Effective inter personal communication initiated by HCWs towards caretakers is needed. |
Estimating the effectiveness of acellular pertussis vaccines
Misegades LK , Martin SW , Messonnier NE , Clark TA . Clin Infect Dis 2012 55 (10) 1432-3; author reply 1435-6 In the 15 June 2012 issue of Clinical Infectious Diseases, Witt et al reported that vaccine effectiveness (VE) of acellular pertussis vaccines was 41% for children aged 2–7 years, 24% for 8- to 12-year-olds, and 79% for 13- to 18-year-olds [1]. The authors conclude that their data “confirms markedly lower than expected protection afforded by the pre-school series of acellular pertussis vaccinations in the 8–12 year age group” and poor durability of protection from the vaccine. While we agree that protection wanes over time, there are important limitations to the Witt et al analysis. | VE estimates are predicated on comparing disease risk in a vaccinated group with disease risk in an unvaccinated group. When calculating VE for multiple dose vaccines, partially vaccinated persons should not be grouped with unvaccinated individuals [2, 3]. Doing so compromises the vaccine-naive comparison group and lowers VE estimates. Although the authors do not specify how undervaccinated individuals were handled in the analyses, the results presented in their Tables 1 and 2 indicate that undervaccinated and unvaccinated individuals were inappropriately categorized together, rather than excluding undervaccinated persons from the analysis. This bias explains the surprisingly low estimates in the 2 younger and combined overall age groups. |
Haemophilus influenzae type B disease and vaccine booster dose deferral, United States, 1998-2009
Briere EC , Jackson M , Shah SG , Cohn AC , Anderson RD , Macneil JR , Coronado FM , Mayer LW , Clark TA , Messonnier NE . Pediatrics 2012 130 (3) 414-20 BACKGROUND: Since the introduction of effective vaccines, the incidence of invasive Haemophilus influenzae type b (Hib) disease among children <5 years of age has decreased by 99% in the United States. In response to a limited vaccine supply that began in 2007, Hib booster doses were deferred for 18 months. METHODS: We reviewed national passive and active surveillance (demographic and serotype) and vaccination status data for invasive H. influenzae disease in children aged <5 years before (1998-2007) and during (2008-2009) the vaccine shortage years to assess the impact of the vaccine deferral on Hib disease. We estimated the average annual number of Hib cases misclassified as unknown (not completed or missing) serotype. RESULTS: From 1998 to 2007 and 2008 to 2009, the annual average incidence of Hib disease per 100,000 population was 0.2 and 0.18, respectively; no significant difference in incidence was found by age group, gender, or race. Among Hib cases in both time periods, most were unvaccinated or too young to have received Hib vaccine. During 2001 to 2009, there were <53 Hib cases per year, with an estimated 6 to 12 Hib cases misclassified as unknown serotype. CONCLUSIONS: The booster deferral did not have a significant impact on the burden of invasive Hib disease in children <5 years of age. Continued surveillance and serotype data are important to monitor changes in Hib incidence, especially during vaccine deferrals. Hib booster deferral is a reasonable short-term approach to a Hib vaccine shortage. |
Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India
Bali NK , Ashraf M , Ahmad F , Khan UH , Widdowson MA , Lal RB , Koul PA . Influenza Other Respir Viruses 2012 7 (4) 540-5 BACKGROUND: Healthcare workers (HCWs) universally have a poor uptake of influenza vaccination. However, no data are available from India. OBJECTIVE: To explore knowledge, attitudes, and practices associated with influenza vaccination in HCWs in a temperate climate area in northern India. PATIENTS AND METHODS: A self-administered questionnaire was offered to all HCWs in three major hospitals of Srinagar and information sought on motivations, perceptions, preferences and practices regarding influenza vaccination. RESULTS: Of the 1750 questionnaires received, 1421 (81%) were returned. Only 62 (4.4%) HCWs had ever received influenza vaccination even as 1348 (95%) believed that influenza poses adverse potential consequences for themselves or their contacts; 1144 (81%) were aware of a vaccine against influenza and 830 (58%) of its local availability. Reasons cited by 1359 participants for not being vaccinated included ignorance about vaccine availability (435; 32%), skepticism about efficacy (248; 18%), busy schedule (166; 12%), fear of side effects (70; 4%), and a perception of not being-at-risk (82; 6%). Sixty-one percent (865) believed that vaccine programs are motivated by profit. Eighty-eight percent opined for mandatory vaccination for HCWs caring for the high-risk patients, as a part of 'employee health program'. Most of the participants intended to get vaccinated in the current year even as 684 (48%) held that vaccines could cause unknown illness and 444 (31%) believed their adverse effects to be underreported. CONCLUSION: Influenza vaccination coverage among HCWs is dismally low in Srinagar; poor knowledge of vaccine availability and misperceptions about vaccine effectiveness, fear of adverse effects and obliviousness to being-at-risk being important barriers. Multifaceted, adaptable measures need to be invoked urgently to increase the coverage. |
An assessment of the screening method to evaluate vaccine effectiveness: the case of 7-valent pneumococcal conjugate vaccine in the United States
Cohen AL , Taylor T Jr , Farley MM , Schaffner W , Lesher LJ , Gershman KA , Bennett NM , Reingold A , Thomas A , Baumbach J , Harrison LH , Petit S , Beall B , Zell E , Moore M . PLoS One 2012 7 (8) e41785 The screening method, which employs readily available data, is an inexpensive and quick means of estimating vaccine effectiveness (VE). We compared estimates of effectiveness of heptavalent pneumococcal conjugate vaccine (PCV7) against invasive pneumococcal disease (IPD) using the screening and case-control methods. Cases were children aged 19-35 months with pneumococcus isolated from normally sterile sites residing in Active Bacterial Core surveillance areas in the United States. Case-control VE was estimated for 2001-2004 by comparing the odds of vaccination among cases and community controls. Screening-method VE for 2001-2009 was estimated by comparing the proportion of cases vaccinated to National Immunization Survey-derived coverage among the general population. To evaluate the plausibility of screening-method VE findings, we estimated attack rates among vaccinated and unvaccinated persons. We identified 1,154 children with IPD. Annual population PCV7 coverage with ≥1 dose increased from 38% to 97%. Case-control VE for ≥1 dose was estimated as 75% against all-serotype IPD (annual range: 35-83%) and 91% for PCV7-type IPD (annual range: 65-100%). By the screening method, the overall VE was 86% for ≥1 dose (annual range: -240-70%) against all-serotype IPD and 94% (annual range: 62-97%) against PCV7-type IPD. As cases of PCV7-type IPD declined during 2001-2005, estimated attack rates for all-serotype IPD among vaccinated and unvaccinated individuals became less consistent than what would be expected with the estimated effectiveness of PCV7. The screening method yields estimates of VE that are highly dependent on the time period during which it is used and the choice of outcome. The method should be used cautiously to evaluate VE of PCVs. |
Slipping and tripping: fall injuries in adults associated with rugs and carpets
Rosen T , Mack KA , Noonan R . J Inj Violence Res 2012 5 (1) 61-9 BACKGROUND: Falls are a leading cause of unintentional injury among adults age 65 years and older. Loose, unsecured rugs and damaged carpets with curled edges, are recognized environmental hazards that may contribute to falls. To characterize nonfatal, unintentional fall-related injuries associated with rugs and carpets in adults aged 65 years and older. METHODS: We conducted a retrospective analysis of surveillance data of injuries treated in hospital emergency departments (EDs) during 2001-2008. We used the National Electronic Injury Surveillance System-All Injury Program, which collects data from a nationally representative stratified probability sample of 66 U.S. hospital EDs. Sample weights were used to make national estimates. RESULTS: Annually, an estimated 37,991 adults age 65 years or older were treated in U.S. EDs for falls associated with carpets (54.2%) and rugs (45.8%). Most falls (72.8%) occurred at home. Women represented 80.2% of fall injuries. The most common location for fall injuries in the home was the bathroom (35.7%). Frequent fall injuries occurred at the transition between carpet/rug and non-carpet/rug, on wet carpets or rugs, and while hurrying to the bathroom. CONCLUSION: Fall injuries associated with rugs and carpets are common and may cause potentially severe injuries. Older adults, their caregivers, and emergency and primary care physicians should be aware of the significant risk for fall injuries and of environmental modifications that may reduce that risk. ((c) 2012 KUMS, All right reserved.) |
Adult opinions about the age at which children can be left home alone, bathe alone, or bike alone: Second Injury Control and Risk Survey (ICARIS-2)
Mack KA , Dellinger A , West BA . J Safety Res 2012 43 (3) 223-6 PROBLEM: This study describes adult opinions about child supervision during various activities. METHODS: Data come from a survey of U.S. adults. Respondents were asked the minimum age a child could safely: stay home alone; bathe alone; or ride a bike alone. Respondents with children were asked if their child had ever been allowed to: play outside alone; play in a room at home for more than 10 minutes alone; bathe with another child; or bathe alone. RESULTS: The mean age that adults believed a child could be home alone was 13.0 years (95% CI = 12.9-13.1), bathe alone was 7.5 years (95% CI = 7.4-7.6), or bike alone was 10.1 years (95% CI = 10.0-10.3). There were significant differences by income, education, and race. DISCUSSION: Assessing adult's understanding of the appropriate age for independent action helps set a context for providing guidance on parental supervision. Guidelines for parents should acknowledge social norms and child development stages. IMPACT ON INDUSTRY: Knowledge of social norms can help guide injury prevention messages for parents. |
Mutations in the West Nile prM protein affect VLP and virion secretion in vitro.
Calvert AE , Huang CY , Blair CD , Roehrig JT . Virology 2012 433 (1) 35-44 Mutation of the West Nile virus-like particle (WN VLP) prM protein (T20D, K31A, K31V, or K31T) results in undetectable VLP secretion from transformed COS-1 cells. K31 mutants formed intracellular prM-E heterodimers; however these proteins remained in the ER and ER-Golgi intermediary compartments of transfected cells. The T20D mutation affected glycosylation, heterodimer formation, and WN VLP secretion. When infectious viruses bearing the same mutations were used to infect COS-1 cells, K31 mutant viruses exhibited delayed growth and reduced infectivity compared to WT virus. Epitope maps of WN VLP and WNV prM were also different. These results suggest that while mutations in the prM protein can reduce or eliminate secretion of WN VLPs, they have less effect on virus. This difference may be due to the quantity of prM in WN VLPs compared to WNV or to differences in maturation, structure, and symmetry of these particles. |
Transcriptomics analysis of lungs and peripheral blood of crystalline silica-exposed rats
Sellamuthu R , Umbright C , Roberts JR , Chapman R , Young SH , Richardson D , Cumpston J , McKinney W , Chen BT , Frazer D , Li S , Kashon M , Joseph P . Inhal Toxicol 2012 24 (9) 570-9 Minimally invasive approaches to detect/predict target organ toxicity have significant practical applications in occupational toxicology. The potential application of peripheral blood transcriptomics as a practical approach to study the mechanisms of silica-induced pulmonary toxicity was investigated. Rats were exposed by inhalation to crystalline silica (15 mg/m(3), 6 h/day, 5 days) and pulmonary toxicity and global gene expression profiles of lungs and peripheral blood were determined at 32 weeks following termination of exposure. A significant elevation in bronchoalveolar lavage fluid lactate dehydrogenase activity and moderate histological changes in the lungs, including type II pneumocyte hyperplasia and fibrosis, indicated pulmonary toxicity in the rats. Similarly, significant infiltration of neutrophils and elevated monocyte chemotactic protein-1 levels in the lungs showed pulmonary inflammation in the rats. Microarray analysis of global gene expression profiles identified significant differential expression [>1.5-fold change and false discovery rate (FDR) p < 0.01] of 520 and 537 genes, respectively, in the lungs and blood of the exposed rats. Bioinformatics analysis of the differentially expressed genes demonstrated significant similarity in the biological processes, molecular networks, and canonical pathways enriched by silica exposure in the lungs and blood of the rats. Several genes involved in functions relevant to silica-induced pulmonary toxicity such as inflammation, respiratory diseases, cancer, cellular movement, fibrosis, etc, were found significantly differentially expressed in the lungs and blood of the silica-exposed rats. The results of this study suggested the potential application of peripheral blood gene expression profiling as a toxicologically relevant and minimally invasive surrogate approach to study the mechanisms underlying silica-induced pulmonary toxicity. |
Monitoring seasonal influenza A evolution: rapid 2009 pandemic H1N1 surveillance with an reverse transcription-polymerase chain reaction/electro-spray ionization mass spectrometry assay
Jeng K , Massire C , Zembower TR , Deyde VM , Gubareva LV , Hsieh YH , Rothman RE , Sampath R , Penugonda S , Metzgar D , Blyn LB , Hardick J , Gaydos CA . J Clin Virol 2012 54 (4) 332-6 BACKGROUND: The emergence of the pandemic H1N1 influenza strain in 2009 reinforced the need for improved influenza surveillance efforts. A previously described influenza typing assay that utilizes RT-PCR coupled to electro-spray ionization mass spectrometry (ESI-MS) played an early role in the discovery of the pandemic H1N1 influenza strain, and has potential application for monitoring viral genetic diversity in ongoing influenza surveillance efforts. OBJECTIVES: To determine the analytical sensitivity of RT-PCR/ESI-MS influenza typing assay for identifying the pandemic H1N1 strain and describe its ability to assess viral genetic diversity. STUDY DESIGN: Two sets of pandemic H1N1 samples, 190 collected between April and June of 2009, and 69 collected between October 2009 and January 2010, were processed by the RT-PCR/ESI-MS influenza typing assay, and the spectral results were compared to reference laboratory results and historical sequencing data from the Nucleotide Database of the National Center for Biotechnology Information (NCBI). RESULTS: Strain typing concordance with reference standard testing was 100% in both sample sets, and the assay demonstrated a significant increase in influenza genetic diversity, from 10.5% non-wildtype genotypes in early samples to 69.9% in late samples (P<0.001). An NCBI search demonstrated a similar increase, from 13.4% to 45.2% (P<0.001). CONCLUSIONS: This comparison of early versus late influenza samples analyzed by RT-PCR/ESI-MS demonstrates the influenza typing assay's ability as a universal influenza detection platform to provide high-fidelity pH1N1 strain identification over time, despite increasing genetic diversity in the circulating virus. The genotyping data can also be leveraged for high-throughput influenza surveillance. |
Oxidized phospholipids as biomarkers of tissue and cell damage with a focus on cardiolipin
Samhan-Arias AK , Ji J , Demidova OM , Sparvero LJ , Feng W , Tyurin V , Tyurina YY , Epperly MW , Shvedova AA , Greenberger JS , Bayir H , Kagan VE , Amoscato AA . Biochim Biophys Acta 2012 1818 (10) 2413-23 Oxidized phospholipid species are important, biologically relevant, lipid signaling molecules that usually exist in low abundance in biological tissues. Along with their inherent stability issues, these oxidized lipids present themselves as a challenge in their detection and identification. Often times, oxidized lipid species can co-chromatograph with non-oxidized species making the detection of the former extremely difficult, even with the use of mass spectrometry. In this study, a normal-phase and reverse-phase two dimensional high performance liquid chromatography (HPLC)-mass spectrometric system was applied to separate oxidized phospholipids from their non-oxidized counterparts, allowing unambiguous detection in a total lipid extract. We have utilized bovine heart cardiolipin as well as commercially available tetralinoleoyl cardiolipin oxidized with cytochrome c (cyt c) and hydrogen peroxide as well as with lipoxygenase to test the separation power of the system. Our findings indicate that oxidized species of not only cardiolipin, but other phospholipid species, can be effectively separated from their non-oxidized counterparts in this two dimensional system. We utilized three types of biological tissues and oxidative insults, namely rotenone treatment of lymphocytes to induce mitochondrial damage and cell death, pulmonary inhalation exposure to single walled carbon nanotubes, as well as total body irradiation, in order to identify cardiolipin oxidation products, critical to the cell damage/cell death pathways in these tissues following cellular stress/injury. Our results indicate that selective cardiolipin (CL) oxidation is a result of a non-random free radical process. In addition, we assessed the ability of the system to identify CL oxidation products in the brain, a tissue known for its extreme complexity and diversity of CL species. The ability of the two dimensional HPLC-mass spectrometric system to detect and characterize oxidized lipid products will allow new studies to be formulated to probe the answers to biologically important questions with regard to oxidative lipidomics and cellular insult. This article is part of a Special Issue entitled: Oxidized phospholipids - their properties and interactions with proteins. |
Improving newborn screening follow-up in pediatric practices: quality improvement innovation network.
Hinton CF , Neuspiel DR , Gubernick RS , Geleske T , Healy J , Kemper AR , Lloyd-Puryear MA , Saul RA , Thompson BH , Kaye CI . Pediatrics 2012 130 (3) e669-75 OBJECTIVE: To implement a 6-month quality improvement project in 15 primary care pediatric practices to improve short-term newborn screening (NBS) follow-up. METHODS: At the start of the project, each practice completed a survey to evaluate office systems related to NBS and completed a chart audit. Practice teams were provided information about NBS and trained in quality-improvement methods, and then implemented changes to improve care. Monthly chart audits over a 6-month period were completed to assess change. RESULTS: At baseline, almost half of practices completed assessment of infants for NBS; after 6 months, 80% of practices completed assessment of all infants. Only 2 practices documented all in-range results and shared them with parents at baseline; by completion, 10 of 15 practices documented and shared in-range results for ≥70% of infants. Use of the American College of Medical Genetics ACTion sheets, a decision support tool, increased from 1 of 15 practices at baseline to 7 of 15 at completion. CONCLUSIONS: Practices were successful in improving NBS processes, including assessment, documentation, and communication with families. Providers perceived no increase in provider time at first visit, 2- to 4-week visit, or during first contact with the family of an infant with an out-of-range result after implementation of improved processes. Primary care practices increased their use of decision support tools after the project. |
Reasons for the increasing Hispanic infant mortality rate: Florida, 2004-2007
Sauber-Schatz EK , Sappenfield W , Hernandez L , Freeman KM , Barfield W , Bensyl DM . Matern Child Health J 2012 16 (6) 1188-96 Assess whether the 55% increase in Florida's Hispanic infant mortality rate (HIMR) during 2004-2007 was real or artifactual. Using linked data from Florida resident live births and infant deaths for 2004-2007, we calculated traditional (infant Hispanic ethnicity from death certificates and maternal Hispanic ethnicity from birth certificates) and nontraditional (infant and maternal Hispanic ethnicity from birth certificate maternal ethnicity) HIMRs. We assessed trends in HIMRs (per 1,000 live births) using Chi-square statistics. We tested agreement in Hispanic ethnicity after implementation of a revised 2005 death certificate by using kappa statistics and used logistic regression to test the associations of infant mortality risk factors. Hispanic was defined as being of Mexican, Puerto Rican, Cuban, Central/South American, or other/unknown Hispanic origin. During 2004-2007 traditional HIMR increased 55%, from 4.0 to 6.2 (Chi-square, P < 0.001) and nontraditional HIMR increased 20%, from 4.5 to 5.4 (Chi-square, P = 0.03). During 2004-2005, agreement in Hispanic ethnicity did not change with use of the revised certificate (kappa = 0.70 in 2004; kappa = 0.76 in 2005). Birth weight was the most significant risk factor for trends in Hispanic infant mortality (OR = 1.33, 95% CI = 1.10-1.61). Differences in Hispanic reporting on revised death certificates likely accounted for the majority of traditional HIMR increase, indicating a primarily artifactual increase. Reasons for the 20% increase in nontraditional HIMR during 2004-2007 should be further explored through other individual and community factors. Use of nontraditional HIMRs, which use a consistent source of Hispanic classification, should be considered. |
Risk factors for neonatal sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis Trial, Soweto, South Africa
Schrag SJ , Cutland CL , Zell ER , Kuwanda L , Buchmann EJ , Velaphi SC , Groome MJ , Madhi SA . Pediatr Infect Dis J 2012 31 (8) 821-826 BACKGROUND: Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early-onset (days 0-2 of life) and late-onset (days 3-28) -sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. METHODS: Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression. RESULTS: About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (<1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis. CONCLUSIONS: Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies. |
Effects of cotrimoxazole prophylactic treatment on adverse health outcomes among HIV-exposed, uninfected infants
Dow A , Kayira D , Hudgens M , Van Rie A , King CC , Ellington S , Kourtis A , Turner AN , Meshnick S , Kacheche Z , Jamieson DJ , Chasela C , Horst CV . Pediatr Infect Dis J 2012 31 (8) 842-847 BACKGROUND: The World Health Organization guidelines recommend cotrimoxazole prophylactic treatment (CPT) for all HIV-exposed infants from age 6 weeks to the cessation of breastfeeding and the exclusion of HIV infection. There are limited data on the effects of CPT among this population of infants. We examined the effects of CPT on adverse health outcomes among HIV-exposed infants during the first 36 weeks of life using data from the Breastfeeding, Antiretrovirals and Nutrition study, a large clinical trial of antiretroviral drugs given to the mother or infant for the prevention of HIV transmission during breastfeeding. METHODS: For the analysis, we assigned a status of CPT-exposed to infants who were participating in the study after the CPT program started. We estimated unadjusted and adjusted hazard ratios for the effect of CPT status on time to incident malaria, severe illness or death, anemia, and weight-for-age Z score < -2.0. Participation in the study was limited to focus exclusively on HIV-exposed, uninfected infants. RESULTS: The hazard ratio for the effect of CPT on incident malaria was 0.35 (95% confidence interval: 0.21, 0.57) during the first 10 weeks of CPT exposure and 0.93 (95% confidence interval: 0.67, 1.29) for the remaining 20 weeks. CPT was not associated with the other outcomes examined. CONCLUSIONS: CPT offered temporary protection against malaria among HIV-exposed, uninfected infants. However, CPT offered no protection against anemia, low weight for age or the collapsed outcome of severe illness or death. |
Impact of a hygiene curriculum and the installation of simple handwashing and drinking water stations in rural Kenyan primary schools on student health and hygiene practices
Patel MK , Harris JR , Juliao P , Nygren B , Were V , Kola S , Sadumah I , Faith SH , Otieno R , Obure A , Hoekstra RM , Quick R . Am J Trop Med Hyg 2012 87 (4) 594-601 School-based hygiene and water treatment programs increase student knowledge, improve hygiene, and decrease absenteeism, however health impact studies of these programs are lacking. We collected baseline information from students in 42 schools in Kenya. We then instituted a curriculum on safe water and hand hygiene and installed water stations in half ("intervention schools"). One year later, we implemented the intervention in remaining schools. Through biweekly student household visits and two annual surveys, we compared the effect of the intervention on hygiene practices and reported student illness. We saw improvement in proper handwashing techniques after the school program was introduced. We observed a decrease in the median percentage of students with acute respiratory illness among those exposed to the program; no decrease in acute diarrhea was seen. Students in this school program exhibited sustained improvement in hygiene knowledge and a decreased risk of respiratory infections after the intervention. |
Assessing cardiovascular disease risk among young women with a history of delivering a low-birth-weight infant
Dietz PM , Kuklina EV , Bateman BT , Callaghan WM . Am J Perinatol 2012 30 (4) 267-73 OBJECTIVE: To assess the prevalence and risk factors of cardiovascular disease (CVD) among younger women by pregnancy history. METHODS: Cross-sectional study using 1999 to 2006 National Health and Nutrition Examination Survey including women aged 20 to 64 years who had delivered at least one infant (n = 4820). Women self-reported pregnancy history and a clinician diagnosed CVD; CVD risk factors included hypertension (mean systolic blood pressure [BP] ≥140 mm Hg or mean diastolic BP ≥90 mm Hg, or currently treated), high cholesterol (total cholesterol ≥240 mg/dL or currently treated), diabetes (self-report or hemoglobin A1c ≥6.5), and smoking (self-report or cotinine-verified). Multivariable logistic regression was used to assess the association between pregnancy history and CVD. RESULTS: Of the women we studied, 4.6% had CVD; 3.1% had delivered a term low-birth-weight infant (TLBWI). Women with a history of TLBWI had an adjusted odds ratio (AOR) of 2.07 (95% confidence intervals [CI] 1.08 to 3.99) for CVD compared with women without a history of LBWI. Adjustment for hypertension and high cholesterol mildly attenuated the association (AOR 1.85, 95% CI 0.89 to 3.83). Among women without CVD (n = 4555), 23.1% with a history of TLBWI had two risk factors compared with 14.0% of those without a history of LBWI (p = 0.0016).CONCLUSION: Women with a history of TLBWI should be informed of a possible increased risk of CVD and encouraged to receive screenings as recommended. |
Treatment of granulomatous amoebic encephalitis with voriconazole and miltefosine in an immunocompetent soldier
Webster D , Umar I , Kolyvas G , Bilbao J , Guiot MC , Duplisea K , Qvarnstrom Y , Visvesvara GS . Am J Trop Med Hyg 2012 87 (4) 715-8 A 38-year-old male immunocompetent soldier developed generalized seizures. He underwent surgical debulking and a progressive demyelinating pseudotumor was identified. Serology and molecular testing confirmed a diagnosis of granulomatous amoebic encephalitis caused by Acanthamoeba sp. in this immunocompetent male. The patient was treated with oral voriconazole and miltefosine with Acanthamoeba titers returning to control levels and serial imaging demonstrating resolution of the residual lesion. |
Impact of cigarette minimum price laws on the retail price of cigarettes in the USA
Tynan MA , Ribisl KM , Loomis BR . Tob Control 2012 22 e78-85 INTRODUCTION: Cigarette price increases prevent youth initiation, reduce cigarette consumption and increase the number of smokers who quit. Cigarette minimum price laws (MPLs), which typically require cigarette wholesalers and retailers to charge a minimum percentage mark-up for cigarette sales, have been identified as an intervention that can potentially increase cigarette prices. 24 states and the District of Columbia have cigarette MPLs. METHODS: Using data extracted from SCANTRACK retail scanner data from the Nielsen company, average cigarette prices were calculated for designated market areas in states with and without MPLs in three retail channels: grocery stores, drug stores and convenience stores. Regression models were estimated using the average cigarette pack price in each designated market area and calendar quarter in 2009 as the outcome variable. RESULTS: The average difference in cigarette pack prices are 46 cents in the grocery channel, 29 cents in the drug channel and 13 cents in the convenience channel, with prices being lower in states with MPLs for all three channels. CONCLUSIONS: The findings that MPLs do not raise cigarette prices could be the result of a lack of compliance and enforcement by the state or could be attributed to the minimum state mark-up being lower than the free-market mark-up for cigarettes. Rather than require a minimum mark-up, which can be nullified by promotional incentives and discounts, states and countries could strengthen MPLs by setting a simple 'floor price' that is the true minimum price for all cigarettes or could prohibit discounts to consumers and retailers. |
Provider attitudes toward clinical protocols in obstetrics
Uddin SG , Marsteller JA , Sexton JB , Will SE , Fox HE . Am J Med Qual 2012 27 (4) 335-40 The Johns Hopkins Oxytocin Protocol (JHOP) Survey was distributed to clinical labor and delivery staff to compare obstetrical providers' attitudes toward clinical protocols and the JHOP. Agreement by registered nurses (RNs), physicians in training (PIT), and attending physicians (APs) and certified nurse midwives (CNMs) was assessed with each of 4 attitudinal statements regarding whether clinical protocol and JHOP use result in better practice and are important to ensure patient safety. Odds of agreement with positive statements regarding clinical protocols did not differ significantly among groups. Odds of agreement with JHOP use resulting in better practice also did not differ significantly among provider groups. Odds of agreement with the JHOP being important to ensure patient safety were lower for the AP/CNM group compared with the RN group. Clinical protocol use is generally well received by obstetrical providers; however, differences exist in provider attitudes toward the use of an institutional oxytocin protocol. |
Relationship between adverse childhood experiences and unemployment among adults from five US states
Liu Y , Croft JB , Chapman DP , Perry GS , Greenlund KJ , Zhao G , Edwards VJ . Soc Psychiatry Psychiatr Epidemiol 2012 48 (3) 357-69 PURPOSE: Our study assesses the relationships between self-reported adverse childhood experiences (ACEs) (including sexual, physical, or verbal abuse, along with household dysfunction including parental separation or divorce, domestic violence, mental illness, substance abuse, or incarcerated household member) and unemployment status in five US states in 2009. METHODS: We examined these relationships using the 2009 Behavioral Risk Factor Surveillance System survey data from 17,469 respondents (aged 18-64 years) who resided in five states, completed the ACE Questionnaire, and provided socio-demographic and social support information. We also assessed the mediation of these relationships by respondents' educational attainment, marital status, and social support. RESULTS: About two-third of respondents reported having had at least one ACEs, while 15.1 % of men and 19.3 % of women reported having had ≥4 ACEs. Among both men and women, the unemployment rate in 2009 was significantly higher among those who reported having had any ACE than among those who reported no ACEs (p < 0.05). Educational attainment, marital status, and social support mediated the relationship between ACEs and unemployment, particularly among women. CONCLUSIONS: ACEs appear to be associated with increased risk for unemployment among men and women. Further studies may be needed to better understand how education, marital status, and social support mediate the association between multiple ACEs and unemployment. |
The role of heavy episodic drinking and hostile sexism in men's sexual aggression toward female intimate partners
Lisco CG , Parrott DJ , Tharp AT . Addict Behav 2012 37 (11) 1264-70 Research indicates that men's heavy episodic drinking is a significant risk factor for their perpetration of sexual aggression toward intimate partners. The aim of this investigation was to examine how hostile sexism (i.e., antipathy toward women) and benevolent sexism (i.e., subjectively positive, yet patriarchal, views of women) influence the relation between men's heavy episodic drinking and their perpetration of sexual aggression toward intimate partners. METHOD: Participants were 205 heterosexual drinking men who completed self-report measures of quantity of alcohol consumption during the past 12 months, hostile sexism, and sexual aggression toward an intimate partner during the past 12 months. RESULTS: Men's heavy episodic drinking was positively associated with sexual aggression perpetration toward intimate partners amongst men who endorsed high, but not low, levels of hostile sexism. No such interactive effect emerged for men's endorsement of benevolent sexism. CONCLUSIONS: These results have important implications for understanding cumulative risk factors for the perpetration of sexual aggression toward intimates. |
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