Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004-2007
Duong LM , McCarthy BJ , McLendon RE , Dolecek TA , Kruchko C , Douglas LL , Ajani UA . Cancer 2012 118 (17) 4220-7 BACKGROUND: Primary tumors of the spinal cord, spinal meninges, and cauda equina are relatively rare, and a paucity of population-based data exist on tumors in these sites. This study intends to augment the current literature by examining incidence of these tumors on a national level. METHODS: Data from central cancer registries in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs for 2004-2007 (covering 99.2% of US population) and 1999-2007 (covering 89.4% of US population) were analyzed. Analyses for diagnosis years 2004-2007 included cases of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors. Descriptive statistics including estimated age-adjusted incidence rates standardized to the 2000 US standard population were conducted for both malignant and nonmalignant primary spinal tumors from cases diagnosed during 2004-2007 as well as trend analyses on malignant cases of primary spinal tumors (n = 5103) for cases diagnosed during 1999-2007 using SEER*Stat 6.6.2 software. RESULTS: There were 2576 cases of malignant primary spinal tumors and 9136 cases of nonmalignant primary spinal tumors in 2004-2007. The incidence of malignant and nonmalignant primary spinal tumors combined differed by age, sex, race, and ethnicity. Results of trend analyses indicated that malignant primary spinal tumors have been stable throughout the 1999-2007 period. CONCLUSIONS: This large population-based study adds new insights into the descriptive epidemiology of primary spinal cord, spinal meninges, and cauda equina tumors by providing in-depth analyses of the incidence of these tumors on a national level. (Cancer 2012. (c) 2012 American Cancer Society.) |
Responding to pertussis
Clark TA . J Pediatr 2012 161 (6) 980-2 In his textbook published in 1940, Holmes noted that the “prevention of whooping cough by ordinary public health measures is almost impossible.”1 Despite the advent and universal implementation of effective pertussis vaccines in the intervening half century, in this issue of The Journal, Winter et al2 describe the largest statewide pertussis epidemic in California in more than 60 years, which is largely a recapitulation of this vexing problem. | Vaccines are licensed on the basis of safety and either demonstrated efficacy or immunogenicity known to correlate with efficacy in protecting individuals against disease. Yet, the greatest benefit of vaccines comes from applying them at public health scale to achieve both direct and indirect protection, or herd immunity. Childhood pneumococcal vaccination rapidly reduced the incidence of disease in adults, attributable to a reduction of nasopharyngeal carriage in children, who serve as a reservoir of transmission to adults.3 A shortage of Haemophilus influenzae type b vaccine resulted in a recommendation to defer the booster dose for a period of 18 months. Despite decreases in coverage, no increases in Haemophilus influenzae type b disease were observed. Although the booster dose is associated with long-term protection, sustained reductions in transmission achieved through vaccination effectively served as a blanket of protection for young children against reintroduction of the organism and return of disease.4, 5 High coverage with measles vaccine protected a sufficiently high proportion of the population to reduce susceptibility and eliminate indigenous measles transmission in the Americas.6 In each example, transmission of the causative organism was disrupted to a sufficient degree to achieve a benefit greater than the sum of the individual level of vaccine effectiveness. |
Self-reported influenza-like illness and receipt of influenza antiviral drugs during the 2009 pandemic, United States, 2009-2010
Biggerstaff M , Jhung M , Kamimoto L , Balluz L , Finelli L . Am J Public Health 2012 102 (10) e21-6 OBJECTIVES: The purpose of our study was to more accurately characterize people reporting influenza-like illness (ILI) and evaluate trends in health care seeking and influenza diagnosis and treatment during the 2009 influenza pandemic. METHODS: From September 2009 to March 2010, we ascertained ILI (fever with cough or sore throat), health care seeking, and clinical diagnosis and treatment of influenza with influenza antiviral drugs among adults in 51 jurisdictions, and ILI and health care seeking among children in 41 jurisdictions. RESULTS: Among 216,431 adults and 43,511 children, 8.1% and 28.4% reported ILI, respectively. ILI peaked during November interviews and was higher among young people and American Indian/Alaska Natives. Of those with ILI, 40% of adults and 56% of children reported seeking health care; 26% of adults who sought care reported receiving a diagnosis of influenza. Of adults reporting an influenza diagnosis, 36% were treated with influenza antiviral drugs; treatment was highest among adults aged 18 to 49 years. CONCLUSIONS: Analysis of ILI data from the Behavioral Risk Factor Surveillance System enabled a better understanding of the factors associated with self-reported ILI, health care seeking, and clinical influenza diagnosis and treatment, and will help inform year-to-year influenza trends. (Am J Public Health. Published online ahead of print August 16, 2012: e1-e6. doi:10.2105/AJPH.2012.300651). |
Tenofovir use and renal insufficiency among pregnant and general adult population of HIV-infected, ART-naive individuals in Lilongwe, Malawi
Johnson DC , Chasela C , Maliwichi M , Mwafongo A , Akinkuotu A , Moses A , Jamieson DJ , Kourtis AP , King CC , van der Horst C , Hosseinipour MC . PLoS One 2012 7 (7) e41011 BACKGROUND: The Malawian government recently changed its prevention of mother-to-child transmission (PMTCT) regimen and plans to change its first-line antiretroviral therapy (ART) regimen to Tenofovir(TDF)/Lamivudine/Efavirenz as a fixed-dose combination tablet. Implementation could be challenging if baseline creatinine clearance (CrCl) screening were required to assess renal function prior to TDF therapy. Our goal is to determine predictors of CrCl<50 ml/min among HIV-infected, ART-naive individuals. METHODOLOGY: Data on HIV-infected, ART-naive adults screened for enrollment into 5 HIV clinical trials in Lilongwe, Malawi were combined for a pooled analysis of predictors for CrCl<50 ml/min. CrCl was derived from the Cockroft-Gault equation. Multivariable logistic regression modeled the association of age, body mass index (BMI), hemoglobin, CD4 cell count <350 cells/mm(3), gender, and pregnancy with CrCl<50 ml/min. RESULTS: The analysis included 3508 patients with values for creatinine clearance. Most subjects were female (90.6%) with a median age of 26 years (IQR 22-29). The median CD4 cell count was 444 (IQR 298.0-561.0), and 85.2% percent of women in our study were pregnant. Few patients had CrCl<50 ml/min (n = 38, 1.1%). A BMI less than 18.5 in non-pregnant females (OR = 8.87, 95% CI = 2.45-32.09)) was associated with CrCl<50 ml/min. Hemoglobin level higher than 10 g/dL in males (OR = 0.69, 95% CI = 0.56-0.86) and non-pregnant females (OR = 0.21, 95% CI = 0.04-0.97) was protective against CrCl<50 ml/min. DISCUSSION: Our findings indicate few patients would be excluded from a TDF-based antiretroviral regimen, suggesting baseline creatinine clearance assessment may not be necessary for implementation. However, in ART settings individuals with low BMI or anemia could potentially be at increased risk for lower CrCl. |
Viral and bacterial causes of severe acute respiratory illness among children less than 5 years old in a high malaria prevalence area of western Kenya, 2007-2010
Feikin DR , Njenga MK , Bigogo G , Aura B , Aol G , Audi A , Jagero G , Muluare PO , Gikunju S , Nderitu L , Winchell JM , Schneider E , Erdman DD , Oberste MS , Katz MA , Breiman RF . Pediatr Infect Dis J 2012 32 (1) e14-9 BACKGROUND: Few comprehensive data exist on the etiology of severe acute respiratory illness (SARI) among African children. METHODS: From March 1, 2007, to February 28, 2010, we collected blood for culture and nasopharyngeal and oropharyngeal swabs for real-time quantitative PCR for ten viruses and three atypical bacteria among children <5 years old with SARI, defined as WHO-classified severe or very severe pneumonia or oxygen saturation <90%, who visited a clinic in rural western Kenya. We collected swabs from controls without febrile or respiratory symptoms. We calculated odds ratios (OR) for infection among cases, adjusting for age and season in logistic regression. We calculated SARI incidence, adjusting for healthcare-seeking for SARI in the community. RESULTS: 2,973 SARI cases were identified (54% inpatient, 46% outpatient), yielding an adjusted incidence of 56 cases per 100 person-years. A pathogen was detected in 3.3% of non-contaminated blood cultures; non-typhi Salmonella (1.9%) and Streptococcus pneumoniae (0.7%) predominated. A pathogen was detected in 84% of nasopharyngeal/oropharyngeal specimens, the most common being rhino/enterovirus (50%), respiratory syncytial virus (RSV, 22%), adenovirus (16%) and influenza viruses (8%). Only RSV and influenza viruses were found more commonly among cases than controls (OR 2.9, 95% CI 1.3-6.7 and OR 4.8, 95% CI 1.1-21, respectively). Incidence of RSV, influenza viruses and S. pneumoniae were 7.1, 5.8 and 0.04 cases per 100 person-years, respectively. CONCLUSIONS: Among Kenyan children with SARI, RSV and influenza virus are the most likely viral causes and pneumococcus the most likely bacterial cause. Contemporaneous controls are important for interpreting upper respiratory tract specimens. |
Outbreak of Mycobacterium chelonae infection associated with tattoo ink
Kennedy BS , Bedard B , Younge M , Tuttle D , Ammerman E , Ricci J , Doniger AS , Escuyer VE , Mitchell K , Noble-Wang JA , O'Connell HA , Lanier WA , Katz LM , Betts RF , Mercurio MG , Scott GA , Lewis MA , Goldgeier MH . N Engl J Med 2012 367 (11) 1020-4 BACKGROUND: In January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection. METHODS: We analyzed data from structured interviews with the patients, histopathological testing of skin-biopsy specimens, acid-fast bacilli smears, and microbial cultures and antimicrobial susceptibility testing. We also performed DNA sequencing, pulsed-field gel electrophoresis (PFGE), cultures of the ink and ingredients used in the preparation and packaging of the ink, assessment of source water and faucets at tattoo parlors, and investigation of the ink manufacturer. RESULTS: Between October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved. CONCLUSIONS: The premixed ink was the common source of infection in this outbreak. These findings led to a recall by the manufacturer. |
An outbreak of wild poliovirus in the Republic of Congo, 2010 - 2011
Patel MK , Konde MK , Didi-Ngossaki BH , Ndinga E , Yogolelo R , Salla M , Shaba K , Everts J , Armstrong GL , Daniels D , Burns C , Wassilak S , Pallansch M , Kretsinger K . Clin Infect Dis 2012 55 (10) 1291-8 BACKGROUND: The Republic of Congo has had no cases of wild poliovirus type 1 (WPV1) since 2000. In October 2010, a neurologist noted an abnormal number of cases of acute flaccid paralysis (AFP) among adults which were later confirmed to be caused by WPV1. METHODS: Those presenting with AFP underwent clinical history, physical examination, and clinical specimen collection to determine if they had polio. AFP cases were classified as laboratory-confirmed, clinical, or non-polio AFP. Epidemiologic features of the outbreak were analyzed. RESULTS: From September 19, 2010 to January 22, 2011, 445 WPV1 cases were reported in the ROC; 390 cases were from Pointe Noire. Overall, 331 cases were among adults; 378 cases were clinically confirmed and 64 cases were laboratory confirmed. The case fatality ratio (CFR) was 43%. Epidemiologic characteristics differed among polio cases reported in Pointe Noire and cases reported in the rest of ROC, including age distribution and CFR. The outbreak stopped after multiple vaccination rounds with oral poliovirus vaccine which targeted the entire population. CONCLUSIONS: This outbreak underscores the need to maintain high vaccination coverage to prevent outbreaks, the need to maintain timely high quality surveillance to rapidly identify and respond to any potential cases before an outbreak escalates, and the need to perform ongoing risk assessments of immunity gaps in polio-free countries. |
A population-based study of neurologic manifestations of severe influenza A(H1N1)pdm09 in California
Glaser CA , Winter K , Dubray K , Harriman K , Uyeki TM , Sejvar J , Gilliam S , Louie JK . Clin Infect Dis 2012 55 (4) 514-20 BACKGROUND: Reported influenza-associated neurologic complications are generally limited to case series or case reports. We conducted a population-based study of neurologic manifestations associated with severe and fatal influenza A(H1N1)pdm09 (2009 H1N1) cases. METHODS: Medical records of patients with fatal or severe (hospitalized in intensive care unit) laboratory-confirmed 2009 H1N1 reported to the California Department of Public Health from 15 April 2009 through 31 December 2009 were reviewed to identify those with primary neurological manifestations. Cases with secondary neurologic manifestations (eg, hypoxia) were excluded. Primary influenza-associated neurologic complications (INCs) were classified into 4 groups: encephalopathy/encephalitis, seizures, meningitis, and other. Severe 2009 H1N1-associated neurologic incidence was calculated by using estimates of 2009 H1N1 illnesses in California. RESULTS: Of 2069 reported severe or fatal 2009 H1N1 cases, 419 (20%) had neurologic manifestations. Of these, 77 (18%) met our definition of INCs: encephalopathy/encephalitis (n = 29), seizures (n = 44), meningitis (n = 3), and other (Guillain-Barre Syndrome) (n = 1). The median age was 9 years (range, 4 months-92 years); the highest rate of disease was among pediatric Asian/Pacific Islanders (12.79 per 1,000,000) compared with pediatric white, non-Hispanics (3.09 per 1,000,000), Hispanics (4.58 per 1,000,000), and blacks (6.57 per 1,000,000). The median length of stay (LOS) was 4 days (range, 1-142), and there were 4 fatalities. The estimated incidence of INCs was 1.2 per 100,000 symptomatic 2009 H1N1 illnesses. CONCLUSIONS: Influenza-associated neurologic complications were observed in 4% of patients with fatal or severe 2009 H1N1. They were observed most often in pediatric patients, and Asian/Pacific Islanders appear to be overrepresented compared with the California population. Most patients with INCs had a relatively short LOS, and there were few fatalities. |
Investigation of elevated case-fatality rate in poliomyelitis outbreak in Pointe Noire, Republic of Congo - 2010
Gregory CJ , Ndiaye S , Patel M , Hakizamana E , Wannemuehler K , Ndinga E , Chu S , Talani P , Kretsinger K . Clin Infect Dis 2012 55 (10) 1299-306 BACKGROUND: Multiple cases of paralysis, often resulting in death, occurred among young adults during a wild poliovirus (WPV) type 1 outbreak in Pointe Noire, the Republic of Congo in 2010. We conducted an investigation to identify factors associated with fatal outcomes among persons with poliomyelitis in Pointe Noire. METHODS: Polio cases were defined as AFP cases reported from October 7 to December 7, 2010 with either a stool specimen positive for WPV or clinically classified as polio-compatible. Data were obtained from medical records, hospital databases, AFP case investigation forms and, when possible, via interviews with persons with polio or surrogates using a standard questionnaire. RESULTS: Three hundred and sixty nine polio cases occurred in Pointe Noire between October 7 to December 7, 2010. Median age was 22 years for non-survivors and 18 years for survivors (P=0.01). Small home size, as defined by ≤ 2 rooms, use of a well for drinking water during a water shortage and age ≥15 years were risk factors for death in multivariate analysis. CONCLUSIONS: Consideration should be given during polio risk assessment planning and outbreak response to water/sanitation status and potential susceptibility to polio in older children and adults. Serosurveys to estimate immunity gaps in older age groups in countries at high risk of polio importation might be useful to guide preparedness and response planning. |
Clinical recognition and management of tularemia in Missouri: a retrospective chart review of 121 cases
Weber IB , Turabelidze G , Patrick S , Griffith KS , Mead PS , Kugeler KJ . Clin Infect Dis 2012 55 (10) 1283-90 BACKGROUND: Clinical recognition of tularemia is essential for initiating prompt appropriate antibiotic treatment. Although fluoroquinolones have desirable attributes as a treatment option, there are limited data on efficacy in the U.S. setting. METHODS: To define the epidemiology of tularemia in Missouri, and to evaluate practices and outcomes of tularemia management in general, we conducted a detailed retrospective review and analysis of clinical records for patients reported to the State from 2000-2007. RESULTS: We reviewed records of 121 (64%) of 190 patients reported with tularemia; 79 (65%) were males; the median age was 37 years. Most patients presented with ulceroglandular (37%) and glandular (25%) forms of tularemia, followed by pneumonic (12%), typhoidal (10%), oculoglandular (3%), and oropharyngeal (2%) forms. Most cases (69%) were attributed to tick bites. Median incubation period was 3 days (range 1-9 days), and patients sought care after a median of three days of illness (range 0-44 days). Systemic disease occurred more commonly in older patients. Patients were prescribed tetracyclines (49%), aminoglycosides (47%), and fluoroquinolones (41%). Nine of ten patients treated with ciprofloxacin for ≥ 10 days recovered uneventfully, without accompanying aminoglycosides or tetracyclines. CONCLUSIONS: Tularemia is frequently initially misdiagnosed. A thorough exposure history, particularly for tick bites, and awareness of clinical features may prompt clinicians to consider tularemia and facilitate appropriate testing. Promising success with oral fluoroquinolones could provide an acceptable alternative to intravenous aminoglycosides or long courses of tetracyclines where clinically appropriate. |
Prenatal bisphenol A exposure and child behavior in an inner-city cohort
Perera F , Vishnevetsky J , Herbstman JB , Calafat AM , Xiong W , Rauh V , Wang S . Environ Health Perspect 2012 120 (8) 1190-4 BACKGROUND: Experimental laboratory evidence suggests that bisphenol A (BPA), an endocrine disruptor, is a neurodevelopmental toxicant. However, there have been limited and inconclusive results with respect to sex-specific BPA effects on child behavior. OBJECTIVE: We examined the association between prenatal BPA exposure and child behavior, adjusting for postnatal BPA exposure and hypothesizing sex-specific effects. METHODS: We followed African-American and Dominican women and their children from pregnancy to child's age 5 years, collecting spot urine samples from the mothers during pregnancy (34 weeks on average) and from children between 3 and 4 years of age to estimate BPA exposure. We assessed child behavior between 3 and 5 years of age using the Child Behavior Checklist (CBCL) and used generalized linear models to test the association between BPA exposure and child behavior, adjusting for potential confounders. RESULTS: The analysis was conducted on 198 children (87 boys and 111 girls). Among boys, high prenatal BPA exposure (highest quartile vs. the lowest three quartiles) was associated with significantly higher CBCL scores (more problems) on Emotionally Reactive [1.62 times greater; 95% confidence interval (CI): 1.13, 2.32] and Aggressive Behavior syndromes (1.29 times greater; 95% CI: 1.09, 1.53). Among girls, higher exposure was associated with lower scores on all syndromes, reaching statistical significance for Anxious/Depressed (0.75 times as high; 95% CI: 0.57, 0.99) and Aggressive Behavior (0.82 times as high; 95% CI: 0.70, 0.97). CONCLUSION: These results suggest that prenatal exposure to BPA may affect child behavior, and differently among boys and girls. |
Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water
Yoder JS , Straif-Bourgeois S , Roy SL , Moore TA , Visvesvara GS , Ratard RC , Hill VR , Wilson JD , Linscott AJ , Crager R , Kozak NA , Sriram R , Narayanan J , Mull B , Kahler AM , Schneeberger C , da Silva AJ , Poudel M , Baumgarten KL , Xiao L , Beach MJ . Clin Infect Dis 2012 55 (9) e79-85 BACKGROUND: Naegleria fowleri is a climate-sensitive, thermophilic ameba found in the environment, including warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In 2011, 2 adults died in Louisiana hospitals of infectious meningoencephalitis after brief illnesses. METHODS: Clinical and environmental testing and case investigations were initiated to determine the cause of death and to identify the exposures. RESULTS: Both patients had diagnoses of PAM. Their only reported water exposures were tap water used for household activities, including regular sinus irrigation with neti pots. Water samples, tap swab samples, and neti pots were collected from both households and tested; N. fowleri were identified in water samples from both homes. CONCLUSIONS: These are the first reported PAM cases in the United States associated with the presence of N. fowleri in household plumbing served by treated municipal water supplies and the first reports of PAM potentially associated with the use of a nasal irrigation device. These cases occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Virginia. These infections introduce an additional consideration for physicians recommending nasal irrigation and demonstrate the importance of using appropriate water (distilled, boiled, filtered) for nasal irrigation. Furthermore, the changing epidemiology of PAM highlights the importance of raising awareness about this disease among physicians treating persons showing meningitislike symptoms. |
Screening strategies for tuberculosis prevalence surveys: the value of chest radiography and symptoms
Van't Hoog AH , Meme HK , Laserson KF , Agaya JA , Muchiri BG , Githui WA , Odeny LO , Marston BJ , Borgdorff MW . PLoS One 2012 7 (7) e38691 BACKGROUND: We conducted a tuberculosis (TB) prevalence survey and evaluated the screening methods used in our survey, to assess if screening in TB prevalence surveys could be simplified, and to assess the accuracy of screening algorithms that may be applicable for active case finding. METHODS: All participants with a positive screen on either a symptom questionnaire, chest radiography (CXR) and/or sputum smear microscopy submitted sputum for culture. HIV status was obtained from prevalent cases. We estimated the accuracy of modified screening strategies with bacteriologically confirmed TB as the gold standard, and compared these with other survey reports. We also assessed whether sequential rather than parallel application of symptom, CXR and HIV screening would substantially reduce the number of participants requiring CXR and/or sputum culture. RESULTS: Presence of any abnormality on CXR had 94% (95%CI 88-98) sensitivity (92% in HIV-infected and 100% in HIV-uninfected) and 73% (95%CI 68-77) specificity. Symptom screening combinations had significantly lower sensitivity than CXR except for 'any TB symptom' which had 90% (95%CI 84-95) sensitivity (96% in HIV-infected and 82% in HIV-uninfected) and 32% (95%CI 30-34) specificity. Smear microscopy did not yield additional suspects, thus the combined symptom/CXR screen applied in the survey had 100% (95%CI 97-100) sensitivity. Specificity was 65% (95%CI 61-68). Sequential application of first a symptom screen for 'any symptom', followed by CXR-evaluation and different suspect criteria depending on HIV status would result in the largest reduction of the need for CXR and sputum culture, approximately 36%, but would underestimate prevalence by 11%. CONCLUSION: CXR screening alone had higher accuracy compared to symptom screening alone. Combined CXR and symptom screening had the highest sensitivity and remains important for suspect identification in TB prevalence surveys in settings where bacteriological sputum examination of all participants is not feasible. |
Sentinel versus population-based surveillance of pneumococcal conjugate vaccine effectiveness
Hampton LM , Zell ER , Schrag S , Cohen AL . Bull World Health Organ 2012 90 (8) 568-77 OBJECTIVE: To compare sentinel and population-based surveillance of the effect of seven-valent pneumococcal conjugate vaccine (PCV7), introduced in 2000, on the hospitalization of children aged under 5 years with invasive pneumococcal disease (IPD) in the United States of America. METHODS: Population surveillance data were used to identify children hospitalized between 1998 and 2006 with IPD caused by Streptococcus pneumoniae serotypes. The change from 1998 and 1999 (baseline) to 2006 in the number of hospitalized IPD cases recorded by sentinel surveillance systems involving single hospitals or groups of hospitals was compared with the change in the incidence of hospitalized IPD cases measured by population-based surveillance. FINDINGS: The change in incidence in the eight surveillance areas varied from -37 to -82% for IPD caused by any serotype and from -96 to -100% for IPD caused by serotypes contained in PCV7. All individual sentinel hospitals with more than three cases annually at baseline reported a decrease in cases by 2006. In addition, over 95% of sentinel systems with an average of more than 30 cases annually at baseline recorded a change by 2006 in the number of cases caused by any serotype that fell within the 95% confidence interval for the change in the incidence of hospitalized cases in the corresponding population surveillance area. The change in cases caused by PCV7 serotypes was accurately measured by 93% and 100% of sentinel systems with ≤ 20 and > 20 cases annually at baseline, respectively. CONCLUSION: Sentinel surveillance can accurately measure the effect of PCV7 on the number of children hospitalized with IPD, provided sufficient cases are detected at baseline. Serotyping increases accuracy. |
Virological and molecular characterization of a simian human immunodeficiency virus (SHIV) encoding the envelope and reverse transcriptase genes from HIV-1.
Pal R , Galmin L , Pereira LE , Li B , Zhang J , Li D , Francis J , McNicholl JM , Weiss DE , Smith JM . Virology 2012 432 (1) 173-83 Simian-human immunodeficiency virus encoding both reverse transcriptase (RT) and envelope genes of HIV-1 (RT Env SHIV) is important for evaluating biomedical prevention modalities for HIV/AIDS. We describe virological characterization of a clade B RT Env SHIV following infection of macaques via multiple routes. In vivo passage of the RT Env SHIV through Indian rhesus macaque enhanced infectivity. Expanded virus had minimal envelope heterogeneity and was inhibited by NNRTIs and CCR5 antagonists. Infection of macaques with RT Env SHIV via mucosal or intravenous routes resulted in stable infection accompanied by peak plasma viremia of approximately 5x10(6) copies/ml that was controlled beyond set point. Molecular homogeneity of the virus was maintained following in vivo passage. Inhibition of RT Env SHIV by RT and entry inhibitors and ease of in vivo transmission make it a useful model for testing the efficacy of combinations of entry and RT inhibitors in nonhuman primates. |
Progressive vaccinia: case description and laboratory-guided therapy with vaccinia immune globulin, ST-246 and CMX001
Lederman ER , Davidson W , Groff HL , Smith SK , Warkentien T , Li Y , Wilkins KA , Karem KL , Akondy RS , Ahmed R , Frace M , Shieh WJ , Zaki S , Hruby DE , Painter WP , Bergman KL , Cohen JI , Damon IK . J Infect Dis 2012 206 (9) 1372-85 Progressive vaccinia (PV) is a rare but potentially lethal complication which develops in smallpox vaccine recipients with severely impaired cellular immunity. We report a patient with PV requiring treatment with vaccinia immune globulin and who received two investigational agents, ST-246 and CMX001. We describe the various molecular, pharmacokinetic, and immunologic studies which provided guidance to escalate and then successfully discontinue therapy. Despite development of resistance to ST-246 during treatment, the patient had resolution of his PV. This case demonstrates the need for continued development of novel anti-orthopoxvirus pharmaceuticals and the importance of both intensive and timely clinical and laboratory support in management of PV. |
H1N1 and seasonal influenza vaccination of U.S. healthcare personnel, 2010
Lu PJ , Ding H , Black CL . Am J Prev Med 2012 43 (3) 282-92 BACKGROUND: Seasonal influenza vaccination routinely has been recommended for healthcare personnel (HCP) since 1984. The influenza A (H1N1) 2009 monovalent vaccine (H1N1 vaccine) became available in the U.S. in October 2009. PURPOSE: To assess 2009 H1N1 and seasonal influenza vaccination coverage and identify factors independently associated with vaccination among HCP in the U.S. METHODS: Data from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS) influenza supplemental survey were analyzed in 2011. Multivariable logistic regression and predictive marginal models were performed to identify factors independently associated with vaccination among HCP. The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of people vaccinated. RESULTS: Among 16,975 HCP surveyed, 2009 H1N1, seasonal, and any-dose vaccination coverage were 34.1% (95% CI=32.7%, 35.5%); 52.4% (95% CI=50.9%, 53.9%); and 58.0% (95% CI=56.5%, 59.5%), respectively, all of which were significantly higher than those for non-HCP (19.1%, 34.9%, and 40.3%, respectively). The H1N1 vaccination coverage among HCP ranged from 18.4% in Mississippi to 56.1% in Massachusetts and seasonal influenza vaccination coverage ranged from 40.4% in Florida to 73.1% in Nebraska. Characteristics independently associated with an increased likelihood of 2009 H1N1, seasonal, and any-dose vaccinations among HCP were as follows: non-Hispanic white, higher income, having a high-risk condition, having health insurance, the ability to see a doctor if needed, and having had a routine checkup in the previous year. CONCLUSIONS: Vaccination coverage was higher among HCP than non-HCP but still below the national health objective of 90%. Knowledge of national and state-specific H1N1 and seasonal vaccination coverage among HCP is useful for evaluating the vaccination campaign and implementing strategies for increasing yearly seasonal vaccination coverage and improving vaccination coverage among HCP in possible future pandemics. |
7-valent pneumococcal conjugate vaccine and otitis media: effectiveness of a 2-dose versus 3-dose primary series
Stoecker C , Hampton LM , Moore MR . Vaccine 2012 30 (44) 6256-62 BACKGROUND: Seven-valent pneumococcal conjugate vaccination (PCV7) has been shown to reduce rates of otitis media (OM) when given as a 2- or 3-dose primary series followed by a booster dose. However, data on the 2- or 3-dose primary series' relative effectiveness against OM is very limited. Using data from the United States after the 2000 introduction of PCV7, we compared the effectiveness of a 2- versus a 3-dose primary series against acute otitis media (AOM). METHODS: We examined the 2002 birth cohort from the Medstat MarketScan insurance claims database and compared the incidence of AOM in children that received two or three doses in the primary PCV7 series using propensity score matching. We assessed AOM rates after completion of the primary series and before the booster dose, and after the booster dose until four years of age. RESULTS: Among the 2002 birth cohort captured by MarketScan, we identified 38,786 children we could match with immunization data; of these 8515 (22%) received a 2-dose primary series and 10,152 (26%) received a 3-dose primary series. After matching, cumulative AOM incidence between 6 and 12 months among children who did not receive a PCV7 dose between the primary series and the booster dose was 37.6% for the 2-dose series and 35.0% for the 3-dose series. This difference was not statistically significant (p=0.22). Cumulative AOM incidence between one and four years, i.e., after the booster dose, was 104.4% for the 2-dose primary series and 102.5% for the 3-dose primary series and was also statistically insignificant (p=0.87). CONCLUSION: In a population of highly-insured children, a 2-dose primary series of PCV7 appears to provide similar protection against AOM as a 3-dose primary series. These data have important implications for national immunization programs where AOM is an important driver of cost-effectiveness. |
Antiviral activity of nucleoside analogues against norovirus.
Costantini VP , Whitaker T , Barclay L , Lee D , McBrayer TR , Schinazi RF , Vinje J . Antivir Ther 2012 17 (6) 981-91 BACKGROUND: Norovirus (NoV) is the leading cause of epidemic gastroenteritis worldwide. The lack of a cell culture has significantly hampered the development of effective therapies against human NoV. Clinically approved nucleoside and non-nucleoside analogues have been used successfully against RNA viruses. METHODS: In this study, we evaluated the efficacy of four nucleoside analogues (2'-C-MeC, 2'-F-2'-C-MeC, beta-D-N(4)-hydroxycytidine [NHC] and lamivudine) on Norwalk virus (NV) RNA levels and protein expression in NV replicon-harbouring cells (HG23 cells), and their efficacy in blocking murine norovirus (MNV) replication in RAW 264.7 cells. RESULTS: 2'-C-MeC and 2'-F-2'-C-MeC reduced MNV RNA levels and infectivity in RAW 264.7 cells in a concentration- and time-dependent manner. The median effective concentrations (EC(50)) of 2'-C-MeC and 2'-F-2'-C-MeC were 6.9 mcM and 12.7 mcM, respectively. 2'-C-MeC, 2'-F-2'-C-MeC and NHC reduced NV RNA levels and protein expression in HG23 cells. For the NV replicon, the EC(50) of 2'-C-MeC (1.3 mcM) was comparable to the antiviral activity of NHC (1.5 mcM) and twofold more potent than 2'-F-2'-C-MeC (3.2 mcM). The combination of 2'-C-MeC/ribavirin resulted in modest synergistic activity, whereas NHC/ribavirin was antagonistic for NV replication in HG23 cells. CONCLUSIONS: The antiviral activity of 2'-C-MeC against strains of two different NoV genogroups and the low EC(50) suggest that this nucleoside analogue may be effective against the more prevalent GII NoVs. In the absence of a vaccine, antiviral agents could be an effective intervention to control the spread of human NoV in populations at a high risk for NoV disease. |
Pathogenicity and transmission in pigs of the novel A(H3N2)v influenza virus isolated from humans and characterization of swine H3N2 viruses isolated in 2010-2011.
Kitikoon P , Vincent AL , Gauger PC , Schlink SN , Bayles DO , Gramer MR , Darnell D , Webby RJ , Lager KM , Swenson SL , Klimov A . J Virol 2012 86 (12) 6804-14 Swine influenza virus (SIV) H3N2 with triple reassorted internal genes (TRIG) has been enzootic in Unites States since 1998. Transmission of the 2009 pandemic H1N1 (pH1N1) virus to pigs in the United States was followed by reassortment with endemic SIV, resulting in reassorted viruses that include novel H3N2 genotypes (rH3N2p). Between July and December 2011, 12 cases of human infections with swine-lineage H3N2 viruses containing the pandemic matrix (pM) gene [A(H3N2)v] were detected. Whole-genome analysis of H3N2 viruses isolated from pigs from 2009 to 2011 sequenced in this study and other available H3N2 sequences showed six different rH3N2p genotypes present in the U.S. swine population since 2009. The presence of the pM gene was a common feature among all rH3N2p genotypes, but no specific genotype appeared to predominate in the swine population. We compared the pathogenic, transmission, genetic, and antigenic properties of a human A(H3N2)v isolate and two swine H3N2 isolates, H3N2-TRIG and rH3N2p. Our in vivo study detected no increased virulence in A(H3N2)v or rH3N2p viruses compared to endemic H3N2-TRIG virus. Antibodies to cluster IV H3N2-TRIG and rH3N2p viruses had reduced cross-reactivity to A(H3N2)v compared to other cluster IV H3N2-TRIG and rH3N2p viruses. Genetic analysis of the hemagglutinin gene indicated that although rH3N2p and A(H3N2)v are related to cluster IV of H3N2-TRIG, some recent rH3N2p isolates appeared to be forming a separate cluster along with the human isolates of A(H3N2)v. Continued monitoring of these H3N2 viruses is necessary to evaluate the evolution and potential loss of population immunity in swine and humans. |
Schistosoma mansoni infection impairs anti-malaria treatment and immune responses in mosquito-borne Plasmodium coatneyi infected rhesus macaques
Semenya AA , Sullivan JS , Barnwell JW , Secor WE . Infect Immun 2012 80 (11) 3821-7 Malaria and schistosomiasis are the world's two most important parasitic infections in terms of distribution, morbidity and mortality. In areas where Plasmodium and Schistosoma species are both endemic, co-infections are commonplace. Mouse models demonstrate that schistosomaisis worsens a malaria infection; however, just as mice and humans differ greatly, the murine infecting Plasmodium species differ as much from those that infect humans. Research into human co-infections (S. haemotobium-P. falciparum versus S. mansoni-P. falciparum) has produced conflicting results. The rhesus macaque model provides a helpful tool for understanding the role of S. mansoni on malaria parasitemia and anti-malarial immune responses using P. coatneyi, a malaria species that closely resembles P. falciparum infection in humans. Eight rhesus macaques were exposed to S. mansoni cercariae. Eight weeks later, these animals plus 8 additional macaques were exposed to malaria either through bites of infected mosquitos or intravenous inoculation. When malaria infection was initiated from mosquito bites, co-infected animals displayed increased malaria parasitemia, decreased hematocrit levels, and suppressed malaria specific antibody responses compared to malaria infection alone. However, macaques infected by intravenous inoculation with erythrocytic stage parasites did not display these same differences in parasitemia, hematocrit or antibody responses between the two groups. Use of the macaque model provides information that begins to unravel differences in pathological and immunological outcomes observed between humans with P. falciparum that are co-infected with S. mansoni or S. haematobium. Our results suggest that migration of malaria parasites through livers harboring schistosome eggs may alter host immune responses and infection outcomes. |
Performance of succinylacetone assays and their associated proficiency testing outcomes
Adam BW , Hall EM , Meredith NK , Lim TH , Haynes CA , De Jesus VR , Hannon WH . Clin Biochem 2012 45 (18) 1658-63 BACKGROUND: Succinylacetone (SUAC) is the primary metabolic marker for hepatorenal tyrosinemia. MATERIALS AND METHODS: We used results reported for dried-blood-spot proficiency testing (PT) specimens and hepatorenal tyrosinemia patients' newborn screening (NBS) samples to demonstrate analytic biases in SUAC recoveries and differences in presumptive clinical classifications. RESULTS: SUAC recoveries from non-kit and NeoBase kit tandem mass spectrometry methods were markedly different. Kit users that set high cutoff values submitted discordant clinical assessments of "within normal limits" for PT specimens enriched with 10-15mcmol SUAC/L in blood. SUAC levels in tyrosinemia patients' NBS samples analyzed by NeoBase kit were lower than those in samples analyzed by non-kit methods. CONCLUSIONS: From 2009 to 2011, analytic biases in SUAC recoveries were consistent. Discordant clinical assessments of PT specimens were associated with high cutoff values for NeoBase kit results. Method-related differences in SUAC concentrations of tyrosinemia patients' samples were consistent with those of PT specimens. |
Implication of inflammatory macrophages, nuclear receptors, and interferon regulatory factors in increased virulence of pandemic 2009 H1N1 influenza A virus after host adaptation
Josset L , Belser JA , Pantin-Jackwood MJ , Chang JH , Chang ST , Belisle SE , Tumpey TM , Katze MG . J Virol 2012 86 (13) 7192-206 While pandemic 2009 H1N1 influenza A viruses were responsible for numerous severe infections in humans, these viruses do not typically cause corresponding severe disease in mammalian models. However, the generation of a virulent 2009 H1N1 virus following serial lung passage in mice has allowed for the modeling of human lung pathology in this species. Genetic determinants of mouse-adapted 2009 H1N1 viral pathogenicity have been identified, but the molecular and signaling characteristics of the host response following infection with this adapted virus have not been described. Here we compared the gene expression response following infection of mice with A/CA/04/2009 (CA/04) or the virulent mouse-adapted strain (MA-CA/04). Microarray analysis revealed that increased pathogenicity of MA-CA/04 was associated with the following: (i) an early and sustained inflammatory and interferon response that could be driven in part by interferon regulatory factors (IRFs) and increased NF-kappaB activation, as well as inhibition of the negative regulator TRIM24, (ii) early and persistent infiltration of immune cells, including inflammatory macrophages, and (iii) the absence of activation of lipid metabolism later in infection, which may be mediated by inhibition of nuclear receptors, including PPARG and HNF1A and -4A, with proinflammatory consequences. Further investigation of these signatures in the host response to other H1N1 viruses of various pathogenicities confirmed their general relevance for virulence of influenza virus and suggested that lung response to MA-CA/04 virus was similar to that following infection with lethal H1N1 r1918 influenza virus. This study links differential activation of IRFs, nuclear receptors, and macrophage infiltration with influenza virulence in vivo. |
Racial/ethnic differences in infant mortality attributable to birth defects by gestational age
Broussard CS , Gilboa SM , Lee KA , Oster M , Petrini JR , Honein MA . Pediatrics 2012 130 (3) e518-27 OBJECTIVE: Birth defects are a leading cause of infant mortality in the United States. Previous reports have highlighted black-white differences in overall infant mortality and infant mortality attributable to birth defects (IMBD). We evaluated the impact of gestational age on US racial/ethnic differences in IMBD. METHODS: We estimated the rate of IMBD (using International Classification of Diseases, 10th Revision codes for the underlying cause of death) using the period-linked birth/infant death data for US residents for January 2003 to December 2006. We excluded infants with missing gestational age, implausible values based on Alexander's index of birth weight for gestational age norms, or gestational ages <20 weeks or >44 weeks; we categorized gestational age into 3 groups: 20 to 33, 34 to 36, and 37 to 44 weeks. Using Poisson regression, we compared neonatal and postneonatal mortality attributable to birth defects for infants of non-Hispanic black and Hispanic mothers with that for infants of non-Hispanic white mothers stratified by gestational age. RESULTS: IMBD occurred in 12.2 per 10,000 live births. Among infants delivered at 37 to 44 weeks, blacks (and Hispanics, to a lesser degree) had significantly higher neonatal and postneonatal mortality attributable to birth defects than whites; however, among infants delivered at 20 to 33 or 34 to 36 weeks, neonatal (but not postneonatal) mortality attributable to birth defects was significantly lower among blacks compared with whites. CONCLUSIONS: Racial/ethnic differences in IMBD were not explained in these data by differences in gestational age. Further investigation should include an assessment of possible racial/ethnic differences in severity and/or access to timely diagnosis and management of birth defects. |
Patterns of contact with hospital for children with an autism spectrum disorder: a Danish register-based study
Atladottir HO , Schendel DE , Lauritsen MB , Henriksen TB , Parner ET . J Autism Dev Disord 2012 42 (8) 1717-28 The aim of this study was to study patterns of contact with hospital for children with autism spectrum disorder (ASD) using Danish population based register data. We included all children born in Denmark from 1994 through 2002. We found that children diagnosed with ASD had an increased rate of contact with hospital, almost regardless of the cause for the hospital contact. Given the overall association between hospital contact for various causes and ASD observed in these data, hospital data should be used cautiously in future studies searching for associations between a specific disease and ASD. If the increased rate of hospital contact overall for children with ASD is not considered, then misleading over interpretations might be made of observed associations between specific diseases and ASD. |
Preventing rapid repeat births among Latina adolescents: the role of parents
Bouris A , Guilamo-Ramos V , Cherry K , Dittus P , Michael S , Gloppen K . Am J Public Health 2012 102 (10) 1842-7 Latina adolescent parents are at increased risk for rapid repeat births (second birth ≤ 24 months after the first), sexually transmitted infections, and negative educational and social outcomes. Although several effective parent-based interventions have been developed to prevent Latino youths' sexual risk taking, little research has explored the development of interventions to prevent repeat births that involve the parents of these adolescents. Existing preventative interventions involving parents suffer from important methodological limitations. Additional research is needed to advance theories of behavior, identify the causal pathways of parental influence, and specify appropriate behavioral targets. Future parent-based interventions to prevent repeat births should target pregnancy intentions, age of partners, contraceptive use, integrated prevention of pregnancies and sexually transmitted infections, educational attainment, and future orientations. (Am J Public Health. Published online ahead of print August 16, 2012: e1-e6. doi:10.2105/AJPH.2011.300578). |
Is maternal food security a predictor of food and drink intake among toddlers in Oregon?
Cunningham TJ , Barradas DT , Rosenberg KD , May AL , Kroelinger CD , Ahluwalia IB . Matern Child Health J 2012 16 Suppl 2 339-46 Food insecurity has detrimental effects on the mental, physical, and behavioral health of developing children. Few studies, however, have sought to determine whether associations exist between food insecurity and intake of vegetables, fresh or canned fruit, candy or cookies, French fries, fast food, water, milk, fruit juices, fruit drinks, soda, and sports drinks. To identify independent associations that exist between maternal food insecurity and food and drink intake among toddlers, population-based data from the 2006-2008 Oregon Pregnancy Risk Assessment Monitoring System follow-back survey (Oregon PRAMS-2) of 1,522 mothers of 2-year-old children were analyzed. Maternal food insecurity was defined as mothers' report of eating less because of lack of money for food. Typical weekly child food and drink intake was examined using polytomous logistic regression: 0-1 days/week, 2-3 days/week, and 4-7 days/week. Maternal food insecurity prevalence was 11.7 %. Compared to toddlers of food secure mothers, toddlers of food insecure mothers consumed vegetables (adjusted odds ratio [AOR] for 4-7 days/week = 0.31; 95 % confidence interval [CI] 0.12, 0.79) and fruit (AOR for 4-7 days/week = 0.25; 95 % CI 0.08, 0.75) fewer days of the week. Toddlers of food insecure mothers consumed soda (AOR for 4-7 days/week = 3.21; 95 % CI 1.12, 9.14) more days of the week. Maternal food insecurity is associated with weekly intake of certain foods and drinks. Among toddlers, consumption of fewer vegetables and fruit, and more soda may help explain the link between food insecurity and poor health. |
The use of biomarkers in occupational health research, practice, and policy
Schulte PA , Hauser JE . Toxicol Lett 2012 213 (1) 91-9 Biomarkers are potentially useful tools for occupational health and safety research, practice, and policy. However, the full realization of this potential has not been achieved. In this paper, the progress made in these three usage areas is reviewed to identify what efforts can be taken to realize the full promise of biomarkers. Biomarker uses are described by a diverse taxonomy that builds on the categories of exposure, effect and susceptibility, and the continuum between exposure and disease prognosis. The most significant uses of biomarkers in occupational health have been in biological monitoring of workers. Other important uses have been in enhancing research and assessing mechanisms of action of occupational toxicants at low exposures. Seven critical areas will influence the extent to which the potential of biomarkers in occupational health and safety is realized. These include: (1) adequate investment in validation; (2) obtaining international agreement on exposure guidelines; (3) exploring the utility of biomarkers in regulation; (4) applying biomarkers to critical occupational safety and health questions; (5) developing the exposome; (6) utilizing biomarkers to address emerging occupational health issues; and (7) continuing to address the ethical and social justice issues related to biomarkers. Overall, if biomarkers are to make a major contribution to occupational health and safety then a more holistic approach to bringing them from the laboratory to practice will be needed. |
Prevalence rates of work organization characteristics among workers in the U.S.: data from the 2010 National Health Interview Survey
Alterman T , Luckhaupt SE , Dahlhamer JM , Ward BW , Calvert GM . Am J Ind Med 2012 56 (6) 647-59 BACKGROUND: Surveillance is needed to capture work organization characteristics and to identify their trends. METHODS: Data from the 2010 National Health Interview Survey (NHIS) were used to calculate prevalence rates for four work organization characteristics (long work hours, non-standard work arrangements, temporary positions, and alternative shifts) overall, and by demographic characteristics, and industry and occupation of current/recent employment. RESULTS: Data were available for 27,157 adults, of which 65% were current/recent workers. Among adults who worked in the past 12 months, 18.7% worked 48 hr or more per week, 7.2% worked 60 hr or more per week, 18.7% had non-standard work arrangements, 7.2% were in temporary positions, and 28.7% worked an alternative shift. CONCLUSIONS: Prevalence rates of work organization characteristics are provided. These national estimates can be used to help occupational health professionals and employers to identify emerging occupational safety and health risks, allow researchers to examine associations with health, and use the data for benchmarking. (Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
The economic burden of all-terrain vehicle related adult deaths in the U.S. workplace, 2003-2006
Helmkamp JC , Biddle E , Marsh SM , Campbell CR . J Agric Saf Health 2012 18 (3) 233-43 The objective of this study was to estimate the societal economic burden associated with work-related ATV fatalities among civilian persons more than 17 years of age in the U.S. from 2003 through 2006. ATV death data were obtained from the Bureau of Labor Statistics' annual Census of Fatal Occupational Injuries. Costs were estimated using a model employing a cost-of-illness method developed by the National Institute for Occupational Safety and Health. From 2003 to 2006, a total of 129 work-related ATV deaths occurred among persons more than 17 years of age in the U.S., nearly doubling from 20 deaths in 2003 to 39 deaths in 2006. The collective lifetime cost of the deaths was $103.6 million (M), with a four-year mean of $803,100 and a four-year median of $772,100. Decedents age 35 to 54 years accounted for one-third of the deaths (n = 41) at a cost of $50.1 M. Montana had the most deaths (13). Fifty-two percent of the deaths were overturns costing $48.3 M. Eighty-four (65%) of the deaths were workers in agricultural production at a cost of $62.3 M. Short-term investment in prevention measures, such as training and helmets for workers, could provide lasting dividends by preventing work-related ATV deaths and reducing their economic impact. |
The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort
Pietrzak RH , Schechter CB , Bromet EJ , Katz CL , Reissman DB , Ozbay F , Sharma V , Crane M , Harrison D , Herbert R , Levin SM , Luft BJ , Moline JM , Stellman JM , Udasin IG , Landrigan PJ , Southwick SM . J Psychiatr Res 2012 46 (7) 835-42 BACKGROUND: This study examined the prevalence, correlates, and perceived mental healthcare needs associated with subsyndromal PTSD in police involved in the World Trade Center (WTC) rescue and recovery effort. METHODS: A total of 8466 police completed an interview/survey as part of the WTC Medical monitoring and Treatment Program an average of four years after 9/11/2001. RESULTS: The past month prevalence of full and subsyndromal WTC-related PTSD was 5.4% and 15.4%, respectively. Loss of someone or knowing someone injured on 9/11 (odds ratios [ORs]=1.56-1.86), pre-9/11 stressors (ORs=1.30-1.50), family support (ORs=0.83-0.94), and union membership (ORs=0.50-0.52) were associated with both full and subsyndromal PTSD. Exposure to the dust cloud (OR=1.36), performing search and rescue work (OR=1.29), and work support (OR=0.89) were additionally associated with subsyndromal PTSD. Rates of comorbid depression, panic disorder, and alcohol use problems (ORs=3.82-41.74), and somatic symptoms and functional difficulties (ORs=1.30-1.95) were highest among police with full PTSD, with intermediate rates among police with subsyndromal PTSD (ORs=2.93-7.02; and ORs=1.18-1.60, respectively). Police with full and subsyndromal PTSD were significantly more likely than controls to report needing mental healthcare (41.1% and 19.8%, respectively, versus 6.8% in trauma controls). CONCLUSIONS: These results underscore the importance of a more inclusive and dimensional conceptualization of PTSD, particularly in professions such as police, as operational definitions and conventional screening cut-points may underestimate the psychological burden for this population. Accordingly, psychiatric clinicians should assess for disaster-related subsyndromal PTSD symptoms in disaster response personnel. |
Development of risk-based nanomaterial groups for occupational exposure control
Kuempel ED , Castranova V , Geraci CL , Schulte PA . J Nanopart Res 2012 14 1029 Given the almost limitless variety of nanomaterials, it will be virtually impossible to assess the possible occupational health hazard of each nanomaterial individually. The development of science-based hazard and risk categories for nanomaterials is needed for decision-making about exposure control practices in the workplace. A possible strategy would be to select representative (benchmark) materials from various mode of action (MOA) classes, evaluate the hazard and develop risk estimates, and then apply a systematic comparison of new nanomaterials with the benchmark materials in the same MOA class. Poorly soluble particles are used here as an example to illustrate quantitative risk assessment methods for possible benchmark particles and occupational exposure control groups, given mode of action and relative toxicity. Linking such benchmark particles to specific exposure control bands would facilitate the translation of health hazard and quantitative risk information to the development of effective exposure control practices in the workplace. A key challenge is obtaining sufficient dose-response data, based on standard testing, to systematically evaluate the nanomaterials' physical-chemical factors influencing their biological activity. Categorization processes involve both science-based analyses and default assumptions in the absence of substance-specific information. Utilizing data and information from related materials may facilitate initial determinations of exposure control systems for nanomaterials. (2012 Springer Science+Business Media B.V. (outside the USA).) |
A new taxonomy for stakeholder engagement in patient-centered outcomes research
Concannon TW , Meissner P , Grunbaum JA , McElwee N , Guise JM , Santa J , Conway PH , Daudelin D , Morrato EH , Leslie LK . J Gen Intern Med 2012 27 (8) 985-91 Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach. |
Evaluation of bleeding disorders in women with menorrhagia: a survey of obstetrician-gynecologists
Byams VR , Anderson BL , Grant AM , Atrash H , Schulkin J . Am J Obstet Gynecol 2012 207 (4) 269 e1-5 OBJECTIVE: To better understand the current evaluation of unexplained menorrhagia by obstetrician-gynecologists and the extent to which a bleeding disorder diagnosis is being considered in this population. STUDY DESIGN: A total of 1200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population and their evaluation of patients with unexplained menorrhagia. RESULTS: The overall response rate was 42.4%. Eighty-two percent of respondents reported having seen patients with menorrhagia caused by a bleeding disorder. Seventy-seven percent of physicians reported they would be likely or very likely to consider a bleeding disorder as causing menorrhagia in adolescent patients; however, only 38.8% would consider bleeding disorders in reproductive age women. CONCLUSION: The current data demonstrate that obstetrician-gynecologists seem to have a relatively high awareness of bleeding disorders as a potential underlying cause of menorrhagia. |
Expedited partner therapy for sexually transmitted infections
Hogben M , Kidd S , Burstein GR . Curr Opin Obstet Gynecol 2012 24 (5) 299-304 PURPOSE OF REVIEW: In 2006, the Centers for Disease Control and Prevention recommended Expedited Partner Therapy (EPT) as a clinical option for assuring treatment of sex partners of persons infected with sexually transmitted infections. In this review, we provide an update on research, evaluation and efforts to increase EPT coverage. We also attend to EPT for gonorrhea in the context of antimicrobial resistance. RECENT FINDINGS: Controlled trials in the United States and United Kingdom have presented increasing variety in intervention approaches. Trials and program evaluations typically demonstrate increased partner treatment rates, although only some studies show reductions in follow-up infection rates. Coverage has increased substantially, with over 30 states permitting EPT for chlamydial infection, gonorrhea, or both. The prospect of cephalosporin-resistant gonorrhea, however, raises the prospect that EPT may become less feasible as a partner treatment approach for gonorrhea patients. SUMMARY: Clinicians should continue to be aware of the importance of partner managements for STD-infected patients, with EPT being an evidence-based intervention in that respect. The variety in EPT models provides alternatives that may suit some practices and venues. For clinicians seeing gonorrhea patients, effective counseling models - enhanced patient referral - should be closely examined in case oral treatment for gonorrhea becomes infeasible. |
Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index
Fiebelkorn AP , Person B , Quick RE , Vindigni SM , Jhung M , Bowen A , Riley PL . Soc Sci Med 2012 75 (4) 622-33 Point-of-use water treatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use water treatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index. We used 22 key words to search peer-reviewed literature from 1950 to 2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use water treatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the water treatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation. In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions. Seven (27%) papers reported high sustained use of point-of-use water treatment with rates >50% at the last recorded follow-up. Despite documented health benefits of point-of-use water treatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation methodology. The scarcity of papers on behavior change with respect to point-of-use water treatment technologies suggests that this field is underdeveloped. |
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