A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure
Butz AM , Matsui EC , Breysse P , Curtin-Brosnan J , Eggleston P , Diette G , Williams D , Yuan J , Bernert JT , Rand C . Arch Pediatr Adolesc Med 2011 165 (8) 741-8 OBJECTIVE: To test an air cleaner and health coach intervention to reduce secondhand smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter (PM), air nicotine, and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker. DESIGN: Randomized controlled trial, with randomization embedded in study database. SETTINGS: The Johns Hopkins Hospital Children's Center and homes of children. PARTICIPANTS: Children with asthma, residing with a smoker, randomly assigned to interventions consisting of air cleaners only (n = 41), air cleaners plus a health coach (n = 41), or delayed air cleaner (control) (n = 44). MAIN OUTCOME MEASURES: Changes in PM, air nicotine, and urine cotinine concentrations and symptom-free days during the 6-month study. RESULTS: The overall follow-up rate was high (91.3%). Changes in mean fine and coarse PM (PM(2.5) and PM(2.5-10)) concentrations (baseline to 6 months) were significantly lower in both air cleaner groups compared with the control group (mean differences for PM(2.5) concentrations: control, 3.5 mcg/m(3); air cleaner only, -19.9 mcg/m(3); and air cleaner plus health coach, -16.1 mcg/m(3); P = .003; and PM(2.5-10) concentrations: control, 2.4 mcg/m(3); air cleaner only, -8.7 mcg/m(3); and air cleaner plus health coach, -10.6 mcg/m(3); P = .02). No differences were noted in air nicotine or urine cotinine concentrations. The health coach provided no additional reduction in PM concentrations. Symptom-free days were significantly reduced in both air cleaner groups compared with the control group (P = .03). CONCLUSION: Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke. Trial Registration clinicaltrials.gov Identifier: NCT00466024. |
Diabetes performance measures: current status and future directions
O'Connor PJ , Bodkin NL , Fradkin J , Glasgow RE , Greenfield S , Gregg E , Kerr EA , Pawlson LG , Selby JV , Sutherland JE , Taylor ML , Wysham CH . Diabetes Care 2011 34 (7) 1651-9 Just as treatment guidelines for diabetes care were at the forefront of medical guideline development (1), diabetes has been a prominent focus of performance measurement and quality improvement initiatives for well over a decade. However, the constraints of pre-electronic health records (EHRs) data systems have consistently limited the clinical scope and sophistication of current diabetes quality measures. The U.S. health care system is nearing a tipping point in the use of more sophisticated EHR-based information systems, and widespread use of these systems will usher in a new era for diabetes quality measurement. New information system capabilities will enable improvements to existing measures and enable development of much more sophisticated measures that can accommodate personalization of clinical goals, patient preferences, and patient-reported data, thus moving both guidelines and measures toward personalization based on sophisticated assessment of the risks and benefits of certain clinical actions for a given patient at a given clinical encounter. | To facilitate discussion of the future of performance measurement in diabetes in this era of rapid transition to EHRs, the American Diabetes Association (ADA) convened a consensus development conference in December 2010. Participating experts identified and discussed the following questions: | 1. | What is the evidence that measuring quality, benchmarking, and providing feedback or incentives improve diabetes care? | 2. | What are the limitations, burdens, and consequences (intended or unintended) of diabetes quality measures as currently structured? | 3. | What should be the role of shared decision making, patient preferences, and patient-reported data in quality measures? | 4. | What is the future of quality measurement in diabetes? | 5. | How can quality monitoring be integrated into population surveillance efforts? | This report summarizes the consensus meeting, and represents the expert opinion of its authors and not the official position of the ADA or any other participating organization. |
Demographic but not geographic insularity in HIV transmission among young black MSM.
Oster AM , Pieniazek D , Zhang X , Switzer WM , Ziebell RA , Mena LA , Wei X , Johnson KL , Singh SK , Thomas PE , Elmore KA , Heffelfinger JD . AIDS 2011 25 (17) 2157-65 OBJECTIVE: To understand patterns of HIV transmission among young black men who have sex with men (MSM) and others in Mississippi. DESIGN: Phylogenetic analysis of HIV-1 polymerase (pol) sequences from 799 antiretroviral-naive persons newly diagnosed with HIV infection in Mississippi during 2005-2008, 130 (16%) of whom were black MSM aged 16-25 years. METHODS: We identified phylogenetic clusters and used surveillance data to evaluate demographic attributes and risk factors of all persons in clusters that included black MSM aged 16-25 years. RESULTS: We identified 82 phylogenetic clusters, 21 (26%) of which included HIV strains from at least one young black MSM. Of the 69 persons in these clusters, 59 were black MSM and 7 were black men with unknown transmission category; the remaining three were MSM of white or Hispanic race/ethnicity. Of these 21 clusters, 10 included residents of one geographic region of Mississippi, whereas 11 included residents of multiple regions or outside of the state. CONCLUSIONS: Phylogenetic clusters involving HIV-infected young black MSM were homogeneous with respect to demographic and risk characteristics, suggesting insularity of this population with respect to HIV transmission, but were geographically heterogeneous. Reducing HIV transmission among young black MSM in Mississippi may require prevention strategies that are tailored to young black MSM and those in their sexual networks, and prevention interventions should be delivered in a manner to reach young black MSM throughout the state. Phylogenetic analysis can be a tool for local jurisdictions to understand the transmission dynamics in their areas. |
Genotypic distribution of hepatitis B virus (HBV) among acute cases of HBV infection, selected United States counties, 1999-2005.
Teshale EH , Ramachandran S , Xia GL , Roberts H , Groeger J , Barry V , Hu DJ , Holmberg SD , Holtzman D , Ward JW , Teo CG , Khudyakov Y . Clin Infect Dis 2011 53 (8) 751-6 BACKGROUND: Knowledge of the genotypic distribution of hepatitis B virus (HBV) facilitates epidemiologic tracking and surveillance of HBV infection as well as prediction of its disease burden. In the United States, HBV genotyping studies have been conducted for chronic but not acute hepatitis B. METHODS: Serum samples were collected from patients with acute hepatitis B cases reported from the 6 counties that participated in the Sentinel Counties Study of Acute Viral Hepatitis from 1999 through 2005. Polymerase chain reaction followed by nucleotide sequencing of a 435-base pair segment of the HBV S gene was performed, and the sequences were phylogenetically analyzed. RESULTS: Of 614 patients identified with available serum samples, 75% were infected with genotype A HBV and 18% were infected with genotype D HBV. Thirty-two percent of genotype A sequences constituted a single subgenotype A2 cluster. The odds of infection with genotype A (vs with genotype D) were 5 times greater among black individuals than among Hispanic individuals (odds ratio [OR], 5; 95% confidence interval [CI], 2.3-10.7). The odds of infection with genotype A were 49, 8, and 4 times greater among patients from Jefferson County (Alabama), Pinellas County (Florida), and San Francisco (California), respectively, than among those living in Denver County (Colorado). Genotype A was less common among recent injection drug users than it was among non-injection drug users (OR, 0.2; 95% CI, 0.1-0.4). CONCLUSIONS: HBV genotype distribution was significantly associated with ethnicity, place of residence, and risk behavior. |
Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis
Van Kerkhove MD , Vandemaele KA , Shinde V , Jaramillo-Gutierrez G , Koukounari A , Donnelly CA , Carlino LO , Owen R , Paterson B , Pelletier L , Vachon J , Gonzalez C , Hongjie Y , Zijian F , Chuang SK , Au A , Buda S , Krause G , Haas W , Bonmarin I , Taniguichi K , Nakajima K , Shobayashi T , Takayama Y , Sunagawa T , Heraud JM , Orelle A , Palacios E , van der Sande MA , Wielders CC , Hunt D , Cutter J , Lee VJ , Thomas J , Santa-Olalla P , Sierra-Moros MJ , Hanshaoworakul W , Ungchusak K , Pebody R , Jain S , Mounts AW . PLoS Med 2011 8 (7) e1001053 BACKGROUND: Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures. METHODS AND FINDINGS: Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions-Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom-to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients <5 y and 5-14 y (relative risk [RR] = 3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50-64 y and ≥65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the ≥65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be a risk factor for ICU admission and fatal outcome (RR = 36.3). CONCLUSIONS: Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes. Please see later in the article for the Editors' Summary. |
Seroprevalence and correlates of hepatitis A among HIV-negative American men who have sex with men
Bialek SR , Barry V , Bell BP , Valleroy LA , Behel S , Mackellar DA , Secura G , Thiede H , McFarland W , Ford WL , Bingham TA , Shehan DA , Celentano DD . Sex Health 2011 8 (3) 343-8 BACKGROUND: Hepatitis A outbreaks are well documented among men who have sex with men (MSM). This analysis examines characteristics associated with hepatitis A virus (HAV) infection among a large group of young adult MSM from five USA cities. METHODS: The Young Men's Survey was a cross-sectional prevalence study of HIV infection and related behavioural risk factors among MSM aged 15-29 years during 1994-2000. Serum specimens from HIV-negative participants were retrospectively tested for antibodies to HAV (anti-HAV). Data were stratified by ethnicity and analysed with logistic regression. RESULTS: Overall anti-HAV prevalence was 18.4% among the 2708 participants, and varied by ethnicity from 6.9 to 45.3% and was highest among Hispanic and Asian men (P < 0.001). Prevalence increased with age across all racial/ethnic groups. Among white men, anti-HAV positivity was associated with having 20 or more lifetime male sex partners for those aged 15-22 years (adjusted odds ratio (AOR)=2.1, 95% confidence interval (CI)=1.0-4.1) and ever having had unprotected anal sex for those aged 23-29 years (AOR=2.4, 95% CI=1.2-4.5). CONCLUSIONS: Factors associated with a history of HAV infection among MSM in non-outbreak settings are probably similar to those among non-MSM. MSM are still at risk for HAV infection as a result of outbreaks occurring in MSM communities. Additional studies of hepatitis A vaccination coverage are needed to determine if strategies to vaccinate MSM are adequate. |
Placental malaria and mother-to-child transmission of human immunodeficiency virus-1 in rural Rwanda
Bulterys PL , Chao A , Dalai SC , Zink MC , Dushimimana A , Katzenstein D , Saah AJ , Bulterys M . Am J Trop Med Hyg 2011 85 (2) 202-206 We conducted a nested case-control study of placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1) within a prospective cohort of 627 mother-infant pairs followed from October 1989 until April 1994 in rural Rwanda. Sixty stored placentas were examined for PM and other placental pathology, comparing 20 HIV-infected mother-infant (perinatal transmitter) pairs, 20 HIV-uninfected pairs, and 20 HIV-infected mothers who did not transmit to their infant perinatally. Of 60 placentas examined, 45% showed evidence of PM. Placental malaria was associated with increased risk of MTCT of HIV-1 (adjusted odds ratio [aOR] = 6.3; 95% confidence interval [CI] = 1.4-29.1), especially among primigravidae (aOR = 12.0; 95% CI = 1.0-150; P < 0.05). Before antiretroviral therapy or prophylaxis, PM was associated with early infant HIV infection among rural Rwandan women living in a hyper-endemic malaria region. Primigravidae, among whom malaria tends to be most severe, may be at higher risk. |
Prevention of HIV-1 infection with early antiretroviral therapy
Cohen MS , Chen YQ , McCauley M , Gamble T , Hosseinipour MC , Kumarasamy N , Hakim JG , Kumwenda J , Grinsztejn B , Pilotto JH , Godbole SV , Mehendale S , Chariyalertsak S , Santos BR , Mayer KH , Hoffman IF , Eshleman SH , Piwowar-Manning E , Wang L , Makhema J , Mills LA , de Bruyn G , Sanne I , Eron J , Gallant J , Havlir D , Swindells S , Ribaudo H , Elharrar V , Burns D , Taha TE , Nielsen-Saines K , Celentano D , Essex M , Fleming TR . N Engl J Med 2011 365 (6) 493-505 BACKGROUND: Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. METHODS: In nine countries, we enrolled 1763 couples in which one partner was HIV-1-positive and the other was HIV-1-negative; 54% of the subjects were from Africa, and 50% of infected partners were men. HIV-1-infected subjects with CD4 counts between 350 and 550 cells per cubic millimeter were randomly assigned in a 1:1 ratio to receive antiretroviral therapy either immediately (early therapy) or after a decline in the CD4 count or the onset of HIV-1-related symptoms (delayed therapy). The primary prevention end point was linked HIV-1 transmission in HIV-1-negative partners. The primary clinical end point was the earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death. RESULTS: As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years; 95% confidence interval [CI], 0.9 to 1.7); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years, 95% CI, 0.6 to 1.3). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04; 95% CI, 0.01 to 0.27; P<0.001). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59; 95% CI, 0.40 to 0.88; P=0.01). CONCLUSIONS: The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events, indicating both personal and public health benefits from such therapy. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 052 ClinicalTrials.gov number, NCT00074581.). |
Early use of glucocorticoids was a risk factor for critical disease and death from pH1N1 infection
Han K , Ma H , An X , Su Y , Chen J , Lian Z , Zhao J , Zhu BP , Fontaine RE , Feng Z , Zeng G . Clin Infect Dis 2011 53 (4) 326-33 BACKGROUND: Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk. METHODS: We enrolled all patients with confirmed pandemic influenza A (pH1N1) virus infection aged ≥3 years with available medical records at 4 Shenyang City hospitals from 20 October to 30 November 2009. A critical patient was any confirmed, hospitalized pH1N1 patient who developed ≥1 of the following: death, respiratory failure, septic shock, failure or insufficiency of ≥2 nonpulmonary organs, mechanical ventilation, or ICU admission. In a retrospective cohort study, we evaluated the risk of developing critical illness in relation to early (≤72 hours of influenza-like illness [ILI] onset) glucocorticoids treatment. RESULTS: Of the 83 hospitalized case-patients, 46% developed critical illness, 17% died, and 37% recovered and were discharged. Critically ill and other patients did not differ by underlying conditions and severity, median temperature at first clinic visit, and other measured risk factors. Of 17 patients who received early glucocorticoid treatment, 71% subsequently developed critical disease compared with 39% of 66 patients who received late (>72 hours) or no glucocorticoid treatment (RR(M-H) = 1.8, 95% CI = 1.2-2.8, after adjusting for 2 summary variables; ie, presence of underlying diseases and presence of underlying risk factors). Proportional hazards modeling showed that use of glucocorticoids tripled the hazard of developing critical disease (hazard ratio [HR] = 2.9, 95% CI = 1.3-6.2, after adjusting for the same summary variables). CONCLUSIONS: Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced. |
Determinants of early and late mortality among HIV-infected individuals receiving home-based antiretroviral therapy in rural Uganda
Moore DM , Yiannoutsos CT , Musick BS , Tappero J , Degerman R , Campbell J , Were W , Kaharuza F , Alexander LN , Downing R , Mermin J . J Acquir Immune Defic Syndr 2011 58 (3) 289-96 BACKGROUND: Up to 20% of people initiating antiretroviral therapy (ART) in sub- Saharan Africa die during the first year of treatment. Understanding the clinical conditions associated with mortality could potentially lead to effective interventions to prevent these deaths. METHODS: We examined data from participants aged ≥18 years in the Home-Based AIDS Care project in Tororo, Uganda, to describe mortality over time and to determine clinical conditions associated with death. Survival analysis was used to examine variables associated with mortality at baseline and during follow-up. RESULTS: A total of 112 (9.4%) deaths occurred in 1,132 subjects (73% women) during a median of 3.0 years of ART. Mortality was 15.9 per 100 person-years (PYR) during the first 3 months and declined to 0.3 per 100 PYR beyond 24 months after ART initiation. Tuberculosis (TB) was the most common condition associated with death (21% of deaths), followed by Candida disease (15%). In 43% of deaths no specific clinical diagnosis was identified. Deaths within 3 months after ART initiation were associated with WHO clinical stage III or IV at baseline, diagnosis of TB at baseline, a diagnosis of a non-TB opportunistic infection (OI) in follow-up and a body mass index (BMI) ≤ 17 kg/m during follow-up. Mortality after 3 months of ART was associated with CD4 cell counts <200 cells/mcL, a diagnosis of TB or other OI, adherence to therapy <95%, and low hemoglobin levels during follow-up. CONCLUSION: Potentially remediable conditions and preventable infections were associated with mortality while receiving ART in Uganda. |
Recipients of hyperbaric oxygen treatment for carbon monoxide poisoning and exposure circumstances
Clower JH , Hampson NB , Iqbal S , Yip FY . Am J Emerg Med 2011 30 (6) 846-51 BACKGROUND: Unintentional carbon monoxide poisoning is preventable. Severe cases are often referred for hyperbaric oxygen treatment. To guide prevention efforts and treatment practices, this study provides some of the most detailed current information about patients with carbon monoxide poisoning who have been treated at hyperbaric facilities across the United States and the circumstances surrounding their exposures. This study can help improve efforts to prevent carbon monoxide poisoning and enhance treatment practices. METHODS: From August 2008 to January 2010, nonidentifiable, patient-level data were reported by 87 hyperbaric facilities in 39 states via an online reporting system. This reporting system was developed collaboratively by the Undersea and Hyperbaric Medical Society and the Centers for Disease Control and Prevention. RESULTS: Among the 864 patients reported to receive hyperbaric oxygen treatment for unintentional, non-fire-related, carbon monoxide poisoning, most of the patients were white men aged between 18 and 44 years. Only 10% of patients reported the presence of a carbon monoxide alarm at their exposure location, and 75% reported being part of a group exposure. Nineteen patients (2%) reported a prior carbon monoxide exposure. About half (55%) of the patients treated were discharged after treatment; 41% were hospitalized. CONCLUSIONS: The findings in this report expand the knowledge about patients with carbon monoxide poisoning. These results suggest that prevention efforts, such as educating the public about using carbon monoxide alarms and targeting the most at-risk populations, may help reduce the number of exposures, the number of persons with chronic cognitive sequelae, and the resulting burden on the health care system. |
Visual contrast sensitivity in children exposed to tetrachloroethylene
Storm JE , Mazor KA , Aldous KM , Blount BC , Brodie SE , Serle JB . Arch Environ Occup Health 2011 66 (3) (3) 166-177 This study examined relationships between indoor air, breath, and blood tetrachloroethylene (perc) levels and visual contrast sensitivity (VCS) among adult and child residents of buildings with or without a colocated dry cleaner using perc. Decreasing trends in proportions of adults or children with maximum VCS scores indicated decreased VCS at a single spatial frequency (12 cycles per degree [cpd]) among children residing in buildings with colocated dry cleaners when indoor air perc level averaged 336 mcg/m(3); breath perc level averaged 159.5 mcg/m(3); and blood perc level averaged 0.51 mcg/L. Adjusted logistic regression indicated that increases in indoor air, breath, and blood perc levels among all child participants significantly increased the odds for decreased VCS at 12 cpd. Adult VCS was not significantly decreased by increasing indoor air, breath, or blood perc level. These results suggest that elevated residential perc exposures may alter children's VCS, a possible subclinical central nervous system effect. Copyright 2011 Taylor & Francis Group, LLC. |
Modeling of road traffic noise and estimated human exposure in Fulton County, Georgia, USA
Seong JC , Park TH , Ko JH , Chang SI , Kim M , Holt JB , Mehdi MR . Environ Int 2011 37 (8) 1336-41 Environmental noise is a major source of public complaints. Noise in the community causes physical and socio-economic effects and has been shown to be related to adverse health impacts. Noise, however, has not been actively researched in the United States compared with the European Union countries in recent years. In this research, we aimed at modeling road traffic noise and analyzing human exposure in Fulton County, Georgia, United States. We modeled road traffic noise levels using the United States Department of Transportation Federal Highway Administration Traffic Noise Model implemented in SoundPLAN(R). After analyzing noise levels with raster, vector and facade maps, we estimated human exposure to high noise levels. Accurate digital elevation models and building heights were derived from Light Detection And Ranging survey datasets and building footprint boundaries. Traffic datasets were collected from the Georgia Department of Transportation and the Atlanta Regional Commission. Noise level simulation was performed with 62 computers in a distributed computing environment. Finally, the noise-exposed population was calculated using geographic information system techniques. Results show that 48% of the total county population [N=870,166 residents] is potentially exposed to 55dB(A) or higher noise levels during daytime. About 9% of the population is potentially exposed to 67dB(A) or higher noises. At nighttime, 32% of the population is expected to be exposed to noise levels higher than 50dB(A). This research shows that large-scale traffic noise estimation is possible with the help of various organizations. We believe that this research is a significant stepping stone for analyzing community health associated with noise exposures in the United States. |
Cadmium, lead, and mercury in relation to reproductive hormones and anovulation in premenopausal women
Pollack AZ , Schisterman EF , Goldman LR , Mumford SL , Albert PS , Jones RL , Wactawski-Wende J . Environ Health Perspect 2011 119 (8) 1156-61 BACKGROUND: Metals can interfere with hormonal functioning by binding at the receptor site and through indirect mechanisms; thus, they may be associated with hormonal changes in premenopausal women. OBJECTIVES: We examined the associations between cadmium, lead, and mercury, and anovulation and patterns of reproductive hormones [estradiol, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone] among 252 premenopausal women 18-44 years of age who were enrolled in the BioCycle Study in Buffalo, New York. METHODS: Women were followed for up to two menstrual cycles, with serum samples collected up to eight times per cycle. Metal concentrations were determined at baseline in whole blood by inductively coupled mass spectroscopy. Marginal structural models with stabilized inverse probability weights and nonlinear mixed models with harmonic terms were used to estimate the effects of cadmium, lead, and mercury on reproductive hormone levels during the menstrual cycle and anovulation. RESULTS: Geometric mean (interquartile range) cadmium, lead, and mercury levels were 0.29 (0.19-0.43) mcg/L, 0.93 (0.68-1.20) mcg/dL, and 1.03 (0.58-2.10) mcg/L, respectively. We observed decreases in mean FSH with increasing cadmium [second vs. first tertile: -10.0%; 95% confidence interval (CI), -17.3% to -2.5%; third vs. first tertile: -8.3%; 95% CI, -16.0% to 0.1%] and increases in mean progesterone with increasing lead level (second vs. first tertile: 7.5%; 95% CI, 0.1-15.4%; third vs. first tertile: 6.8%; 95% CI, -0.8% to 14.9%). Metals were not significantly associated with anovulation. CONCLUSION: Our findings support the hypothesis that environmentally relevant levels of metals are associated with modest changes in reproductive hormone levels in healthy, premenopausal women. |
Detection of the first G6P[14] human rotavirus strain from a child with diarrhea in Egypt.
El Sherif M , Esona MD , Wang Y , Gentsch JR , Jiang B , Glass RI , Baker SA , Klena JD . Infect Genet Evol 2011 11 (6) 1436-42 We report the first detection of a G6P[14] rotavirus strain in Egypt from the stool of a child participating in a hospital-based diarrhea surveillance study conducted throughout the year 2004. Rotavirus infection was initially detected using a rotavirus group A VP6 enzyme immunoassay; the P (VP4) and G (VP7) genotypes of the strain were identified by RT-PCR. We sequenced the VP7 gene and the VP8* portion of the VP4 gene and the strain displayed the strongest identity to the VP7 [>94% nucleotides (nt), >97% amino acids (aa)] and VP4 (>93% nt, >98% aa) sequences of PA169, a novel G6P[14] strain first isolated from a child in Italy during the winter of 1987. Additional sequencing and analysis of the other remaining structural (VP1-VP3, VP6) and non-structural (NSP1-NSP5) proteins support this animal-to-human reassortment theory. According to the full genome classification system, the G6P[14] strain (EGY3399) was assigned to G6-P[14]-I2-R2-C2-M2-A11-N2-T6-E2-H3 genotypes. The greatest similarity of EGY3399 NSP4 and NSP5 gene sequences were to those of ovine and simian origin, respectively. Coupled with other observations, our results suggest G6P[14] isolates rarely cause severe diarrhea in Egyptian children, and support other studies that indicate animal rotavirus contribute to the genetic diversity of rotavirus detected from humans through interspecies transmission and single or multiple segments reassortment. |
Mycobacterium shinjukuense sp. nov., a slowly growing, non-chromogenic species isolated from human clinical specimens.
Saito H , Iwamoto T , Ohkusu K , Otsuka Y , Akiyama Y , Sato S , Taguchi O , Sueyasu Y , Kawabe Y , Fujimoto H , Ezaki T , Butler R . Int J Syst Evol Microbiol 2011 61 1927-32 Seven isolates of a slowly growing, non-chromogenic Mycobacterium species were obtained from sputum and bronchial lavage fluid samples from elderly patients in different regions of Japan. These isolates were distinguished from related non-tuberculous species by colony morphology, positive results for Tween hydrolysis, catalase at 68 degrees C, nitrate reductase and pyrazinamidase and negative results for semi-quantitative catalase, urease and arylsulfatase. The mycolic acid pattern obtained by HPLC revealed a single cluster of late-eluting mycolic acids similar to but different from those of Mycobacterium malmoense ATCC 29571(T). The 16S rRNA gene, 16S-23S internal transcribed spacer (ITS), rpoB and hsp65 sequences were unique in comparison with those of other mycobacteria. Comparison of 16S rRNA gene sequences showed that the isolates were most closely related to Mycobacterium tuberculosis H37Rv(T) (21 base differences in 1508 bp; 98.6 % 16S rRNA gene sequence similarity). A representative strain, GTC 2738(T), showed 91.9 % rpoB sequence similarity with Mycobacterium marinum strain M, 95 % hsp65 sequence similarity with Mycobacterium kansasii CIP 104589(T) and 81.1 % 16S-23S ITS sequence similarity with Mycobacterium gordonae ATCC 14470(T). Phylogenetic analysis of concatenated sequences of the 16S rRNA, rpoB and hsp65 genes showed that strain GTC 2738(T) was located on a distinct clade adjacent to M. tuberculosis, M. ulcerans and M. marinum, with bootstrap values of 81 %. DNA-DNA hybridization demonstrated less than 70 % reassociation with type strains of genetically related species and supported the novel species status of the isolates. On the basis of this evidence, a novel species with the name Mycobacterium shinjukuense sp. nov. is proposed. The type strain, isolated from a sputum sample, is strain GTC 2738(T)( = JCM 14233(T) = CCUG 53584(T)). |
Common ancestry and novel genetic traits of Francisella novicida-like isolates from North America and Australia as revealed by comparative genomic analyses.
Siddaramappa S , Challacombe JF , Petersen JM , Pillai S , Hogg G , Kuske CR . Appl Environ Microbiol 2011 77 (15) 5110-22 Francisella novicida is a close relative of Francisella tularensis, the causative agent of tularemia. The genomes of F. novicida-like clinical isolates 3523 (Australian strain) and Fx1 (Texas strain) were sequenced and compared to F. novicida strain U112 and F. tularensis strain Schu S4. The strain 3523 chromosome is 1,945,310 bp and contains 1,854 protein-coding genes. The strain Fx1 chromosome is 1,913,619 bp and contains 1,819 protein-coding genes. NUCmer analyses revealed that the genomes of strains Fx1 and U112 are mostly colinear, whereas the genome of strain 3523 has gaps, translocations, and/or inversions compared to genomes of strains Fx1 and U112. Using the genome sequence data and comparative analyses with other members of the genus Francisella, several strain-specific genes that encode putative proteins involved in RTX toxin production, polysaccharide biosynthesis/modification, thiamine biosynthesis, glucuronate utilization, and polyamine biosynthesis were identified. The RTX toxin synthesis and secretion operon of strain 3523 contains four open reading frames (ORFs) and was named rtxCABD. Based on the alignment of conserved sequences upstream of operons involved in thiamine biosynthesis from various bacteria, a putative THI box was identified in strain 3523. The glucuronate catabolism loci of strains 3523 and Fx1 contain a cluster of nine ORFs oriented in the same direction that appear to constitute an operon. Strains U112 and Schu S4 appeared to have lost the loci for RTX toxin production, thiamine biosynthesis, and glucuronate utilization as a consequence of host adaptation and reductive evolution. In conclusion, comparative analyses provided insights into the common ancestry and novel genetic traits of these strains. |
Erratum: Molecular monitoring of resistant dhfr and dhps allelic haplotypes in Morogoro and Mvomero districts in south eastern Tanzania
Malisa A , Pearce R , Abdullah S , Mutayoba B , Mshinda H , Kachur P , Bloland P , Roper C . Afr Health Sci 2011 11 (2) 142-50 BACKGROUND: Resistance to the antimalarial drug sulfadoxine-pyrimethamine (SP) emerged in Plasmodium falciparum from Asia in the 1960s and subsequently spread to Africa. In Tanzania, SP use as a national policy began in 1983 as a second line to chloroquine (CQ) for the treatment of uncomplicated malaria, until August 2001 when it was approved to replace CQ as a national first line. OBJECTIVE: The present study assesses the frequency of resistant dhfr and dhps alleles in Morogoro-Mvomero district in south eastern Tanzania and contrast their rate of change during 17 years of SP second line use against five years of SP first line use. METHODOLOGY: Cross sectional surveys of asymptomatic infections were carried out at the end of rainy season during July-September of 2000, when SP was the national second line (CQ was the first line) and 2006 when SP was the national first line antimalarial treatment. Genetic analysis of SP resistance genes was carried out on 1,044 asymptomatic infections and the effect of the two policies on SP evolution compared. RESULTS: The frequency of the most resistant allele, the double dhps-triple dhfr mutant genotype, increased by only 1% during 17 years of SP second line use, but there was a dramatic increase by 45% during five years of SP first line use. CONCLUSION: We conclude that National policy change from second line to first line SP, brought about an immediate shift in treatment practice and this in turn had a highly significant impact on drug pressure. The use of SP in specific programs only such as intermittent preventive treatment of infants (IPTi) and intermittent preventive treatment of pregnant women (IPTp) will most likely reduce substantially SP selection pressure and the SP resistance alleles alike. [This corrects the article on p. 367 in vol. 10, PMID: 21416039.]. |
Age, poverty and alcohol use as HIV risk factors for women in Mongu, Zambia
Singh K , Buckner B , Tate J , Ndubani P , Kamwanga J . Afr Health Sci 2011 11 (2) 204-10 BACKGROUND: Age, poverty and alcohol use are seen as risk factors for HIV among women in sub-Saharan Africa. OBJECTIVE: The objective of this study was to understand the influence of socioeconomic factors (including age and poverty) as well as alcohol use on risky sexual behaviors among women in Mongu, Zambia. METHODS: This study examines these factors in the local context of Mongu, Zambia using the Priorities for Local AIDS Control Efforts (PLACE) methodology. This methodology allows for the study of risky behaviors while taking into consideration local factors. The two outcome variable studied were transactional sex in the past year and having two or more sexual partners in the past year. RESULTS: In this study age was not a significant factor, but alcohol use and poverty/desire for economic advancement were significant factors. CONCLUSION: Programs and policies need to address the influence of alcohol on risky sexual behaviors and also the important but complex influence of poverty. |
Difficulties leaving home: a cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan
Hirose A , Borchert M , Niksear H , Alkozai AS , Cox J , Gardiner J , Osmani KR , Filippi V . Soc Sci Med 2011 73 (7) 1003-13 This study used an analytical cross-sectional design to identify risk factors associated with delays in care-seeking among women admitted in life-threatening conditions to a maternity hospital in Herat, Afghanistan, from February 2007 to January 2008. Disease-specific criteria of 'near-miss' were used to identify women in life-threatening conditions. Among 472 eligible women and their husbands, 411 paired interviews were conducted, and information on socio-demographic factors; the woman's status and social resources; the husband's social networks; health care accessibility and utilisation; care-seeking costs; and community characteristics were obtained. Decision and departure delays were assessed quantitatively from reported timings of symptom recognition, care-seeking decision, and departure for health facilities. Censored normal regression analyses suggest that although determinants of decision delay were influenced by the nature and symptoms of complications, uptake of antenatal care (ANC) and the birth plan reduced decision delay at the time of the obstetric emergency. Access to care and social networks reduced departure delay. Programmatic efforts may be directed towards exploiting the roles of ANC and social resources in facilitating access to emergency obstetric care. |
A cluster of mucormycosis infections in hematology patients: challenges in investigation and control of invasive mold infections in high-risk patient populations
Llata E , Blossom DB , Khoury HJ , Rao CY , Wannemuehler KA , Noble-Wang J , Langston AA , Ribner BS , Lyon GM , Arnold KE , Jackson DR , Brandt ME , Chiller TM , Balajee SA , Srinivasan A , Magill SS . Diagn Microbiol Infect Dis 2011 71 (1) 72-80 Mucormycosis has been reported to be occurring more frequently in hematopoietic stem cell transplant (HSCT) recipients in recent years. We investigated a hospital cluster of mucormycosis cases among patients with hematologic disorders. Case-patients were identified through hospital microbiology and pathology database searches and compared to randomly selected controls matched on underlying disease and hospital discharge date using conditional logistic regression. Environmental assessments, including collection of samples for fungal cultures, were performed. Of 11 case-patients, 6 (55%) had acute myelogenous leukemia and 3 (27%) were allogeneic HSCT recipients. Five case-patients (45%) died. In univariate analysis, case-patients were more likely than controls to have refractory hematologic disease (odds ratio [OR], 13.75; 95% confidence interval [CI], 1.31-689); neutropenia >14 days (OR, 11.50; 95% CI, 1.27-558) or to have received voriconazole prophylaxis (OR, 11.26; 95% CI, 1.11-infinity). A point source was not identified. Factors such as underlying disease state and antifungal prophylaxis type may identify hematology patients at highest risk for mucormycosis. Our investigation highlighted critical knowledge gaps, including strain typing methods, the role of the hospital environment in mucormycosis outbreaks, and hospital environmental infection control measures most likely to reduce exposure of immunosuppressed persons to mucormycetes. |
Safety of trivalent inactivated influenza vaccine in children aged 24 to 59 months in the Vaccine Safety Datalink
Glanz JM , Newcomer SR , Hambidge SJ , Daley MF , Narwaney KJ , Xu S , Lee GM , Baggs J , Klein NP , Nordin JD , Naleway AL , Belongia EA , Weintraub ES . Arch Pediatr Adolesc Med 2011 165 (8) 749-55 OBJECTIVES: To evaluate the safety of trivalent inactivated influenza vaccine (TIV) in children aged 24 to 59 months and to evaluate the risk of medically attended events (MAEs) in a subcohort of children who had multiple annual doses of TIV over their lifetimes. DESIGN: Self-controlled screening study. SETTING: Seven US managed care organizations from October 1, 2002, to March 31, 2006. PARTICIPANTS: Children aged 24 to 59 months who received at least 1 TIV dose (66,283 children and 91,692 TIV doses). Exposure Vaccination with TIV. MAIN OUTCOME MEASURES: Medically attended events in inpatient and emergency department settings in one of the following risk windows: 0 to 2, 1 to 14, or 1 to 42 days after vaccination. All MAEs that met the screening criteria of incidence rate ratios (IRRs) exceeding 1.0 and P ≤ .05 or IRRs exceeding 2.0 and P < .20 underwent medical record review. A secondary analysis examined the risk of MAEs in children who had multiple annual lifetime TIV doses. RESULTS: Nine diagnoses met the screening criteria. After medical record review, gastrointestinal tract symptoms (IRR, 1.18; 95% confidence interval [CI], 1.10-1.25), gastrointestinal tract disorders (7.70; 1.11-53.52), and fever (1.71; 1.64-1.80) remained significantly associated with vaccination. None of the events seemed to be serious, and none had complications. In the secondary analysis, there was an apparent dose response for vaccine and allergic reactions in the 1- to 3-day risk window. CONCLUSIONS: There was no evidence of serious MAEs following vaccination with TIV among children aged 24 to 59 months. Further studies are warranted to evaluate the risk of MAEs in children with multiple lifetime TIV doses. |
Modeling the impact of RV144-like vaccines on HIV transmission
Hankins CA , Glasser JW , Chen RT . Vaccine 2011 29 (36) 6069-71 Some 30 years after the public first became aware of AIDS, the need for a safe, effective, and affordable HIV vaccine remains compelling [1]. To date, the road to an HIV vaccine has been rocky, marked by the well-publicized failures of the first two candidates to reach large population trials. The first, a recombinant gp120 AIDSVAX® B/E vaccine, proved ineffective [2, 3]. The second, a Merck recombinant adenovirus 5 gag/pol/nef HIV-1 vaccine targeting cell-mediated immunity in the STEP trial, actually increased the risk of HIV acquisition among vaccinees relative to placebo recipients [4]. Then, just as vaccine developers were returning to their drawing boards [5], the roller-coaster swung up again. On 20 October 2009, results of RV144 – a large, long duration, expensive (~120 million US$), community Phase III trial in Thailand evaluating a combination of two vaccines, ALVAC® HIV vaccine (a 4-dose prime) and the aforementioned AIDSVAX® B/E vaccine (a 2-dose boost) – were announced at the AIDS Vaccine 2009 Conference in Paris, France. There were 51 infections in 26,507 vaccinated person-years versus 74 in 26,478 unvaccinated person-years (p=0.04). Excluding 7 trial participants who were infected before vaccination, this prime-boost combination reduced the risk of HIV infection by 31.2% (95% CI, 1.1 to 51.2) overall compared to placebo [6]. | In March of 2010, at the request of the Ministry of Public Health in Thailand, a consultation was co-sponsored by the WHO, UNAIDS, Global HIV Vaccine Enterprise, Thai Ministry of Public Health, and US Military HIV Research Program to address the utility of RV144 trial results, particularly public health and future access; ethical, regulatory, and community issues; science and vaccine development; and clinical trial design and statistics. Among the recommendations was to encourage modeling teams to estimate the cost and impact on the HIV epidemic of vaccine regimens with varying efficacy and durability, including a 31% efficacious general population vaccine with a 1-year duration of protection [7]. Accordingly, the editors invited modelers capable of evaluating the potential impact of RV144-like vaccines to investigate a common scenario with variations for a number of countries. This special issue of Vaccine contains several articles from this joint modeling exercise, along with several other HIV vaccine papers, most of which were presented at a satellite symposium, entitled ‘Preparing for the Availability of a Partially Effective HIV Vaccine’, held at the AIDS Vaccine 2010 Conference in Atlanta, USA. |
Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, National Immunization Survey--Teen, 2009
Dorell C , Yankey D , Strasser S . Clin Pediatr (Phila) 2011 50 (12) 1116-24 OBJECTIVES: To identify parent-reported reasons for non-receipt of adolescent vaccinations by provider recommendation status. METHODS: Parental reasons for non-receipt of adolescent vaccines were analyzed among adolescents 13-17 years using data from the 2009 National Immunization Survey-Teen (n=20,066). RESULTS: Among unvaccinated adolescents, 87.9% (Td/Tdap), 90.9% (MenACWY), and 66.0% (HPV) of parents reported that they did not receive a healthcare provider recommendation for their adolescent to receive the vaccine. Among those without a provider recommendation, the most common reasons for not receiving the vaccines were 'vaccine not recommended' [Td/Tdap, MenACWY] and 'not needed' [HPV]. Among those with a recommendation, the most common parental reasons were 'lack of knowledge' [Td/Tdap], 'vaccine not needed' [MenACWY], and 'lack of knowledge' [HPV]. CONCLUSIONS: Non-receipt of provider recommendations was a main parent-reported reason for not getting vaccinated. Increasing parental knowledge and vaccination coverage through increased provider-parent communication about disease risk and vaccine benefits is needed. |
Chronic disease and health behaviours linked to experiences of non-consensual sex among women and men
Smith SG , Breiding MJ . Public Health 2011 125 (9) 653-9 OBJECTIVES: Few studies have examined the association between non-consensual sex and health indicators for both women and men. The current study examined this relationship as part of a large public health survey that collected information on a range of health behaviours and health risks. METHODS: The Behavioural Risk Factor Surveillance System (BRFSS) is an annual random-digit-dialled telephone survey providing surveillance of health behaviours and health risks among US adults. In 2005, an optional module on sexual violence was available for use at the discretion of each US state/territory. Over 115,000 respondents in 25 states/territories were administered the sexual violence module within the BRFSS. Logistic regression analyses were conducted from January to December 2008. RESULTS: Among both women and men, previous non-consensual sex was associated with health conditions such as high cholesterol, stroke and heart disease, and risk behaviours such as human immunodeficiency virus risk factors, smoking and excessive drinking. Sexually victimized women were more likely to report having had a heart attack or heart disease than non-victims. CONCLUSIONS: The experience of non-consensual sex is associated with a number of chronic disease outcomes and risk factors. The development and implementation of effective sexual violence prevention strategies may reduce the risk of chronic conditions among persons who have experienced sexual victimisation. |
Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP).
Harris JR , Marston BJ , Sangrujee N , Duplessis D , Park B . PLoS One 2011 6 (8) e23158 BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone. |
Standardization and monitoring of laboratory performance and quality assurance by use of the less-sensitive HIV incidence assay: seven years of results
Mei J , Kennedy M , Linley L , Hanson D , Schiffer J , Ethridge S , Branson B . J Acquir Immune Defic Syndr 2011 58 (5) 482-8 BACKGROUND: The Performance Evaluation Program for HIV-1 Incidence Tests provided quality assurance services to laboratories conducting the Serological Testing Algorithm for Recent HIV Seroconversion by use of a modified, less sensitive version of the Vironostika HIV-1 MicroElisa System assay. We report on the performance of the assay using proficiency testing and quality control materials tested from 2001-2008. METHODS: Two sets of five blinded serum panels using common calibration and quality control materials were tested. The mean, standard deviation, and coefficient of variation were calculated. Results were analyzed for misclassifications: false recent HIV-infection errors (long-term infection classified as HIV infection less than one year), false long-term infection errors (HIV infection less than one year classified as long-term infection), and differences in standardized optical density (SOD) means and variances over time. RESULTS: The false recent error rate was 1.26% (N = 2219). The false long-term error rate was 0.25% (N = 1618). No significant trends were observed for misclassification rates by year, and no significant trend in the SOD over seven years was observed. CONCLUSION: Laboratories using the less sensitive Vironostika HIV-1 assay produced consistent results by use of a common calibrator and quality control materials. |
The vibration transmissibility and driving-point biodynamic response of the hand exposed to vibration normal to the palm
Xu XS , Welcome DE , McDowell TW , Wu JZ , Wimer B , Warren C , Dong RG . Int J Ind Ergon 2011 41 (5) 418-427 Prolonged, intensive exposure to vibrations from palm and orbital sanders could cause finger disorders. They are likely to be associated with the biodynamic responses of the fingers. Although the biodynamic responses of the hand-arm system have been studied by many researchers, the detailed biodynamic responses distributed in the hand substructures have not been sufficiently understood. To advance the knowledge in this aspect and to aid in the development of improved finite element models of the substructures, this study simultaneously measured the overall driving-point biodynamic response and the distribution of vibration transmissibility at the fingers and back of the hand exposed to a flat plate vibration (as an approximate simulation of the operations of the palm and orbital sanders) and examined the relationship between these two measures of biodynamic responses. Ten subjects (five males and five females) participated in the experiment. A scanning laser vibrometer was used to measure the distributed vibration. This study confirmed that the distributed hand responses generally varied with locations on each finger, vibration frequencies, and applied hand force. Two major resonances were observed in the vibration transmissibility. At the first resonance, the transmitted vibrations at different locations were more or less in phase; hence, this resonance was also observed in the driving-point biodynamic response that measures the overall biodynamic response of the system. The second resonance was observed at the fingers. Because this resonant frequency varied greatly among the fingers and the specific segments of each finger, it is difficult to identify this resonance in the driving-point biodynamic response. The implications of the findings for further model developments and applications are discussed. |
Lack of evidence for the direct activation of endothelial cells by adult female and microfilarial excretory-secretory products
Weinkopff T , Lammie P . PLoS One 2011 6 (8) e22282 Lymphangiectasia (dilation of the lymphatic vessel (LV)) is pathognomonic for lymphatic filariasis. In both infected humans and animal models of infection, lymphangiectasia is not restricted to the site of the worm nest, but is found along the infected vessel. These observations argue that soluble products secreted by the worm could be mediating this effect by activating the lymphatic endothelial cells (LEC) lining the vessel. We tested the ability of filarial Excretory-Secretory products to activate LECs, but were unable to detect a direct effect of the Excretory-Secretory products on the activation of LEC as assessed by a variety of approaches including cellular proliferation, cell surface molecule expression and cytokine and growth factor production (although other mediators used as positive controls did induce these effects). Collectively, these results do not support the hypothesis that Excretory-Secretory products directly activate LECs. |
Nanoparticle inhalation alters systemic arteriolar vasoreactivity through sympathetic and cyclooxygenase-mediated pathways
Knuckles TL , Yi J , Frazer DG , Leonard HD , Chen BT , Castranova V , Nurkiewicz TR . Nanotoxicology 2011 6 (7) 724-35 The widespread increase in the production and use of nanomaterials has increased the potential for nanoparticle exposure; however, the biological effects of nanoparticle inhalation are poorly understood. Rats were exposed to nanosized titanium dioxide aerosols (10 mcg lung burden); at 24 h post-exposure, the spinotrapezius muscle was prepared for intravital microscopy. Nanoparticle exposure did not alter perivascular nerve stimulation (PVNS)-induced arteriolar constriction under normal conditions; however, adrenergic receptor inhibition revealed a more robust effect. Nanoparticle inhalation reduced arteriolar dilation in response to active hyperaemia (AH). In both PVNS and AH experiments, nitric oxide synthase (NOS) inhibition affected only controls. Whereas cyclooxygenase (COX) inhibition only attenuated AH-induced arteriolar dilation in nanoparticle-exposed animals. This group displayed an enhanced U46619 constriction and attenuated iloprost-induced dilation. Collectively, these studies indicate that nanoparticle exposure reduces microvascular NO bioavailability and alters COX-mediated vasoreactivity. Furthermore, the enhanced adrenergic receptor sensitivity suggests an augmented sympathetic responsiveness. |
Pendrin mediates uptake of perchlorate in a mammalian in vitro system
Attanasio R , Scinicariello F , Blount BC , Valentin-Blasini L , Rogers KA , Nguyen DC , Murray HE . Chemosphere 2011 84 (10) 1484-8 Perchlorate is a known endocrine disruptor present in groundwater, vegetables and dairy food products in many regions of the United States. It interferes with the uptake of iodide into the thyrocyte by the sodium-iodide symporter at the basolateral surface, thus potentially disrupting the synthesis of thyroid hormone. Because transport of iodide from the thyroid follicular cells to the follicular lumen is mediated by the protein pendrin at the apical surface, we hypothesized that perchlorate may also interact with this protein. Therefore, HeLa cells were transfected with the human SLC26A4 gene, which encodes pendrin, to generate an in vitro mammalian system expressing the recombinant pendrin protein (HeLa-PDS). The HeLa-PDS cells, along with untransfected cells, were then cultured in presence of iodide and/or perchlorate. Intracellular levels of these two chemicals were measured by ion chromatography tandem mass spectrometry. Results from this study show that iodide and perchlorate uptake increases significantly in HeLa-PDS cells as compared to untransfected cells. Thus, recombinant HeLa cells expressing pendrin protein accumulate iodide and perchlorate intracellularly, indicating that pendrin is involved in the uptake of perchlorate. Additional results from this study suggest that iodide and perchlorate competitively inhibit each other for uptake by pendrin. The ability of perchlorate to compete with iodide for uptake by both basal and apical transporters may increase the potential of perturbation of thyroid homeostasis and therefore the estimated risk posed to susceptible human populations. |
Gestational and chronic low-dose PFOA exposures and mammary gland growth and differentiation in three generations of CD-1 mice
White SS , Stanko JP , Kato K , Calafat AM , Hines EP , Fenton SE . Environ Health Perspect 2011 119 (8) 1070-6 BACKGROUND: Prenatal exposure to perfluorooctanoic acid (PFOA), a ubiquitous industrial surfactant, has been reported to delay mammary gland development in female mouse offspring (F1) and the treated lactating dam (P0) after gestational treatments at 3 and 5 mg PFOA/kg/day. OBJECTIVE: We investigated the consequences of gestational and chronic PFOA exposure on F1 lactational function and subsequent development of F2 offspring. METHODS: We treated P0 dams with 0, 1, or 5 mg PFOA/kg/day on gestation days 1-17. In addition, a second group of P0 dams treated with 0 or 1 mg/kg/day during gestation and their F1 and F2 offspring received continuous PFOA exposure (5 ppb) in drinking water. Resulting adult F1 females were bred to generate F2 offspring, whose development was monitored over postnatal days (PNDs) 1-63. F1 gland function was assessed on PND10 by timed-lactation experiments. Mammary tissue was isolated from P0, F1, and F2 females throughout the study and histologically assessed for age-appropriate development. RESULTS: PFOA-exposed F1 dams exhibited diminished lactational morphology, although F1 maternal behavior and F2 offspring body weights were not significantly affected by P0 treatment. In addition to reduced gland development in F1 females under all exposures, F2 females with chronic low-dose drinking-water exposures exhibited visibly slowed mammary gland differentiation from weaning onward. F2 females derived from 5 mg/kg PFOA-treated P0 dams displayed gland morphology similar to F2 chronic water exposure groups on PNDs 22-63. CONCLUSIONS: Gestational PFOA exposure induced delays in mammary gland development and/or lactational differentiation across three generations. Chronic, low-dose PFOA exposure in drinking water was also sufficient to alter mammary morphological development in mice, at concentrations approximating those found in contaminated human water supplies. |
The host phosphoinositide 5-phosphatase SHIP2 regulates dissemination of vaccinia virus
McNulty S , Powell K , Erneux C , Kalman D . J Virol 2011 85 (14) 7402-10 After fusing with the plasma membrane, enveloped poxvirus virions form actin-filled membranous protrusions, called tails, beneath themselves and move toward adjacent uninfected cells. While much is known about the host and viral proteins that mediate formation of actin tails, much less is known about the factors controlling release. We found that the phosphoinositide 5-phosphatase SHIP2 localizes to actin tails. Localization requires phosphotyrosine, Abl and Src family tyrosine kinases, and neural Wiskott-Aldrich syndrome protein (N-WASP) but not the Arp2/Arp3 complex or actin. Cells lacking SHIP2 have normal actin tails but release more virus. Moreover, cells infected with viral strains with mutations in the release inhibitor A34 release more virus but recruit less SHIP2 to tails. Thus, the inhibitory effects of A34 on virus release are mediated by SHIP2. Together, these data suggest that SHIP2 and A34 may act as gatekeepers to regulate dissemination of poxviruses when environmental conditions are conducive. |
Immunogenicity of low-pH treated whole viral influenza vaccine
Quan FS , Li ZN , Kim MC , Yang D , Compans RW , Steinhauer DA , Kang SM . Virology 2011 417 (1) 196-202 Low pH treatment of influenza virus hemagglutinin (HA) exposes its relatively conserved stalk domain, suggesting a potential immunogen with capability to induce broader immune responses. Here, we describe characterization, immunogenicity, antigenicity, and protective immunity induced by low pH treated inactivated whole viral vaccine in comparison with the untreated vaccine. The acidic pH treated viral vaccine showed high susceptibility to proteolytic cleavage and low hemagglutination activity indicating conformational changes. Immunization of mice with low pH treated viral vaccine induced lower levels of homologous or heterologous virus-specific binding and neutralizing antibodies compared to the untreated vaccine. Also, low pH treated influenza viral antigen showed lower antigenicity compared to the untreated influenza viral antigen. Lower efficacy of cross-protection against heterosubtypic virus was observed in the low-pH treated vaccine group. The results provide evidence that there is a correlation between protective efficacy and the stability of vaccines. |
Collaborative evaluation of an erythromycin-clindamycin combination well for detection of inducible clindamycin resistance in beta-hemolytic streptococci by use of the CLSI broth microdilution method
Jorgensen JH , McElmeel ML , Fulcher LC , McGee L , Richter SS , Heilmann KP , Ferraro MJ , Spargo J , Glennen A . J Clin Microbiol 2011 49 (8) 2884-6 Constitutive or inducible clindamycin resistance can occur in beta-hemolytic streptococci due to the presence of an erm gene. The Clinical and Laboratory Standards Institute (CLSI) has recommended a disk approximation test (D-zone test) with erythromycin and clindamycin disks and a single-well broth test combining erythromycin and clindamycin for detection of inducible clindamycin resistance in staphylococci, but only a disk approximation test for the beta-hemolytic streptococci. This collaborative study assessed two different erythromycin and clindamycin concentration combinations in single wells (1 mcg/ml + 0.25 mcg/ml [erythromycin plus clindamycin] and 1 mcg/ml + 0.5 mcg/ml) with three different brands of Mueller-Hinton broth supplemented with 3% lysed horse blood for testing of frozen panels prepared for this study. All labs performed the D-zone test as described by the CLSI. A total of 155 nonduplicate streptococcal isolates (50 group A, 48 group B, 28 group C, and 29 group G isolates) were tested; 99 isolates showed inducible resistance by the D-zone test. There were some differences noted based upon the test medium. The sensitivity of the erythromycin plus clindamycin combination of 1 mcg/ml + 0.25 mcg/ml was 91 to 100%, while the sensitivity of the combination of 1 mcg/ml + 0.5 mcg/ml was 95 to 100%. Specificity overall was 98%. The slightly higher sensitivity of the combination of 1 mcg/ml + 0.5 mcg/ml is recommended. This study has demonstrated that a single-well microdilution test incorporating erythromycin and clindamycin in combination is a sensitive and specific indicator of inducible clindamycin resistance and could be included in routine test panels. |
Acculturation factors are associated with folate intakes among Mexican American women
Hamner HC , Cogswell ME , Johnson MA . J Nutr 2011 141 (10) 1889-97 Folic acid can prevent neural tube defects (NTD). Hispanic women have a higher prevalence of NTD than non-Hispanic white (NHW) women and consume less folic acid. Among Hispanics, acculturation has been associated with lower intakes of natural folate. It is unknown if this same relationship is seen for fortified foods. This article describes the associations of acculturation factors with usual folate intakes from foods and supplements and compares the proportion that meets recommended intakes of folic acid of US Mexican American (MA) women with those of NHW women. For US NHW and MA women aged 15-44 y (n = 3167), usual folate intakes (i.e., natural food folate, folic acid from food, total folic acid [fortified foods plus supplements], and total folate) were estimated using measurement error models from NHANES 2001-2008. Compared with NHW women, MA women did not differ in their intake of natural food folate or folic acid from food. Similarly, compared with NHW women (332 +/- 17.3 mcg/d), the mean total usual folic acid intakes were lower among MA women who reported speaking Spanish (224 +/- 24.9 mcg/d) but not for MA women who reported speaking English (283 +/- 36.2 mcg/d). MA women were more likely than NHW women to consume a total folic acid intake <400 mcg/d. MA women with lower acculturation factors were the most likely to have an intake <400 mcg/d compared to NHW women. Public health efforts should focus on increasing total folic acid intake among MA women, emphasizing those with lower acculturation factors (e.g., MA women who report speaking Spanish). |
A recirculation aerosol wind tunnel for evaluating aerosol samplers and measuring particle penetration through protective clothing materials
Jaques PA , Hsiao TC , Gao P . Ann Occup Hyg 2011 55 (7) 784-96 A recirculation aerosol wind tunnel was designed to maintain a uniform airflow and stable aerosol size distribution for evaluating aerosol sampler performance and determining particle penetration through protective clothing materials. The oval-shaped wind tunnel was designed to be small enough to fit onto a lab bench, have optimized dimensions for uniformity in wind speed and particle size distributions, sufficient mixing for even distribution of particles, and minimum particle losses. Performance evaluation demonstrates a relatively high level of spatial uniformity, with a coefficient of variation of 1.5-6.2% for wind velocities between 0.4 and 2.8 m s(-1) and, in this range, 0.8-8.5% for particles between 50 and 450 nm. Aerosol concentration stabilized within the first 5-20 min with, approximately, a count median diameter of 135 nm and geometric standard deviation of 2.20. Negligible agglomerate growth and particle loss are suggested. The recirculation design appears to result in unique features as needed for our research. |
Nanomaterials in humans: identification, characteristics, and potential damage
Song Y , Li X , Wang L , Rojanasakul Y , Castranova V , Li H , Ma J . Toxicol Pathol 2011 39 (5) 841-9 Nanomaterials are increasingly being used for commercial purposes. However, concerns about the potential risks of exposure to humans have been raised. We previously reported unusual pulmonary disease and death in a group of patients with occupational exposure to spray paint. However, the nanoparticle and chemical composition of the exposure was not fully described. The present study aimed to isolate and identify the nanoparticles observed in the patients' biopsies and report the potential deleterious effects to human lungs using electron microscopy. Using electron microscopy and energy dispersive x-ray analysis, silica nanoparticles were identified and characterized mainly in macrophages, pulmonary microvessels, vascular endothelial cells, microlymphatic vessels, pleural effusions, and a few in alveolar epithelial cells and pulmonary interstitial tissue (with no microscale particles present). Notably, damage to alveolar epithelial cells, macrophages, vascular endothelial cells, and the blood-gas barrier was observed. Given the well-documented toxicity of microscale silica, it is possible that these silica nanoparticles may have contributed in part to the illness reported in these workers. Such a possibility supports the adoption of controls and prevention strategies to minimize inhalation of nanoparticles by workers, and it highlights the urgent need and the importance of the nanosafety study in humans. |
An official American Thoracic Society Statement: work-exacerbated asthma
Henneberger PK , Redlich CA , Callahan DB , Harber P , Lemiere C , Martin J , Tarlo SM , Vandenplas O , Toren K . Am J Respir Crit Care Med 2011 184 (3) 368-378 RATIONALE: Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work. OBJECTIVES: The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research. METHODS: Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus. MEASUREMENTS AND MAIN RESULTS: WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful. CONCLUSIONS: WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions. |
Efficacy of the revised NIOSH lifting equation to predict risk of low back pain due to manual lifting: expanded cross-sectional analysis
Waters TR , Lu ML , Piacitelli LA , Werren D , Deddens JA . J Occup Environ Med 2011 53 (9) 1061-7 OBJECTIVE: To evaluate whether the Revised NIOSH Lifting Equation (RNLE) is a valid tool for assessing risk of low back pain (LBP) due to manual lifting by using combined data from two cross-sectional studies of 1-year prevalence. METHODS: Results from a symptom and occupational history questionnaire and RNLE analysis for 677 subjects employed in 125 manual lifting jobs at nine industrial sites were combined from two studies. RESULTS: The odds of LBP increased as the lifting index (LI) increased from 1.0 to 3.0. A statistically significant odds ratio (OR) was found for both the 1 < LI ≤ 2 (OR = 1.81) and the 2 < LI ≤ 3 categories (OR = 2.26). For jobs with an LI value greater than 3.0, however, the OR remained nonsignificant. The 2 < LI ≤ 3 group remained statistically significant after adjusting for age, gender, body mass index, and psychosocial factors. CONCLUSIONS: It is clear that as the LI increases, the risk of LBP increases. Longitudinal studies are needed. |
Association of general fatigue with cellular immune indicators among healthy white-collar employees
Nakata A , Irie M , Takahashi M . J Occup Environ Med 2011 53 (9) 1078-86 OBJECTIVE: Although fatigue is a common complaint in the working population, underlying immunological mechanisms are not well understood. This study investigated the association of general fatigue with cellular immune indicators. METHODS: A total of 148 healthy white-collar employees (70% men) underwent a blood draw for the measurement of natural killer (NK), B, and T cell counts as well as NK cell cytotoxicity (NKCC) and completed two different fatigue scales, that is, Profile of Mood State (POMS) and Maastricht Questionnaire (MQ). RESULTS: Multiple linear regression analyses revealed that POMS fatigue score was significantly associated with decreases of NK cells (beta = -.407) and NKCC (beta = -.215), whereas MQ fatigue score was significantly associated with reduced NK cells (beta = -.290) but not with NKCC (beta = -.127). CONCLUSION: The results suggest that general fatigue may be related to impaired NK cell competency among healthy employees. |
Association of shift work with physical activity among police officers: the Buffalo cardio-metabolic occupational police stress study
Ma CC , Burchfiel CM , Fekedulegn D , Andrew ME , Charles LE , Gu JK , Mnatsakanova A , Violanti JM . J Occup Environ Med 2011 53 (9) 1030-6 OBJECTIVE: To examine relations of shift work with occupational, sports, and household physical activity (PA) among police officers. METHODS: Self-reported PA was assessed among 350 male and female officers (aged 27 to 66). Day, afternoon, or midnight shift was identified from daily payroll records. RESULTS: Shift work was associated with prevalence of hard-intensity (occupational and sport) PA among men, and very hard-intensity sport PA among women, with afternoon workers reporting the highest prevalence. Shift work was independently associated with total hours of hard-intensity PA among men and very hard-intensity PA among women, with afternoon workers reporting the most hours. CONCLUSION: Results indicated that hard and very hard-intensity PA varied significantly across shifts with afternoon workers being the most active. |
Release of beryllium from mineral ores in artificial lung and skin surface fluids
Duling MG , Stefaniak AB , Lawrence RB , Chipera SJ , Abbas Virji M . Environ Geochem Health 2011 34 (3) 313-22 Exposure to some manufactured beryllium compounds via skin contact or inhalation can cause sensitization. A portion of sensitized persons who inhale beryllium may develop chronic beryllium disease (CBD). Little is understood about exposures to naturally occurring beryllium minerals. The purpose of this study was to assess the bioaccessibility of beryllium from bertrandite ore. Dissolution of bertrandite from two mine pits (Monitor and Blue Chalk) was evaluated for both the dermal and inhalation exposure pathways by determining bioaccessibility in artificial sweat (pH 5.3 and pH 6.5), airway lining fluid (SUF, pH 7.3), and alveolar macrophage phagolysosomal fluid (PSF, pH 4.5). Significantly more beryllium was released from Monitor pit ore than Blue Chalk pit ore in artificial sweat buffered to pH 5.3 (0.88 +/- 0.01% vs. 0.36 +/- 0.00%) and pH 6.5 (0.09 +/- 0.00% vs. 0.03 +/- 0.01%). Rates of beryllium released from the ores in artificial sweat were faster than previously measured for manufactured forms of beryllium (e.g., beryllium oxide), known to induce sensitization in mice. In SUF, levels of beryllium were below the analytical limit of detection. In PSF, beryllium dissolution was biphasic (initial rapid diffusion followed by latter slower surface reactions). During the latter phase, dissolution half-times were 1,400 to 2,000 days, and rate constants were ~7 x 10(-10) g/(cm(2).day), indicating that bertrandite is persistent in the lung. These data indicate that it is prudent to control skin and inhalation exposures to bertrandite dusts. |
Recommendations on dram shop liability and overservice law enforcement initiatives to prevent excessive alcohol consumption and related harms
Task Force on Community Preventive Services , Hahn RA . Am J Prev Med 2011 41 (3) 344-6 The Task Force on Community Preventive Services recommends the use of dram shop liability laws, on the basis of strong evidence of effectiveness in preventing and reducing alcohol-related harms. The Task Force found insufficient evidence to determine the effectiveness of overservice law enforcement initiatives as a means to reduce excessive alcohol consumption and related harms, because too few studies were identified and findings were inconsistent. |
Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: two community guide systematic reviews
Rammohan V , Hahn RA , Elder R , Brewer R , Fielding J , Naimi TS , Toomey TL , Chattopadhyay SK , Zometa C . Am J Prev Med 2011 41 (3) 334-43 CONTEXT: Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. EVIDENCE ACQUISITION: Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. EVIDENCE SYNTHESIS: Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. CONCLUSIONS: According to Community Guide rules of evidence, the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms. It will be important to assess the possible effects of legal modifications to dram shop proceedings, such as the imposition of statutes of limitation, increased evidentiary requirements, and caps on recoverable amounts. According to Community Guide rules of evidence, evidence is insufficient to determine the effectiveness of enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. |
Adherence to the Advisory Committee on Immunization Practices recommendation to prevent injuries from postvaccination syncope: a national physician survey
Huang WT , Suh C , Campagna E , Broder KR , Daley MF , Crane LA , Stokley S , Kempe A . Am J Prev Med 2011 41 (3) 317-21 BACKGROUND: Little is known about physicians' adherence to the 2006 Advisory Committee on Immunization Practices (ACIP) recommendation that providers strongly should consider observing vaccine recipients for 15 minutes to prevent injuries from postvaccination syncope. PURPOSE: To assess physicians' knowledge, attitudes, and practices toward observing adolescents for 15 minutes postvaccination. METHODS: A survey was administered during October 2008-January 2009 to 425 pediatricians (Peds) and 424 family medicine physicians (FPs) from a nationally representative network. Adherence was defined as reporting routinely observing patients for ≥15 minutes after vaccination. Data analysis was completed in 2009. RESULTS: The overall response rate was 73%. A minority of physicians (37% Peds, 24% FPs) were aware that ACIP strongly encourages observing patients for 15 minutes postvaccination, but most physicians (69% Peds, 84% FPs) thought that their practice easily could adhere to this recommendation. Lack of room space (76% Peds, 65% FPs) was the most frequently reported barrier. Seventeen percent of physicians reported adherence to postvaccination observation. Practice in a hospital, university, or community health center compared with private practice (RR=1.64, 95% CI=1.05, 2.40); awareness of the ACIP syncope recommendation (RR=5.55, 95% CI=3.60, 9.37); and believing that postvaccination syncope can result in serious injuries (RR=1.74, 95% CI=1.06, 4.22) were independently associated with self-reported adherence. CONCLUSIONS: Few physicians are aware of recommendations for postvaccination observation for syncope and even fewer adhere to them. Strategies to improve this should be developed and tested. |
The associations between organizational culture and knowledge, attitudes, and practices in a multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus
Sinkowitz-Cochran RL , Burkitt KH , Cuerdon T , Harrison C , Gao S , Scott Obrosky D , Jain R , Fine MJ , Jernigan JA . Am J Infect Control 2011 40 (2) 138-43 BACKGROUND: Previous research demonstrates that organizational culture (OC) and knowledge, attitudes, and practices of health care personnel are associated with the overall success of infection control programs; however, little attention has been given to the relationships among these factors in contributing to the success of quality improvement programs. METHODS: Cross-sectional surveys assessing OC and knowledge, attitudes, and practices related to methicillin-resistant Staphylococcus aureus (MRSA) were distributed to 16 medical centers participating in a Veterans Affairs MRSA prevention initiative in 2 time periods. Factor analysis was performed on the OC survey responses, and factor scores were generated. To assess associations between OC and knowledge, attitudes, and practices of health care personnel, regression analyses were performed overall and then stratified by job type. RESULTS: The final analyzable sample included 2,314 surveys (43% completed by nurses, 9% by physicians, and 48% by other health care personnel). Three OC factors emerged accounting for 53% of the total variance: "Staff Engagement," "Overwhelmed/Stress-Chaos," and "Hospital Leadership." Overall, higher Staff Engagement was associated with greater knowledge scores, better hand hygiene practices, fewer reported barriers, and more positive attitudes. Higher Hospital Leadership scores were associated with better hand hygiene practices, fewer reported barriers, and more positive attitudes. Conversely, higher Overwhelmed/Stress-Chaos scores were associated with poorer reported prevention practices, more barriers, and less positive attitudes. When these associations were stratified by job type, there were significant associations between OC factors and knowledge for nurses only, between OC factors and practice items for nurses and other health care personnel, and between OC factors and the barriers and attitudes items for all job types. OC factors were not associated with knowledge and practices among physicians. CONCLUSIONS: Three OC factors-Staff Engagement, Overwhelmed/Stress-Chaos, and Hospital Leadership-were found to be significantly associated with individual health care personnel knowledge, attitudes, and self-reported practices regarding MRSA prevention. When developing a prevention intervention program, health care organizations should not only focus on the link between OC and the knowledge, attitudes, and practices of health care personnel, but also target programs based on health care personnel type to maximize their effectiveness. |
Validation data-based adjustments for outcome misclassification in logistic regression: an illustration
Lyles RH , Tang L , Superak HM , King CC , Celentano DD , Lo Y , Sobel JD . Epidemiology 2011 22 (4) 589-97 Misclassification of binary outcome variables is a known source of potentially serious bias when estimating adjusted odds ratios. Although researchers have described frequentist and Bayesian methods for dealing with the problem, these methods have seldom fully bridged the gap between statistical research and epidemiologic practice. In particular, there have been few real-world applications of readily grasped and computationally accessible methods that make direct use of internal validation data to adjust for differential outcome misclassification in logistic regression. In this paper, we illustrate likelihood-based methods for this purpose that can be implemented using standard statistical software. Using main study and internal validation data from the HIV Epidemiology Research Study, we demonstrate how misclassification rates can depend on the values of subject-specific covariates, and we illustrate the importance of accounting for this dependence. Simulation studies confirm the effectiveness of the maximum likelihood approach. We emphasize clear exposition of the likelihood function itself, to permit the reader to easily assimilate appended computer code that facilitates sensitivity analyses as well as the efficient handling of main/external and main/internal validation-study data. These methods are readily applicable under random cross-sectional sampling, and we discuss the extent to which the main/internal analysis remains appropriate under outcome-dependent (case-control) sampling. |
Impact of cigarette smoking on volatile organic compound (VOC) blood levels in the U.S. population: NHANES 2003-2004
Chambers DM , Ocariz JM , McGuirk MF , Blount BC . Environ Int 2011 37 (8) 1321-8 The impact of cigarette smoking on volatile organic compound (VOC) blood levels is studied using 2003-2004 National Health and Nutrition Examination Survey (NHANES) data. Cigarette smoke exposure is shown to be a predominant source of benzene, toluene, ethylbenzene, xylenes and styrene (BTEXS) measured in blood as determined by (1) differences in central tendency and interquartile VOC blood levels between daily smokers [≥1 cigarette per day (CPD)] and less-than-daily smokers, (2) correlation among BTEXS and the 2,5-dimethylfuran (2,5-DMF) smoking biomarker in the blood of daily smokers, and (3) regression modeling of BTEXS blood levels versus categorized CPD. Smoking status was determined by 2,5-DMF blood level using a cutpoint of 0.014ng/ml estimated by regression modeling of the weighted data and confirmed with receiver operator curve (ROC) analysis. The BTEXS blood levels among daily smokers were moderately-to-strongly correlated with 2,5-DMF blood levels (correlation coefficient, r, ranging from 0.46 to 0.92). Linear regression of the geometric mean BTEXS blood levels versus categorized CPD showed clear dose-response relationship (correlation of determination, R(2), ranging from 0.81 to 0.98). Furthermore, the pattern of VOCs in blood of smokers is similar to that reported in mainstream cigarette smoke. These results show that cigarette smoking is a primary source of benzene, toluene and styrene and an important source of ethylbenzene and xylene exposure for the U.S. population, as well as the necessity of determining smoking status and factors affecting dose (e.g., CPD, time since last cigarette) in assessments involving BTEXS exposure. |
Cigarettes smoked per day among high school students in the U.S., 1991-2009
Jones SE , Kann L , Pechacek TF . Am J Prev Med 2011 41 (3) 297-9 BACKGROUND: Recent declines in current cigarette smoking among youth are encouraging, but less is known about the trends in the number of cigarettes smoked per day among youth. PURPOSE: This study examined trends in the number of cigarettes smoked per day among U.S. high school students during 1991-2009. METHODS: Nationally representative data from the 1991-2009 national Youth Risk Behavior Surveys (YRBS) were analyzed in 2010. The YRBS is a biennial, school-based survey representative of 9th- through 12th-grade students in the U.S. Each survey year, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. The number of cigarettes smoked per day on smoking days was categorized as light smoking (<1-5 cigarettes per day); moderate smoking (6-10 cigarettes per day); and heavy smoking (≥11 cigarettes per day). Sample sizes ranged from 10,904 to 16,410. Overall response rates ranged from 60% to 71%. RESULTS: During 1991-2009, among current cigarette users overall, light smoking increased from 67.2% to 79.4% and heavy smoking decreased from 18.0% to 7.8%. These trends were found among female and male students overall and white students. Among Hispanic students, light smoking remained stable, but heavy smoking significantly increased from 3.1% in 1991 to 6.4% in 2009. The prevalence of light, moderate, and heavy smoking did not change during 1991-2009 among black students. CONCLUSIONS: The finding that during 1991-2009 light smoking increased and heavy smoking decreased among current cigarette users is encouraging; however, even light smoking is detrimental to health and efforts to reduce all cigarette use should continue. |
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