Upper and lower extremity motor performance and functional impairment in Alzheimers disease
Hebert LE , Bienias JL , McCann JJ , Scherr PA , Wilson RS , Evans DA . Am J Alzheimers Dis Other Demen 2010 25 (5) 425-431 This report examines the relation of upper and lower extremity motor performance to functional impairment among 371 persons with probable Alzheimers disease (AD). Cognitive and motor performance tests were administered at 6-month intervals for up to 4 years. Motor performance was assessed using 3 lower extremity tests and 2 upper extremity tests. Functional impairment was measured at 3-month intervals using caregiver ratings of impairments in activities of daily living, mobility, and range of motion. Both lower and upper extremity performance were inversely related to functional impairments on all 3 scales (all Ps <.001), after controlling for age, sex, and level of cognitive impairment. This suggests that motor performance contributes to functional impairments in AD, independent of cognitive impairment. It is important to preserve motor performance in individuals with AD because it influences physical function throughout the course of the disease. 2010 The Author(s). |
Reinfections during the Florida syphilis epidemic, 2000-2008
Brewer TH , Peterman TA , Newman DR , Schmitt K . Sex Transm Dis 2010 38 (1) 12-7 BACKGROUND: The last 3 syphilis epidemics in the United States peaked after 5 to 6 years, but rates have now increased for 8 years. We questioned whether persons with multiple syphilis diagnoses (repeaters) are fueling the epidemic. METHODS: The Florida Department of Health database of all syphilis cases reported between 2000 and 2008 was used to examine demographics and disease presentation of repeaters and nonrepeaters using bivariate and multivariate analyses. RESULTS: Of 26,070 persons diagnosed with syphilis, 643 (2.5%) were repeaters (range, 2-5 diagnoses): 82 women, 444 men who have sex with men (MSM), and 117 men identified as either heterosexual (n = 43) or unknown sexual orientation (n = 74). The mean time between first and second diagnosis was approximately 3 years. Median titer increase among those with a second diagnosis of early latent was 32-fold. In multivariate analysis, compared with nonrepeaters, repeaters were more likely to be MSM (odds ratio [OR], 5.3), human immunodeficiency virus (HIV)-infected (OR, 2.0), white (OR, 1.5), ages 35 to 39 (OR, 1.8), and to live in Miami-Dade or Broward Counties (OR, 1.7). Overall, the stage at diagnosis was similar for repeaters, whether it was their initial or subsequent diagnosis. However, HIV-infected MSM were more likely to be diagnosed with early latent at second diagnosis compared with initial diagnosis (P ≤ 0.01). CONCLUSIONS: Most syphilis diagnosed in the current Florida epidemic is among persons infected for the first time. Repeaters are mainly MSM who present with symptoms or large increases in titers. HIV-infected MSM may have higher rates of early asymptomatic disease because of more frequent screening. These are likely to be true new infections. |
The epidemiology of rotavirus diarrhea in countries in the Eastern Mediterranean Region
Malek MA , Teleb N , Abu-Elyazeed R , Riddle MS , Sherif ME , Steele AD , Glass RI , Bresee JS . J Infect Dis 2010 202 Suppl S12-22 OBJECTIVE: Rotavirus is the leading cause of severe diarrhea among children worldwide, killing approximately 600,000 children annually, including 64,800 in the Eastern Mediterranean Region. Safe, effective rotavirus vaccines will be available soon, and accurate disease burden data will be needed to assess the burden of rotavirus and the value of new vaccines and monitor vaccine program impact. METHODS: To identify epidemiologic studies in which rotavirus diagnostics were applied to children with acute gastroenteritis, we performed a systematic literature review. We selected studies that met 4 criteria and extracted rotavirus data on prevalence estimates, strain identification, age distribution of patients, and seasonal trends. RESULTS: Of the 63 published studies with some rotavirus detection data, 29 met inclusion criteria. Among patients with diarrhea, rotavirus was detected in 40% of inpatients and 23% of outpatients. By 3 years of age, 75% of children experienced a documented rotavirus infection. Circulation of rotavirus occurred year-round, and no clear relationship between the timing of the rotavirus peak with either season or latitude was observed. Comparison of country-specific rotavirus detection rates indicated that the proportion of hospitalizations for rotavirus infection increased with income. CONCLUSION: This systematic review of studies of rotavirus diarrhea among children in the countries of the Eastern Mediterranean Region documents that rotavirus is one of the most significant causes of childhood diarrhea in the region. The findings of this review will be used to establish sentinel hospital surveillance in these countries, estimate disease burden, and characterize its epidemiology using common protocols and diagnostics. |
Influenza antiviral prescribing practices during the 2007-08 and 2008-09 influenza seasons in the setting of increased resistance to oseltamivir among circulating influenza viruses
Dharan NJ , Beekmann SE , Fiore A , Finelli L , Uyeki TM , Polgreen PM , Fry AM . Antiviral Res 2010 88 (2) 182-6 INTRODUCTION: In December 2008, new interim guidelines on the use of influenza antiviral agents were released in response to a high prevalence of circulating oseltamivir-resistant seasonal influenza A(H1N1) and adamantane-resistant influenza A(H3N2) viruses. Zanamivir, oseltamivir +/- an adamantane, or oseltamivir was recommended, depending on virus type, subtype, and local surveillance data. MATERIALS AND METHODS: Information about antiviral prescribing practices among IDSA Emerging Infections Network (EIN) members was obtained using two web-based questionnaires; one in January 2009 regarding the prior 2007-08 influenza season and one in April 2009 (prepandemic), regarding the concurrent 2008-09 season. RESULTS: In the 2007-08 survey, 646 (52%) of 1249 EIN members responded and in the 2008-09 season survey, 350 (27%) of 1281 responded. In 2008-09 vs. 2007-08: 59% vs. 69% prescribed or recommended antivirals for treatment (p<.0001); 48% vs. 80% prescribed oseltamivir alone and 39% vs. 10% prescribed zanamivir alone (p<.0001 for both). During 2008-09 28% reported treating fewer patients compared with 2007-08; 42% felt antivirals were less effective due to resistance and 40% felt patients had less severe illness. During 2008-09, 42% of respondents reported difficulty providing zanamivir to patients vs. 5% for oseltamivir (p<.0001). Only 11% of respondents could test for influenza A subtype. During both seasons, approximately 55% used local surveillance data to make treatment decisions. DISCUSSION: A mild winter influenza season, difficulty obtaining recommended agents, and lack of access to subtype diagnosis and surveillance data may have contributed to reduced antiviral use during 2008-2009. |
Influenza in refugees on the Thailand-Myanmar border, May-October 2009
Turner P , Turner CL , Watthanaworawit W , Carrara VI , Kapella BK , Painter J , Nosten FH . Emerg Infect Dis 2010 16 (9) 1366-72 We describe the epidemiology of influenza virus infections in refugees in a camp in rural Southeast Asia during May-October 2009, the first 6 months after identification of pandemic (H1N1) 2009 in Thailand. Influenza A viruses were detected in 20% of patients who had influenza-like illness and in 23% of those who had clinical pneumonia. Seasonal influenza A (H1N1) was the predominant virus circulating during weeks 26-33 (June 25-August 29) and was subsequently replaced by the pandemic strain. A review of passive surveillance for acute respiratory infection did not show an increase in acute respiratory tract infection incidence associated with the arrival of pandemic (H1N1) 2009 in the camp. |
Birth cohort effect on latent tuberculosis infection prevalence, United States
Winston CA , Navin TR . BMC Infect Dis 2010 10 206 BACKGROUND: Latent tuberculosis infection (LTBI) prevalence in the United States decreased approximately 60% in the three decades between the 1971-1972 and 1999-2000 National Health and Nutrition Examination Survey (NHANES) surveys. We examined the effects of birth cohort on LTBI prevalence over time. METHODS: Using weighted data analysis software to account for NHANES survey design, we calculated the difference in LTBI prevalence between 1971-1972 and 1999-2000 for birth cohorts corresponding to 5-year intervals (1912-1916, 1917-1921,1922-1926, 1927-1931, 1932-1936, 1937-1941, 1942-1946). RESULTS: LTBI prevalence was significantly lower in 1999-2000 compared to 1971-1972 for cohorts born in 1926 or earlier (19% versus 5%), but not for cohorts born 1927-1946 (9% versus 7%). Adjustment for cohort restriction and foreign-birth did not qualitatively change the results. CONCLUSIONS: Although older age groups have higher rates of TB infection than younger groups, nationally representative U.S. survey data suggest that observed LTBI prevalence in older people represents an underestimate of infection, because of the birth cohort effect and waning immunologic reactivity. |
Convalescent cultures for control of shigellosis outbreaks
Turabelidze G , Bowen A , Lin M , Tucker A , Butler C , Fick F . Pediatr Infect Dis J 2010 29 (8) 728-30 BACKGROUND: A shigellosis outbreak in the St Louis, Missouri metropolitan area. OBJECTIVE: To evaluate the utility of a second convalescent stool culture following an initial negative convalescent stool culture among persons excluded from work or childcare for shigellosis. METHODS: An observational study of 219 shigellosis cases. Laboratory-confirmed shigellosis patients who are required to submit 2 negative convalescent stool cultures before returning to childcare facilities or work and who submitted at least 1 culture were included in the study. Univariate and multivariable logistic regression analyses were performed to evaluate potential risk factors for a convalescent stool culture being positive. RESULTS: Of 308 persons, 219 (71%) submitted at least 1 convalescent stool culture, and 164 (53%) submitted 2 negative convalescent stool cultures. Among 172 cases with > or =2 follow-up cultures, the probability that the second test result would agree with the first test result was 7% for a "positive" initial stool culture, and 100% for a "negative" stool culture. When adjusted for age, sex, and child care attendance, treated case-patients who had Shigella organisms in the first convalescent culture were more likely to have had stool collected <48 hours after the treatment completion and were more likely to have been treated with trimethoprim-sulfamethoxazole. CONCLUSIONS: Compliance is poor with statutes requiring serial negative stool cultures among certain populations with shigellosis. Absence of Shigella species in the first convalescent stool culture of patients recovering from shigellosis appears to be an adequate measure of bacteriologic cure; however, the health impacts of requiring any convalescent cultures during shigellosis outbreaks remain unclear. |
Dissolution of cemented carbide powders in artificial sweat: implications for cobalt sensitization and contact dermatitis
Stefaniak AB , Harvey CJ , Virji MA , Day GA . J Environ Monit 2010 12 (10) 1815-22 Skin exposure to cobalt-containing materials can cause systemic immune sensitization and upon repeat contact, elicitation of allergic contact dermatitis (ACD). Data on cobalt dissolution rates are needed to calculate uptake through skin and for development of models to understand risk of sensitization or dermatitis. The purpose of this research was to measure the dissolution kinetics of feedstock and process-sampled powders encountered in the production of hard metal alloys using artificial sweat. The physicochemical properties of each material were characterized prior to evaluation of dissolution behavior. Variations in artificial sweat solvent pH and chemistry were used to understand critical factors in dissolution. Dissolution of cobalt, tungsten, and tungsten carbide was often biphasic with the initial rapid phase being up to three orders of magnitude faster than the latter long-term phase. Artificial sweat pH did not influence dissolution of cobalt or tungsten carbide. Solvent composition had little influence on observed dissolution rates; however, vitamin E suppressed the dissolution of cobalt and tungsten carbide from sintered particles obtained from a chamfer grinder. There was no effect of particle size on dissolution of feedstock cobalt, tungsten, tungsten carbide, and admixture powders. Particle physicochemical properties influenced observed dissolution rates with more cobalt and tungsten carbide dissolving from chamfer grinder particles compared to the feedstock powders or admixture powder. Calculations using the observed dissolution rates revealed that skin exposure concentrations were similar to concentrations known to induce cobalt sensitization and elicit ACD. Observed dissolution rates for cobalt in artificial sweat indicate that dermal uptake may be sufficient to induce cobalt sensitization and allergic dermatitis. |
Redesign and operation of the National Home and Hospice Care Survey, 2007
Dwyer LL , Harris-Kojetin LD , Branden L , Shimizu IM . Vital Health Stat 1 2010 (53) 1-192 OBJECTIVES: This methods report provides an overview of the redesigned National Home and Hospice Care Survey (NHHCS) conducted in 2007. NHHCS is a national probability sample survey that collects data on U.S. home health and hospice care agencies, their staffs and services, and the people they serve. The redesigned survey included computerized data collection, greater survey content, increased sample sizes for current home health care patients and hospice care discharges, and a first-ever supplemental survey called the National Home Health Aide Survey. METHODS: The 2007 NHHCS was conducted between August 2007 and February 2008. NHHCS used a two-stage probability sampling design in which agencies providing home health and/or hospice care were sampled. Then, up to 10 current patients were sampled from each home health care agency, up to 10 discharges from each hospice care agency, and a combination of up to 10 patients/discharges from each agency that provided both home health and hospice care services. In-person interviews were conducted with agency directors and their designated staff; no interviews were conducted directly with patients. The survey instrument contained agency- and person-level modules, sampling modules, and a self-administered staffing questionnaire. RESULTS: Data were collected on 1036 agencies, 4683 current home health care patients, and 4733 hospice care discharges. The first-stage agency weighted response rate (for differential probabilities of selection) was 59%. The second-stage patient/discharge weighted response rate was 96%. Three public-use files were released: an agency-level file, a patient/discharge-level file, and a medication file. The files include sampling weights, which are necessary to generate national estimates, and design variables to enable users to calculate accurate standard errors. |
Time-space sampling and respondent-driven sampling with hard-to-reach populations
Semaan S . Method Innov 2010 5 (2) 60–75 Time-space sampling (TSS; also referred to as time-location sampling, TLS) and respondent-driven sampling (RDS) are strategies that can be used for sampling hard-to-reach populations, for whom it is difficult to construct a sampling frame of the individual members of the population. With proper planning, execution, weighting, and analysis of relevant sampling-related data, both strategies have the potential to produce samples that are representative of the target populations. TSS is a probability-based strategy for recruiting members of a target population congregating at specific locations and times. RDS is predicated on the recognition that project participants are better able than project staff to locate and refer to the study site other potential participants; peers from the target population with whom they have an established relationship. Capture-recapture analysis can incorporate TSS and RDS data to estimate the size of a hard-to-reach population. TSS and RDS have been used extensively around the world in public health projects with populations at high risk for HIV infection. The collective experience gained from using TSS and RDS in HIV-related projects can be valuable in using these sampling strategies with other hard-to-reach populations in projects related to economics, political science, or sociology. Although TSS and RDS have specific strengths and limitations in terms of their abilities to produce valid results that enhance generalizability of findings, the choice of a particular sampling strategy depends on characteristics of the target population and the goal and resources of the project. Proper planning, monitoring, and evaluation of the sampling strategy and attention to logistical, regulatory, and ethical considerations are important to the successful implementation and effectiveness of the sampling strategy. |
National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary
Niska R , Bhuiya F , Xu J . Natl Health Stat Report 2010 (26) 1-31 OBJECTIVE: This report presents data on U.S. emergency department (ED) visits in 2007, with statistics on hospital, patient, and visit characteristics. METHODS: Data are from the 2007 National Hospital Ambulatory Medical Care Survey, which uses a national probability sample of visits to emergency departments of nonfederal general and short-stay hospitals in the United States. Sample data were weighted to produce annual national estimates. RESULTS: In 2007, there were about 117 million ED visits in the United States. About 25 percent of visits were covered by Medicaid or the State Children's Health Insurance Program (SCHIP). About one-fifth of ED visits by children younger than 15 years of age were to pediatric EDs. There were 121 ED visits for asthma per 10,000 children under 5 years of age. The leading injury-related cause of ED visits was unintentional falls. Two percent of visits resulted in admission to an observation unit. Electronic medical records were used in 62 percent of EDs. |
In Snow's footsteps: commentary on shoe-leather and applied epidemiology
Koo D , Thacker SB . Am J Epidemiol 2010 172 (6) 737-9 The term shoe-leather epidemiology is often synonymous with field epidemiology or intervention epidemiology. All 3 terms imply investigations initiated in response to urgent public health problems and for which the investigative team does much of its work in the field (i.e., outside the office or laboratory). Alexander D. Langmuir is credited with articulating the concept of disease surveillance as it is applied to populations rather than individuals. He also founded the Epidemic Intelligence Service (EIS) Program in 1951, a 2-year training experience in applied epidemiology that places professionals in the field, domestically and internationally, in real-life situations. Today, 70-90 EIS officers are assigned each year to Centers for Disease Control and Prevention programs and to state and local health departments to meet the broad spectrum of challenges in chronic disease, injury prevention, violence, environmental health, occupational safety and health, and maternal and child health, as well as infectious diseases. Throughout their assignments, EIS officers are encouraged to strive for analytic rigor as well as public health consequence, which requires technical competence blended with good judgment and awareness of context. Effective applied epidemiologists must have skills beyond just epidemiology to improve a population's health; the field of applied epidemiology requires multiple team members, all having different but complementary skills, to be effective. |
Association study between an outbreak of Guillain-Barre syndrome in Jilin, China, and preceding Campylobacter jejuni infection
Zhang M , Li Q , He L , Meng F , Gu Y , Zheng M , Gong Y , Wang P , Ruan F , Zhou L , Wu J , Chen L , Fitzgerald C , Zhang J . Foodborne Pathog Dis 2010 7 (8) 913-9 From June to July 2007, 36 cases of Guillain-Barre syndrome (GBS) occurred in a township in north China. Serological study and bacteria culture were performed to investigate the association between preceding Campylobacter jejuni infection and this GBS outbreak. Anti-C. jejuni antibodies were found in significantly higher numbers of GBS patients (IgM 84%, IgG 87.5%) than in healthy inspection cases (IgM 33%, IgG 27%). IgG anti-GM1 was the dominant anti-ganglioside antibody among the GBS patients. Seven C. jejuni isolates (four from human stool and three from poultry specimens taken from the patients' houses) were obtained. Serotyping and molecular analysis were used to investigate the genetic relatedness among these C. jejuni isolates. The four human isolates, collected from residents of the same district, were indistinguishable by both pulsed-field gel electrophoresis and multilocus sequence typing, suggesting these patients had a common source of infection. A new sequence type, sequence type-2993, was assigned to the human C. jejuni isolates, three of which belonged to Penner serotype heat-stable (HS):41. Both serotype and molecular subtype of the human C. jejuni isolates were different from those of isolates obtained from poultry specimens. Our results suggest that the antecedent C. jejuni infection triggered this GBS outbreak in China. |
Design and operation of the National Survey of Adoptive Parents, 2007
Bramlett MD , Foster EB , Frasier AM , Satorius J , Skalland BJ , Nysse-Carris KL , Morrison HM , Chowdhury SR . Vital Health Stat 1 2010 (50) 1-154 OBJECTIVE: This report presents the development, plan, and operation of the National Survey of Adoptive Parents (NSAP), a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. NSAP was designed to produce national estimates of the characteristics, health, and well-being of adopted children and their families, the preadoption experiences of the adoptive parents, and their access to and utilization of postadoption supports and services. Funding for the survey was provided by the Office of the Assistant Secretary for Planning and Evaluation and the Administration for Children and Families, both of the Department of Health and Human Services. METHODS: The National Survey of Children's Health, 2007 (NSCH) was a random-digit-dial telephone survey of households with children under age 18 years. In households with more than one child, one child was randomly selected to be the subject of the interview. Children identified as adopted, who did not live with a biological parent and who lived in households where English was spoken, were eligible for the NSAP follow-up interview. The NSAP interview was a call-back scheduled at the end of the NSCH telephone interview. Sampled children included those adopted from other countries, from the U.S. foster care system, and from private domestic sources. Respondents were either the adoptive mother or the adoptive father. RESULTS: A total of 2,089 NSAP interviews were completed from April 2007 to July 2008. The interview completion rate (i.e., cooperation rate) for eligible respondents was 74.4%. The overall response rate, taking into account nonresponse to NSCH, was 34.6%. |
Multidrug-resistant Salmonella isolates from retail chicken meat compared with human clinical isolates
M'Ikanatha N M , Sandt CH , Localio AR , Tewari D , Rankin SC , Whichard JM , Altekruse SF , Lautenbach E , Folster JP , Russo A , Chiller TM , Reynolds SM , McDermott PF . Foodborne Pathog Dis 2010 7 (8) 929-34 AIM: To examine the prevalence of antimicrobial-resistant Salmonella in chicken meat and correlate with isolates from ill humans. METHODS: We isolated Salmonella from raw chicken purchased from a randomly selected sample of retail outlets in central Pennsylvania during 2006-2007. Salmonella isolates from meat were compared, using pulsed-field gel electrophoresis, to isolates in the PulseNet database of Salmonella recovered from humans. RESULTS: Of 378 chicken meat samples, 84 (22%) contained Salmonella. Twenty-six (31%) of the Salmonella isolates were resistant to > or = 3 antimicrobials and 18 (21%) were resistant to ceftiofur. All ceftiofur-resistant isolates exhibited reduced susceptibility (minimum inhibitory concentration >2 microg/mL) to ceftriaxone and carried a bla(CMY) gene, as detected by polymerase chain reaction. Among the 28 Salmonella serovar Typhimurium isolates, 20 (71.4%) were resistant to > or = 3 antimicrobials and 12 (42.9%) were resistant to ceftiofur. One ceftiofur-resistant Salmonella serovar Typhimurium poultry isolate exhibited a rare pulsed-field gel electrophoresis pattern indistinguishable from a human isolate in PulseNet; both isolates carried the bla(CMY-2) gene. CONCLUSIONS: These data demonstrate the presence of multidrug-resistant Salmonella in poultry meat, including bla(CMY) plasmid-mediated genes that confer resistance to both ceftiofur, used in poultry, and ceftriaxone, used for treating salmonellosis in humans. This study illustrates the potential for molecular subtyping databases to identify related Salmonella isolates from meat and ill humans, and suggests that chicken could be a source for multidrug-resistant salmonellosis in humans. |
[The example of cystic fibrosis to highlight the complexity of genetic screening]
Bochud M , Fellmann F , Vader JP , Grosse S , Paccaud F , Guessous I . Rev Med Suisse 2010 6 (256) 1395-9 Various institutions and countries often reach different conclusions about the utility of introducing a newborn screening test in the general population. This paper highlights the complexity of population screening including genetic tests. Using the example of cystic fibrosis genetic screening, for which a Swiss Working Group for Cystic Fibrosis is currently evaluating the pertinence, we outline that screening recommendations are often based more on expert opinion and emerging new technologies rather than on evidence. We also present some ethical and economic issues related to cystic fibrosis genetic screening. |
Preparing for a healthy future today: folic acid formative research with young Latina adults
Flores AL , Prue CE , Panissidi P , Lira A . Fam Community Health 2010 33 (4) 301-17 Young Latina adults require targeted health messages to meet the unique needs of this life stage. Folic acid messages for the prevention of neural tube defects that are effective for other women might not be relevant to this group. The aim of this study was to identify barriers and motivators to folic acid consumption for this population and develop educational materials and messages that address their needs. This article presents 3 phases of formative research that formed the basis for the development of Spanish-language print materials and radio advertisements aimed at promoting folic acid consumption among young Latina adults. |
Effectiveness of the VOICES/VOCES sexually transmitted disease/human immunodeficiency virus prevention intervention when administered by health department staff: does it work in the "real world"?
Neumann MS , O'Donnell L , Doval AS , Schillinger J , Blank S , Ortiz-Rios E , Garcia T , O'Donnell C R . Sex Transm Dis 2010 38 (2) 133-9 BACKGROUND: Prevention providers wonder whether benefits achieved in the original, researcher-led, efficacy trials of interventions are replicated when the intervention is delivered in real-world settings by their agency's staff. METHODS: A replication study was conducted at 2 public sexually transmitted disease (STD) clinics (New York City and San Juan, PR). Using a controlled trial design, intervention (VOICES/VOCES) and comparison conditions (regular clinic services) were assigned in alternating 4-week blocks. Trained agency staff delivered the intervention. Effectiveness was assessed for incident STDs, redemption of coupons for condoms at neighborhood location after the visit, and improved knowledge and attitudes about STDs and condoms.RESULTS: A total of 3365 patients were recruited, completed the protocol, and followed through STD surveillance systems for an average of 17 months. Of 397 with an incident infection, 226 (13.4%) were among those enrolled during comparison blocks; 171 were among those in the intervention condition (10.2%). Controlling for site and gender, participants enrolled during intervention blocks were significantly less likely to have an incident STD reported to the surveillance system (hazard ratio, 0.78; 95% confidence interval, 0.64-0.96). Intervention block participants scored higher on scales of STD knowledge (4.89 vs. 3.87, P < 0.001) and condom knowledge, attitude, and efficacy (10.98 vs. 9.16, P < 0.001). More of those exposed to VOICES/VOCES redeemed condoms (P < 0.05). Positive effects were more consistent in New York, which may be related to fidelity of implementation. CONCLUSIONS: A packaged human immunodeficiency virus prevention intervention can be delivered by agencies, with benefits similar to those achieved in the research setting. |
The development of the residential Fire H.E.L.P. tool kit: a resource to protect homebound older adults
Diekman S , Huitric M , Netterville L . J Public Health Manag Pract 2010 16 S61-7 This article describes the development of the Fire H.E.L.P. tool kit for training selected Meals On Wheels (MOW) staff in Texas to implement a fire safety program for homebound older adults. We used a formative evaluation approach during the tool kit's development, testing, and initial implementation stages. The tool kit includes instructional curricula on how to implement Fire H.E.L.P., a home assessment tool to determine a residence's smoke alarm needs, and fire safety educational materials. During the tool kit's pilot test, MOW participants showed enhanced fire safety knowledge and high levels of confidence about applying their newfound training skills. After the pilot test, MOW staff used the tool kit to conduct local training sessions, provide fire safety education, and install smoke alarms in the homes of older adults. We believe the approach used to develop this tool kit can be applied to education efforts for other, related healthy home topics. |
Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients
Patel PR , Thompson ND , Kallen AJ , Arduino MJ . Am J Kidney Dis 2010 56 (2) 371-8 Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV transmission among patients undergoing hemodialysis has been documented frequently. Outbreak investigations have implicated lapses in infection control practices as the cause of HCV infections. Preventing these infections is an emerging priority for renal care providers, public health agencies, and regulators. Adherence to recommended infection control practices is effective in preventing HCV transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of incident HCV infections and hemodialysis-related transmission is an essential component of patient safety and infection prevention efforts. This article describes the current epidemiology of HCV infection in US maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission. |
Calling it 'multidose' doesn't make it so: inappropriate sharing and contamination of parenteral medication vials
Schaefer MK , Shehab N , Perz JF . Am J Infect Control 2010 38 (7) 580-1 Motamedifar and Askarian reported the results of a study evaluating aerobic bacterial contamination of medication vials present on multiple wards at a large, teaching hospital in Iran.1 The authors identified bacterial contamination in 5.6% of the 637 medication vials that were sampled. In the United States, contamination of parenteral medication vials has served as an underappreciated source of health care-associated infections including bloodstream infections, epidural abscesses, and viral hepatitis.2, 3, 4, 5 This study highlighted the general risk of extrinsic contamination of medication vials and prompts us to comment on several important factors that contribute to the potential for contamination and spread of infections. | The investigators described all of the medication vials tested as “multidose” based on a functional definition: “a vial that was used more than once.” However, only 1 of the contaminated vials contained antimicrobial preservative. In the United States, these preservative-free parenteral medications would likely have been labeled as single-dose or single-use vials, not intended for use in more than 1 patient. Unfortunately, the distinction between true multidose vials, which are labeled as such and generally contain an antimicrobial preservative, and other types of medication is often not understood by health care providers. There have been repeated instances in which parenteral medications labeled as single-use or single-dose were mistakenly referred to by health care personnel as “multidose” and used for multiple patients because they appeared to contain quantities in excess of those needed for a single patient. When used properly, vials that are labeled by manufacturers as multidose can be safely accessed multiple times. This stands in contrast to other injectable medications labeled as single-use or single-dose, which should only be used for a single patient. |
Receipt of tetanus-containing vaccinations among adolescents aged 13 to 17 years in the United States: National Immunization Survey-Teen 2007
Jain N , Stokley S , Cohn A . Clin Ther 2010 32 (8) 1468-1478 BACKGROUND: Tetanus-diphtheria-acellular pertussis (Tdap) was licensed in the United States in 2005 to be given in place of tetanus-diphtheria (Td) for single use in adolescents. OBJECTIVES: This analysis was conducted to determine vaccination coverage with Td and Tdap among adolescents in the United States aged 13 to 17 years and to characterize adolescents who had not received a tetanus-containing booster vaccine. METHODS: Data were analyzed from the National Immunization Survey-Teen (NIS-Teen) 2007, a random-digit-dialing telephone survey that is weighted to be nationally representative of adolescents aged 13 to 17 years. Parents gave verbal consent so that vaccination providers could be contacted to obtain the adolescents' immunization histories. Weighted coverage of Td and Tdap vaccines was estimated with bivariate analysis from returned vaccination data from the providers' records. A multivariable analysis was conducted to determine factors independently associated with nonreceipt of tetanus-containing vaccines. Missed opportunities for vaccination with Td or Tdap were determined from documented vaccination visits for other vaccines. RESULTS: Out of 69,289 households screened, 6572 had an eligible adolescent aged 13 to 17 years and 5486 (83.5%) completed the household interview. Among 5474 adolescents who met the age criterion and completed a household interview, consent to contact providers was obtained for 4114 (75.2%). A total of 2947 adolescents (53.7% of those with completed household interviews) had immunization histories returned from providers for verification. In 2007, a total of 2149 adolescents (weighted percentage, 72.3%) aged 13 to 17 years had received at least one tetanus booster since age 10 years; Tdap coverage was 30.4%. The mean (SE) age at Td or Tdap receipt was 13.04 (0.04) years (range, 10.00-17.84 years); the median age was 12.86 years. More than half (59.4%) of sampled adolescents had received their booster dose on or after January 1, 2005; among those vaccinated in 2007, 89.1% received Tdap as their booster dose. Factors associated with nonreceipt of Td or Tdap included geographic location and not having a provider-reported well-child visit at ages 11 to 12 years. CONCLUSIONS: Almost three quarters of adolescents aged 13 to 17 years included in the NIS-Teen 2007 received a tetanus-containing vaccine, and almost one third received Tdap. Among adolescents who received a tetanus-containing vaccine in 2007, a total of 89.1% received the new Tdap vaccine in place of Td, as recommended. Adolescents not receiving Td or Tdap may face barriers to accessing health care. Research is needed to identify evidence-based strategies to improve vaccination coverage among adolescents. |
The effectiveness of varicella vaccine in China
Fu C , Wang M , Liang J , Xu J , Wang C , Bialek S . Pediatr Infect Dis J 2010 29 (8) 690-3 BACKGROUND: The attenuated live varicella vaccine had been shown to be effective in preventing varicella and reducing the disease burden in the United States. However, little work has been done on investigating vaccine effectiveness in China where 3 varicella vaccines are available. Although the vaccines contain the same strain of virus, the vaccines licensed in China were from manufacturers different from the one licensed in the United States. We conducted a matched case-control study to assess the effectiveness of the 3 varicella vaccines in use in China. METHODS: In 2005, we enrolled 1000 cases from Guangzhou, China and 1000 controls matched by age and place of residence. The cases were children clinically diagnosed with acute onset of a diffuse maculopapulovesicular rash without other apparent cause. We interviewed the legal guardians of the participants for demographic information and disease history after obtaining informed consent. We collected information on vaccination status from electronic vaccination records. RESULTS: The 3 varicella vaccines in China (Varilrix from GlaxoSmithKline, Changchun and Shanghai from Changchun and Shanghai Institutes of Biologic Products, respectively) had similar effectiveness: Varilrix 86.4% (95% confidence interval [CI]: 72.6, 93.2), Changchun 79.5% (95% CI: 58.1, 90.0), and Shanghai 92.6% (95% CI: 68.9, 98.2). Vaccine effectiveness was higher during the first year after vaccination than during the subsequent 5 years, but the differences did not reach statistical significance. CONCLUSIONS: The varicella vaccines in China are highly effective in preventing clinical varicella. Further studies on laboratory-confirmed cases are needed to verify the change of vaccine-induced immunity over time. |
Hepatitis E vaccine: not a moment too soon
Holmberg SD . Lancet 2010 376 (9744) 849-51 Hepatitis E virus (HEV) remains one of the least understood and perplexing viruses pathogenic to human beings. From 5% to 20% of people in developed countries show a steady increase in the titre of anti-HEV IgG with increasing age,1 but infection with the prevalent genotype in Europe and the USA, genotype 3, rarely results in symptoms. Although this genotype has been recovered from feral and domestic pigs—and sometimes from people who have eaten raw pork or offal—convincing epidemiological evidence that this zoonotic reservoir is the source of most human exposures or infections remains elusive.2 | Unlike the situation in developed countries, HEV infection with genotypes 1, 2, and 4, which predominate in developing countries, is not merely an academic quandary but a major cause of disease and death. Some areas of east and south Asia are highly endemic for the virus. Large outbreaks (tens of thousands of cases) have occurred in India3, 4 and China5, 6 since 1955; these were deemed to have been waterborne. More recently there have been very large outbreaks in southern Sudan7 and nearby northern Uganda,8 in what seem to be susceptible African populations in which HEV outbreaks had not previously been recorded. In these outbreaks, the testing of drinking water from wells did not reveal the virus or coliforms, and continued provision of clean water did not prevent additional infections. Several other lines of evidence suggest that some of these outbreaks are attributable to person-to-person transmission.9 |
Inactivated rotavirus vaccine induces protective immunity in gnotobiotic piglets
Wang Y , Azevedo M , Saif LJ , Gentsch JR , Glass RI , Jiang B . Vaccine 2010 28 (33) 5432-6 Live oral rotavirus vaccines that are effective in middle and high income countries have been much less immunogenic and effective among infants in resource-limited settings. Several hypotheses might explain this difference, including neutralization of the vaccine by high levels of maternal antibody in serum and breast milk, severe malnutrition, and interference by other flora and viruses in the gut. We have pursued development of an alternative parenteral rotavirus vaccine with the goal of inducing comparable levels of immunogenicity and efficacy in populations throughout the world regardless of their income levels. In the present study, we assessed the immunogenicity and protection of a candidate inactivated rotavirus vaccine (IRV), the human strain CDC-9 (G1P[8]) formulated with aluminum phosphate, against rotavirus infection in gnotobiotic piglets. Three doses of IRV induced high titers of rotavirus-specific IgG and neutralizing activity in the sera of gnotobiotic piglets and protection against shedding of rotavirus antigen following oral challenge with a homologous virulent human strain Wa (G1P[8]). Our findings demonstrate the proof of concept for an IRV in a large animal model and provide evidence and justification for further clinical development as an alternative candidate vaccine. |
Mobile messaging as surveillance tool during pandemic (H1N1) 2009, Mexico
Lajous M , Danon L , Lopez-Ridaura R , Astley CM , Miller JC , Dowell SF , O'Hagan JJ , Goldstein E , Lipsitch M . Emerg Infect Dis 2010 16 (9) 1488-9 To the Editor: Pandemic (H1N1) 2009 highlighted challenges faced by disease surveillance systems. New approaches to complement traditional surveillance are needed, and new technologies provide new opportunities. We evaluated cell phone technology for surveillance of influenza outbreaks during the outbreak of pandemic (H1N1) 2009 in Mexico. |
The relationship between intimate partner violence and children's asthma in 10 US states/territories
Breiding MJ , Ziembroski JS . Pediatr Allergy Immunol 2010 22 e95-100 Intimate partner violence (IPV) has been shown to negatively impact the health of both the adults who experience IPV and the children who are exposed to IPV. Although IPV experienced by women has been linked to children's asthma, this study is the first to examine this question among both women and men, and the first study in the United States to examine this question as part of a population-based data set. In 2005, ten US states/territories administered an IPV module and a children's asthma module within the Behavioral Risk Factor Surveillance System (BRFSS). Lifetime IPV was assessed by four questions that asked about threatened, attempted, or completed physical violence, as well as unwanted sex, by a current or former intimate partner. The children's asthma module asked respondents to report whether a randomly selected child in their household had ever been diagnosed with asthma and whether the same child currently had asthma. Women who experienced lifetime IPV, in contrast to women who never experienced IPV, were significantly more likely to report that their children had ever had asthma and currently have asthma. Among men, significant differences were not found when comparing men who reported lifetime IPV to those that did not report lifetime IPV. The results highlight the importance of primary prevention of IPV, as reducing the occurrence of IPV could improve not only the long-term health of those who experience IPV but also the health of their children. |
Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005
Naumann RB , Dellinger AM , Zaloshnja E , Lawrence BA , Miller TR . Traffic Inj Prev 2010 11 (4) 353-60 OBJECTIVES: To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. METHODS: Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. RESULTS: Motor vehicle-related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle-related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). CONCLUSIONS: The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available. |
Release of beryllium from beryllium-containing materials in artificial skin surface film liquids
Stefaniak AB , Virji MA , Day GA . Ann Occup Hyg 2010 55 (1) 57-69 PURPOSE: Skin exposure to soluble beryllium compounds causes systemic sensitization in humans. Penetration of poorly soluble particles through intact skin has been proposed as a mechanism for beryllium sensitization; however, this mechanism is controversial. The purpose of this study was to investigate the hypothesis that particulate beryllium compounds in contact with skin surface release ions via dissolution in sweat. METHODS: Dissolution of 11 particulate beryllium materials (hydroxide, metal, oxides and copper-beryllium fume), 3 copper-beryllium alloy reference materials (chips and solid block), and 4 copper-beryllium alloy tools was measured over 7 days in artificial sweat buffered to pH 5.3 and pH 6.5. RESULTS: All test materials released beryllium ions in artificial sweat. Particulate from a reduction furnace that contained both crystalline and amorphous beryllium was the most soluble compound-40% dissolved in 8 h. Rates of beryllium release from all other particulate and reference materials were faster at pH 5.3 than at pH 6.5 (P < 0.05). At pH 5.3, values of the chemical dissolution rate constant, k [g (cm(2) day)(-1)] differed significantly for hydroxide, metal, and oxide -1.7 +/- 0.0 x 10(-7), 1.7 +/- 0.6 x 10(-8), and 1.0 +/- 0.5 x 10(-9), respectively (P < 0.05). Up to 30 mug of beryllium was released from the alloy tools within 1 h. Dissolution rates in artificial sweat were equal to or faster than values previously determined for these materials in lung models. CONCLUSIONS: Poorly soluble beryllium materials undergo dissolution in artificial sweat, suggesting that skin exposure is a biologically plausible pathway for development of sensitization. Skin surface acidity, which is regulated by sweat chemistry and bacterial hydrolysis of sebum lipids varies by anatomical region and may be an exposure-modifying factor for beryllium particle dissolution. |
Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms
Owusu-Edusei Jr K , Peterman TA , Ballard RC . Sex Transm Dis 2010 38 (1) 1-7 BACKGROUND: The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new algorithm with the standard algorithm from the perspective of the United States health system. METHODS: We used a cohort decision analysis to estimate the expected costs and effects (including follow-ups and overtreatment) of the 2 algorithms from a health-care system perspective. In the standard algorithm, rapid plasma reagin (RPR) is followed (if reactive) by EIA/CA (Nontreponemal-First). In the new algorithm, EIA/CA is followed (if reactive) by RPR. If the RPR is negative, Treponema pallidum passive particle agglutination assay (TP-PA) test is used (Treponemal-First). RESULTS: For a cohort of 200,000 individuals (1000 current infections and 10,000 previous infections), the net costs were $1.6 m (Treponemal-First) and $1.4 m (Nontreponemal-First). The Treponemal-First option treated 118 more cases (986 vs. 868) but resulted in a substantially higher number of follow-ups (11,450 vs. 3756) and overtreatment (964 vs. 38). Treating the additional 118 cases might prevent 1 case of tertiary syphilis. The estimated cost-effectiveness ratios were $1671 (Treponemal-First) and $1621 (Nontreponemal-First) per case treated. The overtreatment was a function of the specificity of the EIA/CA and the lack of independence of EIA/CA and TP-PA. CONCLUSION: The Treponemal-First option costs slightly more and results in more unnecessary treatment. The use of an independent confirmatory treponemal test, rather than TP-PA, might reduce this overtreatment. |
Vaccination of Rhesus macaques with AVA produces a serum antibody response that effectively neutralizes receptor bound protective antigen in vitro
Clement KH , Rudge TL Jr , Mayfield HJ , Carlton LA , Hester A , Niemuth NA , Sabourin CL , Brys AM , Quinn CP . Clin Vaccine Immunol 2010 17 (11) 1753-62 Anthrax toxin (ATx) is comprised of binary exotoxins lethal toxin (LTx) and edema toxin (ETx). They have separate effector proteins (edema factor (EF) or lethal factor (LF)) and share the common binding protein Protective Antigen (PA). PA is the primary immunogen in current licensed vaccine "Anthrax Vaccine Adsorbed" (AVA, Biothrax(R)). AVA confers protective immunity by stimulating production of ATx neutralizing antibodies, which could block the intoxication process at several steps (binding of PA to target cells surface, furin cleavage, toxin complex formation, and binding/translocation of ATx into the cell. To evaluate ATx neutralization by anti-AVA antibodies, we developed two low-temperature LTx neutralization activity (TNA) assays that distinguish antibody blocking before and after binding of PA to target cells (non-complexed (NC) and receptor-bound (RB) TNAs). These assays were used to investigate anti-PA antibody responses in AVA-vaccinated Rhesus macaques (Macaca mulatta) that survived aerosol challenge with Bacillus anthracis Ames spores. Results showed that macaque anti-AVA sera neutralized LTx in vitro, even when PA was pre-bound to cells. Neutralization titers in surviving versus non-surviving animals and between pre-challenge versus post-challenge activity were highly correlated. These data demonstrate that AVA stimulates a myriad of antibodies that recognize multiple neutralizing epitopes, and confirm that change, loss, or occlusion of epitopes after PA is processed from PA83 to PA63 at the cell surface does not significantly affect in vitro neutralizing efficacy. Furthermore, these data support that full length PA83 monomer is an appropriate immunogen for inclusion in next-generation anthrax vaccines. |
Leptin modulated changes in adipose tissue protein expression in ob/ob mice
Zhang W , Ambati S , Della-Fera MA , Choi YH , Baile CA , Andacht TM . Obesity (Silver Spring) 2010 19 (2) 255-61 Comparative proteomic analyses were performed in adipose tissue of leptin-deficient ob/ob mice treated with leptin or control buffer in order to identify the protein expression changes as the potential targets of leptin. Mice were treated with either phosphate-buffered saline (control) or 10 microg/day leptin for 14 days via subcutaneous osmotic minipumps. Total protein from white adipose tissue was extracted and labeled with different fluorescent cyanine dyes for analysis by two-dimensional difference gel electrophoresis (DIGE). Spots that were differentially expressed and appeared to have sufficient material for mass spectrometry analysis were picked and digested with trypsin and subjected to MALDI-TOF MS for protein identification. Twelve functional protein groups were found differentially expressed in adipose tissue of leptin-treated vs. control ob/ob mice, including molecular chaperones and redox proteins such as calreticulin (CALR), protein disulfide isomerase-associated 3 (PDIA3), prohibitin (PHB), and peroxiredoxin-6 (PRDX6); cytoskeleton proteins such as beta actin, desmin, and alpha-tubulin; and some other proteins. The mRNA levels of CALR, PDIA3, and PHB were measured by real-time reverse transcription-PCR and found to be upregulated (P < 0.05), consistent with the fold change in protein expression level. Our findings suggest that leptin's effects on lipid metabolism and apoptosis may be mediated in part by alterations in expression of molecular chaperones and redox proteins for regulating endoplasmic reticulum stress and cytoskeleton proteins for regulating mitochondrial morphology. |
Newborn screening for Fabry disease by measuring GLA activity using tandem mass spectrometry
Dajnoki A , Fekete G , Keutzer J , Orsini JJ , De Jesus VR , Chien YH , Hwu WL , Lukacs Z , Muhl A , Zhang XK , Bodamer O . Clin Chim Acta 2010 411 1428-31 BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by the deficiency of alpha-galactosidase A (GLA). We evaluated a tandem mass spectrometry method to measure GLA activity. METHODS: One 3.2mm punch from a dried blood spot sample (DBS) was incubated with substrate and internal standard in the reaction buffer for 22 h. The resulting product was quantified against internal standard using MS/MS. RESULTS: The median GLA activity of male newborn DBS (N=5025) was 9.85 + or - 6.4 micromol/h/l (CI 95% is 9.67-10.02 micromol/h/l); The median GLA activity of female newborns (N=4677) was 10.2 + or - 6.3 micromol/h/l (CI 95% is 10.02-10.38 micromol/h/l). The difference between the two subgroups is within assay analytical variation. The GLA activities in the DBS samples from 9 juvenile and adult males with previously identified FD were below 1.64 micromol/h/l. The GLA activities from 32 juvenile and adult females with confirmed FD were below 4.73 micromol/h/l. In 5 (16%) females GLA activities were above the 0.5th percentile of lower limit of CI 95% at 3.18 micromol/h/l. CONCLUSIONS: The MS/MS method for Fabry disease newborn screening is robust and can be readily multiplexed with other lysosomal disorders such as Pompe, Gaucher, Niemann-Pick, and Krabbe diseases. |
Pathogenesis and immune response of Crimean-Congo hemorrhagic fever virus in a STAT-1 knockout mouse model
Bente DA , Alimonti JB , Shieh WJ , Camus G , Stroher U , Zaki S , Jones SM . J Virol 2010 84 (21) 11089-100 Tick-borne Crimean-Congo hemorrhagic fever virus (CCHFV) causes a severe hemorrhagic syndrome in humans but not in its vertebrate animal host. The pathogenesis of the disease is largely not understood due to the lack of an animal model. Laboratory animals typically show no overt signs of disease. Here, we describe a new small animal model to study CCHFV pathogenesis that manifests clinical disease, similar to that seen in humans, without adaptation of the virus to the host. Our studies revealed that mice deficient in the STAT-1 signaling molecule were highly susceptible to infection, succumbing within 3-5 days. After CCHFV challenge, mice exhibited fever, leukopenia, thrombocytopenia, and highly elevated liver enzymes. Rapid viremic dissemination and extensive replication in visceral organs, mainly in liver and spleen, was associated with prominent histopathologic changes in these organs. Dramatically elevated pro-inflammatory cytokine levels were detected in blood of animals suggestive of a cytokine storm. Immunologic analysis revealed delayed immune cell activation and intensive lymphocyte depletion. Furthermore, this study also demonstrated that ribavirin, a suggested treatment in human cases, protects mice from lethal CCHFV challenge. In conclusion, our data demonstrate that the IFN response is crucial in controlling CCHFV replication in this model and this is the first study that offers an in depth in vivo analysis of CCHFV pathophysiology. This new mouse model exhibits key features of fatal human CCHF, proves useful for the testing of therapeutic strategies, and can be used to study virus attenuation. |
Electrochemical and optical behavior of 8-Hydroxypyrene-1,3,6-trisulfonic acid at optically transparent electrodes
Andrews RN , Seliskar CJ , Heineman WR . Electroanalysis 2010 22 (14) 1557-1565 The objective of this work is to elucidate the electrochemical and corresponding optical properties of 8-hydroxypyrene-1,3,6-trisulfonic acid (HPTS), using optically transparent electrodes, thereby deducing its usefulness as a model compound for spectroelectrochemical sensor development. Three pH levels were tested to determine optimal solution conditions for optical signal modulation. The electrolysis of HPTS follows an ECE mechanism, presumably resulting in the formation of a dihydroxy/dione derivative, and modulates the optical response at 405 and 460 nm wavelengths for pH 5 solutions. HPTS is a good candidate for spectroelectrochemical sensor research. |
Improved diagnosis of Strongyloides stercoralis using recombinant antigen-based serologies: a community-wide study in northern Argentina
Krolewiecki AJ , Ramanathan R , Fink V , McAuliffe I , Cajal SP , Won K , Juarez M , Di Paolo A , Tapia L , Acosta N , Lee R , Lammie P , Abraham D , Nutman TB . Clin Vaccine Immunol 2010 17 (10) 1624-30 BACKGROUND: The serodiagnosis of Strongyloides stercoralis infection by enzyme linked immunosorbent assays based on crude antigen (CrAg-ELISA), while useful, has been limited by the reliance on crude parasite extracts. Newer techniques such as the luciferase immunoprecipitation systems assay (LIPS) based on a 31-kDa recombinant antigen (termed NIE) from S. stercoralis and/or the recombinant antigen S. stercoralis immunoreactive antigen (SsIR), or the NIE-ELISA have shown promise in controlled settings. We compared each of these serologic assays in individuals from both endemic and non-endemic regions of the world. METHODS: A comprehensive stool evaluation (sedimentation concentration, Baermann with charcoal cultures, Agar plate, and Harada-Mori) and 4 different serologic techniques using CrAg-ELISA or recombinant NIE-ELISA as well as LIPS using NIE alone or in combination with a second recombinant antigen (NIE/SsIR-LIPS), were compared among individuals with parasitologically proven infection (n=251) and healthy controls from non-endemic regions of the world (n=11). Accuracy was calculated for each assay. RESULTS: The prevalence of S. stercoralis infection was 29.4% among Argentinean stool samples (n=228). Sedimentation concentration and Baermann were the most sensitive stool-based methods. NIE-LIPS showed the highest sensitivity (97.8%) and specificity (100%) of the serologic assays. The calculated negative predictive value was highest for both the NIE-LIPS and CrAg-ELISA (> 97%) irrespective of disease prevalence. No cross reactivity with soil transmitted helminthes was noted. CONCLUSIONS: NIE-LIPS compares favorably against the current CrAg-ELISA and stool evaluation, providing additional accuracy and ease of performance in the serodiagnosis of S. stercoralis infections irrespective of disease prevalence. |
Development of human-murine chimeric immunoglobulin Gs for use in the serological detection of human flavivirus and alphavirus antibodies
Thibodeaux BA , Panella AN , Roehrig JT . Clin Vaccine Immunol 2010 17 (10) 1617-23 Diagnosis of human arboviral infections relies heavily on serological techniques such as the immunoglobulin (Ig) M antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) and the indirect IgG ELISA. Broad application of these assays is hindered by the lack of standardized positive human control sera that react with the wide variety of flaviviruses (e.g., dengue [DEN], West Nile [WN], yellow fever [YF], Japanese encephalitis [JE], Saint Louis encephalitis [SLE], and Powassan [POW] viruses), or alphaviruses (e.g., Eastern equine encephalitis [EEE], Western equine encephalitis [WEE], Venezuelan equine encephalitis [VEE], and chikungunya [CHIK] viruses) that can cause human disease. We have created human-murine chimeric monoclonal antibodies (cMAbs) by combining the variable regions of broadly flavivirus (6B6C-1) or alphavirus (1A4B-6) cross-reactive murine MAbs (mMAbs) with the constant region of human IgG1. These cMAbs may be used as standardized reagents capable of replacing human positive infection-immune control sera in indirect IgG ELISA for diagnosis of all human flavi- or alphaviral infections. The IgG cMAbs secreted from plasmid-transformed Sp2/0-Ag14 cells had serological activity identical to the parent mMAbs as measured by ELISA using multiple flaviviruses or alphaviruses. |
Recognizing excellence in Maternal and Child Health (MCH): 2009 National MCH epidemiology awards
Kroelinger CD , Sappenfield WM . Matern Child Health J 2010 14 (6) 822-6 Since 2000, the Coalition for Excellence in Maternal and Child Health (MCH) Epidemiology has recognized the significant contributions of individuals and organizations to improve the health of women, children, infants, and families by giving the National MCH Epidemiology Awards. The awards are presented annually at the MCH Epidemiology Conference. These awards are supported each year by sixteen national health organizations, and all should be commended for recognizing and promoting continuing excellence in the field of MCH epidemiology (Table 1) The Coalition for Excellence in MCH Epidemiology defines MCH Epidemiology in the following way: | Table 1 Coalition for excellence in maternal and child health (MCH) epidemiology member organizations | Full size table | The systematic collection, analysis, and interpretation of population-based and program-specific health and related data in order to assess the distribution and determinants of the health status and needs of the maternal child population for the purpose of planning, implementing, and assessing effective, science-based strategies and promoting policy development [1]. |
Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception: a population-based cohort study
Hvidtjorn D , Grove J , Schendel D , Svaerke C , Schieve LA , Uldall P , Ernst E , Jacobsson B , Thorsen P . Hum Reprod 2010 25 (8) 2115-23 BACKGROUND: This paper assesses the risk of cerebral palsy (CP) in children born after assisted conception compared with children born after natural conception (NC). METHODS: This population based follow-up study included all 588,967 children born in Denmark from 1995 to 2003. Assisted conception was defined as IVF, with or without ICSI, and ovulation induction (OI), with or without subsequent insemination. RESULTS: There were 33 139 (5.6%) children born in Denmark from 1995 to 2003 as a result of assisted conception and through to June 2009, 1146 (0.19%) children received a CP diagnosis. Children born after assisted conception had an increased risk of a CP diagnosis, crude hazard rate ratio (HRR) 1.90 (95% CI: 1.57-2.31) compared with NC children. Divided into IVF and OI children compared with NC children, the risk was HRR 2.34 (95% CI: 1.81-3.01) and HRR 1.55 (95% CI: 1.17-2.06), respectively. When we included the intermediate factors multiplicity and gestational age in multivariate models, the risk of CP in assisted conception disappeared. In general, children with CP born after assisted conception had similar CP subtypes and co-morbidities as children with CP born after NC. CONCLUSION: The risk of CP is increased after both IVF and OI. The increased risk of CP in children born after assisted conception, and in particular IVF, is strongly associated with the high proportion of multiplicity and preterm delivery in these pregnancies. A more widespread use of single embryo transfer warrants consideration to enhance the long-term health of children born after IVF. |
Temporal patterns in work-related fatalities among foreign-born workers in the US, 1992-2007
Menendez CK , Havea SA . J Immigr Minor Health 2010 13 (5) 954-62 In the United States, approximately 20% of all workers who died on the job in 2007 were foreign-born. The objective of this study was to describe trends in occupational fatalities among foreign-born workers. An analysis of fatal injuries among foreign-born workers in the US occurring from 1992 through 2007 was conducted using the Bureau of Labor Statistics' Census of Fatal Occupational Injuries. Individual characteristics, employment characteristics, injury events and industry employment were summarized and evaluated for trends. Both the number and proportion of foreign-born workers who died from a traumatic work-related injury increased substantially over the time period studied. The proportion who were men, aged 25-44 years, Hispanic, non self-employed, employed by business establishments with 10 or fewer employees, working at private residences and working in Construction and Services consistently increased throughout the time period. While some trends among foreign-born decedents are improving, others are worsening. More comprehensive research efforts are needed to address the occupational injury and safety issues among foreign-born workers, with a focus on Hispanics. |
Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis
Tak S , Sweeney MH , Alterman T , Baron S , Calvert GM . Am J Public Health 2010 100 (10) 1938-45 OBJECTIVES: We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. METHODS: We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. RESULTS: Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR]=1.65; 95% confidence interval [CI]=1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR=1.49; 95% CI=1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. CONCLUSIONS: Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients. (Am J Public Health. Published online ahead of print August 19, 2010: e1-e8. doi:10.2105/AJPH.2009.185421). |
Effects of gloves on the total grip strength applied to cylindrical handles
Wimer B , McDowell TW , Xu XS , Welcome DE , Warren C , Dong RG . Int J Ind Ergon 2010 40 (5) 574-583 The major objectives of this study were to establish an alternative method for measuring the effects of gloves on the grip strength applied to cylindrical handles and to quantify the strength reduction due to the use of typical anti-vibration (AV) gloves. Different from previous studies that measure the grip force in a specific plane, the alternative method measures the total contact force normal to a cylindrical handle; the total grip strength is defined as the total contact force measured when a subject applies a power grip to the handle with his/her maximum voluntary contraction (MVC) effort. Two instrumented cylindrical handles (30 and 40. mm) were used in this study. Ten subjects participated in the experiment. Four types of AV gloves and two types of non-AV gloves were used in the experiment. Compared with bare-handed trials, each of the four anti-vibration gloves reduced the grip strength by more than 29%, regardless of handle size. One of the non-AV gloves also largely reduced the grip strength (>=25%) whereas the grip strength reduction of the other one was less than 10%. The gloves also influenced the grip force distribution pattern around the circumference of the cylindrical handles. The results suggest that the thickness of a glove is one of the major factors associated with these effects. Relevance to industry: Glove use is generally recommended to keep the hands warm and dry and to protect them from many other hazards, provided this is consistent with safe and effective tool operation. However, a user of thicker, stiffer gloves, such as some AV gloves, could be trading one health risk for another. Knowledge of the effects of gloves on grip strength can help workers, managers, and safety professionals make informed decisions about glove selection and use in the workplace. This knowledge may also lead to work glove improvements. 2010. |
Evaluation of chemical hazards at a criminal investigation section of a police department. Case studies
Fent KW . J Occup Environ Hyg 2010 7 (10) 73-8 The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation at a municipal police department in response to a request submitted by management concerning chemical exposures encountered by criminalists during criminal investigation procedures. At the time of the evaluation, several methods were used by criminalists for processing criminal evidence. Latent fingerprints were identified using one of three methods: (1) fingerprint powder dusting, (2) ninhydrin solution spraying, and (3) super glue fuming. Latent blood was detected by luminol solution spraying. | When fingerprint powder is dusted over evidence or on surfaces at a crime scene, the dust adheres to residual oils that fingers leave behind, thereby revealing ridge patterns, or fingerprints. When sprayed on evidence, ninhydrin reacts with residual amino acids that fingers leave behind to form a deep blue or purple fingerprint.( Citation1 ) In the super glue “fuming” method, ethyl cyanoacrylate, the main ingredient in super glue, is heated inside a chamber containing evidence. The ethyl cyanoacrylate vapors and atmospheric moisture react with fingerprint residues to form a white polymer.( Citation1 ) When luminol solution is sprayed onto latent blood, the iron in the hemoglobin catalyzes the reaction between luminol and other components of the solution (including hydrogen peroxide) to produce chemiluminescence, which refers to the emission of light from a chemical reaction.( Citation2 ) | Our evaluation included observing methods used by criminalists and collecting general area and personal breathing zone (PBZ) air samples for the different chemicals they use. We also compared the pressure differentials in the crime lab with adjacent office areas and measured the airflow and capture efficiencies of the local exhaust ventilation (LEV) systems used in the crime lab. |
Industry-wide medical surveillance of California flavor manufacturing workers: cross-sectional results
Kim TJ , Materna BL , Prudhomme JC , Fedan KB , Enright PL , Sahakian NM , Windham GC , Kreiss K . Am J Ind Med 2010 53 (9) 857-65 BACKGROUND: Two cases of bronchiolitis obliterans in flavor manufacturing workers prompted California health and labor agencies to initiate industry-wide surveillance. METHODS: Companies' physicians submitted cross-sectional questionnaire and spirometry data for 467 workers in 16 workplaces. We compared prevalence ratios of respiratory symptoms, diagnoses, and abnormal spirometry to a general population sample. We calculated odds ratios for risk factors for spirometric obstructive abnormality. RESULTS: Flavoring workers were 2.7 times more likely than the general population to have severe airways obstruction. Risk factors identified for 18 cases with obstruction from six companies included younger age, Hispanic ethnicity, liquid and powder production work, greater company diacetyl usage, and having a coworker with obstruction. Severity of obstruction was related to tenure. At least 12 workers had probable occupational fixed airways obstruction. CONCLUSIONS: The flavoring industry risk of severe lung disease justifies lowering flavoring exposures and medical screening for secondary prevention until worker safety is demonstrated. |
A national overview of the training received by certified nursing assistants working in U.S. nursing homes
Sengupta M , Harris-Kojetin LD , Ejaz FK . Gerontol Geriatr Educ 2010 31 (3) 201-19 A few geographically limited studies have indicated that training of direct care workers may be insufficient. Using the first-ever nationally representative sample of certified nursing assistants (CNAs) from the 2004 National Nursing Assistant Survey (NNAS), this descriptive article provides an overview of the type of initial training and continuing education received by CNAs working in nursing homes, reports CNAs' assessments of the adequacy of their training, and identifies perceived training needs from the points of view of CNAs. Findings could be used to inform changes to the initial training and continuing education curriculum for this essential labor workforce. |
Estimates of costs for housing-related interventions to prevent specific illnesses and deaths
Mason J , Brown MJ . J Public Health Manag Pract 2010 16 S79-89 Public health is embracing economic analyses in an effort to use limited resources in the most efficient manner. However, users of economic analyses in the public health arena should recognize the inherent strengths and weaknesses of different types of analysis, as well as understand how the inclusion or omission of certain costs or benefits might influence study results. For example, asthma is a chronic condition that can result in health care costs that accrue well beyond the duration of a housing intervention. Thus, an economic analysis that omits long-term health care costs can underestimate the total economic benefit of the housing intervention. This article contains reviews of economic articles on housing interventions published in PubMed, examines salient differences between studies, and discusses pertinent gaps in the literature. In addition, this article attempts to provide an overview of key economic evaluation methods in relation to housing interventions to a target audience of local and state public health practitioners. Specific housing-related health issues discussed include asthma, lead, and carbon monoxide poisoning and radon-related lung cancer. |
Federal agency support for healthy homes
Brown MJ , Ammon M , Grevatt P . J Public Health Manag Pract 2010 16 S90-3 Numerous studies have demonstrated that housing interventions such as addressing structural deficiencies or lack of safety devices improve health. These successes, coupled with reports by health care and housing professionals of other health and safety issues in homes that they were unable to address, have renewed interest in promoting health by addressing unhealthy housing conditions--but with a holistic approach. The Centers for Disease Control and Prevention, US Department of Housing and Urban Development, and US Environmental Protection Agency fund programs to improve indoor air and drinking water quality and prevent childhood lead poisoning. All of these programs offer valuable lessons for designing more integrated programs. The federal agencies and their grantees have demonstrated that interagency collaboration is essential for successful outcomes. However, the Department of Housing and Urban Development, the Environmental Protection Agency, and the Centers for Disease Control recognize that no individual agency has all of the necessary resources or expertise to formulate national programs and policies and implement a national healthy homes agenda. Thus, they have come together with the US Department of Health and Human Services, the Department of Energy, the US Department of Agriculture, the National Institute of Standards and Technology, the National Institute of Environmental Health Sciences, and the Office of the Surgeon General to form an interagency working group to ensure that vigorous, healthy homes policies are implemented at federal, national, and community levels. |
Preconception health: awareness, planning, and communication among a sample of US men and women
Mitchell EW , Levis DM , Prue CE . Matern Child Health J 2010 16 (1) 31-9 It is important to educate both men and women about preconception health (PCH), but limited research exists in this area. This paper examines men's and women's awareness of exposure to PCH information and of specific PCH behaviors, PCH planning, and PCH discussions with their partners. Data from Porter Novelli's 2007 Healthstyles survey were used. Women and men of reproductive age were included in the analysis (n = 2,736) to understand their awareness, planning, and conversations around PCH. Only 27.9% of women and men reported consistently using an effective birth control method. The majority of men (52%) and women (43%) were unaware of any exposure to PCH messages; few received information from their health care provider. Women were more aware than men of specific pre-pregnancy health behaviors. Women in the sample reported having more PCH conversations with their partners than did men. PCH education should focus on both women and men. Communication about PCH is lacking, both between couples and among men and women and their health care providers. PCH education might benefit from brand development so that consumers know what to ask for and providers know what to deliver. |
Antiretroviral use among active injection-drug users: the role of patient-provider engagement and structural factors
Knowlton AR , Arnsten JH , Eldred LJ , Wilkinson JD , Shade SB , Bohnert AS , Yang C , Wissow LS , Purcell DW . AIDS Patient Care STDS 2010 24 (7) 421-8 HIV-seropositive, active injection-drug users (IDUs), compared with other HIV populations, continue to have low rates of highly active antiretroviral therapy (HAART) use, contributing to disparities in their HIV health outcomes. We sought to identify individual-level, interpersonal, and structural factors associated with HAART use among active IDUs to inform comprehensive, contextually tailored intervention to improve the HAART use of IDUs. Prospective data from three semiannual assessments were combined, and logistic general estimating equations were used to identify variables associated with taking HAART 6 months later. Participants were a community sample of HIV-seropositive, active IDUs enrolled in the INSPIRE study, a U.S. multisite (Baltimore, Miami, New York, San Francisco) prevention intervention. The analytic sample included 1,225 observations, and comprised 62% males, 75% active drug users, 75% non-Hispanic blacks, and 55% with a CD4 count <350; 48% reported HAART use. Adjusted analyses indicated that the later HAART use of IDUs was independently predicted by patient-provider engagement, stable housing, medical coverage, and more HIV primary care visits. Significant individual factors included not currently using drugs and a positive attitude about HAART benefits even if using illicit drugs. Those who reported patient-centered interactions with their HIV primary care provider had a 45% greater odds of later HAART use, and those with stable housing had twofold greater odds. These findings suggest that interventions to improve the HIV treatment of IDUs and to reduce their HIV health disparities should be comprehensive, promoting better patient-provider engagement, stable housing, HAART education with regard to illicit drug use, and integration of drug-abuse treatment with HIV primary care. |
Blood donors in Kenya: a comparison of voluntary and family replacement donors based on a population-based survey
Kimani D , Mwangi J , Mwangi M , Bunnell R , Kellogg TA , Oluoch T , Gichangi A , Kaiser R , Mugo N , Odongo T , Oduor M , Marum L . Vox Sang 2010 100 (2) 212-8 BACKGROUND AND OBJECTIVES: Blood safety and sufficiency are major challenges in Kenya and other sub-Saharan African countries forcing many countries to rely on family replacement donors (FRD). We analysed data from a national AIDS indicator survey to describe blood donors in Kenya and potential risks of transfusion transmissible infections (TTI) comparing voluntary donors and FRD. MATERIALS AND METHODS: A population-based, cross-sectional survey was conducted in 2007 among 15- to 64- year-olds. Consenting participants were interviewed about blood donation history and were tested for HIV, HSV-2 and syphilis. RESULTS: Of the 17 940 people surveyed, 445 (2.3%) reported donating blood in the prior 12 months. Sixty-four per cent were voluntary donors, and the rest were FRD. Compared to FRD, the majority of voluntary donors were < 25 years old (59% versus 18%), from the highest wealth quintile (57% versus 42%) and single (64% versus 23%). In addition, voluntary donors were less likely to have been sexually active than replacement donors (43% versus 13%). HIV prevalence was lower among voluntary donors than among FRD (2.6% versus 7.4%, P-value = 0.07). CONCLUSIONS: The majority of blood donors in Kenya are voluntary with lower potential risk of TTI. |
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